What Is Explant Surgery?

Since breast implants are not permanent medical devices, at some point, every woman with breast implants will need to have them removed and/or replaced. The average lifespan of breast implants is about 10 years, but that number is not a hard and fast rule. Saline implants will eventually leak leaving patients with a flat chest that is obvious. These implants can be electively replaced if/when that occurs. New-generation silicone gel breast implants are more form stable and if the outer shell is compromised it is not nearly as obvious. This is called a “silent leak.” Patients with silicone implants should follow FDA guidelines with routine screening to assess their implants.

Reasons Why Women Have Breast Implants Removed

There are many reasons patients may want their implants removed.

Preparing For Breast Implant Removal

As with any procedure, it is important to be in good health, don’t smoke, and prepare to follow all post-surgery instructions. It is important to consider what your chest will look like after the procedure. During breast augmentation, there is considerable stretching of the skin envelope and underlying muscle. In many cases, removing the implant will leave your breast appearance looking both deflated and droopy or saggy. Often, the excess skin can adhere to the underlying tissue, causing adhesions that are deforming.

To avoid these potential adverse outcomes of explant surgery, attention should be focused on creating a feminine aesthetic for the patient. Dr. Burns is known nationally and worldwide for his expertise in cosmetic explant surgery and for creating beautiful outcomes for patients who no longer want implants.

There are two excellent options to reconstruct the breast shape and volume after the explant procedure: fat transfer and /or breast lift surgery.

With fat transfer, liposuction is used to harvest your own fat which is purified and then grafted into the tissue to add back volume. A breast lift can also be done which removes excess skin while lifting and shaping the tissue for explant patients. In many cases, both a breast lift and fat transfer can be done to remove excess skin, lift the breasts, and add back volume.

How Is Explant Surgery Performed?

Removing breast implants is not quite as simple as it sounds. In response to implant placement, the body forms a thin layer of scar tissue around the device called a capsule. When performing explant surgery, most plastic surgeons recommend removing the scar tissue (capsule) around the implant as well. This is called a capsulectomy.

Implant capsules vary in thickness and are graded on a scale of 1 to 4:

• Grade 1: Asymptomatic. No effect on the size, shape, or feel of the breasts. The breasts remain natural and soft.
• Grade 2: Minor cosmetic symptoms. The breasts look normal but feel somewhat firm.
• Grade 3: Significant cosmetic changes. The breasts feel firm and appear misshapen.
• Grade 4: Breasts are hard and misshapen. In cases where grade iv capsules are present, the patient often admits breast pain

If not removed, the capsule won’t adhere to itself and leaves a potential space inside which could fill with excess fluid over time (this is called a seroma). If the breast capsule is left behind, it may also contract over time, and become calcified which may appear cancerous on routine breast imaging studies like a mammogram or ultrasound. Removing the capsule involves separating it from the breast tissue, muscle, or chest wall. Once removed, the surface re-adheres to the chest wall, restoring normal anatomy.

Before and After Explant Surgery Results by Dr. John Burns

Will I Need Drains With Explant Surgery?

When the implant and capsule are removed there will be a large space where the implant resided. A drain tube is typically placed to prevent fluid, blood, or serous fluid, from accumulating in that space. The drain is removed about 7 to 10 days after the surgery, or once the collection of fluid captured in the drain bulbs has ceased.

What Will My Breasts Look Like After Explant Surgery?

The appearance of the breast skin will vary widely depending on how much excess skin and residual breast tissue remains. In cases where the implant is relatively small compared to the native breast tissue, removing the implant might not result in drastic changes. However, in cases where the implant is large and the native breast tissue is much less, the breast may appear deflated and droopy. In severe cases, the breast can scar down unnaturally to the chest wall and form adhesions.

Getting Beautiful Breasts After Explant

Optimizing breast aesthetics after explant is one of Dr. Burns’ specialties. One approach is to remove excess skin with a breast lift. After the implant and capsules are removed, the excess skin is then removed with a breast lift giving the patient smaller, perkier breasts. Another approach is to replace the implant volume with a fat transfer. Dr. Burns has a national reputation as an expert in explant and fat transfer. Once the implant is removed, fat can be harvested using liposuction and added back to the breast to replace the missing implant volume. In some cases, a breast lift can be combined with a fat transfer to both lift and fill the breast.

Procedure Length

The explant and capsulectomy procedure takes between one and two hours to complete and is done under general anesthesia. Adding a breast lift or fat transfer adds another hour to the procedure.

Anesthesia

The procedure is done under general anesthesia under the care of a board-certified anesthesiologist. Dr. Burns has a wonderful team of female board-certified anesthesiologists from Dallas Anesthesia Associates specializing in plastic surgery care.

Recovery From Explant Surgery

Caring For Incisions

After explant, the incision under the breast will need to heal. The dissolvable sutures are placed under the skin surface, and the breast incisions will be covered with tan surgical band-aids called steri-strips. The steri-strips are removed around 2 weeks following the surgical procedure.

There will be mild to moderate discomfort inside the chest where the capsule was removed. The pain is typically managed with pain medication, rest, and ice. Patients are instructed to wear a post-surgical bra with no underwire that will be worn for about 3 months around the clock to help the breasts heal in a good position. The incision under the breast is treated with scar gel, silicone sheeting, and laser treatments at our skin care and laser center, EpiCentre.

When Will My Drains Be Removed After Explant?

Drains are typically removed one week after surgery if the amount of fluid is minimal.

Activity Restrictions

Most implants are placed underneath the chest muscle. After the implant is removed the muscle returns to its original position on top of the chest. Dr. Burns always places sutures in the muscle to re-attach it to the breast bone and breast crease. This is sometimes called “muscle repair.” It is critical to not overuse the chest muscle as it heals back to the chest. Patients should avoid heavy lifting for the first 3 months, and then gradually advance to weight training as tolerated. Wearing the compression bra is critical to shape the breasts and allow the skin to contract in the best possible position.

Medications For Discomfort

Typically only a few days of narcotic pain medication is necessary. Many patients can manage their pain with non-steroidal anti-inflammatory medications (NSAIDs) or Tylenol.

Keep Your Follow-up Appointments

Patients are seen one week after surgery, with additional appointments throughout the healing journey. Out-of-town patients are managed via virtual care at routine intervals using video conferencing.

What Do We Do With Your Implants And Capsules After Explant Surgery?

If requested, we are happy to clean and return your implants to you on the day of your procedure. The scar capsule tissue is sent to a pathology lab for analysis. You will receive a copy of the scar tissue capsule pathology report for your medical records

What Will My Breasts Look Like After Explant Surgery?

It can be difficult to predict what you will look like after explant surgery. If the implants are relatively small compared to the native breast tissue, the result is generally good. However, if the implants are large and the native tissue is scarce, there will be excess skin which leaves the breasts looking both deflated and droopy. In some cases, the excess skin can adhere to the chest wall resulting in a deformity. The deformity is caused when the excess skin forms adhesions that leave unsightly folds and wrinkles or cause distortion of the nipple-areola complex (NAC). There can also be a deformity in the lower pole where the muscle does not stretch back to its original position leaving a step-off or animation deformity in the inferior and medial breast.

It's best to thoroughly review your personal options for getting a beautiful outcome prior to having explant surgery to maximize the opportunity and time spent in the operating room and to ensure you'll be pleased with the final result.

What Does Breast Explant Surgery Cost?

Surgical costs reflect the surgeon’s fee, anesthesia, facility fee, and post-surgery garments. The cost for the explant/implant removal and full or total capsulectomy is about $7,000. Adding a fat transfer (explant/capsulectomy plus fat transfer) or breast lift (explant/capsulectomy plus breast lift) increases the total cost to around $12,000.

Breast Explant Before and After Results by Dr. John Burns

Explant Surgery- Frequently Asked Questions

Will explant affect my mammograms?

Any breast surgery will cause some scar tissue which can be evident on routine screening tests such as mammograms or ultrasounds. A breast lift or fat transfer would add more scar tissue. However, modern radiology technology is quite precise and capable of accurate discernment. In rare cases, a biopsy might be needed to clear up a questionable finding.

Can I get a breast lift with my explant surgery?

Yes, a breast lift removes excess skin caused by the augmentation. The incision used to remove the implant are incorporated into the breast lift incisions. The breast is lifted and shaped leaving a smaller but perky breast. If more volume is desired a fat transfer can be combined with the breast lift.

When will my breasts be fully healed?

The most intense period of healing takes place during the first week. The discomfort diminishes rapidly in the first several days. There will be some bruising and swelling initially which is mostly resolved at 2 - 3 weeks. The incisions will be red and raised and then fade dramatically over the next several months. After explant, the skin will contract to a certain extent. The final appearance is evident at 6 months.

Will my breast tissue shrink to its pre-implant size?

No. The breasts won’t resume their pre-implant appearance. There will be non-reversible stretching of the skin, breast tissue, and muscle. The skin might contract to a variable extent but the breasts will appear deflated and droopy to varying degrees.

Will having an explant improve my neck & back pain?

Maybe. If you have large implants the procedure can be similar to a breast reduction in terms of symptom improvement. Large implants can cause neck and back pain, bra strap grooving, and difficulty fitting into normal clothing. Removing large implants can relieve these symptoms.

Can I do a fat transfer to my breasts in the future?

Yes. Dr. Burns prefers to do the fat graft at the same time as the explant. This is because the skin is loose and in the shape of the implant. The expanded tissue will hold more fat and the shape is typically better than delaying the fat transfer. Once the breast scars down to the chest, it can be difficult to expand the breast as fat is essentially a thick liquid that can’t overcome the force of scar tissue.

That said, many patients do choose to delay their fat transfer and it can be done as a separate procedure after explant. In this case, it is recommended to wait about 6 months to allow the tissue to soften up adequately before attempting the fat transfer.

Plastic Surgery Financing

Explant surgery is considered elective and not covered by insurance.  For those who prefer to review financing options, Dr. Burns' practice recommends financing with CareCredit, Alphaeon, and PatientFi.

Schedule Your Explant Consult with Dallas Plastic Surgeon,
Dr. John Burns

Schedule your private consultation with Dr. John Burns.  Dr. Burns offers both virtual and in-office plastic surgery consultations for women desire explant surgery in Dallas, throughout the United States, and the world.