Why breast implants are removed, what explant surgery involves, and what to expect.

Common reasons for removal include capsular contracture, implant rupture, movement of the implant with the chest muscle, chronic pain and asymmetry.⁵ Others simply no longer want implants, and some remove them because of systemic symptoms they attribute to them, often called breast implant illness.

In a Dutch registry, 1.6% of cosmetic implants were revised over a median of 1.8 years. Breast implant illness accounted for 4.7% of those revisions, or 0.1% of all implants placed, so local complications were far more common reasons.¹

The body forms a thin scar capsule around every implant. At removal, the capsule can be left, partly removed or removed completely, depending on its condition and the reason for surgery.

A 2026 review identified four evidence-based reasons to remove the capsule, namely confirmed implant-associated lymphoma, a cancer in the capsule, symptomatic calcification that interferes with mammograms and severe capsular contracture that a capsule release cannot fix.⁶ In a prospective study of 109 patients, symptom recovery after explantation was not associated with whether the capsule was removed.⁷

Breast implant illness is an unofficial diagnosis covering a broad cluster of symptoms that patients attribute to their implants.⁷ In a meta-analysis of 33 studies, the most common symptoms were fatigue (58.3%), joint pain (51%) and muscle pain (44%).²

Across reviews, most patients reported improvement after removal, 81.9% in one and 83.5% in another.^2,8 In 750 patients, symptom scores fell within 30 days of removal and stayed lower, and a prospective cohort found improved quality of life four months after surgery.^7,9

The cause remains debated. Proposed explanations include immune responses, inflammation and bacterial biofilm.² However, a large controlled cohort cited in a 2026 review found no difference in symptom prevalence between women with and without implants, and none of the proposed capsule contaminants distinguished patients with symptoms from those without.⁶

After removal, the breasts are smaller and may look deflated or droop, especially after large implants or with thin, stretched skin. Options include removal alone, a breast lift, fat grafting to restore some volume, or replacement with new implants for those who want to keep implants.

In 14 patients who had a breast lift and fat grafting at the time of removal, all lost about one cup size, but satisfaction with the breasts improved by a median of 19 points on the BREAST-Q.⁵

Recovery reflects common practice and varies with how much of the capsule is removed and whether a lift is added.

In 248 patients who had implant removal with capsulectomy, there was one collapsed lung (0.4%), three hematomas needing drainage (1%) and two blood clots in the legs (0.8%).³ Removing the full capsule carries a higher complication rate than removing the implant alone.⁶

Other risks include bleeding, infection, fluid collection, changes in nipple sensation, contour irregularities and dissatisfaction with the smaller, softer breast shape.

Breast implant-associated anaplastic large cell lymphoma is a rare lymphoma that forms around implants. In a review of 178 cases, most patients presented with fluid around the implant (70.4%), and treatment included en bloc capsulectomy in 96.8%.⁴ Advanced disease at presentation carried a much higher risk of recurrence and death, which is why new swelling around an implant should be evaluated promptly.⁴

• BII Cause: Whether breast implant illness has a biological cause, and what it is, remains unresolved.^2,6
• Capsule Removal: Whether removing the capsule adds benefit for symptoms has not been tested directly.⁶
• Long-Term Outcomes: Most studies follow patients for months rather than years.^7,9