I’ve placed a lot of breast implants over my career. I’ve also taken a lot of them out. And something I want every patient to hear from a surgeon who does both: choosing to remove your implants is not a failure, not a step backward, and not something you need to justify to anyone — including me.
Women come to my Paramus office for explant surgery for all kinds of reasons. Some have a medical issue that needs addressing. Some have symptoms they suspect are implant-related. And some simply feel done — their implants suited a version of their life that has changed. Every one of those is a valid reason. What matters is that the removal is done thoughtfully, because how implants come out has a bigger effect on your result than most patients realize.
The Reasons Patients Choose Explant Surgery
In my practice, requests for breast implant removal generally fall into four buckets.
Capsular contracture. Your body naturally forms a capsule of scar tissue around any implant. In some women, that capsule tightens over time, making the breast feel firm, look distorted, or ache. Significant contracture is the most common medical reason I remove or replace implants.
Rupture or age of the implant. Implants are not lifetime devices — something I tell every augmentation patient on day one. Most modern implants last 10 to 20 years, but shells can fail. A ruptured saline implant announces itself by deflating. A ruptured silicone implant often doesn’t, which is why the FDA recommends periodic MRI or ultrasound screening for silicone implants — I covered that schedule in my article on breast implants and mammograms.
Symptoms attributed to the implants. More on this below, because it deserves an honest, unhurried discussion.
A change in preference. Lifestyle changes, weight changes, back and shoulder comfort, or simply wanting a more natural look. No medical justification required.
Whatever the driver, you’re part of a growing group. Implant removals have climbed steadily in ASPS procedure statistics year over year, and explant consultations are now a regular part of my week.
Let’s Talk Honestly About Breast Implant Illness
If you’ve spent any time in explant communities online, you’ve encountered breast implant illness, or BII — a pattern of symptoms including fatigue, joint pain, brain fog, hair loss, and rashes that some women attribute to their implants.
Here’s where I stand, and I’d rather be straight with you than tell you what an algorithm thinks you want to hear. BII is not currently an official medical diagnosis, and research hasn’t yet established a clear mechanism. But the FDA now requires implant manufacturers to include these symptom risks in patient labeling, the symptoms these women experience are real, and I’ve had explant patients report meaningful improvement after removal. I’ve also had patients whose symptoms persisted, because the cause was something else all along.
So when a patient comes to me suspecting BII, I do two things. I take her seriously — no eye-rolling, no dismissal. And I encourage a parallel medical workup, because I never want a woman to undergo surgery expecting a cure for symptoms that have a different, treatable cause. If after that she still wants her implants out, I support that decision completely. It’s her body, and peace of mind has genuine value.
What About the Textured Implant Recall?
Patients still call about this, so let me address it. In 2019, Allergan recalled its Biocell textured implants due to their association with BIA-ALCL, a rare lymphoma of the capsule around textured implants — not a breast cancer. Important context: the FDA does not recommend removal for women with these implants who have no symptoms, because the condition is rare and removal carries its own surgical risks.
If you have textured implants and you’re worried, the right move is an evaluation, not panic. We’ll review your implant cards, examine you, image if needed, and make a plan based on facts. Some of those patients choose monitoring; some choose removal for peace of mind. Both are reasonable when chosen with clear information. And if you notice swelling or fluid buildup around an older textured implant, see a surgeon promptly — that specific symptom always warrants a workup.
What Explant Surgery Actually Involves
“Just take them out” sounds simple. Surgically, there are real decisions to make, and this is where surgeon experience matters.
The main question is what to do with the capsule. Options range from removing the implant alone, to a total capsulectomy — removing the implant and the entire capsule — to what’s often called en bloc removal, taking the capsule and implant out together as one sealed unit. Explant communities online often insist that en bloc is the only acceptable technique. The truth is more nuanced: en bloc is appropriate and sometimes important in specific situations, such as confirmed BIA-ALCL or certain ruptures, but it requires longer incisions and more dissection, and in a patient with a paper-thin capsule against the chest wall, forcing it can create risk without benefit. I make a recommendation based on your capsule, your implants, and your reason for explanting — and I’ll explain that reasoning to you, not just hand you a decision.
The second question is what your breasts will look like afterward, and I owe you honesty here too: it depends on how much natural tissue you have, your skin quality, implant size, and how long they’ve been in. Some women look remarkably like they did before augmentation. Others — particularly after large implants, pregnancies, or many years — have stretched skin that will look deflated with removal alone. Which brings us to the options.
Removal Alone, Removal With a Lift, or Fat Transfer
For women with good skin elasticity and modest implants, removal alone can give a lovely, natural result. Skin retracts more than patients expect, especially over the first several months.
For women with looser skin, I usually recommend combining removal with a breast lift in the same operation. The lift removes the excess skin, repositions the nipple, and restores shape — and doing it at the time of explant means one recovery instead of two.
The third option surprises many patients: fat transfer. I can harvest fat from the abdomen, flanks, or thighs with liposuction and graft it into the breasts to restore a portion of the lost volume with your own tissue. It won’t replicate an implant’s fullness — I’m careful to set that expectation — but for a woman who wants her implants gone and still wants softness and shape, it’s an excellent middle path. And some patients simply want their implants exchanged rather than removed entirely; if you’re rethinking size or type rather than implants altogether, start with my silicone versus saline comparison and we’ll talk through revision options at your breast augmentation consultation.
In select straightforward cases, implant removal can even be performed awake under local anesthesia — an approach I’ve used across my practice for years. More involved procedures, like a full capsulectomy with a lift, are a different conversation. We’ll determine what’s appropriate for your case together.
Cost and Insurance
Explant pricing varies with the surgical plan — removal alone costs considerably less than removal with capsulectomy and a lift. Insurance occasionally contributes when there’s a documented medical indication, such as a ruptured silicone implant or severe capsular contracture, though policies vary widely and cosmetic-origin implants face stricter criteria. My staff helps patients navigate that paperwork, and we offer financing for the remainder. If you’re comparing overall costs of implant-related surgery, my breast augmentation cost guide explains how surgical pricing is structured in New Jersey.
My Bottom Line
Implants serve a season of life, and for some women that season ends. When it does, you deserve a surgeon who treats the explant with the same care and artistry as the original augmentation — because removal done thoughtfully isn’t an undoing. It’s a redesign.
If you’re considering breast implant removal in New Jersey, schedule a consultation at my Paramus office. Bring your implant device cards if you have them, bring your questions, and bring your reasons — whatever they are, they’ll be respected here.
Frequently Asked Questions
Do breast implants have to be removed after 10 years?
No. There is no mandatory expiration date. Implants should be removed or replaced when there’s a problem — rupture, significant capsular contracture, or symptoms — or when you decide you no longer want them. That said, implants are not lifetime devices, and the FDA recommends periodic imaging for silicone implants to catch silent ruptures.
What are the symptoms of breast implant illness?
Commonly reported symptoms include fatigue, joint and muscle pain, brain fog, hair loss, rashes, and anxiety. BII is not currently an official medical diagnosis, and these symptoms overlap with many other conditions, which is why a full medical workup should accompany any explant decision. Many women report improvement after removal, though results vary.
Will my breasts sag after implant removal?
It depends on your skin elasticity, natural tissue, implant size, and how long you’ve had them. Women with good skin tone and smaller implants often see impressive natural retraction over several months. Those with stretched or thinner skin typically get the best result by combining removal with a breast lift in the same surgery.
Does insurance cover breast implant removal?
Sometimes. Coverage is most likely when there’s a documented medical indication such as a ruptured silicone implant or severe capsular contracture, and more common when the original implants were placed for reconstruction. Purely elective removal is generally not covered. Your surgeon’s office can help you understand your policy’s criteria.
Do I need en bloc capsulectomy?
Not necessarily. En bloc removal — taking the implant and capsule out as one sealed unit — is important in specific situations like confirmed BIA-ALCL, but it isn’t automatically the best technique for every patient. The right approach depends on your capsule condition, implant status, and reason for removal, and should be decided with a surgeon experienced in explant surgery.
