Explant Surgery: What Actually Happens When Breast Implants Come Out

Breast implant removal, commonly called explant surgery, has moved from a quiet corner of plastic surgery into one of the most searched procedures in Los Angeles. Some patients arrive because a device ruptured. Some are managing capsular contracture. Some have simply lived with implants for fifteen years and want their own body back. And a large group arrives having read a great deal online, much of it wrong, about a technique called en bloc.

This explainer covers what explant surgery actually involves, the four decisions that shape the operation, what the breast looks like afterward, and how to read the marketing that surrounds this procedure in this city.

Why patients remove implants

The reasons cluster into five groups. Rupture, which is obvious with saline and usually silent with silicone, is the most straightforward. Capsular contracture, the scar tissue tightening we covered in our guide to signs, causes, and treatment, is the leading surgical reason patients return to the operating room. Some patients want a size change or a device swap. Some are managing systemic symptoms they attribute to their implants. And a growing share simply no longer want implants at all, a preference shift that needs no medical justification.

The American Society of Plastic Surgeons frames the goal plainly: removal takes out the implant and, when indicated, the surrounding capsule. It also notes what many patients are never told at their first augmentation, which is that implants are not permanent devices and commonly need exchange or removal within roughly ten to fifteen years, a reality we have written about in life with breast implants.

Decision one: does the capsule come out too?

Every implant sits inside a capsule of scar tissue the body builds around it. Whether that capsule is removed, and how much of it, is the central technical decision in explant surgery, and the vocabulary matters.

A capsulotomy cuts the capsule to release it but leaves it in place. A partial or anterior capsulectomy removes the front portion and leaves the back wall against the chest. A total capsulectomy removes the entire capsule. An en bloc capsulectomy removes the implant and the intact capsule together as a single sealed unit, without the capsule ever being opened.

Each has real indications. Total capsulectomy is standard practice for Grade III or IV contracture and for an intracapsular silicone rupture, where keeping the gel contained is the whole point. Partial capsulectomy or simple removal is often reasonable for a soft, healthy capsule, particularly when the posterior capsule sits directly on the ribs and removing it adds risk without adding benefit.

Decision two: what en bloc actually means

Here is where the online conversation and the surgical literature diverge sharply. En bloc is a term borrowed from cancer surgery, describing removal of a mass along with a contiguous margin of healthy tissue in one uninterrupted piece. In implant surgery, its clear evidence-based indication is BIA-ALCL, the rare lymphoma of the capsule that we covered in our piece on what the FDA recommends.

A 2021 analysis in the Aesthetic Surgery Journal, En Bloc Capsulectomy for Breast Implant Illness: A Social Media Phenomenon?, compared how the procedure is discussed in peer-reviewed literature versus on social platforms and found a clear communication gap: the scientific literature reserves en bloc for BIA-ALCL, while social media promoted it far more broadly for breast implant illness. A 2024 review in Case Reports in Plastic Surgery and Hand Surgery went further on the question patients most care about, reporting that symptom improvement after implant removal appeared independent of whether the capsule was removed.

None of this means capsulectomy is pointless. It means en bloc is a specific operation with specific indications, not a quality tier. A surgeon who declines to promise en bloc for a soft, thin capsule against the chest wall is not cutting corners. A surgeon who advertises it as a universal upgrade is selling a phrase.

Decision three: replace, or go without?

Three paths follow removal. Straight explant takes the implants out and closes. Implant exchange places new devices, often at a different size or in a different plane, and is common when the reason for removal is rupture or a size preference rather than a wish to be implant-free. Explant with a lift, formally a mastopexy, removes the implants and reshapes the remaining breast tissue to sit higher, which addresses the loose skin envelope left behind after years of stretch.

That last option is the one patients most often skip in their planning and most often need. The distinction between adding volume and changing position applies in reverse here: removing volume does not tighten skin. Some surgeons stage the lift a few months after explant, letting tissue retract on its own first, then reassessing. Others combine both in one operation. Both approaches are defensible, and the honest answer usually depends on how much skin laxity you have and how long the implants were in.

What the breast looks like afterward

Expect an unsettling first few weeks. Immediately after explant, breasts often look deflated, flattened, or slightly rippled, and swelling makes it worse before it makes it better. Skin retraction is gradual and continues for three to six months, and younger patients with better elastic tissue retract more completely than patients whose implants were large or long-standing. Volume rarely returns to the pre-augmentation baseline, because breast tissue itself thins over time and under pressure.

Recovery is generally easier than the original augmentation when the capsule is left alone, and comparable or somewhat longer when a full capsulectomy or a lift is added. Drains are more common in explant than in primary augmentation, particularly after total capsulectomy, because a large empty space is left behind.

Cost, insurance, and Los Angeles specifics

Explant in Los Angeles is built from the same four fees we broke down in our cost analysis: surgeon, facility, anesthesia, and devices if you are exchanging. Capsulectomy adds operating room time and therefore cost, and a simultaneous lift adds more. Insurance almost never covers cosmetic explant, though some plans cover removal for documented rupture, contracture, or BIA-ALCL, so it is worth submitting rather than assuming.

Questions worth asking

Ask which capsulectomy the surgeon recommends for your specific case and why, in anatomical terms. Ask what they will do if the posterior capsule is adherent to the ribs. Ask whether they recommend a lift now, later, or not at all. Ask how many explants they performed last year, since this is a different skill set from augmentation. And ask what your breasts will realistically look like at three months, not at three weeks.

The takeaway

Explant is a legitimate, common, and often deeply satisfying operation, and it is also one where marketing has outrun evidence. The US Food and Drug Administration has been consistent that implants require long-term monitoring and may eventually need removal, so removal is not a failure of your original decision. It is the other end of a commitment you already made. Choose the surgeon on their reasoning, not on whether they will repeat a phrase you read online, and give your tissue six months before you judge the result.

Related reading: Capsular contracture: signs, causes, and how it is treated.