Breast Implant Removal Surgery In San Francisco

Breast implant removal, also known as explantation surgery, is a straightforward outpatient Plastic Surgery procedure designed to remove breast implants.

There are a variety of reasons that women who have had breast augmentation (or breast implant reconstruction) may decide to have their breast implants removed. Often, women find that their aesthetic preferences for their body change with time and they may want a smaller breast volume or a more natural look to their breasts. Occasionally, women can experience implant-related complications such as implant leakage or rupture, capsular contracture or feel that breast implant removal would benefit their health.

A rare indication for explantation of textured breast implants is anaplastic large-cell lymphoma (BIA-ALCL) or breast cancer that is unrelated to breast implants.

Learn About “Breast Implant Illness”
Learn About the FDA’s Labeling Requirement for Breast Implants

Other potential reasons for breast implant removal include the following:

Change in body image

Many women seeking breast implant removal state that they’ve “outgrown” their implants or that their original surgeon never truly listened to what they wanted for their augmentation results. While they may have enjoyed having fuller breasts, they feel that their implants no longer match their lifestyle or personal style and they wish to go back to their original smaller breast size. Just like fashion or makeup trends, breast size preferences can change over time. What was popular in the 1980’s, 1990’s or even 2000’s is not always what a woman wants in the 2020’s. Luckily, breast augmentation is reversible! Once a breast implant is removed, the breast usually returns to its pre-augmentation state. The breast is a naturally distensible organ—think about breastfeeding! Following explantation surgery, a breast lift is not always needed. Continue reading to learn more about what explantation surgery entails and what to expect afterwards.

Capsular Contracture

Some women develop capsular contracture after breast implants have been placed. This condition refers to a fibrous scar tissue that forms around one or both implants, creating a hard capsule.¹ While it is normal for the body to form a protective tissue capsule around foreign objects, this capsule is typically soft and unnoticeable, and keeps breast implants in position on the chest wall. However some women develop a capsule that is dense and hard, squeezing the implant and causing distortion in breast shape or even chronic pain. This is thought to be due to bacteria accumulating around the implant. In general, once the implant (foreign body) is removed, the bacteria will clear the body as there is nothing for them to adhere to.

Saline Implant Deflation

When a saline breast implant deflates, it gives the opportunity for a woman to see what her breast would look like without an implant. In fact, women with saline breast augmentations have the unique opportunity to “test drive” what their breasts would look like without their breast implants. See examples of saline implant deflation and/or explantation surgery results in our Explantation Gallery.

Breast Implant Illness

“Breast implant illness” (BII) refers to a wide and vague range of symptoms including muscle and joint pain, fatigue, weight gain, depression, breathing issues, sleep disturbances, and others that may develop after breast augmentation with implants. BII can occur with silicone or saline implants and symptoms can appear immediately or after several years.² Breast implant illness is a poorly understood constellation of symptoms that is currently being investigated scientifically. If a woman is worried she may have BII, explantation may help alleviate some of these symptoms.

Breast Implant Removal Procedure

Breast implant removal surgery is performed under general anesthesia by Board Certified Plastic Surgeon, Dr. Karen Horton. Dr. Horton is skilled in several explant techniques and will select the treatment plan that is best for you.

Explantation Under Local Anesthesia

In most cases, breast implant removal can be performed in the office under local anesthesia with an oral anti-anxiety medication and inhaled nitrous oxide (N2O). The preferred incision is in the fold under the breast; if an inframammary scar is present, it can be used for explantation. If the breast implants were originally inserted through a scar in the armpit (transaxillary incision), a new incision will be required under the breast—the axillary scar is unfortunately a one-time incision. If there is a scar under the areola (periareolar incision), it may be possible to use this incision for explanation.

Explantation with Capsulectomy

Removal of the scar tissue surrounding the implant (known as a capsulectomy) is not usually required for straightforward explantation procedures. Once the implant is removed, the capsule around the implant usually fades on its own as it has nothing to rub up against and there is no friction going forward (similar to a callus on the hand or foot, if the rubbing stops, the firm tissue will fade and go away). Breast implant removal takes an hour or less when performed in the office under local anesthesia, and is often a very empowering experience for patients! Exercise can resume in two weeks and drains are not usually required.

A capsulectomy will be performed for patients who choose to replace their implants instead of having them removed altogether. Capsulectomy is required to open up the implant space, create a more normal pocket for a new breast implant, and to send a sample of the scar tissue for bacterial culture. In a capsulectomy + breast implant removal procedure, the breast implant may be removed through the original incision site or a new incision in the inframammary fold, and the capsule of scar tissue surrounding it is excised.

En Bloc Total Capsulectomy

A radical explantation technique that is rarely required for most patients is called en bloc total capsulectomy. This procedure involves removing both the breast implant and the entire circumferential capsule of scar tissue intact, as a whole (“en bloc”, French for “all together”), typically without replacing the implants. This technique requires a lengthy scar (20-30 cm or up 12 inches), takes 3-4 hours in the operating room and has the longest recovery with drains and potential loss of the natural breast shape.

Explantation with Mastopexy (Breast Lift)

Because women may experience deflation in breast tissue that previously had implants, many women choose to enhance their breast appearance after breast implant removal with another type of breast surgery, such as breast lift (mastopexy), fat grafting, a combination of both, or the placement of new implants.

However, it’s often not just breast procedures that patients choose to add to a breast implant removal surgery. If you’re one of the many women who have chosen to remove your breast implants because you’re entering a stage of life where they no longer make sense, you may be considering other body contouring procedures such as liposuction or tummy tuck or facial procedures like an eyelid surgery or a facelift.

The Aesthetic Society (formerly ASAPS), the Aesthetic Society Education and Research Foundation (ASERF), and the International Society of Aesthetic Plastic Surgery (ISAPS) released a joint statement about what types of treatments are recommended for women who no longer want their breast implants.

Read the Full Statement Here

Risks and Recovery After Breast Implant Removal

Like any surgical procedure, breast implant removal does have potential risks and complications. After surgery and during the healing process, it’s normal to experience temporary pain, swelling and asymmetry. There will be an expected change in your body image, and temporary anxiety, insomnia and possible depression can occur for hours, days or weeks after a change in your body. You can read about Dr. Horton’s personal experience with body image adjustment after her breast augmentation here.

While downtime needed varies from patient to patient, breast implant removal recovery typically takes approximately two weeks.⁴ To learn more about risks associated with this surgery, please visit the Preparing for Surgery section, as well as Special Considerations for Breast Implant Surgery and Postoperative Instructions for Breast Surgery for additional information.

¹ Breastcancer.org. Capsular Contracture. Available at: https://www.breastcancer.org/treatment/surgery/reconstruction/corrective/capsular-contracture. Accessed May 27, 2021.
² Breastcancer.org. What Is Breast Implant Illness? Available at: https://www.breastcancer.org/treatment/surgery/reconstruction/types/implants/special-report/breast-implant-illness. Accessed May 27, 2021.
³ ASPS. Who is a good candidate for breast implant removal? Available at: https://www.plasticsurgery.org/cosmetic-procedures/breast-implant-removal/candidates. Accessed May 27, 2021.
⁴ ASPS. What should I expect during my breast implant removal recovery? Available at: https://www.plasticsurgery.org/cosmetic-procedures/breast-implant-removal/recovery. Accessed May 27, 2021.