Implant Explantation & Breast Reshaping

Breast implant removal is one of the most consequential decisions a patient can make in the field of breast surgery. Whether for clinical, aesthetic or personal reasons, an increasing number of women are choosing to have their implants removed — not necessarily replaced. The surgical challenge lies in the fact that simple explantation, without addressing the tissue envelope that has formed around the implant, typically leaves a wide, flat and laterally displaced breast that is notoriously difficult to reshape at a later stage.

What happens to the breast after implant removal?

Over the years that an implant is in place, it creates expansion of the breast tissue and skin envelope. When the implant is simply removed, the remaining tissue is typically spread laterally and lacks the central breast mound that the implant had provided. This makes any future reconstructive procedure considerably more difficult.

The solution requires surgical mobilisation of the displaced tissue, reshaping it into a breast mound and supporting it — all while preserving the blood supply to the nipple-areola complex and overlying skin.

The BEP Technique — Borenstein Explantation-Pexy

The approach developed with Dr. Borenstein and published in Plastic and Reconstructive Surgery Global Open (2019) rebuilds the breast mound from the bottom upward, using the breast tissue remaining after implant removal. Unlike classical mastopexy approaches, the BEP technique mobilises the laterally displaced breast tissue and repositions it centrally to recreate projection and shape.

The technique achieves three objectives simultaneously: capsulectomy where indicated; central tissue mobilisation and reshaping; and reduction of skin tension to minimise scarring and achieve a durable long-term result. A key intraoperative stage is performed with the patient sitting upright, allowing precise determination of nipple-areola position and final breast symmetry.

Where the breast is particularly wide, an additional suture may be placed between the lateral breast tissue and the rectus fascia at the level of the inframammary fold. This draws the lateral tissue inward and helps define the fold, narrowing the breast rather than allowing it to remain spread across the chest wall.

Capsulectomy — is removal of the capsule always necessary?

A capsule is a layer of scar tissue that forms naturally around any implant. In the majority of cases it is thin and asymptomatic. I do not perform complete capsulectomy. The FDA and the ASPS do not recommend prophylactic capsule removal in women without symptoms, and en bloc resection, removing implant and capsule as a single unit, is reserved for cases of BIA-ALCL. Outside that context, complete capsulectomy adds bleeding, tissue injury, pain and recovery time without demonstrated benefit.

There is also a reason that goes to the centre of the approach I work by. The capsule is available tissue, and the technique depends on using as much of the existing tissue as possible to rebuild the structure of the breast. Removing the capsule extensively takes away tissue that can be used, and makes reshaping harder rather than easier. Where there is symptomatic capsular contracture or rupture with silicone extravasation, the capsule is treated according to the finding, to the extent required and no further.

Who is a suitable candidate?

Suitable candidates are women with existing implants wishing to have them removed — whether due to capsular contracture, suspected rupture, age-related changes, symptoms attributed to Breast Implant Illness (BII), discomfort, or a personal change of preference. The procedure can also form part of an implant exchange, reshaping the breast before a new implant of a more appropriate size and position is placed.

Where the question is between exchange and removal, that is discussed separately. About implant exchange →

The preoperative consultation includes a clinical examination, implant ultrasound assessment and Crisalix 3D imaging to preview the expected outcome.

Breast Implant Illness — what do we know?

Breast Implant Illness (BII) describes a cluster of symptoms reported by women with implants — fatigue, cognitive difficulties and joint pain among others. A causal relationship between implants and these symptoms has not been scientifically established, and no agreed diagnostic criteria exist. Many women nevertheless report improvement following explantation. I present patients with the current available evidence, neither encouraging nor dismissing it, and respect their informed decision.

What to expect after surgery

The operation is performed as day surgery. Patients are discharged the same day, and I do not use drains routinely.

Recovery from this operation is easier than recovery from breast augmentation. The reason is not the size of the operation but what is done during it: there is no manipulation of or injury to the pectoralis muscle and its fascia, where pain receptors are most dense, and there is no stretching or expansion of the tissues of the kind an implant requires. Most patients operated on before the weekend are driving and managing ordinary daily activity, including desk work, within a few days. The vertical scar improves significantly over 12–18 months. The final shape is established at three to six months, once swelling has resolved and the breast tissues have settled into their new position.