Breast implant removal (also called explant surgery) is a procedure that removes breast implants previously placed during breast augmentation. Women consider this surgery for various reasons — from lifestyle changes to health concerns.
With over 30 years in practice, Dr. Rudderman has performed thousands of explant surgeries for women who once chose breast augmentation but now prefer to return to a more natural state. While implants may last for decades, they aren’t lifetime devices. At some point, removal, replacement or revision may become necessary.
Why Do Women Consider Breast Implant Removal?
Women seek breast implant removal for a variety of reasons. Some have experienced symptoms of breast implant illness or other complications like capsular contracture, while others want to restore a more natural appearance as their aesthetic preferences evolve. Women who visit our Atlanta and Alpharetta offices have shared these reasons for implant removal:
- “ I no longer feel my breast implants fit my lifestyle and desires.”
- “ The way my breasts feel has changed, and one side is too firm.”
- “ I am concerned that having implants may be impacting my health.”
- “ I’m no longer comfortable with the shape or size of my breasts.”
- “ I may have a ruptured breast implant and am concerned that a leak may occur.”
- “ I’ve gained weight, and my breasts are now too large.”
Let’s take a closer look at some of these reasons and how they might influence your decision to pursue implant removal, with or without a breast lift or revision surgery to replace old implants.
Change in Breast Shape
Over time, your breast shape or size may change due to weight fluctuations, pregnancy or aging and hormonal changes, particularly menopause. These changes may cause an unbalanced appearance that no longer serves your goals or lifestyle. Breast implant removal can restore a more natural appearance, with many women finding their own breasts more attractive after implant removal than they anticipated.
During your consultation, we will examine your breast implant position and size and discuss the anticipated changes in contour and volume following the removal of your implants. A breast lift may be a good option at the time of removal or in the future to maintain a youthful shape.
Implant Rupture or Leakage
Breast implants should be removed when evidence of rupture or leak is encountered. With silicone implants, a rupture occurs when there is a rip or tear in the lining, causing the gel inside to leak out slowly. A ruptured silicone implant doesn’t always cause symptoms and can be difficult to detect without an imaging test but may lead to problems such as:
- Changes in breast size or shape
- Pain, soreness or discomfort
- Lumps or firmness
- Inflammation
- Calcification or hardening of the capsular tissue, resulting in a “hard” breast
With gel-filled implants, any rupture may allow the silicone to leak into the capsule. Older implants were constructed with less cohesive (sticky) gel that acted more like a thick liquid. The most recent implants are made using cohesive gel technology that helps restrict leakage. When implants are removed for any reason and calcification is encountered, a capsulectomy is performed (surgical removal of the capsule), and the capsules are sent for pathologic evaluation. These patients typically receive a written report of findings from the pathologist.
Leaks or ruptures of saline implants are much easier to identify. The saline inside leaks out quickly, causing visible changes in breast shape and size. While the saline is absorbed by the body and isn’t a health risk, it can result in soreness, discomfort and mild inflammation. In the past, some surgeons were known to add antibiotics or soap solutions such as Betadine to saline implants — these patients may experience more inflammation following a leak or rupture.
Hardening of the Breasts (Capsular Contracture)
A known complication of breast implant placement is the occurrence of capsular contracture. All breast implants placed in the body become surrounded by a layer of tissue called a capsule that, in most patients, stays soft and thin. This is the body’s natural response to an implant. However, some women will find that one or both breasts harden over time. This hardness can be noticeable over weeks or may be so gradual that they may not be able to remember when their breast first became firm, hard or misshapen. Symptoms of capsular contracture include:
- Firmness or hardening of the breasts
- Pain, discomfort or soreness
- Changes in breast shape
- Asymmetry or distortions in breast appearance
- Interference with physical or sexual activity
Capsular contracture is believed to occur in some cases because of a reaction to the natural bacteria within the breast tissue that stimulates a response, causing the capsule tissue to contract. These “biofilms” are not considered infections and treatment with antibiotics does not result in resolution. Capsular contracture is also often associated with ruptured implants, particularly when significant chronic inflammatory changes occur. It can occur with saline or silicone implants, textured or smooth implants, and implants placed above or below the muscle.
Breast Implant Illness & Concerns for General Health
Many women choose implant removal because they suspect their implants may be affecting their overall health. Some will notice changes in their health within a year of breast augmentation, while others will present years later with concerns attributed to their breast implants. Known as breast implant illness (BII), some frequently reported symptoms include:
- Persistent fatigue that doesn’t resolve with rest
- Brain fog and memory issues
- Heart palpitations
- Hair loss
- New allergies or sensitivities
- Joint pain
- Digestive issues
- Skin changes and rashes
- Sleep disturbances
- Anxiety, depression and mood changes
- Endocrine disruption
Multiple studies have been done, supported by the American Society of Plastic Surgeons (ASPS), to determine the relationship between these symptoms and breast implants. Factors evaluated include material reactions, heavy metals, allergies, inflammatory changes, infections, biofilms and autoimmune complexes. Although no direct link has been established yet, symptom reduction with implant removal occurs at a statistically significant rate in these studies.
Women who visit our office for breast implant evaluation are often sent by their general practitioner, rheumatologist or other health provider. Some women have been evaluated by other surgeons who may either dismiss their symptoms or recommend extreme treatment solutions. It is not possible to accurately predict if a patient experiencing medical problems will see a positive impact on their health following implant removal, but many women report a significant and dramatic improvement in their symptoms soon after explant surgery.d to return to a more natural state. While breast implants may last for decades, the reality is that anyone who has breast implants at some point should expect to need implant removal, replacement, or revision. Implants are not considered lifetime devices.
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Treatment Options for Capsular Contracture
Many women decide to have implants removed after developing capsular contracture. If replacement of the implants is considered, brand new implants should be used, and the capsules should be removed, in most cases. Using the original implants is not recommended due to the possibility that the implant surface has adherent bacteria called a biofilm. And you may be at greater risk for a recurrence of the contracture after surgery.
Capsulectomy (the surgical removal of the capsule) is often performed at the time of implant replacement to reduce the recurrence rate of the capsular contracture. Removal of the capsule generally results in a dramatic change in breast shape. Capsule removal may also result in more lateral positioning of any implant replacement due to changes in breast pocket size.
During your consultation, Dr. Rudderman will assess the size and positioning of your implants, as well as your soft tissue characteristics and the severity of your capsular contracture, to determine the best treatment approach. Many of the symptoms associated with the effects of a hardening capsule may resolve quickly after implant and capsule removal.mplant position size, tissue characteristics, and volume and contour changes anticipated following removal of your implants. A breast lift may be a good option at the time of removal or in the future if desired.
Encapsulated Breast Implant
- Breast Implant Age: 28 years
- Breast Implant Type: Saline
- Breast Implant Size: Unknown
- Breast Implant Placement: Subglandular
- Reason for Explant Surgery: Breast implant age, bilateral hardening of breasts, pain, and discomfort
- Surgery Performed: Bilateral breast implant removal and bilateral capsulectomy, enbloc
Surgical Options for Breast Implant Removal
Women who present for implant removal evaluation, in many cases, have health concerns. The general expectation for treatment includes implant removal and capsulectomy. The capsule is the tissue that your body makes that surrounds the implant. This is the “normal” reaction to foreign objects placed in the body. This tissue is living tissue with a blood supply. Dr. Rudderman does not recommend additional operations, such as lymph node removal, as this carries additional significant and long-term risks and is not considered appropriate unless other health concerns are documented. Limiting surgery to the safest and least invasive method is often the best way to address your concerns and restore your health.
Total Capsulectomy With Implant Removal
Total capsulectomy is a technique that involves removing the tissue that surrounds the breast implant. True en bloc procedures involve removal without creating any opening in the capsule and is a term reserved for tumor resection. For breast implant removal patients, true en bloc is associated with additional known risks, and current studies have not indicated a greater reduction in post-op symptoms using this approach.
Total capsulectomy removal involves removing the implant and the surrounding lining, often as a single segment. In order to successfully achieve this result, a significantly larger incision is required. Patients must realize when implants are first put in place, the incisions may be quite short — often 4 cm or less. However, removal of an implant cannot be done through the same small incision, and if total capsulectomy is to be performed, the incisions can be significantly longer. The incision is usually in the inframammary crease — the fold under the breast — and may include the original incision if the implant was placed through this site.
Implants placed above the muscle may be most successfully removed with the capsule as a single segment. Implants placed below the muscle can be removed with this approach if the capsules are thick enough to allow for dissection without disturbing the surrounding tissue. Capsules behind the implant and adjacent to the ribs may be too thin to perform this type of resection due to the risk of damage to the ribs, lungs, cardiac space and muscle, depending on conditions found during surgery. Intraoperative findings determine the safety of techniques used for capsule removal.
The potential advantage of keeping the capsule intact is that it may help control and facilitate the removal of ruptured gel and calcified tissue, potential biofilm from bacteria, and other inflammatory components found during surgery. There are specifically increased surgical risks associated with capsulectomy approaches of all techniques, particularly with thin capsules.
The end goal, however, is the removal of all safely resectable capsular tissue. Studies indicate that patients treated with this approach report a greater than 88+% chance of resolution of some concerning symptoms. Removing the implant and leaving the capsule may eventually result in the capsule resorbing, and this has been used as an option for treatment based on other study results and surgeon recommendations. Current data supports this as an effective option with implant removal. Implant removal surgery performed with any approach to the capsule — thick and calcified or millimeter thin — should be approached to preserve and protect the surrounding muscle, bone, cartilage, and soft tissue.
Total Intact Capsulectomy & Breast Implant Removal
- Reason: Breast Implant Capsulectomy
- Patient Age: 55 years old
- Breast Implant Size: 300CC
- Breast Implant Age: 20 years
- Breast Implant Type: Textured Silicone
A consultation is required to evaluate your potential for performing and block resection. It is not accurate to state that all implants can be removed safely by “en bloc” resection and the pros and cons should be seriously reviewed during your exam to determine realistic options and expectations.
Consensus Statement on Breast Implant Capsulectomy Definitions and Management Created by Breast Surgery Collaborative Community, The Aesthetic Society/ The Aesthetic Foundation , June 8, 2024
“The FDA recently created a strategic priority for the creation of collaborative communities to bring together stakeholders in the medical device realm to solve challenges and achieve a collective betterment for patients, physicians, industry, as well as the medical community at large. The Breast Surgery Collaborative Community (BSCC), a consortium of patient advocates, board-certified plastic surgeons, the medical device industry, and others with a vested interest in enhancing breast surgery safety, was assembled to offer clarity for women seeking guidance on removal of breast implants related to health concerns. “
“The BSCC consensus statement defines four types of capsulectomy: “
- “Total intact capsulectomy: Complete removal of the breast implant capsule as a single unit.
- Total capsulectomy (total precise capsulectomy): Complete removal of the breast implant capsule, not necessarily done as a single unit or in one piece.
- Partial capsulectomy: Removal of the breast implant capsule where some capsule is left behind.
- En bloc capsulectomy: Removal of the breast implant capsule with a margin of uninvolved tissue for treatment of suspected or established breast implant-associated cancers after appropriate medical workup. “
The statement explicitly declares, “the absolute and only indication for an en bloc capsulectomy is for an established or suspected breast implant-associated cancer after appropriate medical workup.” This decision for surgery is clearly a part of the informed consent process, and any decisions should be shared between the patient and surgeon in a formal discussion around risk assessment, benefits, and alternatives, as well as the expected outcomes. ” The Aesthetic Society June 8, 2024.
What Are The Most Common Breast Implant Removal Concerns?
Here are some common patient concerns when breast implants are removed:
- “Will I look deflated?”
- “Will my clothing fit?”
- “How will I feel about my breast change?”
- “How will my partner feel about my breast change?”
- “Will I need additional surgery to address drooping, sagging or uneven breasts, and can this be safely and reliably done?”
Dr. Rudderman has treated hundreds of women with breast implants who have decided to return to a more natural state. While breast implants may last for decades, the reality is that anyone who has breast implants at some point should expect to need implant removal, replacement or revision. Implants are not considered lifetime devices.
Breast Lift After Implant Removal
Many patients have adequate breast volume to maintain a normal appearance after implant removal. Some find that their breast volume has increased over time, particularly with weight changes, pregnancy and menopause. A breast lift can help reshape and restore a more youthful breast look and can be associated with dramatic improvement in comfort.
Some women avoid having a breast lift after implant removal due to concerns about scarring and healing. It is not uncommon for a surgeon to advise you to keep your implants or have new breast implants inserted. Many women simply no longer want this option. During your consultation, Dr. Rudderman can assess your needs and recommend the best approach for achieving your goals. This may include the removal of extra skin and adjustments to the breast tissue, especially if the breasts may become more droopy after explant surgery.
Breast lifts work well for women with little breast volume who have concerns they may be “traumatized” by the thought of removing implants when they feel the “only” breast tissue they have are the implants. A breast lift can effectively reduce skin laxity to “repackage” the remaining breast tissue, optimizing the volume in a “smaller” package to improve appearance. The remaining volume of the breasts can usually be reasonably estimated. There may be areas of asymmetry, wrinkling, or indentations after implant removal that cause concern. Many times, these irregularities improve during healing. In the few patients who require additional treatment, additional skin may be removed, tissue repositioned, and, in some cases, fat grafting may be performed to address contour irregularities.
Dr. Rudderman has performed hundreds of mastopexy (breast lift/reshaping) operations for breast implant removal patients with great success. Many patients are thrilled with their new breasts after implant removal and are relieved they have achieved satisfying results without implants. Dr. Rudderman’s mastopexy technique may be an excellent solution for patients who no longer desire breast implants and are dedicated to their long-term health and well-being.
Fat Grafting
Fat grafting can be effective for select patients who have dimpling, residual asymmetry and need for “modest” volume. Fat grafting should be performed by an experienced board-certified plastic surgeon like Dr. Rudderman who understands its applications and limitations.
Real Patient Reviews
Written and reviewed by:
Dr. Randy Rudderman, who is board certified by the American Board of Plastic and Reconstructive Surgery (1994). He practices medicine at his offices in Alpharetta and Atlanta. The content written reflects current accurate information and is consistent with ethical positioning of the ASPS. (American Society of Plastic Surgeons).
Last modified: February 2, 2024
Learn more about Dr. Rudderman, his medical training, and credentials.
Schedule a Consultation With Us
There are millions of women who love their implants and experience no concerning symptoms. Then there are those who have what they describe as “great looking and feeling breasts” with implants but are troubled by unexplained health concerns that impact their daily lives. Making the decision to remove your breast implants isn’t one to be taken lightly — it deserves thoughtful consideration. Dr. Randy Rudderman, a board-certified plastic surgeon with a 30-year track record of successful breast revision and implant removal procedures, can help you decide if explant surgery is right for you. He is empathetic to the very real concerns his patients have and dedicated to helping women reclaim their health and well-being with expert care.
To schedule a consultation with Dr. Rudderman, call us today at 678-855-8187. You can also complete the online contact form for our Alpharetta or Midtown Atlanta location.
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