Breast Implant Removal with Total Capsulectomy (En Bloc)

Explant (Implant removal ) with En Bloc (Total) Capsulectomy

There are a variety of reasons why patients want to get rid of their implants.  This can be a very difficult and emotional decision.  Reasons for wanting your breast implants removed can include concern for breast implant illness (BII), mastodynia (breast pain), the desire to have a different breast size, capsular contracture, and simply wanting to be natural.  No matter what your reason for seeking explant surgery, our surgeons will work with you to determine the best procedure to achieve an aesthetically pleasing outcome for your new breasts.  We perform this procedure of breast implant removal with total capsulectectomy in an en bloc fashion hundreds of times per year and do everything we can to achieve the best outcomes for our patients.  

Breast Explant & En Bloc Capsulectomy 

Being informed about the implant removal process can help you plan for treatment and ultimately decide if this is an option you’d like to pursue. This procedure is very different than the original procedure you had for the breast augmentation.   

Breast Explantation with total en bloc capsulectomies  is performed under general anesthesia and usually takes between one to three hours. The timing depends on which procedures are being performed.  Patients may simply undergo explant with en bloc capsulectomies, or the patient may decide to have a breast lift (mastopexy) and possible fat grafting as well which would make the procedure take longer.  A typical explant with total capsulectomies usually takes 1.5 hours.  An explant with total capsulectomies and breast lift usually takes 2-2.5 hrs.  An explant with total capulectomies, breast lift, and fat grafting takes 2.5-3hrs.  

The procedure of explant with total capsulectomies involves making an incision through the skin, usually through the existing scar in the inframammary fold (base of the breast).  The incision is longer than the original incision to help us perform a safe and effective procedure.  We carefully dissect down to he capsule around the implant, and  separate the capsule from the surrounding tissue (breast, chest wall, and pectorals muscle) and removed the entire capsule.  This is done in every attempt in an en bloc fashion, with the capsule intact and the implant inside, but at times with a total capsulectomy is performed if there is a patch that is too adherent to the chest wall.  In these cases everything is removed all together and anything that was still left behind is then removed with aggressive scrapping, electrocautery, and other resection techniques without causing potential harm to our patients.  At the end of the procedure both the implant and capsule is removed from your body in one operation.  


Reconstruction Options

Once the implant and capsules are removed, the next step in the surgery will depend on what you and your surgeon have decided during your consultation for reconstruction. This is a personal decision.  Additional procedures are not necessary but many women not only want their implants out but they also desire to have an aesthetic breast that they are confident with.    This discussion may include whether you’d like to increase volume with fat transfer or if a lift to reposition your existing breast tissue to help meet your aesthetic goals.

Once your implants are removed, it’s likely that your natural breast tissue will appear more relaxed than before. This can be caused by the natural aging process as well as the prolonged use of large implants. In these cases, it’s often the best choice to have a breast lift after the implants have been removed. With this procedure, our surgeons can remove excess skin and reshape the remaining tissue to ensure your natural breasts sit at the desired position on the chest wall. The nipple and areola will be moved to a higher position and, if needed, the areola can be reduced in size.  Often autologous fat grafting can be performed to help shape the upper pole and provide added volume for perky youthful breasts.  

If you would like to maintain a larger breast size than your natural tissue provides but don’t want to do so with implants, there is another option. Fat grafting involves taking fat from one area of the body where there is an excess—such as the buttocks, thighs, or abdomen—and transplanting it to an area that needs more volume, such as the breasts.

Harvesting and grafting fat is completed in the same surgery; our team at HKB often recommends fat transfer breast augmentation for patients who no longer want implants but are still looking for a natural-looking improvement in volume. The results you can achieve with fat transfer are dependent on whether enough excess fat exists in other areas of the body, as well as how much of the fat is naturally absorbed after grafting. If the breasts still sag or droop after fat grafting, a breast lift may also be recommended.

Before & After Photos

Be sure to visit our Before and After gallery to view photos of real H/K/B patients.

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The Importance of Having Breast Reconstruction Completed by an Expert

Breast explant with total capsulectomy (en bloc) and reconstruction are a delicate process and should only be performed by board-certified plastic surgeons who have years of experience. At HKB, Drs. Hunstad, Kortesis, and Bharti are all board-certified plastic surgeons with stellar reputations and thousands of breast surgeries performed. No matter which surgeon performs your procedure, you will receive the highest patient care and individualized attention.

If you plan to have your breast implants and capsules removed, it’s important to realize that other work may be necessary to ensure your breasts have the right shape and amount of fullness you were hoping for. When you consult with the surgeons at HKB, you will be able to ask questions about the different types of reconstruction as well as learn which options are best for you depending on your desired results. Book your consultation today to learn more!

Recovering from Explant with En Bloc Capulectomies and Reconstruction

Your amount of downtime and recovery will be dependent on what type of reconstruction you choose.  The average amount of time a patient takes off work after explant surgery is 2-4 weeks. During this time, you’ll experience some swelling, bruising, and discomfort and will wear a compressive and support bra to aid healing. You should have a friend or family member available to drive you to and from surgery and stay with you for a few days following surgery. Avoiding strenuous exercise or anything that may strain your upper body is recommended for at least 1-2 months post-surgery, and women are urged to sleep on their backs until advised otherwise.  Detailed post operative instructions will be provided to you at your preop appointment and by the recovery nurse to you and your family after the surgery.  

Breast Implant Removal and Reconstruction FAQs

We know that preparing for breast explant surgery usually involves numerous questions. We encourage all potential patients to schedule a consultation so they can receive personalized answers to their breast implant removal questions. Find answers to some of our most frequently asked questions about breast implant removal below.

Breast implant removal is a highly personalized decision, one that only the patient can make. Common reasons for explantation include:

  • Appearance Some patients who were previously happy with their implants decide they want to restore their smaller,  natural breasts.
  • Lifestyle Changes Some women find that after a  change in exercise routine or discovery of new hobby, breast implants no longer fit their active lifestyle.
  • Complications Recurrent capsular contracture, implant rupture or leak, breast pain or malposition may cause women to reevaluate having breast implants. 
  • Breast Implant Illness BII is a condition believed to be a result of an inflammatory reaction triggered by a breast implant. Symptoms vary from patient to patient, and in serious cases, can become debilitating to a woman’s health and quality of life. Some of the symptoms include:
    • Fatigue
    • Chronic pain
    • Rash
    • Depression, anxiety, and brain fog
    • Hair Loss
    • Hormonal Issues

More and more patients are wanting to remove their breast implants for reasons ranging from restoring their natural appearance to restoring their health. As a practice, we are performing many more of this type of surgery with high patient satisfaction rates.  We perform hundreds of these surgeries per year.  Each patient is unique and requires a high level of customized care.  

Some patients report concerns of breast implant illness (BII) and have ruled out other causes for their symptoms and want to undergo explant surgery to see if the their symptoms will improve.  Other concerns include pain, deformity, desire to be natural, asymmetry, malposition, and simply not being happy with the way their breasts look or feel.   If you’re worried about a problem with your breast implants, give your plastic surgeon a call and head into their office for a visit. Some breast implant complications will require testing or imaging to diagnose. Other issues are easy to spot externally. For example, a leaky saline implant will cause the breast to deflate and capsular contracture will cause breast hardening, and in severe cases, changes to breast shape.

Our office does not contract with any insurance companies.  The procedure is a fee for service.  You can elect to submit your procedure to the insurance company and be reimbursed by them directly.  Most insurance companies do not cover breast implant and capsule removal but many patients have had success.  If your implants are still under warranty, you may be eligible for reimbursement of some expenses from the breast implant manufacturer. Payment and financing options are available to help you pay for your procedure.

Breast implants add volume to the breasts. To accommodate this volume, the skin and breast tissues will stretch out. When an implant is removed, the skin and breast tissues are unlikely to contract to their original shape and size. The breasts may appear deflated. Breast lift after implant removal reshapes the breasts. It eliminates the sagging and deflation that is so common after breast implant removal. Generally, the larger the breast implants, the more dramatic the effects on breast shape after removal.  At times fat grafting can be used to help add volume and reshape the breast.  These secondary procedures such as a breast lift and fat grafting can be done immediately after explant or in a delayed fashion.  This is up to the patient.  Many patients want to avoid secondary procedures and prefer to have everything done at once to limit a return to the operating room.  

If you’re experiencing complications with your breast implants or are no longer happy with your breast appearance, contact your plastic surgeon and ask about your options for implant removal, also called explant surgery. The best candidates for this procedure do not smoke, are in good health, and are dissatisfied with their breast implants. Our plastic surgeons will help you decide if you’re a good candidate at your plastic surgery consultation.

Learn more about your options for explant surgery by calling 704-659-9000 and scheduling a consultation with one of our board-certified plastic surgeons.  

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