Better Explantation (Implant Removal) Procedure: 10 Questions & Answers

Posted On: August 06, 2026 Author: The Office of Dr. Stuart Linder Posted In: Implant Removal

Breast explantation, also known as breast implant removal, is a highly individualized surgical procedure. While some patients may simply require removal of their breast implants, others may require additional procedures to address scar tissue, capsular contracture, implant rupture, breast deformity, or loose skin.

The type of implant, whether it is saline or silicone, smooth or textured, and whether the implant is intact or ruptured can all influence the surgical approach. Depending on the individual patient, explantation may include a partial or total capsulectomy, removal of ruptured silicone material or calcified scar tissue, breast lift (mastopexy), or autologous fat grafting.

In this article, I answer 10 common questions about what patients can expect during explantation and explain some of the factors I consider when developing an individualized surgical plan.

Table of Contents

1. What Type of Explant Procedure Do You Recommend for Me and Why?
2. Will the Capsule Be Removed, and Is That Necessary?
3. Will You Use My Existing Incision, or Will I Need a New One?
4. How Long Does Explantation Surgery Typically Take?
5. Has Imaging Shown That My Implants Are Intact or Ruptured?
6. How Does a Ruptured Implant Change the Surgical Plan?
7. If Silicone Has Leaked, How Will It Be Managed?
8. What Complications Are Most Common With Explant Surgery?
9. How Could Explant Surgery Affect Nipple Sensation or Breastfeeding?
10. What Warning Signs Should Prompt Me to Contact My Surgeon?
11. Key Takeaways

1. What Type of Explant Procedure Do You Recommend for Me and Why?

The explantation procedure I recommend is unique to each patient and may differ from the procedure I perform on another patient. The surgical approach depends on several factors, including the type of implant, whether it is saline or silicone, whether it has a textured or smooth surface, whether it is ruptured, and the condition of the surrounding capsule.

For example, patients with textured implants may require a total capsulectomy, including careful removal of the capsule from the chest wall. Patients with smooth saline or silicone implants may be candidates for a partial capsulectomy when complete capsule removal is not necessary. Explantation may also involve removal of ruptured silicone material, calcified granulomas, or severe scar tissue surrounding the implant.

Depending on the patient’s condition, the capsulectomy may be partial, total, or an en bloc capsulectomy in which the capsule is removed as one contiguous piece. In some patients, explantation is combined with immediate breast reconstruction or reshaping. This may include a formal breast lift (mastopexy) or autologous fat grafting to restore breast volume and improve the shape of the breast after implant removal.

My goal is to determine which approach is appropriate for your individual anatomy, implant history, and surgical goals.

2. Will the Capsule Be Removed, and Is That Necessary?

In most of my explantation procedures, I remove at least a portion of the capsule or abnormal scar tissue surrounding the implant. However, the amount of capsule that needs to be removed depends on the individual patient.

For patients with Allergan™ textured silicone implants, I normally perform a total capsulectomy or an en bloc capsulectomy when clinically appropriate. This involves removing the capsule from the implant pocket, including carefully separating the capsule from the chest wall and the periosteum overlying the ribs when necessary.

Patients with smooth implants do not necessarily require a total capsulectomy. In these cases, a partial capsulectomy may be appropriate, depending on the thickness and condition of the capsule. Any capsule or abnormal tissue that is removed may be sent to pathology for diagnostic evaluation.

The decision regarding capsulectomy is made based on the implant type, condition of the capsule, presence of scar tissue or calcification, and the patient’s individual surgical needs.

3. Will You Use My Existing Incision, or Will I Need a New One?

Whenever possible, I may use an existing incision rather than creating an entirely new one. However, the appropriate incision depends on the type of explantation and whether additional breast reconstruction is being performed. If an existing incision was placed along the inframammary fold, I may be able to incorporate that incision into the explantation procedure.

When a formal breast lift is necessary, I commonly use an inframammary approach that can be incorporated into the breast lift incisions. For example, an inferior-pedicle Wise-pattern mastopexy may allow me to address both the implant removal and excess or loose skin at the same time. In some patients with smooth implants who do not require a formal breast lift, a periareolar incision may be used for explantation and capsulectomy.

The incision is therefore determined by the implant, the condition of the breast, the amount of scar tissue that needs to be removed, and whether a breast lift or other reconstructive procedure will be performed.

4. How Long Does Explantation Surgery Typically Take?

The length of explantation surgery varies considerably from patient to patient. It depends on several factors, including:

• Whether the implant is saline or silicone
• Whether the implant is smooth or textured
• Whether the implant is intact or ruptured
• The amount of scar tissue present
• Whether a partial or total capsulectomy is necessary
• Whether an en bloc capsulectomy is performed
• Whether calcified granulomas or ruptured silicone material must be removed
• Whether a breast lift is performed
• Whether autologous fat grafting is performed

A straightforward explantation of an intact smooth implant may require considerably less operating time than removal of a ruptured textured silicone implant with extensive scar tissue and a total capsulectomy.

When breast reconstruction is performed at the same time, additional surgical time may be required for harvesting and processing fat, performing autologous fat grafting, or completing a formal mastopexy.

For these reasons, I determine the expected surgical time after evaluating the patient’s individual circumstances rather than using one standard operating time for every explantation procedure.

5. Has Imaging Shown That My Implants Are Intact or Ruptured?

Imaging can be particularly important when a silicone implant rupture is suspected.

Breast MRI is highly sensitive for detecting silicone implant rupture and is generally considered the most accurate imaging study for evaluating the integrity of a silicone gel implant. One classic MRI finding associated with silicone implant rupture is the linguine sign, which occurs when the silicone implant shell has lost its normal structural integrity and the collapsed shell appears as curvilinear lines within the silicone gel.

Ultrasound can also be useful in evaluating breast implants, but MRI may provide additional information when silicone implant rupture is suspected. Saline implant rupture is often easier to identify clinically. When a saline implant ruptures, the saline is generally absorbed by the body, and the affected breast may become noticeably smaller or deflated compared with the opposite breast.

During your evaluation, I consider your physical examination, implant history, symptoms, and available imaging to determine whether an implant is intact or has ruptured.

6. How Does a Ruptured Implant Change the Surgical Plan?

A ruptured implant can make explantation more complex, particularly when a silicone implant has ruptured and silicone material has entered the surrounding capsule.

When a silicone implant ruptures, the procedure may require additional time to remove the implant and silicone material, clean the implant pocket, and remove significant scar tissue or calcified granulomas that have developed around the ruptured implant.

The surgical approach also depends on whether the silicone rupture is contained within the capsule or has extended outside of it.

Ruptured saline implants are generally handled differently. A ruptured smooth saline implant does not necessarily require a total capsulectomy. However, when a saline implant has been deflated for an extended period, the implant pocket may contract or close significantly. In these situations, additional scar tissue removal may be necessary to restore the breast pocket.

Ultimately, the extent of implant rupture, the condition of the capsule, and the surrounding breast tissue determine the surgical plan.

7. If Silicone Has Leaked, How Will It Be Managed?

Silicone implant rupture can generally be described as either intracapsular or extracapsular.

With an intracapsular rupture, the silicone remains within the fibrous capsule surrounding the implant. In this situation, the silicone may be removed along with the ruptured implant and the affected capsule, followed by careful cleaning of the implant pocket.

An extracapsular rupture occurs when silicone extends beyond the surrounding capsule into adjacent breast tissue or potentially other areas. This can make the procedure more complex because silicone may be present outside of the original implant pocket. The surgical approach depends on the amount and location of the silicone, the condition of the capsule, and whether there is significant scar tissue or calcification.

When I perform explantation for a ruptured silicone implant, my goal is to remove the implant and accessible silicone material and address the surrounding scar tissue as safely and thoroughly as possible.

8. What Complications Are Most Common With Explant Surgery?

As with any surgical procedure, explantation has potential risks and complications. Some of the potential complications include:

• Bleeding or hematoma
• Infection
• Seroma
• Delayed wound healing
• Skin necrosis
• Fat necrosis when fat grafting is performed
• Changes in breast shape or symmetry
• Changes in nipple sensation
• Complications related to a breast lift when performed concurrently

Bleeding and infection are among the important complications that we monitor for after surgery. When explantation is combined with a breast lift, there can be additional risks related to blood supply to the skin and nipple-areolar complex. Patients with significant scar tissue or previous breast surgeries may have more complicated anatomy and therefore require particularly careful surgical planning.

During your consultation, I discuss the potential risks of explantation and any additional procedures you are considering so that you understand both the benefits and limitations of surgery.

9. How Could Explant Surgery Affect Nipple Sensation or Breastfeeding?

Changes in nipple sensation are a potential complication of breast surgery, particularly when extensive dissection is required, because of severe scar tissue or previous operations.

The fourth lateral intercostal nerve contributes to sensation of the nipple-areolar complex. During extensive lateral breast dissection, I make every effort to identify and preserve this nerve when possible. However, severe scar tissue from previous breast surgeries can make identification and preservation more difficult.

Changes in nipple sensation can occur after surgery and may be temporary or permanent. In Dr. Linder’s experience, loss or significant alteration of nipple sensation has been reported in approximately 8% to 11% of patients undergoing these types of procedures.

Breastfeeding or lactation may also be affected, particularly when surgery involves disruption of breast tissue or the milk ducts. Patients who are considering future pregnancy or breastfeeding should discuss these goals during their consultation so that they can be incorporated into the surgical plan.

10. What Warning Signs Should Prompt Me to Contact My Surgeon?

It is important to understand the warning signs of a potential complication after explantation. If you experience concerning symptoms, you should contact your surgeon promptly for evaluation.

One of the most important complications to watch for is bleeding or hematoma formation. A hematoma may cause rapid breast enlargement, significant or increasing breast pain, tightness, swelling, or changes in the breast that develop relatively quickly after surgery.

Severe swelling or bleeding can occasionally place pressure on surrounding tissues and nerves, which may contribute to significant discomfort extending into the arm or shoulder.

Another important warning sign is infection. Symptoms may include:

• Fever, particularly a temperature greater than 101.5°F
• Increasing redness of the breast
• Warmth or burning pain
• Increasing tenderness
• Swelling
• Drainage from the incision
• Increasing pain rather than gradual improvement

If these symptoms occur, contact your surgeon immediately. Some infections may require antibiotics, and more serious infections may warrant additional treatment.

When recovering from explantation, it is important to remember that some swelling, bruising, tightness, and discomfort are normal. What is more concerning is a sudden or significant change, rapidly increasing pain or swelling, fever, or other symptoms that appear to be getting worse rather than better.

When in doubt, contact your surgical team so that you can be properly evaluated.

Key Takeaways

Explantation is not a one-size-fits-all procedure. The surgical approach depends on the type and condition of the implant, the surrounding capsule, previous breast surgeries, and the patient’s individual goals.

The most important points to remember are:

• Every explantation procedure is individualized. Saline versus silicone, smooth versus textured, and intact versus ruptured implants can all influence the surgical approach.
• Capsulectomy may be partial, total, or en bloc. The appropriate technique depends on the condition of the capsule and the individual patient’s needs.
• Ruptured silicone implants may require more extensive surgery. Silicone removal, pocket cleaning, scar tissue removal, and treatment of calcified granulomas may be necessary.
• Breast reconstruction can sometimes be performed at the same time. A breast lift and/or autologous fat grafting may help restore breast shape and volume following implant removal.
• Imaging can help determine implant integrity. MRI is particularly useful when silicone implant rupture is suspected.
• Explantation has potential risks. Bleeding, infection, wound-healing problems, changes in sensation, and other complications can occur.
• Know the warning signs after surgery. Rapid swelling, significant pain, fever, redness, or increasing symptoms should be reported to your surgeon promptly.
• Your surgical plan should reflect your individual anatomy and goals. A detailed consultation is essential before determining the appropriate explantation procedure.

Schedule a Consultation

If you are considering explantation (implant removal) surgery, call Dr. Stuart Linder’s office at (310) 275-4813 or fill out the online contact form to schedule a consultation and discuss your goals.