Explantation vs removal of breast implants

Explantation is NOT the same as removal of breast implants. Removal of breast implants can be done simply under local anesthesia in under 30 minutes. Please do not forget this, should someone suggest a fee of thousands of dollars for just removing implants. What makes the surgery much more difficult is removing the capsule.

What is explantation?

Capsulectomy involves not only the removal of the implant but its surrounding capsule as well, often called EXPLANTATION. Capsule is a thin “scar” tissue that the human body forms around any foreign body, in an attempt to isolate the foreign body. For example, if you get a wood splinter in your finger, your body will form a capsule around the piece of wood. The longer the wood remains, the thicker the capsule becomes. At a certain point, the capsule becomes permanent. The significance of this capsule for patients remains unclear.

While there are numerous reasons for removing the capsule (given later), capsulectomy is obviously more difficult than simple removal of the breast implant. Patients must understand the benefits of capsulectomy and the risks that go along with it in order to make an informed decision. Providing that information is a top priority for Dr. Nicolaidis and is part of the reason he presented his own complication rates at the American Society of Plastic Surgery meeting in 2022 for the first time in the world.

What does explantation consist of?

Explantation requires a long incision in the fold under the breast in order to allow for adequate exposure of the implant and its capsule and their SAFE removal. The surgery can be difficult because the capsule may be adherent to the surrounding muscles, leading to minimal damage to the muscle during explantation. However, muscle is rarely damaged to the point of requiring repair; moreover, repair is not easily done since muscle fibers tear and bleed easily. In the case of implants under the muscle, surgery is more difficult because the capsule may be stuck to the underlying ribs as well, requiring careful dissection without entering the space around the lungs (discussed in COMPLICATIONS). 

The time required for capsulectomy and lift is generally 2 to 3 hours in experienced hands. Factors that make capsulectomy more difficult are: thin capsules, as often seen with saline implants; very large implants, and; presence of internal bras, particularly when large amounts of foreign material are used.

It is important to note that there is NO GUARANTEE that the BII symptoms will improve after explantation.