Explant surgery is breast implant removal — but that three-word definition doesn't capture the complexity, the stakes, or the profound difference that surgical technique makes in outcomes. I have performed more than 2,000 explant procedures, published research on the microbiology of breast implant capsules, testified before the FDA's General and Plastic Surgery Devices Panel on breast implant safety, and written an entire book on this subject: Breast Implants, Explant Surgery and Breast Implant Illness. This is the explainer I wish every patient had access to before they started their research.
The Basic Definition
Explant surgery is the surgical removal of breast implants. That's it — at the definitional level. But what gets removed along with the implant, how the surrounding tissue is handled, and what happens after removal are where the critical differences lie between a procedure that resolves a patient's symptoms and one that doesn't.
What Is a Capsule?
When a breast implant is placed, the body recognizes it as a foreign object and forms a protective layer of fibrous scar tissue around it. This is called the capsule. It is a normal biological response — every breast implant in every patient develops a capsule.
The capsule is not simply harmless scar tissue. My research, published in Microorganisms (2024, 12(9):1830), examined 694 breast implant capsule specimens using advanced polymerase chain reaction (PCR) molecular testing. Twenty-nine percent of those capsules — more than one in four — showed bacterial contamination detectable only through molecular testing. Standard culture testing, which is what most pathology labs use, would have called those specimens negative. The bacteria were there. Culture just couldn't find them.
The dominant species identified were Cutibacterium acnes (formerly Propionibacterium acnes) and Staphylococcus epidermidis — biofilm-forming bacteria that do not grow reliably on standard culture plates. The 103 distinct bacterial species identified across those 694 specimens represent the most comprehensive microbial mapping of breast implant capsules in the published literature.
This matters for explant surgery because it raises a fundamental question: if the capsule harbors biofilm-associated bacteria, what happens when you leave it behind?
Types of Explant Surgery
Not all explant procedures are the same. Understanding the terminology helps patients evaluate what their surgeon is proposing.
Simple Implant Removal
The implant is removed and the capsule is left behind, partially removed, or removed in fragments. This is the most common approach in general surgical settings. It is the fastest and least technically demanding. For patients experiencing capsular contracture, implant rupture, or other mechanical complications without systemic symptoms, this may be sufficient.
Total Capsulectomy
The entire capsule is removed, but not necessarily as a single intact specimen. The implant is removed first, then the capsule is dissected free and removed. This removes more tissue than simple implant removal and may be appropriate for patients with symptoms or concerns about the capsule's contents.
En Bloc Capsulectomy
The capsule and implant are removed together as a single intact specimen, without cutting through the capsule. This is the most complete and most technically demanding approach. It requires both surgical skill and anatomy — the space in the chest must allow the capsule to be freed from surrounding structures without breach. En bloc is not always anatomically possible for every patient, and surgeons who claim to perform en bloc in 100% of cases without reviewing imaging first should be asked how they confirm feasibility preoperatively.
I discuss the nuances of surgical approach in depth across multiple podcast episodes and in my book. The right choice for any individual patient depends on their symptoms, their imaging, and an honest surgical assessment — not a blanket policy.
Why Do Women Choose Explant?
Women pursue explant for different reasons:
Breast implant illness (BII). A growing body of evidence connects breast implants — particularly their biofilm and the immune response those biofilms trigger — to systemic symptoms including fatigue, brain fog, joint pain, hair loss, and autoimmune dysfunction. Research published in the Journal of Clinical Investigation (Khan et al., 2024) identified a specific molecular mechanism: S. epidermidis biofilm produces a compound that drives immune system activation, contributing to the systemic symptoms women describe as breast implant illness. This is not a psychological phenomenon. It has a biological mechanism that is now documented in peer-reviewed literature.
Capsular contracture. When the capsule hardens and contracts around the implant, it causes pain, distortion, and firmness. Commentary published in Plastic and Reconstructive Surgery (Kauke-Navarro & Pomahac) established that capsular contracture is driven by the same biofilm-foreign body mechanism — not a process resembling organ rejection, as had been theorized, but the body's response to bacterial contamination within the capsule.
Implant rupture. Implants are not lifetime devices. Both silicone and saline implants can rupture. Silicone gel implant ruptures may be silent — detectable only on MRI — and the FDA recommends regular monitoring. When rupture is confirmed, removal is typically indicated.
Personal decision. Many women simply no longer want foreign material in their bodies. This is a complete reason. It requires no medical justification.
What Happens After Explant?
Many women experience significant improvement in systemic symptoms after removal — particularly when the surgery achieves complete capsule removal. In my clinical experience over more than 2,000 procedures, patients who present with BII-consistent symptoms most frequently describe improvement across multiple symptom domains within months of surgery.
Breast shape and volume will change after explant. Depending on the degree of ptosis, a simultaneous mastopexy (lift) or fat transfer may be appropriate. I discuss these options with every patient individually during consultation, and I've produced a complete series on post-explant restoration options in my podcast.
Recovery from explant — like recovery from any surgery — benefits from preparation. My SHARP Method was developed specifically for patients undergoing breast surgery, addressing the nutritional, supplemental, and physiologic factors that influence healing.
What Should You Ask Your Surgeon?
Before undergoing explant surgery, I recommend asking your surgeon:
- What type of capsule removal do you perform, and how do you determine the right approach for each patient?
- Do you review preoperative imaging (MRI or ultrasound) before surgery to assess the capsule?
- Do you send capsule specimens to pathology?
- What is your volume of explant procedures annually?
- Do you have published research on breast implant outcomes?
The answers to those questions reveal more about surgical competence than any marketing claim.
Dr. Robert Whitfield, MD is a board-certified plastic surgeon in Austin, Texas, and the author of Breast Implants, Explant Surgery and Breast Implant Illness. He has performed more than 2,000 explant procedures, published the largest PCR-based capsule analysis in the medical literature, and testified before the FDA on breast implant safety.