Breast Implant Explantation Q&A

1. What is breast implant explantation?

Explantation is the medical term for breast implant removal. During an explantation surgery, breast implants are removed and not replaced. Because breast implants are subcutaneous foreign objects in a relatively superficial position, in most cases they can be removed as a minor procedure under local anesthesia, or with light oral sedation if patients prefer that.

Explantation is a simple and straightforward procedure with very little downtime. Patients are back at full-effort exercise in just one week. While I recommend taking it easy for at least 24 hours post-explantation, I have had patients tell me that they went out to dinner the night of their explant and one actually admitted at her one-month follow-up appointment that she went to a concert that evening and felt fine.

There are a number of reasons that may lead a patient to elect to have their implants removed. When the procedure is limited to breast implant removal only, deep IV sedation or general anesthesia is not required. In some cases, additional procedures may be indicated such as capsulectomy or mastopexy (breast lift). Capsulectomy with explantation and mastopexy procedures are usually performed under general anesthesia, but the majority of explantation patients do not require capsulectomy.

2. Why do women have breast implant explantation?

There are wide-ranging reasons that women who have undergone breast augmentation in the past seek treatment in our practice for breast implant removal. One very common scenario that we encounter is the patient who has really never felt comfortable with their augmented breasts. I frequently hear patients report that “my surgeon did not listen to me”, that high-volume implants were placed, and that these patients have never been comfortable with their overly large (and often abnormally-shaped) augmented breasts.

Frequently we see patients who actually needed a breast lift rather than a breast augmentation in the first place, and over time the breast implants have stretched out the breast skin even more and in doing so have made the pre-existing breast droopiness even worse. Many of these patients share that they have never felt comfortable with the result of their breast augmentation in form-fitting clothing or in a swimsuit, and are relieved to have the implants removed. These patients need a breast lift procedure as well, of course, and it is deeply rewarding to help patients make the transition from ‘problem breasts’ which interfere with their lifestyle to breasts that are lifted, youthful-appearing and natural-feeling.

Some patients we treat simply feel ‘done’ with their breast implants and want to return to being ‘all natural’ again. Some patients have dealt with a series of reoperations for complications of breast implant placement and wish to put the breast augmentation phase of their life behind them. These complications often include on or more of the following problems: implant shell failure, implant malposition, capsular contracture, animation deformities, implant size dissatisfaction, breast implant-related pain and discomfort, and visible implant folds and ripples.

We have seen several patients with breast implant illness (BII), and these patients elect to have their implants removed over the concern that their implants may be creating systemic symptoms. Most of our BII patients have reported complete resolution of symptoms following breast implant removal, although that outcome of course cannot be guaranteed, as in some patients the systemic symptoms they are experiencing may not be directly related to their breast implants.

3. How do I know if I have breast implant illness?

Breast implant illness (BII) is a clinical diagnosis based on symptoms. There is no laboratory test or imaging study that can prove or disprove the presence of BII. The patients I have seen and treated for breast implant illness notice the onset of systemic symptoms in the weeks, months, or years following breast implant placement. Symptoms of breast implant illness can include but are not limited to the following: fatigue, joint pain, muscle pain, insomnia, skin rash, headaches, hair loss, gastrointestinal problems, brain fog and anxiety/depression.

Many of the symptoms of BII are also associated with autoimmune disorders such as rheumatoid arthritis and lupus. Some patients who are diagnosed with BII may have an autoimmune disorder, so it is important for patients to look into that possibility as well with their primary care physician.

If you feel that you are experiencing significant systemic symptoms that may be related to your breast implants, you may want to consider having them removed. The majority of our breast implant illness patients have reported dramatic improvement in and often complete resolution of symptoms following breast implant removal.

4. What will my breasts look like after breast implant explantation?

Breast appearance following breast implant removal varies a great deal from patient to patient. Larger breast implants have a more profound effect on breast skin and breast tissue, as the deforming effect of the implant increases with implant volume. Breast implants not only stretch the breast skin but also cause breast tissue atrophy over time, and that effect can be profound in some patients, particularly in the upper pole of the breasts. Smaller-volume implants have a lesser impact on breast appearance following implant removal.

When I evaluate patients for breast implant removal, I make an effort to help the patient clearly understand how much of their current breast volume is created by the implants and how much of their breast appearance is represented by natural tissue. This gives them some idea of what their breast volume will be following implant removal.

If the breast skin is not lax or droopy, most patients elect to have implant removal only. Patients with significant skin laxity or breast ptosis (droopiness) often elect to have a mastopexy procedure performed as well.

For patients who so not have much natural breast tissue volume in the upper aspect of their breasts, and in patients who have experienced significant upper pole breast tissue atrophy because of their implants, we consider and can perform breast fat grafting to enhance the natural fullness of the upper poles. Fat is harvested by means of a liposuction procedure, commonly of the trunk and/or thighs, and the fat is processed and then grafted into the upper poles to enhance volume. This is an effective means of creating additional natural breast tissue volume, while also creating a body contour improvement at the ‘donor’ site, and can be repeated if patients desire additional breast volume enhancement over time.

5. Will I need a breast lift after explantation?

In some breast augmentation patients, the size and weight of the implants have stretched out the breast skin, resulting in the need for a breast lift (mastopexy) surgery. Breast skin laxity has been present in some patients since their breasts developed, and they have never enjoyed a ‘perky’ breast appearance. In other patients, the volume of the implant has stretched the breast skin out over time. Pregnancy/lactation is a contributing factor in some, and so is the natural aging process as breast skin naturally thins with each passing year.

Many patients have breast skin laxity and already know they want to have a breast lift performed along with implant removal. Other patients are not sure and prefer to have the implants removed and spend some time getting accustomed to their natural breasts and thinking about whether or not they want to have breast lift surgery performed. Patients with smaller volume implants and younger patients with good skin tone generally are happy with their breast appearance following explantation only, and often do not require a breast lift surgery.

6. Can explantation and breast lift be performed the same day?

For patients that need a breast lift, it is important to understand that it is challenging to accurately plan a mastopexy surgery with breast implants in the way. Determining the ideal new position for the nipple-areola complex is of paramount importance, and implants make that determination difficult to impossible in most cases.

That issue can be easily addressed by removing the implant volume a week or two before the breast lift surgery. For patients who have saline implants, this is accomplished by means of preoperative implant deflation, an office procedure that takes five or ten minutes. For patients with silicone gel implants, we plan removal of implants as a minor surgical procedure which can be performed under local anesthesia only.

It is extremely helpful for the patient and for me as the plastic surgeon to evaluate the natural breast appearance with the implant volume removed, by means of saline implant deflation or by silicone gel implant removal under local anesthesia. That allows both of us to have a clear understanding of the natural breast tissue that we have to work with, what to expect in terms of the results of the mastopexy surgery. It technically is possible to perform explant and mastopexy the same day, but in my experience it is very useful to perform saline deflation or gel implant removal prior to mastopexy to clearly set expectations, make decisions about whether or not fat grafting is desired, and to accurately plan the ideal position for the nipple-areola complex on the lifted breasts.

For patients who are not sure if they want to have a breast lift performed, we perform explantation only and let the patient decide over the next several weeks or months if they are satisfied with their breast appearance. For those that are dissatisfied and prefer to have a lifted and more youthful breast appearance, mastopexy can be scheduled at any time, and for those who desire a partial restoration of breast volume, fat grafting can be planned as well.