Explant Procedure Choices

Explant Procedure Choices

By Akemi Fisher

Explant Procedure Choices








You’ve decided to explant. Whether you’re just beginning to research surgeons or have scheduled your operation for tomorrow, The Heal is Real is in your corner. Today’s woman chooses to explant for a variety of reasons. Perhaps you’re suffering from breast implant illness (BII), have experienced capsular contraction or are choosing to explant for other reasons such as BIA-ALCL. Whatever the reason, we’re here for you through this journey – with educational resources, a community of women in your proverbial shoes, and more. You are not alone.


Read below as we explain your choices regarding explant and overall breast implant safety. And consider taking this page with you when you meet with your surgeon. This is a great article to use as a resource as you and your medical professional decide which surgery is best for you. Remember: the overall goal of explant is to remove the implant (and ideally its corresponding capsule) with as little stress as possible to your body.


What’s the big deal about the capsule?

Explant choices hinge upon the capsule – and though the differences may seem minute, they can impact your overall healing. Picture an implant as a small balloon. Surrounding that balloon is a layer – sometimes thick, sometimes thin – of scar tissue. It’s referred to as a capsule. Opinions vary regarding how much of this scar tissue barrier should be removed along with the implant.


Though some medical professionals like the American Society of Plastic Surgeons says leaving the capsule within the body is harmless in certain situations, do your research and decide for yourself whether you agree. Capsules are, in effect, scar tissue. If you’ve experienced a leak in your implant, this scar tissue could possibly absorb the silicone or detritus of that implant and then leak throughout the body. Additionally, some capsules harden and can become uncomfortable. 


Are more women opting for capsule removal?

There’s a definite movement toward capsule removal, as seen by the many social media images that feature pictures of explant. Search ‘explant and capsule,’ and your screen will fill with pictures of just-excised implants and their capsules. More and more, women are sharing pictures of their capsules alongside their just-removed implants. Some are even requesting that the surgery team share evidence of capsule removal upon completion of the operation. 


It’s up to you to make the choice regarding which explant procedure to undergo. Many women, upon deciding to explant, only consider the actual implant removal. It’s important to understand that explant surgeries involve the corresponding capsule and the extent to which it is removed.


Explant surgery options include:


  • Total capsulectomy – Say ‘sayonara’ to that breast implant and its breast implant capsule in this surgery, which ultimately removes both of them. This surgery usually progresses with the breast implant being removed first, followed by the scar tissue capsule removal. Total capsulectomy differs from en bloc capsulectomy in that the entirety of the implant and its capsule are not cut from the body at the same time. This results in the scraping of the capsule off any places to which it has adhered. 


Yes, you read that correctly. The capsule, which is scar tissue, in effect ‘sticks’ to nearby surfaces of the body. This is your body’s response to an invader – in this case, a breast implant. You were not born with the natural inclination to accept the implant into your body without consequence. The capsule forms as a reaction to that invader.


A negative aspect of total capsulectomy is that the implant can possibly be punctured during the surgery. Imagine a slurry of silicone being released into your body just at the moment that you are supposed to be making your body healthier? It’s not an ideal situation. By the way, saline can also pose a risk, as the implants can harbor bacteria if punctured. Gummy bear implant leaks can slowly release implant contents long before they’re detected by MRI.


  • En bloc capsulectomy – ‘En bloc’ means ‘as a whole’ in French, and it’s a fitting descriptor for this type of capsulectomy, which originated in France. In this surgery, the surgeon cuts around the entirety of the capsule and its implant, removing both at the same moment. As you can imagine, this is more of a seamless operation than a total capsulectomy, which involves two parts.


The reason this surgery became popular is because it minimizes the possibility of puncturing the implant during surgery. Consider en bloc implant/capsule removal more like tracing around an object and then dislodging it. Have silicone or textured implants in your body? This is likely the preferred capsulectomy procedure for you. 


  • Capsulectomy – Here, you’ll achieve implant removal – but parts of the capsule will stay in the body. This can be a problem. These capsules are not absorbed by the body. Instead, they can release harmful mold or worse into your system. Isn’t it ironic that breast implant illness can possibly occur in your body even after you’ve had implants removed? This scenario can happen. Leave the capsule in the body, and you’ve just negated one threat; another may still exist.


Warning Note: A dwindling number of medical professionals will advise you to drain saline implants. Their rationale is that saline should not harm the body. This in itself is true – but it’s misguided. Your saline breast implants may harbor bacteria. Deflating them releases that into the body. Don’t do it! Consider total or en bloc capsulectomy instead. Refer back to our original description of an implant being not unlike a balloon. If harmful substances are kept inside it and these are released into the body, there may be adverse health outcomes that follow.


How do I know if I really need to have my breast implants removed?

Opting to undergo breast augmentation in the first place is a personal choice. So too is explant. Some women recognize that their implants need to be explanted because the implants are not considered ‘lifetime devices,’ that is, they are not supposed to last throughout a person’s lifespan. This reasoning staves off any future complications of breast implant illness – even if the implants had not to date caused health problems.


Those who opted for Allergan BIOCELL textured implants face a documented recall of their breast implants and must decide whether keeping them is worth the risk of developing cancer. Anaplastic large cell lymphoma has been directly linked to these implants. The women who selected them for breast augmentation likely thought they were choosing wisely: after all, a textured implant likely stays where it is placed and can mimic a natural breast. It also can cause a particular type of cancer. Read more about the FDA’s request for recall of these implants here. 


Asymptomatic women (those who are not suffering from anaplastic large cell lymphoma) are not advised to explant. That is the FDA’s stance. Not everyone agrees with waiting until cancer develops to take action. The cancer is rare, but it is directly linked to those particular textured implants. It would stand to reason that some women will take proactive action and choose explant even when no symptoms are present.


Still other women experience symptoms of breast implant illness and cannot find any other cause for their malaise. They visit health care professionals; they undergo tests. When every test result comes back negative and yet the suffering continues, they find information about BII and realize that they too are victims. Breast implant illness has been reported as manifesting itself differently, depending on the woman. Brain fog, depression, night terrors, anxiety, rapid heartrate, muscle and joint pain, chronic fatigue and more are affecting women – and there is a simple solution.


What is the answer?

Explant. Remove that object that is causing so much suffering. One woman who suffered from breast implant illness describes the experience as the implants being ‘more than her body could take.’ She had the implants removed and felt near-instant relief. There are many more stories like hers. And there are many more women yet to be helped through explant. 


Where can I find more information about explant?

For detailed information regarding explant surgery options, consider reading the breast implant removal protocols as detailed by the American of Plastic Surgeons. This can be found here. Additionally, seek out a community of women who are also experiencing implant issues. And take heart: you chose to have the implants placed inside your body. You can also choose to have them removed.


Good luck as you schedule your explant and undergo the procedure. May you too find that through explant, the heal is real. Share your story with others; you never know who else is suffering in silence. Remember that this is a disease that is curable. All it takes is removing foreign objects from the body.


Where can I find more information about breast implants and their corresponding danger?

For more information about breast implant illness, anaplastic large cell lymphoma, symptoms of breast implant illness, the Allergan BIOCELL recall of textured implants and expansion devices and more, visit https://thehealisreal.org.