Objectives
Explantation is NOT the same as removal of breast implants. Removal of breast implants can be done simply under local anesthesia in about 20 minutes. Please do not forget this, should someone suggest an exorbitant fee for just removing implants. What makes the surgery much more difficult is removing the capsule.
Capsulectomy involves not only the removal of the implant but its surrounding capsule, the thinking being that the capsule contains the inflammatory response to the breast implant. Removal of the capsule is called capsulectomy and 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 exceedingly difficult because the capsule is typically adherent to the surrounding muscles, leading to a small degree of 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. More often, a simple realignment of muscle fibers is done if a muscle splitting approach was used at the time of breast augmentation. In the case of implants under the muscle, surgery is that much more difficult because the capsule is often 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 clarify that although many patients feel much better right after their explantation, there is NO GUARANTEE that the BII symptoms will improve after explantation.