Breast implants do not last a lifetime. If you get breast implants, you should expect that you will need additional surgery in the future to fix problems or remove your implants. How do you know if that time has come? You can read more about the potential complications of breast implants here. Below are some helpful insights that can help you decide if it’s time to consider removing your implants.

Are your implants ruptured or leaking? 

If you have silicone gel filled implants, the FDA recommends that you get a breast coil MRI regularly to detect ruptures that have no symptoms.  When silicone breast implants were first approved, the FDA recommended that all women undergo a breast MRI 3 years after getting breast implants, and every other year after that. However, because of the expense and the reluctance of plastic surgeons to encourage MRIs for silent ruptures, very few women followed the FDA’s advice.  As of October 2020, FDA now recommends an MRI 5-6 years after the initial surgery and every 2-3 years after that. If a leak or rupture is confirmed you will need to have the implant removed as soon as possible.  Ruptured silicone gel implants should be removed en bloc and by an experienced plastic surgeon. Remember that not all ruptures of silicone gel implants will show up on breast coil MRIs or ultrasounds. If your implants are more than 10 years old or you suspect they may be ruptured, you should consider removal as you may have a silent, undetected leak. 

Are you having trouble concentrating, fatigue or other unexplained illnesses?

It could be a sign that you are experiencing autoimmune symptoms that may be a result of your breast implants. If other possible causes have been eliminated by testing, your symptoms have not resolved on their own, and/or you haven’t been able to successfully manage your symptoms with other medical treatments, you may want to consider removing your implants. If you suspect that your autoimmune symptoms or “breast implant illness” are directly linked to your breast implants, you may want to discuss getting your implants removed with a plastic surgeon who is very experienced at removing problem implants. There is now clear scientific evidence establishing a connection between breast implants and autoimmune symptoms, and research shows that most women report significant improvements in their symptoms after removal.  You can read about another woman’s experience with breast implant illness here, and you can read about the recent research here.

Are you concerned about the possibility of BIA-ALCL? Have you developed a lump or swelling around your implant?

If you have been diagnosed with breast implant associated-anaplastic large cell lymphoma (BIA-ALCL) you should get your implants removed as soon as possible. If you have textured breast implants, you are at risk for BIA-ALCL.  However, that does not mean you should immediately get your breast implants removed, if you are not having any other symptoms from your breast implants. BIA-ALCL is rare and treatable if caught early. If you are not experiencing any other symptoms from your implants, the risks of explant surgery may outweigh the benefits. You should monitor your breasts for changes and symptoms of ALCL and see a doctor regularly. If you have textured implants and are having other symptoms like rupture, capsular contracture, breast pain, autoimmune symptoms, or overwhelming anxiety from having textured implants, it may be time to consider permanent removal of your implants.

Key Takeaways

Ultimately, if you suspect that you are experiencing any symptoms from your breast implants it is in your best interest to discuss with a health professional if removal is the best choice for you. Other issues that may lead you to consider breast implant removal include, added weight and strain on the neck, back and shoulders, infections that are not treatable by antibiotics, and unhappiness with how your breasts look. When making your decision, remember that if you decide to replace your implants the risk of complications coming back is high. If you are considering permanent removal, it is important to keep in mind that that your breasts may not look the same as they did before your breast implant surgery. There is likely to be loose skin and changes in the rib area. If this concerns you, you can see an experienced plastic surgeon and discuss alternatives to breast implants to improve the cosmetic look of the breasts, such as a breast lift. You can learn more about breast lifts here.

Removing breast implants is a more complicated surgery than putting them in and requires a skilled plastic surgeon. For more information on finding an experienced plastic surgeon to remove your breast implants, click here.

All articles have been reviewed and approved by Diana Zuckerman, PhD, and other senior staff.

Finding a plastic surgeon to perform your explant surgery is tricky because it can be a more complicated procedure than placing implants. If you have already had a negative experience with your breast implants, it is very important to find a surgeon that can remove your implants carefully. Your surgeon needs to be able to minimize any silicone leakage or other problems during the surgery.

You should start by looking for a surgeon who understands that breast implants can cause serious health problems, because those surgeons will be more careful when removing your implants. It is also important that your plastic surgeon be board-certified by the American Board of Plastic Surgery. Any doctor can call themselves a plastic surgeon, but only those who are board-certified have extensive training. The ABPS website lists all board-certified surgeons.

En Bloc Removal

Your explant surgeon should be experienced in en bloc removal, whenever possible. En bloc removal is when the surgeon removes the scar tissue (or capsule) and implant at the same time, with the implant still inside the intact scar tissue capsule. This is especially important if your implants are filled with silicone gel, are ruptured, or are very old. En bloc removal allows the silicone and other chemicals to stay inside the intact scar tissue capsule as it is removed. En bloc removal prevents silicone, other chemicals, and bacteria from leaking into the woman’s body during surgery. It requires a larger incision (which can mean a larger scar), but it is worth it because it prevents leakage that can cause health problems.  

Keep in mind that en bloc removal may not be possible in all cases, and your surgeon may not know if an en bloc procedure is possible until you are in surgery. For example, if your scar tissue capsule is very thin or tightly attached to the chest wall, en bloc removal may not be possible.

Total Capsulectomy

En bloc removal is also sometimes referred to as a total capsulectomy, but they are not exactly the same. A total capsulectomy is not always performed using the specific en bloc technique. A total capsulectomy is the removal of the breast implants and all the scar tissue, or capsule, that forms around a breast implant. However, during a total capsulectomy, the implant is not necessarily removed while still inside the intact scar capsule (en bloc method). Most surgeons use the term total capsulectomy to mean that they will cut the scar tissue capsule, remove the implants first, and then go back and remove all of the scar tissue capsule.

What if en bloc removal is not possible?

Let your plastic surgeon know in advance that if en bloc removal is not possible, you want the surgeon to remove as much of the scar tissue capsule as possible. Surgeons who are experienced in en bloc removal will know how to remove your implants and scar capsule material as carefully as possible.

Unfortunately, there are not many surgeons experienced in en bloc removal and most do not take insurance. If you cannot find a surgeon near you that performs en bloc removal, or you are required to see a surgeon inside your insurance network, you should select a surgeon who can perform a total capsulectomy.

If you are paying for the surgery yourself, keep in mind that the most important factor to consider is the expertise of the surgeon in performing en bloc removal. In some cases, women have traveled to experienced surgeons in the U.S. and still spent less than their local, less experienced plastic surgeon.

Your Decision

Once you have selected a board-certified plastic surgeon experienced in explantation, there are several questions you should ask to ensure your surgeon understands your wishes. You should ask the surgeon how many en bloc or total capsulectomy procedures he or she has performed to gauge skill and experience. You can also ask to speak with one of your surgeon’s patients who has had en bloc explantation to hear about their experiences. Finally, you may ask for before and after pictures of the plastic surgeon’s own patients. Here is a one-page resource that lists all the questions you should ask your surgeon at your next consultation. Click here to print this one-page list of questions to take with you to your next consultation.

It is also important that you and your surgeon are on the same page about your priorities for the surgery. In order to help make sure that your surgeon knows how strongly you feel about the surgery, we have created a short acknowledgement form that you can print and take with you to your consultation. This form will be signed by you and your doctor and acknowledges that your doctor understands your desire for an en bloc explant whenever possible. Click here to print the acknowledgement form to take with you to your next consultation.

Insurance Coverage

If you want health insurance coverage for your surgery, you can find out if there are plastic surgeons who participate in your health insurance plan, are board-certified, and experienced in the en bloc or total capsulectomy removal. You can start by contacting your insurance company’s member service line to speak with an insurance representative. Many insurance company websites provide online databases of participating physicians.

As mentioned previously, many plastic surgeons experienced in en bloc or total capsulectomies do not accept or work with insurance. If your plan is likely to cover your breast implant removal, you will need to determine if your plan allows you to see out-of-network surgeons and seek reimbursement. If your plan requires you to see in-network surgeons, you will need to decide how important it is for you to have your surgery done en bloc and how you will raise the funds to pay for the procedure up-front.

Once you find participating surgeons, you can call their offices to ask about their experience with en bloc removal or total capsulectomy.  If the surgeon meets the above criteria, you should request an in-person consultation before scheduling your surgery.

Once you have selected a board-certified plastic surgeon experienced in breast implant removal, there are several questions you should ask to ensure your surgeon understands your priorities for surgery and is experienced at explanting. Click Here to print this one-page list of questions to take with you to your next consultation.

Questions About Explant

1. Do you perform “en bloc” removal, which I understand is when the implant is removed while still inside the intact scar tissue capsule?
   • How many times per month or year do you perform en bloc removals?
2. Do you perform “total capsulectomies,” which I understand is when the implant and capsule are removed separately, but the entire scar tissue capsule is removed?
   • How many times per month or year do you perform total capsulectomies?
3. Please explain to me in detail exactly how the procedure will be done?
4. Are there situations where it might be impossible for you to remove the entire capsule? If so, what are they
5. I don’t want my implants replaced. Please tell me about the possible options to improve the look of my breasts once my implants are removed but not replaced (Breast lifts and fat transfers are two such options to discuss)
   • Can I see before and after pictures of women on whom you have performed implant removal?
6. Do you have any explant patients who would be willing to speak to me about their experiences?

Questions About My Health

1. Do I have capsular contracture? If so, what grade (Baker I, II, III, or IV)
2. For silicone gel implants: Will you refer me for a breast coil MRI to detect rupture? Or ultrasound? I don’t want mammography, because the pressure could cause leakage.

Questions About Insurance Coverage

1. Do you accept my insurance? Does your office bill insurance directly or do I need to pay up front for the surgery and seek reimbursement? (If Medicare: Are you a Medicare Participating Provider who takes assignment?)
2. Will you write and/or sign a letter of medical necessity for my insurance claim, saying that based on my symptoms my breast implant removal is medically necessary?
3. Does your office have the medical billing codes for the specific procedure you will perform that I can give to my insurance company if I am filing on my own behalf?