Breast Implant Removal (Explantation)
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Dr. Horton
Emily Sespaniak, MSN, FNP-C
Danielle Bautista, MSN, ANP
About Dr. Karen Horton: Your San Francisco Explantation Specialist
Understanding Breast Implant Removal Surgery
Common Reasons for Breast Implant Removal
Innovative Surgical Approaches: Office-Based Explantation
Recovery and Healing Process
Combination Procedures for Optimal Results
Investment in Your Health: Transparent Pricing
Payment Options and Financing
Frequently Asked Questions
Medically Reviewed by: Dr. Karen Horton, MD, MSc, FACS
If you’re considering breast implant removal in San Francisco, you’re not alone. Many women choose explantation surgery for various personal, medical, or aesthetic reasons. Dr. Karen Horton, a female Board-Certified Plastic Surgeon practicing in San Francisco, specializes in breast implant removal procedures, offering both traditional and innovative approaches to help patients achieve their desired outcomes safely and effectively.
Breast implant removal, also known as explantation surgery, is a surgical procedure designed to remove breast implants that were previously placed during breast augmentation or breast reconstruction. Whether you’re experiencing complications, lifestyle changes, or simply prefer a more natural appearance, explantation can help restore your confidence and comfort.
About Dr. Karen Horton: Your San Francisco Explantation Specialist
Dr. Karen Horton brings over 25 years of specialized experience in breast implant removal surgery to her San Francisco practice. She is internationally Board-Certified in Plastic Surgery by both the American Board of Plastic Surgery and the Royal College of Surgeons of Canada – a rare dual certification that demonstrates her exceptional training and expertise.
Professional Credentials and Training
- Bachelor of Science: Queen’s University, Kingston, Ontario, Canada (1994)
- Master of Science: Queen’s University,, Kingston, Ontario, Canada (1996)
- Medical Degree: University of Toronto Faculty of Medicine (2000)
- Plastic Surgery Residency: Five-year competitive Integrated Residency program in Plastic Surgery (2005)
- Fellowship: Reconstructive Microsurgery Fellowship at The Buncke Clinic Institute for Plastic & Reconstructive Surgery, San Francisco (2006)
- Board Certifications:
- American Board of Plastic Surgery
- Royal College of Surgeons of Canada
- Hospital/Surgery Center Affiliations: San Francisco Plastic Surgery Center, California Pacific Medical Center, UCSF – St. Francis Hospital Campus
- Professional Memberships:
- The Aesthetic Society (American Society of Aesthetic Plastic Surgery)
- American Society of Plastic Surgeons
- American College of Surgeons
- California Society of Plastic Surgeons
- Mountain West Society of Plastic Surgeons
- American Medical Association
- California Medical Association
- International Confederation for Plastic, Reconstructive and Aesthetic Surgery
- International Society of Aesthetic Plastic Surgery
Recognition and Awards
- SFGATE Best of the Bay – Best Cosmetic/Plastic Surgeon (Winner 2025; Finalist 2024)
- San Francisco Magazine: Top Doctor (2025, 2024, 2023, 2022, 2021, 2020, 2019, 2018, 2017, 2016, 2015)
- Castle Connolly Top Doctor (2025, 2024, 2023, 2022, 2021, 2020, 2019, 2018, 2017, 2016, 2015, 2014)
- Castle Connolly Exceptional Women in Medicine Award (2025, 2024, 2023)
- Newsweek: America’s Best Plastic Surgeons (2025, 2024, 2023)
- America’s Best Physicians – National Consumer Advisory Board (2025, 2024, 2023, 2022, 2021, 2019)
- Marin Magazine: Women of Impact Award (2023, 2022)
- Marin Magazine: Top Doctors Award (2026, 2025, 2024, 2023, 2022, 2021, 2020)
- America’s Most Honored Doctors – The American Registry (2025, 2024, 2023)
- Doctor’s Choice Awards: Top Doctor in Plastic Surgery (2015-2023)
- American Institute of Plastic Surgeons: Ten Best Plastic Surgeons – California (2020; 2015-2017)
- Vitals Compassionate Doctor Award(2020, 2014)
- Three Best Rated: Best Plastic Surgery Practice, San Francisco (2018-2019)
- Top Plastic Surgeon – Top Plastic Surgeon Reviews (2018)
- NBC Bay Area’s Top Doctors – Plastic Surgeon (2010)
- Woman of the Year in Medicine & Healthcare – American Biographical Institute (2010)
- Best Plastic Surgeon – Best of the Bay Television (2008)
Experience and Expertise
Dr. Horton has successfully performed over 200 breast implant removal procedures since beginning her practice in San Francisco in 2006.
Patients considering breast implant removal can explore Dr. Horton’s detailed guidance in these related blog articles:
- Explantation (Breast Implant Removal) Surgery, Step-by-Step
- Explantation: What Happens When Breast Implants are Removed?
- Dr. Karen Horton Featured in American Society of Plastic Surgeons’ Trend Watch on Explant Surgery
- Plastic Surgery Trends: Why Breast Implant Removal is Popular Right Now
- Capsular Contracture, Breast Implant Removal and a Lift – One Patient’s Story
These posts share expert insights drawn from Dr. Horton’s extensive experience and are designed to help you make confident, informed decisions.
Before & After
Understanding Breast Implant Removal Surgery
Breast implant removal involves the surgical removal of saline or silicone breast implants from the breast pocket. The procedure can be performed as a standalone surgery or combined with other treatments such as a breast lift (mastopexy) or implant replacement. While fat grafting is sometimes discussed as an option, Dr. Horton does not routinely recommend adding fat to a natural breast and explains why in detail in her blog post on Fat Grafting to the Breasts. The complexity of the surgery depends on factors such as implant type, placement location, presence of scar tissue, and individual patient anatomy.
During the procedure, Dr. Horton makes an incision, typically using the existing scar from your original breast augmentation when possible. The implant is then carefully removed, the internal pocket is inspected, and depending on your specific situation, the surrounding capsule (scar tissue) may also be addressed through capsulectomy techniques.
When possible, Dr. Horton uses the existing inframammary incision (the crease beneath the breast), the preferred approach for its superior visibility, easiest recovery, and because it avoids any risk to nipple sensation, milk ducts, or future ability to breastfeed. In some cases, the periareolar incision (around the lower edge of the areola) may be reused. The axillary incision (underarm) is possible but typically requires muscle relaxation and a trip to the operating room. If the original scar is stretched or of poor quality, it can be fully excised and recreated for a more aesthetic result.
Common Reasons for Breast Implant Removal
Lifestyle and Aesthetic Changes
Many women find that their preferences evolve over time. What felt right in their twenties or thirties may no longer align with their current lifestyle, career, or personal aesthetic goals.
“I realized my implants no longer reflected who I am today. I wanted to feel more like myself again, and Dr. Horton helped me achieve that natural look I was craving. The office-based procedure was so much easier than I expected, and I was back to work in just three days.” – Sarah M., Age 42, Marketing Executive
Capsular Contracture
Capsular contracture occurs when the natural scar tissue that forms around the implant becomes thick and tight, potentially causing pain, distortion, or hardening of the breast. According to FDA data, capsular contracture affects approximately 10-15% of patients with breast implants over their
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Risks and Complications of Breast Implants
U.S. Food and Drug Administration
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lifetime.
Implant Rupture or Deflation
Saline implant deflation is immediately noticeable, as the breast will appear smaller and deflated. Silicone implant ruptures, however, may be “silent” and require imaging studies for detection. The American Society of Plastic Surgeons recommends regular monitoring of silicone implants with MRI or
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What are the risks of breast augmentation?
American Society of Plastic Surgeons
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ultrasound.
“When my saline implant deflated, I was initially upset, but it gave me the opportunity to see what my breast would look like naturally. Dr. Horton’s gentle approach and expertise made the removal process smooth, and I’m thrilled with my natural results.” – Jennifer L., Age 38
Breast Implant Illness (BII) Concerns
Some women report experiencing a constellation of symptoms they attribute to their breast implants, collectively known as Breast Implant Illness (BII) or Systemic Symptoms related to Breast Implants (SSBI). While not officially recognized as an official medical diagnosis, symptoms may include a vague constellation of symptoms such as fatigue, joint pain, cognitive issues, and autoimmune-like
Trusted Source
Systemic Symptoms Associated With Breast Implants: A Psychological Study of Beliefs and Emotions
Glicksman C, McGuire P, Barnes K, Shedden-Mora M, Faasse K
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symptoms.
Research is ongoing to better understand these reported associations.
Read more about Systemic Symptoms Associated With Breast Implants (SSBI), in these articles:
Size Dissatisfaction
Whether implants feel too large, too small, or simply don’t suit your current body proportions, size dissatisfaction is a valid reason for removal. Some patients choose to go completely natural, while others opt for different-sized implants during the same procedure.
Innovative Surgical Approaches: Office-Based Explantation
Office-Based Explantation Under Local Anesthesia
Dr. Horton offers a unique approach for straightforward breast implant removal cases: office-based surgery under local anesthesia with an oral anti-anxiety medication and inhaled nitrous oxide. This innovative technique allows for:
- Reduced surgical risks associated with general anesthesia
- Lower overall costs compared to hospital-based procedures
- Faster recovery times with same-day discharge
Traditional Explantation with General Anesthesia
For more complex cases or when combined with additional procedures, traditional explantation under general anesthesia may be recommended. This approach is typically used when:
- Extensive capsulectomy is required for ruptured implants or extremely thick capsular tissue
- Combining explantation with an auto-augmentation breast lift or other complex procedures
- Patient preference for general anesthesia
- Complex revision cases requiring longer operative times
“I was nervous about the procedure, but Dr. Horton’s office-based approach was amazing. I was comfortable throughout, and the recovery was so much easier than I expected. I highly recommend this option for anyone considering explantation.” – Maria R., Age 35
Surgical Techniques and Capsulectomy Options
Simple Capsulotomy
The capsule is opened internally but not removed, allowing it to naturally soften over time once the implant is removed. This approach is suitable for patients with minimal capsular thickening who require a larger pocket inside.
Partial Capsulectomy
Portions of the capsule are removed, particularly areas that are thick or problematic. This technique balances thorough treatment with minimal tissue disruption.
Total Capsulectomy
The entire capsule is removed, usually in several pieces, which may be recommended in cases of capsular contracture or when replacing older generation ruptured implants where the capsule may be thick and/or calcified. This approach ensures complete removal of all internal scar tissue to avoid future capsular contracture or deformity.
En Bloc Capsulectomy
Rarely required or recommended, en bloc capsulectomy involves removal of the implant and the entire surrounding capsule as one intact unit. According to The Aesthetic Society’s Consensus Statement on Breast Implant Capsulectomy Definitions, this technique involves removing the implant and capsule together without disrupting the capsule
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Consensus Statement on Breast Implant Capsulectomy Definitions and Management Created by Breast Surgery Collaborative Community
The Aesthetic Society
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integrity.
While this approach may be recommended in specific cases, it requires much longer incisions and extended recovery time. This procedure is reserved for invasive cancer cases.
Important Medical Consideration: The Aesthetic Society’s consensus statement emphasizes that while en bloc capsulectomy is sometimes requested by patients out of fear for BII/SSBI concerns, current medical literature does NOT establish this technique as superior to total capsulectomy for symptom resolution. Dr. Horton follows these evidence-based guidelines when discussing the most appropriate technique for your individual situation.
Recovery and Healing Process
Office-Based Procedure Recovery
Recovery from office-based breast implant removal under local anesthesia typically involves:
- Day 1-2: Mild discomfort managed with over-the-counter pain medication
- Day 3-5: Return to desk work and light activities
- Week 1: Gradual increase in daily activities
- Week 2: Full exercise clearance for most patients when bruising is gone
- Month 1-3: Final results become apparent as swelling subsides and breasts contract to their original form
Traditional Recovery Timeline
For procedures performed under general anesthesia or with extensive capsulectomy:
- Days 1-3: Initial recovery period with prescription pain management or over-the-counter medication
- Week 1-2: Avoid lifting more than 5 pounds, dressing change done, drains removed
- Weeks 2-4: Gradual return to exercise and normal activities
- Months 3-6: Final results visible as tissues settle
Managing Expectations: Post-Removal Breast Appearance
Breast appearance after implant removal depends on several factors:
- Original breast size and shape before augmentation
- Duration of implant placement (longer placement may result in more tissue changes)
- Implant size and type (larger implants may cause more skin stretching)
- Skin elasticity and quality (affected by age, genetics, and sun exposure)
- Past capsular contracture or breast infections and thickness of capsule
- Previous pregnancies or significant weight fluctuations
- Implant placement (submuscular vs. subglandular)
- Location of incision (inframammary fold access preferred)
Many patients worry about stretched or loose skin after removal, particularly if they’ve had large implants or implants in place for many years. The good news is that breast tissue tends to be more resilient than expected, much like how abdominal skin bounces back after pregnancy. Most patients are pleasantly surprised by how well their breasts contract and reshape over the weeks and months following explantation.
Combination Procedures for Optimal Results
Explantation with Mastopexy (Breast Lift)
Many patients choose to combine implant removal with a breast lift to address sagging or loose skin. This combination procedure can help achieve a more youthful, natural breast contour while removing implants. Dr. Horton performs the auto-augmentation mastopexy technique, where breast tissue is moved up higher on the chest into a pocket and reshaped internally, as is done for a breast augmentation – except the patient’s own breast tissue is used to fill the breast.
For patients who are unsure whether they’ll need a lift, Dr. Horton often recommends waiting 4–6 months after explantation before making that decision. This allows time for the skin and breast tissue to fully contract and settle into their natural shape, and many patients find that a lift is ultimately not necessary.
Typical Candidates for Combination Surgery:
- Patients with significant breast ptosis (sagging, droop)
- Those who had large implants for extended periods
- Women who experienced breast changes after pregnancy
- Patients seeking optimal aesthetic outcomes
Fat Grafting for Natural Volume Restoration
For patients desiring some volume restoration after implant removal, fat grafting using the patient’s own fat can provide natural-looking enhancement while maintaining a softer, more natural feel. However, Dr. Horton urges caution when considering fat grafting to the breast. Read her blog post about this topic.
Comprehensive Body Contouring
Patients often use explantation as an opportunity to address other areas of concern through procedures such as:
- Liposuction for body contouring
- Tummy tuck for abdominal rejuvenation
- Labiaplasty for vaginal rejuvenation and increased comfort
- Facial procedures for comprehensive rejuvenation
Common Risks and Complications:
- Bleeding (occurs in less than 1% of cases)
- Infection (rare with proper antibiotic protocols)
- Changes in breast sensation (usually temporary)
- Asymmetry (may require revision in rare cases)
- Scarring (minimized through careful surgical technique and postoperative scar therapy)
Investment in Your Health: Transparent Pricing
Dr. Horton’s practice operates as a fee-for-service aesthetic practice and does not work with insurance companies. This allows for personalized care without insurance restrictions and ensures that treatment decisions are made solely between you and Dr. Horton based on your individual needs and goals.
Factors Affecting Investment:
- Surgical technique and complexity
- Facility fees (office vs. hospital)
- Anesthesia type and duration
- Additional procedures performed
- Post-operative care and follow-up visits
Payment Options and Financing
Dr. Horton accepts a range of payment methods and offers convenient patient financing through CareCredit® and PatientFi™.
Benefits of Fee-for-Service Care:
- No insurance pre-authorization delays
- Direct communication between patient and Surgeon
- Personalized treatment plans without insurance limitations
- Transparent pricing with no hidden fees
- Flexible scheduling based on patient needs
Health Savings Account (HSA) and Flexible Spending Account (FSA)
While Dr. Horton’s practice does not bill insurance directly, many procedures may be eligible for payment using HSA or FSA funds. We recommend consulting with your HSA/FSA administrator to determine eligibility for your specific procedure.
Schedule Your Consultation
Ready to take the next step toward breast implant removal in San Francisco? Schedule a comprehensive consultation with Dr. Karen Horton to discuss your goals, evaluate your options, and determine the best surgical approach for your individual needs.
Frequently Asked Questions
When selecting a Plastic Surgeon for breast implant removal in the San Francisco Bay Area, look for:
- Board Certification in Plastic Surgery (both ABPS and international certifications like Dr. Horton’s dual certification)
- Extensive experience specifically with explantation procedures and/or complex breast revision surgery
- Hospital/Accredited Surgery Center affiliations and Professional Plastic Surgery Society Memberships
- Comprehensive before and after photo galleries
- Positive patient testimonials and reviews
- Multiple surgical approach options (office-based and traditional)
Breast appearance after implant removal varies based on multiple factors including original breast size, implant duration, skin quality, and individual healing characteristics. While breasts often return closer to their pre-augmentation state, some changes in shape or position may occur. Dr. Horton will provide realistic expectations during your consultation based on your specific anatomy and/or other body changes you may have experienced since the time of your original breast augmentation surgery.
Dr. Horton operates a fee-for-service practice to provide personalized, high-quality care without insurance restrictions. This model ensures that insurance does not dictate your care, allowing for:
- Direct communication between patient and surgeon
- Personalized treatment plans based solely on medical need
- No insurance pre-authorization delays
- Transparent pricing without hidden fees
- Flexible scheduling based on patient convenience
Like any surgical procedure, breast implant removal carries some risks including bleeding, infection, changes in sensation, and scarring. However, complication rates are generally low, especially when performed by an experienced, Board-Certified Plastic Surgeon. Dr. Horton will discuss all risks and benefits during your consultation.
Yes, Dr. Horton offers office-based breast implant removal under local anesthesia for appropriate candidates. This innovative approach provides several advantages including reduced costs, faster recovery, and elimination of general anesthesia risks. During your consultation, Dr. Horton will evaluate whether you’re a candidate for this approach.
Recovery time depends on the surgical approach:
- Office-based procedure: Most patients return to work within 3-5 days and resume full activities within 2 weeks
- Traditional surgery: Recovery typically takes 1-2 weeks for return to work and 4-6 weeks for full activity clearance – especially if a breast lift is included
Many breast implant removal procedures may be eligible for HSA or FSA payment, especially when performed for medical reasons such as implant complications. We recommend consulting with your HSA/FSA administrator to determine eligibility for your specific situation.
