Overview
Patient motivations for breast implant removal vary significantly. While a subset of patients elects permanent explantation and return to natural contour, a substantial proportion of individuals subsequently decide to pursue re-implantation. We perform breast explant surgery regularly, and when patients request replacement, the standard surgical protocol is to perform removal and re-implantation concurrently during a single operative session.
This guide outlines contemporary surgical approaches to explantation, concurrent re-implantation strategies, and evidence-based energy-based skin tightening modalities employed to manage predictable post-explant tissue laxity.
Explant (Breast Implant Removal) Surgery
Definition & Scope
Breast explantation involves surgical removal of one or both breast implants. Depending on clinical presentation, the procedure may also address the fibrous tissue capsule (scar tissue envelope) that naturally forms around the implant.
Clinical Indications
During consultations, patients frequently present with the following motivations for explantation:
- Personal aesthetic preference to return to natural breast contour
- Implant longevity and structural aging of silicone or saline envelopes
- Life stage transitions (changes in body weight, pregnancy, lifestyle preferences)
- Capsular contracture (Grade III–IV) or other device-related complications
- Desire to downsize to a more subtle, proportionate volume
Surgical Approaches to Capsule Management
Implant Removal Only (Capsule Intact): The device is extracted while the surrounding scar tissue remains undisturbed. This approach is appropriate when the capsule is thin, healthy, and asymptomatic, as it minimizes tissue trauma.
Partial Capsulectomy: Thickened, inflamed, or compromised portions of the capsule are selectively excised, balancing optimal cosmetic outcomes with tissue preservation. This is the most common approach.
Total En Bloc Capsulectomy: The implant and entire capsule are removed together as an intact unit. This technically demanding approach is indicated when structural compromise, rupture, or significant inflammation is suspected.
Capsule management is determined intraoperatively based on visual assessment of tissue health, presence of calcification, and implant integrity. The surgical choice directly impacts the cosmetic contour and risk of recurrent contracture if re-implanting.
Concurrent Explant & Re-implantation Procedure
Rationale for Single-Session Surgery
Performing explantation and re-implantation during a single operative session offers several clinical advantages:
- Unified Recovery Timeline: Eliminates the need for two separate surgical recoveries and anesthesia exposures
- Incision Preservation: Uses existing surgical scars; no secondary scar formation
- Immediate Pocket Modification: The surgical pocket can be revised, repositioned (changing from subglandular to submuscular, dual-plane, or adjusted superior-inferior positioning), and reinforced in real time
- Device Optimization: Allows selection of new implant size, profile, or cohesive density based on intraoperative tissue assessment
Operative Sequence
- Implant Extraction: Careful removal of existing devices and appropriate capsule management based on tissue quality
- Pocket Assessment & Revision: The surgical pocket is inspected, hemostasis achieved, and structural modifications performed
- New Device Insertion: Selection and placement of appropriately sized and positioned new implants
- Skin Envelope Support: If indicated, non-surgical energy-based modalities can be introduced intraoperatively to stimulate early collagen neogenesis
Post-Explant Breast Envelope: Anatomical Considerations
Loss of Upper-Pole Projection
Implants provide distinct superior fullness and projection. Removal results in flattening of the upper-pole slope and loss of upper breast convexity. This change is expected and normal.
Tissue Laxity & Ptosis Risk
Breast skin stretches over the implant’s lifespan to accommodate the internal volume. If implants have been in place for 10+ years—particularly if the original implant volume was large—the elastic fibers may be permanently compromised. Upon removal, the skin envelope may lack the inherent elasticity required to recoil fully, resulting in mild-to-moderate breast ptosis, crepey skin texture, and loss of breast projection.
Re-emergence of Natural Asymmetry
Any inherent skeletal or soft-tissue asymmetries present before initial augmentation will reappear once the implant volume is removed. Patients should be counseled that symmetric augmentation does not correct underlying anatomical asymmetry.
The degree of post-explant tissue laxity is largely predictable based on implant size, duration of wear, patient age, and baseline skin quality. Patients with large implants (>400cc) worn for 15+ years should expect significant skin envelope challenges and are candidates for primary or staged skin tightening intervention.
Energy-Based Skin Tightening: Treatment Modalities & Timeline
Micro-Focused Ultrasound & Radiofrequency Microneedling
Modalities: Ultraformer (HIFU) or Morpheus8
Mechanism: These devices deliver thermal energy into the deep dermis and fibroseptal zones, triggering controlled micro-injury and wound-healing response. This stimulates sustained neocollagenesis and elastin remodeling over 8–12 weeks post-treatment.
Clinical Application:
- Can be deployed intraoperatively (immediately following implant placement) or in the early postoperative period for light, preventative tissue stimulation
- Typically performed in serial treatments (3–4 sessions, 4–6 weeks apart) during the first 3 months post-explant
- Ideal for patients with mild tissue laxity seeking non-invasive intervention
Recovery: Minimal downtime; mild erythema resolves within 24–48 hours. Full activity immediately.
Renuvion (J-Plasma) Subdermal Coagulation
Technology: Renuvion (J-Plasma) combines helium plasma with radiofrequency energy, delivered via controlled micro-incisions
Mechanism: Plasma energy induces immediate, precise thermal contraction of subdermal and fascial tissue, followed by long-term collagen remodeling. The effect is more aggressive than non-invasive devices.
Clinical Timing—Why 3 Months Post-Explant: Renuvion is optimally performed at month 3 post-surgery, when acute post-operative edema has completely resolved, the true baseline skin laxity is accurately assessable, wound healing is mature enough to tolerate additional thermal insult, and the patient has recovered sufficiently from the primary surgery.
Applying subdermal plasma energy to acutely swollen tissue would result in treating transient edema rather than true anatomical laxity, reducing efficacy.
Recovery from Renuvion: Mild erythema and swelling (1–2 weeks). Most activity resumes by day 3–5. Results progressively improve over 8–12 weeks as collagen matures.
Staged Protocol: Integrating Multiple Modalities
For patients with significant post-explant tissue laxity, a progressive approach yields superior outcomes:
- Intraoperative / Days 1–7: Optional light Ultraformer or Morpheus8 stimulation to support early dermal response
- Weeks 1–12: Scheduled series of Ultraformer or Morpheus8 (every 4–6 weeks, 3–4 treatments) to progressively build the dermal matrix
- Month 3+ Post-Explant: Evaluation and possible Renuvion (J-Plasma) if moderate-to-significant laxity persists after non-invasive treatment
Energy-based skin tightening operates over a 3–6 month timeline as collagen deposition and remodeling occur. Results are gradual and cumulative. This modality is highly effective for mild-to-moderate laxity but cannot replicate the structural tissue repositioning achieved via surgical breast mastopexy (lift) if severe ptosis is present.
When Surgical Mastopexy (Breast Lift) Is Indicated
Clinical Threshold for Surgical Intervention
In cases of severe post-explant tissue descent—where the breast parenchyma has dropped significantly below the inframammary fold, the nipple-areola complex points downward at more than 10° below horizontal, or skin laxity is extreme—non-surgical modalities alone will not achieve an acceptable cosmetic result.
Concurrent Mastopexy & Re-implantation
When indicated, a surgical breast lift performed concurrently with re-implantation involves excision of excess, redundant breast skin, surgical elevation and reshaping of breast parenchymal tissue, repositioning of the nipple-areola complex to a youthful apical position, and implant placement in the revised pocket with optimized positioning.
Assessment of whether surgical mastopexy is required occurs during the initial consultation. Baseline photographs and direct tissue assessment determine whether energy-based tightening alone is sufficient or whether a lift is needed.
Postoperative Recovery Timeline
Days 0–3: Bandages/compression brassiere in place. Drains typically present. Pain managed with prescribed analgesia. Head elevation mandatory.
Days 3–7: Drains removed by day 2–3. Bandages removed, replaced with surgical brassiere. Significant edema and ecchymosis present. Sutures out by day 5–7.
Weeks 2–4: Ecchymosis fades rapidly; edema remains moderate. Can perform light daily activities and return to office work. Continued use of supportive brassiere.
Weeks 5–8: Edema significantly reduced. Most visible bruising resolved. Can resume normal daily activities. Strenuous chest exercise still restricted.
Months 2–3: Full recovery from surgery. Swelling resolved. True surgical result becoming apparent. Scars begin fading. Full activity approved.
Risks & Postoperative Complications
Explant-Specific Risks
- Breast Ptosis / Tissue Laxity: The primary cosmetic risk; severity depends on implant size, duration, and baseline elasticity. Managed via staged energy-based tightening or surgical mastopexy.
- Loss of Breast Volume & Upper-Pole Fullness: Expected outcome; mitigated through concurrent re-implantation at appropriate volume.
- Re-emergence of Natural Asymmetry: Pre-existing asymmetries reappear; can be partially addressed via selective re-implantation sizing.
- Sensory Changes: Temporary or permanent changes in nipple sensation; rare with careful surgical technique.
Re-implantation Specific Risks
- Recurrent Capsular Contracture: Risk of 5–10% depending on implant material and surgical pocket technique
- Implant Displacement: Implants may shift slightly over time
- Implant Longevity: Modern implants typically remain intact 10+ years but are not permanent devices
Frequently Asked Questions
Q: Is same-day removal and re-implantation truly the best approach?
A: Yes, in the majority of cases. Single-session surgery minimizes total anesthesia exposure, uses existing scars, and allows optimization of the surgical pocket in real time.
Q: How much sagging should I expect after implant removal?
A: This depends on implant size, duration of wear, and baseline skin elasticity. Large implants (>350cc) worn for 10+ years predict significant laxity.
Q: Why wait until month 3 for Renuvion?
A: Acute surgical edema masks the true skin envelope. By month 3, edema resolves completely, revealing baseline laxity. Renuvion then precisely targets the remaining skin slack.
Q: What if I choose to go completely natural without re-implantation?
A: Explant alone is appropriate for some patients. If you elect to remain natural, staged energy-based tightening can improve remaining breast tissue appearance.
Q: Will I definitely need a surgical breast lift?
A: No. Many patients achieve satisfactory results with explant, re-implantation, and energy-based skin tightening. A formal surgical mastopexy is required only if severe, irreversible ptosis is present.
Breast Implant Check Consultation
Uncertain whether explantation or re-implantation is right for you? Dr. Glenn Murray provides comprehensive breast implant assessment consultations, which are Medicare-bulk-billed in Australia.
Consultation & Regulatory Requirements
In accordance with Australian medical regulations and AHPRA guidelines, two formal consultations are mandatory before any cosmetic surgical procedure can be scheduled. A mandatory 7-day cooling-off period follows your second consultation. A $2,200 deposit is required to lock in your surgical date.
This information is provided for educational purposes only and does not constitute medical advice. All surgical procedures carry inherent risks and potential complications. A comprehensive evaluation with Dr. Glenn Murray is required to determine candidacy, appropriate surgical approach, and realistic individual outcomes.
Important Information: All procedures involve risks. Risks associated with breast augmentation may include infection, bleeding, implant rupture, capsular contracture, changes in sensation, scarring, and the possibility of requiring revision surgery. Suitability varies from individual to individual and a personal consultation is essential to assess your specific circumstances. This information is general in nature and should not be relied upon as a substitute for individual medical advice. A formal consultation with Dr. Glenn Murray is required to discuss your goals, evaluate your suitability, and develop an appropriate treatment plan. This content is intended for adult audiences. Results vary between individuals.
Surgery performed by Dr Glenn Murray (MED0001196978). Breast Implant Removal and Re-implantation. Images taken 1 month apart.
