What is breast implant removal?
Breast implant removal is surgery to take out one or both breast implants, with or without the scar capsule that formed around them. It is often called explant surgery, and it can be done on its own, combined with a breast lift or fat grafting, or combined with placing new implants.
Patients come to it for very different reasons: a ruptured implant, a capsule that has tightened and become painful, a size that no longer suits a body that has changed, pain, systemic symptoms attributed to the implants, or simply not wanting implants anymore. The American Society of Plastic Surgeons treats the last of those as reason enough: “It is your decision to have breast implants placed, and it is your decision to have breast implants removed.”
The decisions that follow are how much of the capsule to remove, whether to add a lift or fat grafting, and whether to replace the implants. Those are individual and are made after an examination. A consultation is where a plan specific to your anatomy and your reason for removal gets made.
Why patients have implants removed.
The common reasons fall into six groups, assessed differently. More than one often applies at once.
Rupture
A ruptured implant has lost the integrity of its shell. A saline implant deflates and the breast visibly loses volume within days, so it announces itself. A silicone gel implant usually holds its shape when the shell fails, because modern gel is cohesive. That is a silent rupture, and physical examination alone cannot find it, which is why the FDA recommends screening with either MRI or ultrasound beginning five to six years after silicone implant placement and repeated every two to three years. A confirmed or suspected rupture is the clearest indication for removal.
Capsular contracture
Capsular contracture is the scar capsule tightening down on the implant. A capsule forms around every implant and that is normal; contracture is the abnormal version, in which the capsule constricts around a device of fixed volume. It is graded clinically in four Baker grades, from a breast that feels normal to one that is hard, distorted and painful. The FDA notes the higher grades may require reoperation, usually removal with or without replacement, and that contracture can recur afterward. Assessment is by examination, sometimes with imaging to rule out a rupture underneath.
Size or shape change over time
Breasts change around an implant and the implant does not change with them. Weight change, pregnancy, breastfeeding and age alter the tissue and the skin, while the implant adds weight that gravity works on continuously. Patients describe implants that have descended, spread apart, or now read as too large. Assessment is by examination: where the nipple sits relative to the fold, how much of the patient's own tissue is left, and how the skin behaves.
Pain
Persistent breast, chest wall or shoulder pain is a legitimate reason to consider removal. The assessment looks for a cause: contracture, rupture, an implant that has malpositioned or is too large for the pocket, and non-implant causes of chest wall pain. Some pain has an identifiable source that removal addresses directly. Some does not, and that should be said before surgery rather than after.
Systemic symptoms
Many patients seek removal for fatigue, joint pain, cognitive symptoms, rashes and related complaints they associate with their implants. Dr. Smith accepts these patients for explantation, and his protocol is to exclude other causes of the symptoms first, because a treatable thyroid, rheumatologic or sleep condition should not be missed on the way to an operating room. The FDA acknowledges these reported symptoms in breast implant labeling, and there is no diagnostic test for them. This is covered in full below.
No longer wanting implants
Wanting implants out, with no device problem and no symptoms, is sufficient. Some patients decided young and want their own proportions back. Some no longer want a device in their body, or no longer want to plan around the screening and eventual exchange implants require. No test needs to be positive for this to be a reasonable operation.
The capsule, and what to do with it.
The capsule is the layer of scar tissue the body forms around any implant. It is normal, everyone with implants has one, and it is the body walling off a foreign object. When the implant comes out the capsule can be left, removed in part, or removed completely. Those are different operations whose names are frequently confused, so the definitions below are taken from the consensus statement published by the Breast Surgery Collaborative Community, a public and private partnership that includes the FDA.
Leaving the capsule
The implant is removed and the capsule stays in the breast. A soft, thin, healthy capsule often does not need to come out, and the body reabsorbs much of it over time. This is the least invasive version, with the least dissection and the smallest disturbance of the chest wall.
Partial capsulectomy
Partial capsulectomy is removal of the capsule “where some capsule is left behind.” It applies when part of the capsule is thickened, calcified or contracted while another part is thin and adherent to structures it would be risky to strip, such as the ribs or the chest wall muscle.
Total capsulectomy
Total capsulectomy is “complete removal of the breast implant capsule, not necessarily done as a single unit or in one piece.” Where it comes out in one piece with the implant still inside it, the consensus statement calls that a total intact capsulectomy.
En bloc capsulectomy
En bloc capsulectomy has a narrower technical meaning than its popular use. The consensus statement defines it as “removal of the breast implant capsule with a margin of uninvolved tissue for treatment of suspected or established breast implant-associated cancers,” and states that “the absolute and only indication for an en bloc capsulectomy is for an established or suspected breast implant-associated cancer after appropriate medical workup.” Many patients asking for en bloc are describing what the statement calls a total intact capsulectomy, which is a reasonable thing to want and a different operation from the one the term names.
How Dr. Smith decides what comes out
It depends on the case, and mostly on why the implants are coming out. In capsular contracture he generally excises the affected portion of the capsule, since that is the tissue causing the problem, and stripping thin, healthy capsule off the chest wall adds dissection without treating anything. Where implants are being removed because of systemic symptoms attributed to them, he performs a total capsulectomy.
Where a patient asks specifically for an en bloc removal, Dr. Smith discusses the risks and the benefits in that patient's own case rather than agreeing or declining on principle. Most patients using the term are describing a total intact capsulectomy, and whether that is achievable and advisable in a given breast depends on how thick the capsule is, where it is adherent, and what the imaging and the examination show.
What the evidence says about removing more capsule
Three things drive the decision in the published literature, mainly. Whether there is a cancer indication, the one circumstance the consensus statement treats as absolute. The condition of the capsule, since a thickened, calcified or contracted capsule is generally removed and a thin soft one often is not. And the added risk, because more capsule removal is more surgery: a study of 7,486 patients in the Tracking Operations and Outcomes for Plastic Surgeons database found complete capsulectomy carried a higher overall complication rate than partial capsule surgery or implant exchange alone, roughly 5.8 percent against 4.5 and 4.4 percent, with seroma and hematoma the risks that rose. The consensus statement adds that capsulectomy “can result in significant breast deformities and be prone to complications,” and that it is currently unknown whether removing implants with or without a capsulectomy prevents an implant-associated cancer later.
Which applies to an individual patient depends on the imaging, the examination and the reason for removal, and is settled at consultation rather than in advance.
Breast implant illness.
Breast implant illness is the term patients use for a cluster of systemic symptoms they attribute to their breast implants. The symptoms most often reported are fatigue, joint and muscle pain, cognitive difficulty that patients describe as brain fog or memory loss, rashes and other skin problems, dry eyes and mouth, hair loss, and chronic flu-like symptoms. The cluster is consistent enough across thousands of patients that it is now studied as a defined entity. A 2025 systematic review and meta-analysis covering 36 studies and 10,519 patients found joint complaints in about 39 percent, fatigue in about 27 percent, muscle pain or weakness in about 25 percent and cognitive dysfunction in about 22 percent of patients reported on.
These symptoms are real, they are disabling for some patients, and they are recognized in the FDA's labeling for breast implants. The boxed warning the FDA recommends states that “patients receiving breast implants have reported a variety of systemic symptoms such as joint pain, muscle aches, confusion, chronic fatigue, autoimmune diseases and others.” The patient decision checklist adds that “some patients have reported relief of these symptoms with removal of their implants.” The FDA is equally direct that these symptoms and what causes them are poorly understood.
What is not established is causation. No mechanism linking breast implants to these symptoms has been demonstrated, there is no diagnostic test, and there is no agreed set of diagnostic criteria. The 2025 meta-analysis states that no definitive scientific link has been established and identifies the absence of a consistent symptom-based definition as the main obstacle to better research. The American Society of Plastic Surgeons describes the condition as “a broad cluster of symptoms that researchers, physicians and patients attribute to breast implants” and states that there is no diagnostic test for it. Nothing in the current literature supports telling a patient that her implants caused her symptoms, and nothing in it supports telling her they did not.
Many patients do report improvement after removal, and the outcome data is genuinely encouraging while also genuinely limited. A prospective cohort of 140 patients undergoing implant removal reported significant improvement across all 19 symptom scores measured and across every quality of life domain assessed; that study found no significant difference in recovery between patients who had no capsulectomy, a partial capsulectomy or a total capsulectomy. A 2026 systematic review and meta-analysis of symptomatic patients undergoing explantation found improvement overall, and its authors were careful about why that cannot be read as proof of cause: there were no symptomatic control groups who kept their implants, follow-up varied from 1 to 96 months, and improvement after any intervention can reflect the natural history of an illness, regression to the mean, or a placebo effect. They concluded that causal inference is not available from the evidence as it stands.
The honest summary is that the symptoms are real and consistently reported, that removal is a reasonable thing to want and does not require proving a mechanism nobody has proved, and that a meaningful proportion of patients feel better afterward. But symptom resolution cannot be promised. Some patients improve only partially, some do not improve, and removal is irreversible surgery with its own risks and its own effect on how the breasts look. The appropriate step beforehand is a workup looking for other explanations, because a treatable thyroid, rheumatologic, sleep or other condition should not be missed on the way to the operating room. Patients considering removal for systemic symptoms should expect that conversation at consultation, framed around what surgery can and cannot be relied on to do.
BIA-ALCL and implant-associated cancers.
BIA-ALCL is a rare cancer of the immune system, a T-cell lymphoma, that develops in the capsule around a breast implant rather than in the breast tissue. It has been identified in patients with all types of textured breast implants. There are no confirmed cases involving only a smooth implant, but that finding carries a stated limitation: the records of many diagnosed patients did not specify the implant surface, so the surface history of a substantial share of cases is unknown.
It usually presents late, years after placement, as sudden swelling of one breast from fluid collecting around the implant, or as a lump or a new capsular contracture. Persistent swelling of one breast long after surgery should be evaluated rather than watched. When BIA-ALCL is confirmed, treatment is removal of the implant and the surrounding capsule, the one indication for which the en bloc operation is specifically defined, and it is often curable when caught early.
The FDA has separately reported cases of squamous cell carcinoma and of lymphomas other than BIA-ALCL arising in the capsule around breast implants. These are rarer still and less well characterized. The operative record from the original surgery, which states what was implanted, is worth tracking down before a consultation.
What the breasts look like after removal.
They will be smaller, and how much else changes depends mostly on the skin and on how much of the patient's own tissue is left. The implant was occupying volume, and when it comes out that volume is gone. The FDA's patient decision checklist states that implant removal may result in “dimpling, chest wall concavity, puckering, or sagging.” That is the honest starting point, and it is better heard before surgery than discovered after it.
Skin sometimes retracts well and sometimes does not. Younger skin, better elastic quality, smaller implants and less time with them all favor retraction. Large implants carried for many years, pregnancy and breastfeeding in the interval, weight change, and skin that has already lost elasticity work against it. Published series suggest skin quality predicts the need for further surgery better than implant size does, and no surgeon can say in advance exactly how far a given patient's skin will contract.
A lift
A breast lift, or mastopexy, removes excess skin and repositions the nipple and remaining tissue higher on the chest, treating loose skin directly rather than waiting to see whether it retracts. Done at the same time as removal it means one operation and one recovery; a consecutive series of 841 patients having explantation with a lift in a single stage reported complication and revision rates each under 5 percent. Done later it lets the breast settle first, so the lift is planned against the shape that actually resulted. A lift leaves permanent scars, in a pattern that depends on how much skin has to come out.
Fat grafting
Fat grafting takes fat from elsewhere by liposuction and transfers it into the breast to restore some volume without a device. It is often combined with a lift rather than used instead of one. Its limits are real: it requires enough fat to harvest, only part of each graft survives, the achievable volume is well short of what an implant provides, and more than one session is common.
Whether a lift or fat grafting is done at the same time as removal, or later, or at all, is decided case by case. Some patients need neither and are happy with removal alone. Some are better served by a single operation and a single recovery; others by letting the breast settle first so the second operation is planned against the shape that actually resulted. What is not reasonable is a promise about the specific result, since it depends on tissue that has to be examined and healing that cannot be predicted.
Recovery after breast implant removal.
Recovery depends entirely on what is done, so nothing below should be planned around. Removing a soft implant and leaving the capsule is a smaller operation than a bilateral total capsulectomy with a lift, and the difference is large. Written instructions specific to the operation performed are provided before surgery.
In general terms, drains are more likely when the capsule is removed, because a capsulectomy leaves a raw surface that produces fluid. A support or compression garment is typical. Swelling is greatest in the first week or two, and the American Society of Plastic Surgeons notes that healing continues for several weeks as swelling decreases. Upper body exercise is restricted for a period of weeks, longer where a lift or extensive capsule work has been done.
Follow-up and who provides it
Patients are seen the morning after surgery, then at one week, two weeks, one month, three months, six months and one year. That is the minimum schedule, and patients are welcome to come in as often as they want beyond it. It matters more in this operation than in most, because the shape changes for months after the implants come out and patients want to be seen while it does.
Dr. Smith leads all post-operative care. He and the practice's physician assistant see post-operative patients together, and he is present for every major visit; some minor visits may be with the physician assistant alone. The surgeon who performed the operation is the one following the result, and a dedicated physician assistant means patients can be seen as often as they need rather than rationed into a fixed number of appointments.
The final shape takes months rather than weeks. Skin retracts gradually, swelling resolves unevenly, grafted fat resolves to the volume that survives, and a lift settles. Judging the result at two weeks is judging it too early.
Risks.
Breast implant removal is surgery and carries real risks. The American Society of Plastic Surgeons lists, among others, risks of anesthesia, bleeding, hematoma, fluid accumulation, infection, poor healing of incisions, unfavorable scarring, changes or loss of sensation in the nipple and skin, asymmetry, fat necrosis, persistent pain, deep vein thrombosis and cardiac and pulmonary complications, recurrent skin looseness, an aesthetic outcome the patient is not satisfied with, and the possibility of revision surgery.
Risks that scale with the capsule work
Removing the capsule adds risk in proportion to how much comes out. The 7,486-patient database study cited above found seroma and hematoma both more common after complete capsulectomy than after partial capsule surgery or implant exchange alone. A capsule adherent to the chest wall or the ribs is where dissection gets more demanding, which is why the extent of capsulectomy is a surgical decision rather than a menu choice.
The aesthetic risk
Dissatisfaction with how the breasts look afterward is a genuine and common risk of this operation, and it is the one patients most often say they were not adequately warned about.
What is required before surgery
No nicotine in any form for four weeks before surgery and four weeks after. Cigarettes, vaping, pouches, patches and gum all count, and the practice tests for it. Skin that has been stretched by an implant and then has to retract and heal is exactly the tissue nicotine punishes, so the rule is not negotiable.
The practice’s ten-day preoperative pause for medicines or supplements that act as blood thinners applies only when the surgical team and, for prescribed medicines, the prescribing clinician agree it is appropriate. Do not stop a prescribed medicine on your own. Medical clearance and laboratory work are required for cases done under anesthesia, with an EKG for patients over 40, and laboratory work for cases done under local. Weight should be stable for three months before operating, since weight change alters the breast and the result is judged against the breast you have.
Where surgery is performed
The practice has an accredited outpatient surgical facility within the office at The Ritz Tower on East 57th Street, accredited by QUAD A and anesthesia is delivered only by board-certified anesthesiologists. Where a given operation is performed, and what anesthesia it calls for, follows from the plan. Dr. Smith is board-certified by the American Board of Plastic Surgery.
What drives the cost of breast implant removal.
A surgical quote is built from the surgeon's fee, the anesthesia fee and the facility fee, plus the cost of implants if new ones are placed. What moves the total is the length and complexity of the operation, and that varies more here than in most breast procedures.
Removing an implant and leaving a soft capsule is a short operation. A total capsulectomy on both sides, particularly where the capsule is thickened, calcified or densely adherent, takes considerably longer and raises the anesthesia and facility components along with the surgeon's fee. Adding a lift, fat grafting or new implants adds operative time and, for implants, device cost. A ruptured silicone implant with gel outside the capsule takes longer to clean up than an intact one. Prior breast surgery, marked asymmetry between the sides, and a plan deliberately staged into two operations all add to the total, and a staged plan means more than one set of fees.
What a quote from the practice includes
A quote is itemized into a surgeon's fee, a facility fee and an anesthesia fee, with the cost of implants added where new ones are placed. All post-operative visits are included, so the follow-up schedule above carries no separate charge and neither do the additional visits patients ask for. Other items are not included, and anything falling outside those fees is identified when the quote is given. A quote is valid for 30 days, and a 10 percent deposit is taken at booking.
If a revision is needed
For one year after surgery there is no surgeon's fee on a revision. The patient remains responsible for the anesthesia and facility fees, which are paid out to the anesthesiologist and for running the operating room. A second operation after explantation is usually about the shape of the breast once it has settled, which is the part of this operation least possible to predict in advance.
Consultation, financing and insurance
A consultation is $500, applied toward any procedure booked, and never waived. Financing is available through CareCredit and Alphaeon Credit. Dr. Smith is out of network with all insurance plans; the practice helps patients use out-of-network benefits toward care. Some implant removal is performed for medical rather than cosmetic reasons, and coverage for it varies by plan, by the documented indication and by the specific policy language. Nothing here should be read as a statement that a given plan will cover a given operation. Patients who want to pursue benefits should raise it early, since the documentation is easier to assemble before surgery than after.
Your questions about breast implant removal.
Will I need a breast lift when my implants come out?
Possibly, and it depends on your skin and how much of your own breast tissue is left. Skin that retracts well may not need a lift; skin stretched by large implants over many years, or by pregnancy and weight change in the interval, usually does. Published series suggest skin quality predicts the need for further surgery better than implant size does. Whether a lift is done at the same operation or later once the breast has settled is decided case by case, and both approaches are used.
What will my breasts look like after implant removal?
Smaller, and beyond that it depends on your tissue. The FDA states that implant removal may result in dimpling, chest wall concavity, puckering or sagging. Some patients are happy with removal alone. Others need a lift, fat grafting or both. No honest prediction of the specific result is possible without an examination, and a promise of a particular outcome should be treated with suspicion.
Do I need en bloc removal?
Almost certainly not in the technical sense of the term. The Breast Surgery Collaborative Community consensus statement defines en bloc capsulectomy as removal of the capsule with a margin of surrounding uninvolved tissue, and states the only indication for it is an established or suspected breast implant-associated cancer. Most patients asking for en bloc are describing a total intact capsulectomy, meaning the capsule removed in one piece with the implant inside it. That is a different operation, it is often reasonable, and using the precise term keeps you and your surgeon discussing the same thing. Where a patient asks for en bloc removal directly, Dr. Smith goes through the risks and the benefits in that patient's specific case rather than agreeing or declining on principle.
Will my symptoms go away after my implants are removed?
They may improve, and that cannot be promised. Multiple studies report meaningful improvement in fatigue, joint pain, cognitive symptoms and quality of life after removal, and the FDA's patient labeling notes that some patients report relief of systemic symptoms once their implants come out. But those studies lack control groups of symptomatic patients who kept their implants, follow-up varies widely, and improvement after any operation can reflect the natural course of an illness or a placebo effect. Some patients improve completely, some partially, some not at all. Anyone guaranteeing resolution is going beyond the evidence.
Does insurance cover breast implant removal?
It depends on the plan and the reason for removal, and it cannot be assumed. Some removals are performed for documented medical reasons and some plans cover those; cosmetic removal generally is not covered. Dr. Smith is out of network with all insurance plans, and the practice helps patients use out-of-network benefits toward care. Coverage is a question for your insurer, and the documentation is easier to assemble before surgery than after.
Does the capsule have to come out?
Not always, and how much comes out depends on why the implants are being removed. In capsular contracture Dr. Smith generally excises the affected portion of the capsule; where removal is for systemic symptoms attributed to the implants, he performs a total capsulectomy. A soft, thin, healthy capsule often does not need removal, and the body reabsorbs much of it over time. More capsule removal is also more surgery: a database study of 7,486 patients found complete capsulectomy carried a higher complication rate than partial capsule surgery, driven mainly by seroma and hematoma.
Can I have my implants removed and replaced at the same time?
Yes, and that is a common plan when the problem is the device rather than implants in general. A ruptured implant, a contracted capsule or a size that no longer suits can all be addressed by exchange. Patients removing implants because they no longer want a device, or because of systemic symptoms, are by definition not candidates for replacement. Implant options are covered on the breast augmentation page.
How do I know if my implant has ruptured?
With saline you will see it; with silicone you often will not. A ruptured saline implant deflates and the breast loses volume within days. A silicone gel implant usually keeps its shape when the shell fails, which is why it is called a silent rupture and why physical examination alone cannot rule it out. The FDA recommends screening with MRI or ultrasound beginning five to six years after silicone implant placement and repeated every two to three years.
How long is recovery after implant removal?
It depends heavily on what is done. Removing an implant and leaving a soft capsule is a considerably smaller operation than a bilateral total capsulectomy with a lift. In general, drains are more likely when the capsule is removed, a support garment is typical, swelling settles over several weeks, and upper body exercise is restricted for a period of weeks. Written instructions specific to your operation are provided before surgery.
Can fat grafting replace my implants?
Only partially. Fat grafting restores some volume without a device, but the achievable increase is well short of what an implant provides, only part of each graft survives, it requires enough fat to harvest, and more than one session is common. It is frequently combined with a lift rather than used as a substitute for one. For patients who want modest volume back and do not want another device, it is a reasonable option.
Is breast implant illness a real condition?
The symptoms are real and consistently reported; the causal link to implants is not established. Patients describe a recognizable cluster of fatigue, joint and muscle pain, cognitive difficulty, rashes and related complaints, and the FDA acknowledges these reported systemic symptoms in breast implant labeling. What has not been shown is a mechanism, and there is no diagnostic test and no agreed set of criteria. Both halves of that are true at once, and neither cancels the other.
Should I have a workup before deciding on removal?
Yes, if you are having systemic symptoms. No test confirms breast implant illness, so the useful workup is one that looks for other explanations, including thyroid, rheumatologic, sleep and other conditions that produce overlapping symptoms and have their own treatments. Finding one of those does not mean your implants are irrelevant, and not finding one does not prove they are the cause. It means surgery is chosen with better information.