Implant Explantation & Breast Reshaping

Breast implant removal is one of the most consequential decisions a patient can make in the field of breast surgery. Whether for clinical, aesthetic or personal reasons, an increasing number of women are choosing to have their implants removed — not necessarily replaced. The surgical challenge lies in the fact that simple explantation, without addressing the tissue envelope that has formed around the implant, typically leaves a wide, flat and laterally displaced breast that is notoriously difficult to reshape at a later stage.

What happens to the breast after implant removal?

Over the years that an implant is in place, it creates expansion of the breast tissue and skin envelope. When the implant is simply removed, the remaining tissue is typically spread laterally and lacks the central breast mound that the implant had provided. This makes any future reconstructive procedure considerably more difficult.

The solution requires surgical mobilisation of the displaced tissue, reshaping it into a breast mound and supporting it — all while preserving the blood supply to the nipple-areola complex and overlying skin.

The BEP Technique — Borenstein Explantation-Pexy

The approach developed with Dr. Borenstein and published in Plastic and Reconstructive Surgery Global Open (2019) rebuilds the breast mound from the bottom upward, using the breast tissue remaining after implant removal. Unlike classical mastopexy approaches, the BEP technique mobilises the laterally displaced breast tissue and repositions it centrally to recreate projection and shape.

The technique achieves three objectives simultaneously: capsulectomy where indicated; central tissue mobilisation and reshaping; and reduction of skin tension to minimise scarring and achieve a durable long-term result. A key intraoperative stage is performed with the patient sitting upright, allowing precise determination of nipple-areola position and final breast symmetry.

Capsulectomy — is removal of the capsule always necessary?

A capsule is a layer of scar tissue that forms naturally around any implant. In the majority of cases it is thin and asymptomatic. Total capsulectomy is indicated in cases of high-grade capsular contracture (Baker III–IV), suspected implant rupture with silicone extravasation, or specific pathological findings. En bloc resection is reserved for selected cases and is not the standard recommendation in every patient. Each decision is made individually on the basis of clinical findings and preoperative ultrasound assessment.

Who is a suitable candidate?

Suitable candidates are women with existing implants wishing to have them removed — whether due to capsular contracture, suspected rupture, age-related changes, symptoms attributed to Breast Implant Illness (BII), discomfort, or a personal change of preference. The procedure can also form part of an implant exchange, reshaping the breast before a new implant of a more appropriate size and position is placed.

The preoperative consultation includes a clinical examination, implant ultrasound assessment and Crisalix 3D imaging to preview the expected outcome.

Breast Implant Illness — what do we know?

Breast Implant Illness (BII) describes a cluster of symptoms reported by women with implants — fatigue, cognitive difficulties and joint pain among others. A causal relationship between implants and these symptoms has not been scientifically established, and no agreed diagnostic criteria exist. Many women nevertheless report improvement following explantation. I present patients with the current available evidence, neither encouraging nor dismissing it, and respect their informed decision.

What to expect after surgery

Recovery is similar to that following breast reduction. Most patients return to desk work within seven to ten days. The vertical scar improves significantly over 12–18 months. The final shape is established at three to six months, once swelling has resolved and the breast tissues have settled into their new position.