Breast Implant Removal & Replacement
Surgical removal, exchange, or explantation of breast implants guided by your anatomy, concerns, and goals.
Breast implants are not lifetime devices. Whether you are seeking removal due to a complication, replacement with updated implants, a change in aesthetic preference, or concerns about systemic symptoms, the decision to undergo implant removal or exchange is deeply personal and deserves the same level of individualized care and clinical expertise as any other procedure at June Plastic Surgery.
Dr. June Yoo approaches every implant removal and replacement consultation without judgment and without a predetermined recommendation. Her role is to understand what is driving your concerns, evaluate your anatomy and implant status thoroughly, and help you make an informed decision that is right for you — whether that means removal alone, removal with mastopexy, exchange with new implants, or simply close monitoring with a clear understanding of your options.
Why Patients Seek Implant Removal or Replacement
There is no single reason patients pursue explantation or implant exchange. Common motivations include:
Capsular contracture — Scar tissue that forms around every breast implant may, in some patients, tighten progressively, causing firmness, distortion, discomfort, or pain. Grades III and IV on the Baker classification system typically warrant surgical intervention.
Implant rupture — Silicone implant rupture is often silent and detectable only on MRI. Saline implant rupture is immediately apparent through visible deflation. Rupture of either type is a recognized indication for removal or replacement. For silicone rupture, removal of the capsule helps minimize gel extrusion and migration beyond the capsule.
Size or aesthetic change — Many patients who augmented years ago now prefer a different size, profile, or implant type, or wish to downsize. Changes in lifestyle, body composition, or personal aesthetic preferences are all valid reasons to consider exchange.
Implant age — While the "replace every ten years" rule is a myth, implants do age. Older-generation devices — particularly those placed more than fifteen to twenty years ago — may benefit from evaluation and consideration of planned exchange, even in the absence of obvious complications.
Textured implant concerns — Macro-textured breast implants carry a disproportionately higher risk of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) compared to smooth-surface devices. Many patients with textured implants are choosing proactive exchange to smooth devices, particularly following the voluntary recall of certain textured implant products. Current consensus from the American Association of Plastic Surgeons recommends discontinuing the use of macro-textured implants due to this elevated risk.
Breast Implant Illness (BII) — Some patients report a constellation of systemic symptoms — including fatigue, joint pain, cognitive difficulty, and rash — that they attribute to their breast implants, a phenomenon referred to as Breast Implant Illness. BII is not currently recognized as a formal diagnosis by the World Health Organization, and the scientific evidence linking breast implants to systemic disease remains inconclusive. However, Dr. Yoo takes these concerns seriously, listens without dismissal, and supports informed shared decision-making regarding implant removal for patients whose quality of life has been significantly affected.
Implant malposition or asymmetry — Implants may migrate over time, developing visible asymmetry, bottoming out, lateral displacement, or symmastia. Pocket revision with or without implant exchange can address these changes.
Personal preference for explantation — Some patients simply no longer wish to have implants, for any number of personal reasons. This is a fully valid basis for surgical planning.
Understanding the Capsule
When a breast implant is placed, the body forms a natural layer of scar tissue around it called the fibrous capsule. This is a normal and expected biological response — not a complication. The capsule serves as the pocket that holds the implant in position.
In most patients, the capsule remains soft and thin throughout the life of the implant. In others, it may gradually thicken, calcify, and tighten around the implant to varying degrees of severity. This is called “capsular contracture”.
At the time of implant removal or exchange, a key surgical decision is what to do with the capsule. This decision is not one-size-fits-all, and it requires shared decision-making between Dr. Yoo and the patient based on the clinical indication, the condition of the capsule, and the degree of surgical risk involved.
Capsulectomy: Understanding Your Options
The FDA Breast Surgery Collaborative Community has standardized terminology for capsulectomy procedures, reflecting a spectrum from least to most invasive:
Partial Capsulectomy — A portion of the capsule is removed, with some capsule left in place. This may be appropriate when the capsule is thin, soft, and adherent to structures that make complete removal unnecessarily risky.
Total Capsulectomy — The complete capsule is removed, though not necessarily as a single intact unit. This is the most commonly performed approach for Grades III and IV capsular contracture and for silicone implant rupture, where complete capsule removal minimizes residual gel contamination. It is also frequently chosen by patients requesting implant removal for systemic symptom concerns.
Total Intact Capsulectomy — The implant and complete capsule are removed together as a single undivided unit. This approach minimizes the risk of capsular contents contacting surrounding tissue during extraction.
En Bloc Capsulectomy — The implant and capsule are removed together with a margin of surrounding uninvolved tissue, analogous to oncologic surgical principles. Properly defined, en bloc capsulectomy is the appropriate and recommended approach when BIA-ALCL or another malignancy of the capsule is confirmed or suspected. It is not indicated as a routine approach for benign indications, and its broader application carries meaningful additional surgical risk without documented clinical benefit in the absence of malignancy.
An important clarification: en bloc capsulectomy is frequently misrepresented online as universally superior or as a required treatment for breast implant illness. The current peer-reviewed literature and FDA guidance do not support routine en bloc capsulectomy for benign indications. Dr. Yoo will help you understand what the evidence actually supports and what approach is genuinely appropriate for your specific situation.
Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
BIA-ALCL is a rare form of T-cell non-Hodgkin lymphoma that arises in the fibrous capsule surrounding breast implants, not in the breast tissue itself. It is not breast cancer. It is associated primarily with macro-textured implants and has not been linked to smooth-surface implants at a rate above the background population risk.
The most common presentation is a late-onset seroma which is a fluid collection developing around the implant, typically one year or more after implant placement, and on average seven to ten years after surgery. New-onset swelling, firmness, or a palpable mass in a patient with breast implants warrants prompt evaluation, including ultrasound-guided aspiration of any periprosthetic fluid for cytologic analysis.
When diagnosed and treated at an early stage with complete surgical removal of the implant and en bloc capsulectomy, BIA-ALCL carries an excellent prognosis. Published overall survival rates are approximately 94% at three years and 91% at five years. Advanced-stage disease requires multidisciplinary oncologic management.
BIA-ALCL is not a reason for routine, prophylactic explantation in asymptomatic patients with smooth implants. For patients with macro-textured implants, proactive exchange to smooth devices is a reasonable discussion to have with Dr. Yoo, and she will help you weigh the relative risks and benefits in the context of your specific implant history.
What Happens to the Breast After Removal
Patients considering explantation without replacement should understand clearly what the breast may look like afterward. The outcome depends heavily on:
The original breast volume before augmentation
How long the implants have been in place
The size of the implants removed
The current quality and elasticity of the overlying skin
Whether significant ptosis has developed
In patients with adequate native breast volume and good skin elasticity, explantation alone may yield an acceptable result. In many patients — particularly those who augmented at a young age, those with larger implants in place for many years, or those who have experienced pregnancy and breastfeeding with implants in, the breast skin may be stretched beyond what it can retract naturally. These patients frequently benefit from a concurrent or staged breast lift (mastopexy) to restore a natural, proportional breast shape after removal. Dr. Yoo uses a specialized technique, or auto-augmentation, to recruit the breast tissue you have to create a lifted breast.
Implant Exchange: Choosing New Implants
For patients who wish to replace rather than simply remove their implants, the exchange consultation involves many of the same decisions as a primary augmentation: implant type, size, profile, and placement plane with the added complexity of working within an existing capsule or pocket that may need to be modified.
Pocket revision at the time of exchange may include capsulotomy (releasing a tight capsule), partial or total capsulectomy, or in some cases a pocket change. The right approach depends on the condition of your current pocket, the size of your new implants, and your aesthetic goals.
Patients exchanging for smaller implants should understand that pocket management is particularly important — a pocket sized for a larger implant will not automatically conform around a smaller device without surgical attention.
Am I a Good Candidate?
You may be a candidate for breast implant removal or exchange if you:
Have been diagnosed with capsular contracture, implant rupture, malposition, or asymmetry
Have existing macro-textured implants and wish to discuss proactive exchange
Experience systemic symptoms you attribute to your implants and wish to explore removal
Have aesthetic concerns or wish to change your implant size, type, or profile
Simply no longer wish to have breast implants, for any personal reason
Are in good overall health appropriate for outpatient surgery
There is no minimum time requirement before implants can be removed or exchanged. Patients at any point in their implant history are welcome to consult.
Recovery & Results
Breast implant removal or exchange is performed under general anesthesia on an outpatient basis. Recovery depends on the scope of the procedure. Simple implant exchange without capsulectomy typically involves a shorter recovery than total capsulectomy or concurrent mastopexy.
Most patients return to light activity and desk work within one week. Strenuous activity and heavy lifting should be avoided for four to six weeks. A supportive bra is worn during the recovery period. When mastopexy is performed concurrently, recovery and aftercare align with those of a standalone breast lift.
Final results following explantation alone are typically apparent within three to six months, as the breast tissue and skin adapt to the new contour. Results following exchange and pocket revision continue to evolve over a similar period as swelling resolves and the new implants settle.
Your consultation with Dr. Yoo
Your consultation for implant removal or exchange is a thoughtful, thorough conversation — one that Dr. Yoo approaches with no predetermined agenda. She will review your implant history, evaluate your current breast anatomy and implant status, discuss your concerns and goals, and walk you through the surgical options most appropriate for your situation.
Key decisions you will make together include:
Removal only, removal with mastopexy, or implant exchange
Capsule management strategy — partial, total, total intact, or en bloc — based on your clinical indication
New implant selection if exchange is desired (size, type, profile, placement plane)
Whether concurrent mastopexy or fat grafting is appropriate to optimize your result after removal
Frequently Asked Questions
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No. The ten-year replacement guideline is a myth. Implants do not have a mandatory replacement schedule. The FDA recommends that patients with silicone implants undergo MRI screening beginning three years after placement and every two years thereafter to assess for silent rupture — but this does not mean exchange is required on any fixed timeline. Implants should be evaluated and exchanged when there is a clinical indication, not on an arbitrary schedule.
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For capsular contracture, implant rupture, and malposition, surgical correction reliably addresses the underlying structural problem. For patients reporting systemic symptoms attributed to breast implant illness, the evidence is less definitive — some patients report meaningful improvement after explantation, while others do not. Dr. Yoo will be honest with you about what the current literature supports, and will support your decision to pursue removal if that is your informed choice.
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It depends on your anatomy, the size of the implants removed, and the quality of your skin. Patients with good skin elasticity and modest implant sizes may not need one. Patients with significant skin laxity, larger implants in place for many years, or a history of pregnancy and breastfeeding frequently benefit from a concurrent or staged mastopexy. Dr. Yoo will assess this at your consultation and give you a candid, anatomy-based recommendation.
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If you have smooth-surface implants, the risk of BIA-ALCL is essentially the same as the background population risk of developing anaplastic large cell lymphoma — it is not an indication for prophylactic removal. If you have macro-textured implants, proactive exchange to smooth devices is a reasonable consideration, and Dr. Yoo can help you understand the relative risks in the context of your specific implant history and current health. Any new or worsening swelling, fluid accumulation, or palpable mass around a breast implant warrants prompt evaluation regardless of implant type.
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Cost varies based on whether the procedure involves simple exchange, capsulectomy, concurrent mastopexy, or fat grafting, as well as anesthesia and facility fees. When a medical indication such as implant rupture, capsular contracture, or BIA-ALCL is documented, some insurers may provide partial coverage. A personalized estimate will be provided following your consultation. Financing options are available.
Your body. Your decision. Expert guidance every step of the way.
Whether you are certain about removal, weighing exchange, or simply seeking answers to questions that have been on your mind, Dr. June Yoo is here to listen without judgment, without pressure, and with the clinical depth to help you make the most informed decision for your body and your health. Book a consultation and start that discussion today.