Removal of Implants With Capsulectomy
Dr Beryl Tan

Dr Beryl Tan - Removal of Implants With Capsulectomy

Dr Beryl Tan, a specialist Plastic and Reconstructive Surgeon, can assist with the explantation or removal of implants, a procedure now commonly performed with capsulectomy (removal of breast capsule). Some may require replacement if volume and projection of the breasts are key desires.

Read on to learn more about this procedure and its possible suitability for your situation.

Dr Beryl Tan Plastic Surgery - Professional Affiliations


There can be several reasons why women seek to have their breast implants removed. These can include:

  • Capsular contracture
  • Rupture or leakage
  • Revision – a change in shape due to ageing breast tissue over the implant; or implant malposition 
  • Patient’s desire 
  • BII 
  • ALCL


Capsular contracture is the most common complication leading to revision breast implant surgery. The breast capsule is a layer of scar-like tissue that encapsulates the implant, formed by the body in response to the foreign object as your body heals after implant insertion surgery.

Everyone with implants has a capsule encasing the implant, but the capsule’s thickness, composition, and characteristics vary with each individual.

Most capsules do not cause problems. However, roughly 3-19%* of women may develop capsular contracture that causes issues to the breast’s appearance or ‘feel’. Firmer or misshapen breasts that experience pain and tenderness may be the result of this condition.

There may also be an increased risk if there was an infection or haematoma formation after radiotherapy in breast cancer treatment.

*rates vary due to multifactorial reasons; genetics can also play a role, as can the surface and type of implant, plane of pocket, and surgical protocol.


In many cases, implants are “silent” initially, showing no symptoms. However, some people may feel a tearing or popping sensation, usually when engaging in a particular physical activity. In other cases, swelling or oedema, fluid collection, or capsular contracture can appear over time.


This often depends on what type of implant you have:

  • The first (1960s) to third (1980s) generation implants’ gel are liquid-like
  • Fourth-generation implants saw further advancement in the cross-linking of the gel molecules which has produced increasing cohesiveness in the gel
  • Fifth and sixth generation implants won’t usually leak when corrupted. The leaked silicone is contained within the capsule (intracapsular). With time, and perhaps with more mechanical pressure (e.g., muscles), the silicone may become extruded into the breast tissue and travel into the lymph nodes. Our body usually recognises this and incites an inflammatory response that results in scar tissue formation encasing the silicone (silicone granuloma).

A highly cohesive gel is sometimes referred to as “gummy bear”. These are usually the form-stable implants, typically made in the teardrop shape with textured surfaces. The cohesiveness of the gel helps maintain its shape and prevents ‘collapse’, especially in the upper pole.


The most common reason for this is capsular contracture; however, there are many other reasons as well, including:

  • The desire for a change in size
  • Implant malposition (change in position)
  • The development of a “double bubble” deformity (the breast tissue and implant form a separate ‘bubble’)
  • Correction of ptosis (or saggy breasts) that was not corrected with implants 
  • Breast implants do not last forever! Most need replacement or revision in about 15 years (10 years in some, 20 years or longer  if you have no issues)


Some women decide they simply do not want implants anymore and are comfortable with having smaller breasts. This can often be due to ageing and a feeling of being more confident in their own body. Others may be tired of dealing with complications such as capsular contracture or the possibility of Breast Implant Illness (BII).


Capsulectomy is a surgical procedure to remove the breast capsule, usually due to rupture (to contain the spillage), to treat capsular contracture, or to treat ALCL or BII (see below).

There are several iterations of this procedure as follows:

  • Partial capsulectomy – about half of the capsule
  • Total capsulectomy – the whole capsule (may not be in one piece)
  • Subtotal – almost a complete removal, but some may be left behind (e.g. stuck to the ribs; when removal may cause more damage and destruction to the adjacent tissue, like the lungs)
  • “en bloc” – the capsule is removed in one piece with the implant within it


Dr Tan cannot guarantee an ‘en bloc’ excision, especially if your implant is under the muscle and the capsule is deeply adherent to the ribs. Your suitability for this procedure also depends on the thickness of the capsule and how adherent it is to your muscle or breast tissue. Everyone is different, and Dr Tan must see it directly to understand what will be possible for you.


Many patients feel that an en bloc resection is required if they think they have Breast Implant Illness (BII). However, there is no evidence-based data or scientific basis for this. 

In fact, a large, very well-designed study in the US is due out soon, and the preliminary data has shown no difference in patients with partial vs total vs en bloc capsulectomy. We will update this section with the results from the final publication when available.

It is important to note that Total capsulectomy is absolutely necessary for treating Anaplastic Large Cell Lymphoma (ALCL).


BII is poorly understood and, unfortunately, is still not recognised by many medical practitioners. This condition is usually self-identified by women who have had breast implant placement and subsequently developed various symptoms that make them feel very ill. 

The duration from implant insertion to the start of symptoms varies. The symptoms are many and can include:

  • Chronic fatigue
  • Dizziness
  • Hair loss
  • Skin rash
  • Joint and muscle ache
  • Poor memory
  • Brain fog
  • Weight loss and poor appetite
  • Unexplained breathing problems
  • Depression
  • Insomnia
  • And others

These symptoms may resolve (although possibly not completely) after implant removal.


Breast Implant-Associated- Anaplastic Large Cell lymphoma, or ALCL, is a rare lymphoma (a white blood cell cancer) and is not breast cancer. It is associated with having breast implants with a textured surface. The highest risk is with the ultra-textured and macro-textured implants (risk of 1 in 2000 to 1 in 4000). 

As a result, these implants have been taken off the shelf.

This condition can develop 3-14 years (or longer) after implant insertion. (On average, eight years). The most common symptom is fluid swelling in the space between the implant and the capsule. Please refer to the following resources for more information:

What are the risks of surgery?

ALL Surgery is associated with some risk. There are general and specific risks related to the operation. 

Understanding the Risks of Surgical Procedures: Every surgical procedure involves inherent risks, and it’s crucial for patients to be well-informed about these before deciding to proceed. Here, we outline not only the general risks associated with surgeries but also emphasize that specific procedures have their own unique risks.

General Surgical Risks: All surgical procedures can potentially lead to complications such as:

  • Bleeding or hematoma formation
  • Infection
  • Healing issues, including slow/delayed healing or separation of the incision (wound dehiscence)
  • Excessive or abnormal scarring, such as keloid formation
  • Seroma (accumulation of tissue fluid)
  • Deep suture extrusion that could lead to infection
  • Fat necrosis (death of fat tissue)
  • Pain- acute post-surgical pain; sometimes chronic pain
  • Change in sensation (usually temporary but may be permanent)
  • Allergic reactions to drugs or local anesthesia
  • Deep vein thrombosis (blood clots in deep veins) that could lead to pulmonary embolism (clots travelling to the lungs)
  • Pressure effect- excessive, unrelieved, or prolonged pressure on tissues can cause temporary or permanent damage. The risk of these complications is increased in lengthy operations and in the obese (BMI 30 or more), smokers, diabetics, and medically compromised patients. Great care is taken to minimize these risks during operations.
  • Unsatisfactory result and need for revisional surgery


Informed Consent: Before any surgical operation, it is mandatory for all patients to read and sign informed consent forms. These documents are essential as they ensure that you have been provided with comprehensive information about the risks associated with your procedure. Dr. Tan and her team are committed to ensuring that you feel informed and confident in your healthcare decisions.

Procedure-Specific Risks: Each type of surgery carries additional risks that are specific to the procedure itself. During your consultation, Dr. Tan will provide a detailed explanation of these risks tailored to the specific surgery being considered. This information will also be included in the informed consent forms, which are discussed and thoroughly reviewed during your consultation. You are encouraged to ask any questions you may have during this time to ensure you fully understand all aspects of the procedure and its risks.


Removal of implants with capsulectomy-

What you need to know..

  • Full attempts will be made by Dr Tan to remove all the capsules but this cannot be guaranteed, especially if it is deem unsafe or in doing so may cause too much tissue destruction. If any capsule is left behind, especially on the ribs, it will be cauterized (burned).
  • Calcium deposits in the capsule. This usually develop gradually over a long period after having the implant inserted. Existing ‘old’ capsule covered with calcium deposits is often very difficult to remove without causing significant destruction to the adjacent tissue. Extreme precautions will be undertaken to minimise that. Some calcified capsule may be left behind if it is too risky to remove it.
  • Fluid accumulation in the space where the implant has been removed (either serum/serous fluid or blood). Small amount of tissue fluid collection is not uncommon and you usually cannot feel it. The drain is left until there is minimal fluid draining. If you develop swelling at any time after surgery, please let Dr Tan know.
  • Altered nipple sensation, usually decreased sensation, but may be increased sensation.

Uncommonly, this may be permanent.

  • Thrombosis of veins within the breast
  • Granuloma, if a gel implant has ruptured, which then leaks gel into the tissues, resulting in a lump. It may not be possible to remove all the gel.
  • Pneumothorax. Particularly in very thin patients, it is possible to let air into the chest cavity through a small hole between the ribs. This rarely needs to be treated with a large drain tube (chest tube) to reinflate the lung post-operatively.
  • Infection- Infection is unusual after this type of surgery but may occur. This would require antibiotics.
  • Breast deformity or asymmetry related to removal of the implants. To reduce the ‘deformity’ of the breasts after removal of breast implants, you may have to consider breast lift/mastopexy, fat grafting, or replacement with new implants.
  • Dissatisfaction with the appearance of the breast following removal of the implant.
  • Residual silicone may be left behind in the breast or in the axilla

Book a consultation for an implant removal with Dr Tan today

Your care is always greatly considered and you can rely on Dr Tan’s over fifteen years of experience in various areas of Reconstructive and Cosmetic Surgery. If your implants are creating any issues or discomfort, book a consultation with Dr Beryl Tan today. Patients can access Dr Tan at Brighton, Cabrini and PRSM in Donvale.