Breast Implant Removal (Explant)

More women than ever are choosing to remove their breast implants — because they no longer want them, because a complication has developed, because their body or life has changed, or because they want to end the cycle of future surgeries. As a breast specialist in Abu Dhabi, Dr. Paulo Michels approaches explant surgery with the same planning discipline as a first augmentation: the goal is not simply to take the implants out, but to leave the breasts looking natural, balanced and supported without them. Every explant is planned around three questions — why the implants are coming out, what condition the capsule is in, and what the breast will look like once the volume is gone.

Why do women remove their breast implants?

There is no single reason, and the reason matters because it changes the operation. The common ones:

• A change of mind. Preferences change over a decade or two — many women want a smaller, softer, more natural breast than the one they chose at 25, or simply want to be implant-free.
• Capsular contracture. The scar-tissue capsule around the implant tightens, making the breast firm, high, round or painful. This is the most common medical reason for removal or revision.
• Rupture or leakage. Modern cohesive silicone ruptures are usually silent and found on imaging; saline rupture shows as a visible deflation.
• Malposition and bottoming out. Implants that have dropped below the fold, drifted to the sides or merged towards the middle.
• Discomfort, heaviness or back and shoulder strain from large implants.
• Symptoms attributed to the implants — the group of complaints patients call breast implant illness.
• A rare implant-associated condition such as BIA-ALCL, which requires removal with a complete capsulectomy.
• Ending the replacement cycle. Implants do not expire on a schedule, but some women prefer a permanent solution over lifelong follow-up.

If your reason is simply that you want them out, that is reason enough. You do not need a complication to justify the decision.

What are the options at explant surgery?

Explant is a family of operations, not a single procedure. Dr. Michels chooses among them based on your anatomy and the imaging findings:

Option	What it involves	Best suited to
Removal alone	Implants removed through the existing scar; capsule left in place	Thin, healthy capsules; smaller implants; patients wanting the simplest operation
Removal with partial capsulectomy	The accessible or abnormal part of the capsule is removed	Moderately thickened capsules; capsule adherent to the chest wall in places
Removal with total capsulectomy	The whole capsule is removed, usually opened during dissection	Contracture, calcification, old implants, patient preference for complete removal
En bloc capsulectomy	Implant and intact capsule removed together as one sealed unit	Rupture, thick or calcified capsule, suspected implant-associated disease
Explant with mastopexy (explant-lift)	Removal plus a breast lift secured with the autologous Internal Bra	Stretched skin, low nipple position, large or long-standing implants
Explant with fat transfer	Removal plus grafting of your own fat to restore modest volume	Women who want some fullness without an implant
Explant with replacement	Removal and immediate exchange for a new implant	Patients who want to keep volume — see the guide to breast implant revision and replacement

Combinations are common: an explant-lift with fat transfer, for instance, restores shape, position and a soft upper pole in a single operation.

Do I need a capsulectomy, and does it have to be en bloc?

The capsule is the thin layer of scar tissue the body builds around any implant. It is normal, and in many women it is thin, soft and harmless. Whether it should be removed depends on its condition:

• A thin, healthy capsule does not have to be removed. Leaving it in place avoids extra dissection against the ribs and muscle, less bleeding and no drain. It shrinks and is reabsorbed over time.
• A thick, contracted or calcified capsule is removed, because it would otherwise remain as a firm, sometimes visible shell and can trap fluid.
• A ruptured implant is best removed with the capsule intact around it, so free silicone gel is contained and not spread into the pocket.
• A suspected implant-associated condition — most importantly BIA-ALCL — requires complete removal of implant and capsule together.

“En bloc” has become a widely searched term, and it is worth being precise about it. En bloc means removing the implant sealed inside its intact capsule, without opening the capsule at any point. It is the correct technique in the situations above. It is not automatically better in every case: when the capsule is paper-thin and adherent to the chest wall, an en bloc dissection can only be achieved by removing healthy tissue, with more bleeding and a higher chance of injury to the muscle, ribs or lining of the chest. In that anatomy a meticulous total capsulectomy — removing the whole capsule, even if it opens during the dissection — reaches the same end point more safely. Dr. Michels tells you before surgery which technique your imaging and examination support, and why.

Whenever the capsule is removed for a clinical reason, it is sent for pathology examination. The removed implants are documented and returned to you if you wish.

Will my breasts sag after the implants come out?

This is the question that matters most to almost every patient, and the honest answer is: it depends on the balance between the volume that leaves and the skin and tissue that remain.

Three factors predict the result. How much natural breast tissue you have — a woman who started with a small A cup and a 400 cc implant is left with far less than one who started with a full B and a 250 cc implant. How much the skin has stretched — large implants, many years in place, pregnancies and weight change all loosen the envelope. And where the nipple sits — if it is already at or below the breast fold, removing volume will leave it lower still.

In practice this means three groups. Women with good elasticity, modest implants and a nipple above the fold often look natural after removal alone, and the breast tightens further over the following months. Women in the middle may be offered fat transfer to soften the upper breast. Women with stretched skin, a low nipple or large implants almost always need a lift at the same time — a removal alone in this group produces the deflated, empty appearance that fuels the “explant regret” stories online. Dr. Michels uses 3D simulation and direct examination at the consultation to tell you plainly which group you are in, so the decision is made with open eyes.

How is an explant-lift (explant mastopexy) planned?

When a lift is indicated, the operation combines the removal with a mastopexy in one session. After the implants — and the capsule, if required — are removed, the remaining breast tissue is reshaped, the nipple is raised to its correct position and excess skin is removed. The incision pattern follows the degree of sagging, exactly as in a breast lift: around the areola for mild ptosis, a vertical lollipop for moderate, an anchor for severe.

Two techniques distinguish Dr. Michels’ approach to the explant-lift:

The autologous Internal Bra. Rather than inserting synthetic mesh, he uses your own fascia and muscle to create an internal supporting sling that holds the lifted breast in place. Without an implant to provide structure, this internal foundation is what keeps the result from settling — the full technique is explained on the Internal Bra breast lift page.

Auto-augmentation. Where the lower breast tissue is generous, instead of discarding it he repositions it higher on the chest wall, restoring upper-pole fullness from your own tissue — the projection of a small implant, without one.

Can fat transfer restore the volume?

For women who want some fullness without an implant, fat grafting is the natural companion to explant surgery. Fat is harvested by gentle liposuction from the abdomen, flanks or thighs, purified and injected in fine layers into the upper breast and cleavage. It softens the transition at the top of the breast and adds a modest, natural volume.

Expectations must be realistic. Fat cannot replicate a large implant in one session, the amount that can be grafted is limited by the recipient tissue, and typically 60 to 80 per cent of the transferred fat survives permanently once the swelling resolves. Some patients choose a second session after several months. The result is soft, moves naturally and is entirely your own tissue.

What about breast implant illness?

Breast implant illness (BII) is the term patients use for a cluster of systemic symptoms — fatigue, brain fog, joint and muscle pain, hair loss, rashes, anxiety, sleep disturbance — that they attribute to their implants. It is not currently an official medical diagnosis, there is no laboratory test for it, and research into its mechanism is ongoing.

That does not mean the symptoms are not real, and they are taken seriously here. Many women report improvement after explantation, and a woman who believes her implants are affecting her health has a legitimate reason to remove them. What Dr. Michels will not do is promise a cure: symptoms with another underlying cause may persist, and a full medical work-up alongside the surgical plan is always recommended. The explant itself is planned in the same way as for any other reason, with the capsule removed when its condition warrants it.

What is BIA-ALCL, and how is it handled?

Breast implant-associated anaplastic large cell lymphoma is a rare cancer of the immune system that arises in the capsule around an implant, associated predominantly with certain textured-surface implants. Its typical sign is a late, one-sided swelling of the breast — years after surgery — caused by a fluid collection around the implant; sometimes a lump or firmness. Evaluation is by ultrasound and analysis of the fluid. When confirmed, the treatment is removal of the implant with a complete en bloc capsulectomy, which is curative in the large majority of cases when caught early. It is rare, and it is not a reason for a woman without symptoms to remove her implants — but it is why any new swelling of one breast should be examined rather than watched.

What does the consultation involve?

Explant planning starts with understanding your reason for removal and what you want the breasts to look like afterwards. Dr. Michels examines the breasts and skin quality, measures the nipple position relative to the fold, reviews your implant records where available, and arranges imaging — ultrasound routinely, MRI when rupture is suspected or implants are old. 3D simulation shows what removal alone would look like on your body compared with an explant-lift or fat transfer. The plan, the incisions, whether the capsule will be removed and how, and whether a drain might be needed are all agreed before surgery day.

What about safety and anaesthesia?

All explant surgery is performed under general anaesthesia in the JCI-accredited surgical theatres of Elyzee Hospital in Abu Dhabi, with board-certified anaesthesiologists monitoring you throughout. Every case includes ultrasound-guided nerve blocks — long-acting local anaesthetic placed around the nerves supplying the chest before you wake — so the first days are comfortable without heavy opioid painkillers. Operating time is roughly one hour for removal alone and two to three hours when capsulectomy, a lift or fat transfer are combined. Most patients go home the same day or after one night, depending on the extent of surgery.

What is the recovery timeline?

Phase	Removal alone / with capsulectomy	Explant with lift or fat transfer
Days 1–3	Mild to moderate discomfort, swelling; compression bra day and night	Moderate tightness; breasts high and firm; compression bra day and night
Week 1	Shower from day 1–2; light walking; desk work possible by day 5–7	Desk work and driving from day 7–10 once off prescription painkillers
Weeks 2–4	Bruising fades; swelling settling	Swelling reduces; incisions maturing; no upper-body training
Weeks 4–6	Compression bra can be stopped; light cardio	Light cardio at 3–4 weeks; compression bra until week 4–6
6 weeks +	Full exercise	Full exercise; breasts settle into final shape over 3–6 months

Fat-transfer patients also wear a light compression garment over the liposuction donor areas for a few weeks. Scars mature over 12 to 18 months; sun protection and the scar-care routine explained at follow-up make a real difference to the final line.

What are the risks?

Every breast operation carries risks — bleeding, infection, fluid collection (seroma), altered nipple sensation, asymmetry, delayed wound healing — and they are minimised with meticulous technique and a hospital setting. The risks specific to explant are two: injury to the chest wall during an aggressive capsulectomy, which is why en bloc is reserved for the cases that need it; and aesthetic disappointment when a needed lift is declined, which is why the honest conversation about sagging happens before surgery, not after.

Why choose Dr. Paulo Michels for explant surgery?

Dr. Michels is a Brazilian board-certified plastic surgeon with over 18 years of experience in breast surgery — augmentation, lift, reduction, revision and removal — and a member of ISAPS, ASPS and the Brazilian Society of Plastic Surgery. He was awarded the Gold Medal for Best Body Contouring at the World Plastic Surgery Olympiads 2025. Explant surgery draws on every part of that breast experience: judging the capsule, removing it safely, and reconstructing a natural breast with the patient’s own tissue. All surgery takes place at Elyzee Hospital in Abu Dhabi, and patients from Dubai and across the UAE are seen routinely, with visits grouped to minimise travel.