A Surgeon’s Perspective on Breast Implant Removal and Capsulectomy

Breast explant surgery is for women who previously had breast implant surgery and would like to have their implants removed. How to remove the implants remains controversial.

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When I did my plastic surgery training in New York, I was instructed that if the patient wants their implants removed, all you have to do is simply remove the implants. The prevailing attitude was that the capsules would go away on their own. I disagreed. When a foreign object, such as an implant or pacemaker, is inserted into the body, it forms a “glove” around it. This is a capsule. It could be very thin and translucent to very thick, scarred, and calcified. I felt it was important that if someone wants their implants removed, the plastic surgeon also needs to remove the capsule. Otherwise, the capsule will always remain there.

I was among the earliest plastic surgeons to routinely remove the capsule during implant removal—a procedure known as a capsulectomy. Years later, studies showed that when capsules were left in place, MRIs often revealed persistent silicone particles embedded within them. These findings led to the growing conclusion that capsule removal may be advisable.

Personally, I prefer to leave the implant in the capsules when I dissect them out. Some people refer to this as an en bloc capsulectomy.

I have treated patients who had undergone removal of breast implants by other surgeons, but the capsules had not been removed. When I operated on those same patients years after their explant surgery, the capsules were still there, completely intact. This confirmed to me that capsules will not resolve on their own unless removed by the surgeon.

Typically, I lose very little blood during this procedure, and patients generally have minimal discomfort. In fact, many are surprised at how well they do after surgery. I attribute this to the specialized techniques I use when performing this surgery.

After removing the breast implants, the breasts can sag and become wrinkly because the skin and tissues have been stretched from the previous augmentation. In order to help my patients who do not wish to have replacement implants, I invented an operation called the three-dimensional breast recruitment lift. My technique preserves the excess skin, yet gives the breasts an enhanced shape and size after surgery.

Another technique for restoring some shape and size to sagging and wrinkly breasts of explant patients is autologous fat grafting to the breasts. Here, I utilize WAL, the water-assisted liposuction machine, which uses a very gentle technique to harvest body fat and inject it into the breasts to enhance their shape and size.

I have performed many explant surgeries and have a range of experiences with them. It is a highly individualized surgery, tailored to each patient. I can offer patients my experience and a range of options to meet their needs.

To learn more about breast explant surgery, call our office at (813) 872-2696 or (800) 963-8483 or fill out our online contact form to schedule your consultation.