Explant surgery

Explant surgery permanently removes silicone or saline breast implants. Explant surgery may also remove some or all of the scar tissue that has formed around the implant(s).

People decide to have explant surgery after breast implant reconstruction for a few reasons, such as:

• Pain and discomfort
• Problems with implants, such as hardening or leaking
• Symptoms such as fatigue, rash, brain fog, and joint pain, which have been linked to breast implants in some women

Explant surgery is different from implant exchange surgery, which replaces old implants with new ones. Women who have implant reconstruction may need to have their implants replaced after about 10–15 years, but sometimes implants last longer than that.

People choose explant surgery because they no longer want their implants. They either replace them with tissue reconstruction (also called flap reconstruction) or go flat.

Why explant surgery is done

Women often choose explant surgery because of ongoing problems with their implants. Others have developed rare but serious health problems linked to implants. Or, women may have concerns about the possible risks of breast implants over the long term and decide to have them removed.

The most common reasons for explant surgery include:

• Capsular contracture: After a breast implant is placed, the body forms a capsule of scar tissue around it. Sometimes, this capsule can harden, leading to pain and distortion.
• Implant rupture or leak: Over time, implants can weaken and leak fluid. An injury to the chest area can sometimes cause a rupture.
• Implant shifting position: Implants can shift out of place over time, causing the breasts to look out of balance.
• Range of motion problems: Some people experience tightness and discomfort in the chest, shoulder, and/or back after having implants. This limits their ability to move freely.
• Infection: Sometimes, bacteria can grow in the scar capsule around the implant. This can lead to frequent infections.
• Other problems:
  • Some people experience dynamic distortion (also called animation deformity). This means that the implant looks out of place or rippled when you flex your chest muscles.
  • Another issue is implant extrusion, which means that the implant pushes through the layer of skin covering it.

Although revision surgery can correct many of these problems, some women choose explant surgery instead. Others decide to have their implants removed if revision surgery doesn't solve the problem.

Less common reasons for explant surgery include:

• Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)
• Breast implant illness (BII)
• Other non-breast cancers
• Certain autoimmune conditions

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)

BIA-ALCL is a rare form of lymphoma, or immune system cancer. It has developed in a small number of women with textured breast implants.

The FDA reports that most cases of BIA-ALCL have occurred in people who had BIOCELL textured implants made by Allergan.

• In 2019, Allergan voluntarily recalled these implants as well as some tissue expanders (temporary, inflatable implants that stretch the skin before a final implant is placed).
• If you have this type of implant, the FDA does not recommend explant surgery unless you are having symptoms.

BIA-ALCL forms in the fluid and capsule that surrounds the implant. It usually grows slowly. Over time, though, it can move into the chest wall or the lymph nodes near the breast. It also can spread to other parts of the body.

BIA-ALCL symptoms can include:

• Swelling, enlargement, or hardening of the breast
• Breast shape changes
• Lumps and/or pain in the breast or armpit
• Skin rash or redness near or on the breast (less common)

BIA-ALCL can develop 1 year or many years after having breast reconstruction with textured implants. On average, though, symptoms appear 8-10 years after implants are placed.

BIA-ALCL is diagnosed using a combination of tests:

• Medical imaging, such as ultrasound and MRI
• A needle biopsy that removes fluid and/or tissue
• Lab testing on any samples taken

People who develop BIA-ALCL need to have explant surgery right away to remove the breast implant(s) and the entire capsule of scar tissue. Lymph nodes in the area may need to be removed, too. The goal is to prevent the cancer from moving beyond the breast area. It’s important to work with a plastic surgeon and a cancer care team who have experience with BIA-ALCL.

If you have textured implants:

• It’s important to know that BIA-ALCL is rare, and the risk is still considered low. The American Society of Plastic Surgeons reports that as of February 2025, there were about 460 suspected or known cases of BIA-ALCL in the U.S. and about 1,600 cases worldwide.
• Talk with your care team and plastic surgeon about BIA-ALCL. Some women who are concerned about the risk of BIA-ALCL, even with no symptoms, have chosen to have explant surgery. Others may decide to have the textured implants exchanged for smooth implants.

To learn more, visit Implant reconstruction.

Breast implant illness (BII)

Breast implant illness (BII): Some women have experienced a range of difficult symptoms after having saline or silicone breast implants placed. Doctors aren’t sure why. It may be that the immune system is reacting to the breast implant material. Or, the body might react to a film of bacteria that can form over the implant (called biofilm).

Since there’s no specific test for BII, it’s usually diagnosed after your doctor rules out other causes. It’s also hard to say how many women develop it. However, more people are sharing their experiences with BII in the press, online, and through social media.

Some BII symptoms include:

• Joint and muscle pain
• Fatigue that doesn't go away
• Trouble sleeping
• Brain fog and memory issues
• Trouble breathing
• Skin problems including rash
• Stomach, intestine, and other digestive system issues
• Dry mouth, eyes, skin, and/or hair
• Anxiety and depression
• Headaches
• Hair loss
• Heart racing or changes in heartbeat
• Frequent viruses and bacterial illnesses

If you experience these or other unusual symptoms after implant reconstruction, talk to your cancer care team and your plastic surgeon. If they haven’t treated patients with BII, or they don’t take your symptoms seriously, get a second opinion.

Small studies have found that anywhere from 70–96% of people with BII report feeling better after having their implants and capsule scar tissue removed.

Other conditions possibly linked to breast implants

Researchers are studying other conditions that may be associated with breast implants. The risk is considered low. However, they have led some people to choose explant surgery. Examples include:

• Non-breast cancers that can form in the scar capsule around breast implants, such as other lymphomas (different from BIA-ALCL) and squamous cell carcinoma (SCC). Breast-implant associated SCC, or BIA-SCC, is an aggressive cancer that starts in the lining of the capsule. In March 2023, the FDA published an alert that said small numbers of lymphomas and BIA-SCC had been reported.
• Autoimmune conditions: These happen when the body’s immune system starts attacking normal, healthy tissues. Some studies have found that implants filled with silicone gel may increase the risk of autoimmune conditions. Some examples include:
  • Sjögren’s syndrome, which causes dry eyes and dry mouth
  • Scleroderma, which causes the skin and connective tissues to become hard and tight
  • Rheumatoid arthritis, which leads to swelling and inflammation in the joints

If you had implant reconstruction and are concerned about these conditions, talk to your care team.

How explant surgery is done

There are different approaches to explant surgery. Not all plastic surgeons are experienced with these procedures. Take time to find someone who is.

A plastic surgeon qualified to perform explant surgery may be a different plastic surgeon than the one who did your implant reconstruction. The surgeon should also have experience in whatever procedure you decide to have next:

• Aesthetic flat closure, which creates a smooth, flat chest, or
• Tissue (flap) reconstruction

There are different ways to perform explant surgery. Below, we’ll share three common types of explant surgery.

En bloc capsulectomy

In en bloc capsulectomy, the surgeon removes the implant and the scar capsule in one step, with the implant still encased in the capsule. En bloc capsulectomy is strongly recommended if you:

• Have symptoms that suggest there may be bacteria, mold, or fungus growing between the implant and capsule
• Have symptoms of breast implant illness (BII) or any autoimmune condition that might be linked to implants
• Have BIA-ALCL (breast implant-associated anaplastic large cell lymphoma)

Total capsulectomy

A total capsulectomy involves removing the implant first and then removing all of the capsule in pieces. Surgeons may use this approach if they're removing implants due to pain, discomfort, or shifting, rather than illness.

They also might choose total capsulectomy if an en bloc capsulectomy isn’t possible. Sometimes, a surgeon may find that the capsule is very thin, or it is sticking to the chest wall or ribs. This makes it difficult to remove the implant and capsule together in one piece.

Partial capsulectomy

In partial capsulectomy, the surgeon removes the implant first, and then most of the capsule.

If the scar tissue is flexible and healthy, with no signs of inflammation or infection, it might be useful in supporting a tissue flap reconstruction if you choose to have one.

In other cases, the surgeon may leave some scar tissue behind if it’s stuck very firmly to the chest wall. Removing it could risk making a hole in the chest wall, which can lead to:

• Pain
• Bleeding
• Hematoma (blood that forms a pool under the skin)
• In rare cases, a collapsed lung; if this happens at all, it’s more likely if the implant was placed below muscle

If you want to have explant surgery, talk with your plastic surgeon about your reasons, including any symptoms you’re experiencing. Together you can decide which approach makes sense for you.

During explant surgery, your surgeon also will:

• Remove regenerative tissue, such as acellular dermal matrix, that may have been used to support the implant and hold it in place.
• Repair and reposition the chest muscle, if needed. If your implants were placed under the chest muscle, the surgeon may need to reattach that muscle to the chest wall.

After performing explant surgery, many surgeons take photos of the removed implant and capsule to show what type of capsulectomy you had.

Reconstruction options after explant surgery

After explant surgery, there are two main reconstruction options:

• Going flat, using a procedure called aesthetic flat closure. This removes extra skin and tissue to create a look that is as smooth and flat as possible, although the final result may be different from person to person.
  • Some plastic surgeons offer fat grafting to help create a smooth look. They suction fat cells from another area of the body, process them, and inject them into the breast area. This requires a few treatments, spaced out over time.
  • If you are not sure you want to go flat permanently, your surgeon may recommend leaving some extra skin that can be used in a future reconstruction.
• Tissue reconstruction, also called flap reconstruction. This uses a section of tissue and blood vessels from the belly, buttocks, thighs, or another location to recreate the breast shape.

These procedures are usually done at the same time as explant surgery. For example, if you have explant surgery because of breast implant illness (BII), immediate tissue reconstruction is generally considered to be safe.

Depending on what type of reconstruction you have, recovery can take up to several weeks.

Sometimes, a plastic surgeon may recommend waiting before having tissue reconstruction after explant surgery:

• If you were diagnosed with an infection, your surgeon may recommend allowing time for treatment and recovery.
• If you are diagnosed with BIA-ALCL (rare), you may need to delay any further reconstruction for a couple of years after treatment is finished, although this can vary. Talk with your doctor about the best timing for you.

Your plastic surgeon can help you figure out what type of reconstruction is best for you.

Capsule, tissue, and fluid testing after explant surgery

If your surgeon recommends it, testing (also called pathology testing) may be done on the capsule and any other tissue and fluid that’s removed. Testing can check for:

• Cancer cells
• Bacteria, fungi, and mold, which can be signs of infection
• Silicone and other materials that may have been absorbed from the implant
• A protein called CD30, which can be a sign of BIA-ALCL (breast implant-associated anaplastic large cell lymphoma). Sometimes, fluid testing for CD30 is done before explant surgery, based on symptoms that suggest BIA-ALCL.

Your plastic surgeon will make recommendations on whether testing is needed in your situation. If there are signs of infection, your surgeon may prescribe antibiotics to treat it.

In cases of BIA-ALCL, your surgeon should refer you to a cancer care team with experience in treating it. You may need additional tests to confirm whether lymphoma cells have moved beyond the chest area. If so, the lymphoma would require additional treatments, such as radiation therapy or chemotherapy.

Explant surgery benefits and risks

The benefits of explant surgery depend on whatever problems you were experiencing. Examples can include:

• Relief from the pain and tightness of capsular contracture (scar capsule hardening)
• Wider, more comfortable range of motion
• Not having to worry about the future risk of rupture or leaks
• Improvement in breast implant illness symptoms, which many women with BII report happens after having their implants removed
• Not needing to have more procedures to correct problems with implants
• An end to concerns about having rare but possibly serious complications in the future, such as BIA-ALCL or immune system conditions

The risks of explant surgery include:

• Seroma, a buildup of fluid under the skin
• Hematoma, a pooling of blood under the skin
• Wound healing issues if you’ve had radiation to the area in the past
• Collapsed lung (this is rare) if the scar tissue capsule was stuck to the chest wall

Your care team can help you weigh the benefits and risks of explant surgery and any additional surgeries you have next, such as flat closure or tissue reconstruction.

Paying for explant surgery

The Women’s Health and Cancer Rights Act (WHCRA) of 1998 requires health insurance plans to pay for reconstruction procedures after mastectomy. This includes any surgeries that are medically necessary to fix problems with implants.

Explant surgery generally would be covered for the following reasons:

• Rupture or leaking
• Capsular contracture
• Pain that persists over time
• Difficulty with arm movement or range of motion
• Frequent infections
• Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)

Health insurance plans may not cover the cost of explant surgery if you want to have your implants removed due to:

• Symptoms of breast implant illness (BII)
• An autoimmune condition that may be linked to breast implants
• Concerns about the risks of keeping your implants

In these cases, if you’re also having any physical problems with the implants themselves, you and your surgeon may wish to use that as the reason for explant surgery.

Your surgeon’s office should be able to help you figure out what’s covered on your insurance plan. This includes:

• The explant surgery itself
• Any testing on the tissue and fluid removed
• What surgery you have next (flat closure or tissue reconstruction)

Keep in mind that there may be out-of-pocket costs such as copays, coinsurance, and deductibles.

You also can review your plan or call your insurance company to find out what is and isn’t covered.

Visit Financial matters, health insurance, and work to learn more about paying for care.