Call Us
Contact Us
Breast explant surgery can be performed in several ways. Terms such as “en bloc”, “total capsulectomy” and “explant with lift” are often used interchangeably, even though they describe different procedures. This article explains what each approach involves and when each may be considered.
What Is a Breast Explant?
A breast explant is surgery to remove breast implants. Over time, the body forms a layer of scar tissue around each implant, called the capsule. Explant surgery may involve removing the implants alone, or removing the implants together with some or all of the capsule. Patients consider removal for many reasons, including capsular contracture, implant rupture, concerns about breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), or a change in personal preference.
Some patients report symptoms they attribute to their implants, often referred to as breast implant illness (BII). The Therapeutic Goods Administration notes that it is not currently known whether breast implants cause these symptoms. Some patients report improvement after explant surgery, but this cannot be guaranteed.
Types of Breast Explant Surgery
The right approach depends on the reason for removal, the condition of the capsule, the implant type and position, and whether the implant is intact.
Implant Removal Only
The implants are removed, and the capsule is left in place. This usually involves the smallest incision and shortest surgery, but may not be appropriate where the capsule is thickened, calcified, or associated with complications.
Partial Capsulectomy
The implants are removed along with part of the capsule. Portions that are thin or firmly attached to the ribs or chest wall may be left in place where removing them would add unnecessary risk.
Total Capsulectomy
The implants and the entire capsule are removed, but not necessarily in one piece. Often the implant is removed first, followed by the capsule. A total capsulectomy is commonly recommended for capsular contracture and is often preferred when implants are being removed permanently.
En Bloc Capsulectomy
The term “en bloc” is widely used on social media, but it has a specific surgical meaning. What many patients mean by “en bloc” is more accurately called a total intact capsulectomy, where the implant is removed still sealed inside its intact capsule. A true en bloc resection removes the implant and the entire capsule as a single intact unit, sometimes with a margin of surrounding tissue. Capsule removal is generally recommended for capsular contracture, silicone implant rupture, or confirmed BIA-ALCL. Where BIA-ALCL is suspected, investigations are performed first.
Removing the implant and capsule in one piece can help contain silicone from a ruptured implant. However, it generally requires a longer incision and is not always technically possible. A thin capsule can tear, and where implants sit beneath the muscle, the back of the capsule may be firmly attached to the chest wall. Dr Scamp will explain which technique is appropriate and why at consultation.
Explant with Lift
After implants are removed, the skin that stretched to accommodate them may not fully retract, and the breasts may appear deflated or lower on the chest. In these cases, a breast lift (mastopexy) may be performed at the same time as the explant or as a second procedure. A lift removes excess skin and repositions the nipple and areola higher on the chest, but adds scarring. Dr Scamp will assess whether a lift is appropriate based on the implant size, skin quality, and amount of natural breast tissue.
For more on preparation, recovery, and life after implant removal, see the guide to breast implant removal: what to expect.
Risks and Possible Complications
Recognised risks of breast explant surgery include:
- Bleeding, including haematoma
- Infection
- Fluid accumulation (seroma)
- Changes in nipple or breast sensation, which may be permanent
- Asymmetry or contour irregularities
- Poor wound healing or visible scarring
- Injury to the chest wall during capsule removal, which is uncommon
- Reaction to anaesthesia
- Dissatisfaction with breast shape after removal, which may lead to further surgery
Additional risks apply if a breast lift is performed at the same time. Dr Scamp will discuss the specific risks that apply to each patient’s case during consultation.
Frequently Asked Questions
Does the capsule always need to be removed?
Not always. It depends on the capsule’s condition, the reason for removal, and the risks involved. Capsule removal is generally recommended for capsular contracture, rupture, or suspected BIA-ALCL.
Can an en bloc capsulectomy always be performed?
No. It depends on the thickness of the capsule, its attachment to the chest wall, the implant position, and whether a longer incision is acceptable. Where it is not possible or safe, a total capsulectomy may be performed instead.
Can new implants be placed during explant surgery?
Yes. Some patients choose to replace their implants rather than remove them permanently. This is discussed at consultation as a separate option.
Book a Consultation with Dr Terrence Scamp
Dr Terrence Scamp is an AHPRA-registered specialist plastic surgeon (MED0001157212) and a Fellow of the Royal Australasian College of Surgeons (FRACS). Consultations are held at 95 Upton Street, Bundall, and surgery is performed under general anaesthesia at Pacific Private Hospital in Southport. A GP referral is required before consultation.
Where breast explant surgery is performed for cosmetic reasons, Medical Board of Australia guidelines require a minimum of two pre-operative consultations, followed by a cooling-off period of at least seven days after the second consultation and informed consent. Surgery cannot be booked, and no deposit can be paid, until the cooling-off period has ended.
Individual results vary. The outcomes experienced by one person do not necessarily reflect the outcomes other people may experience.
Learn more about breast implant removal or contact the practice to arrange a consultation.
Disclaimer: Any surgical or invasive procedure carries risks. Before proceeding, patients have the option to seek a second opinion from an appropriately qualified health practitioner.
