Should I Have My Breast Implants Removed?
Not necessarily. If your implants are intact, comfortable and you are happy with how they look, there is no medical rule that says they must come out after a set number of years.
Equally, there are good reasons why many women do choose removal.
The decision usually rests on four questions:
is there a problem with the implant?
do you have symptoms you feel may be linked to the implants?
do you still want them?
what will your breasts look like without them?
This article focuses on the decision itself and the surgical options. The problems that can lead to removal are covered in detail in What Problems Can Occur With Breast Implants?, and implant lifespan in How Long Do Breast Implants Last?
This is the last article in a series of four:
Should I Have My Breast Implants Removed?
What are the medical reasons to consider removal?
The commonest are:
Capsular contracture: a hard, tight capsule that distorts the breast or causes pain, especially if it has come back after previous surgery.
Rupture: a confirmed rupture of a silicone implant, particularly if gel has escaped beyond the capsule.
Possible BIA-ALCL: new swelling or a lump appearing a year or more after surgery, which must be investigated. If BIA-ALCL is confirmed, removal of the implant and the entire capsule is the treatment.
Symptoms you link to your implants: often called breast implant illness. In the best prospective study to date, around 88% of women reported at least partial improvement after removal, though the cause of the symptoms remains unproven.
Persistent problems with position or comfort: malposition, rotation, rippling, or discomfort from larger implants.
Each of these is explained more fully in What Problems Can Occur With Breast Implants?
When is removal not necessary?
The age of an implant alone is not a reason to remove it. Intact, comfortable implants can be monitored rather than replaced. Neither the UK MHRA, the US Food and Drug Administration (FDA) nor UK plastic surgery bodies recommend removing implants simply to prevent BIA-ALCL if you have no symptoms are signs.
I've had them for years and simply don't want them anymore. Is that a good enough reason?
Yes. You do not need a complication or a diagnosis to justify removal. Some of the most straightforward and satisfying explant (removal) decisions are made by women who had implants in their twenties or thirties and, decades later, find they no longer fit their life.
The reasons vary.
Priorities change, and the shape and size that once mattered may matter less.
Larger implants can feel heavy, contribute to neck or back discomfort, or get in the way of running, swimming or sleeping on your front.
Some women want to simplify: no more monitoring scans, no lingering question about rupture, nothing to think about.
The main caution is about expectation rather than permission. After 15 or 25 years, the natural breast tissue around an implant has usually thinned and stretched, and skin elasticity declines with age. What lies underneath will not look like your breasts did before your first operation. Understanding what you are likely to see afterwards, and what can be done about it, is the most important part of the conversation.
What will my breasts look like after the implants come out?
Usually smaller, softer and lower than before, and sometimes deflated or uneven. How much depends on a few predictable factors:
Implant size: the larger the implant relative to your own tissue, the more empty skin envelope it leaves behind.
How long you've had them: long-standing implants thin the overlying tissue (pressure atrophy) and stretch the skin.
Your own breast volume: women with a reasonable amount of natural tissue tend to recover a better shape.
Skin quality: age, pregnancy, breastfeeding, weight change and smoking all reduce elasticity.
Implant position: implants placed under the muscle can leave a flatter upper chest; removal of a thick capsule can leave hollowing.
Some women are pleasantly surprised: the skin retracts over three to six months and they like the natural result. Others find the change difficult. Neither outcome is unusual.
What are the surgical options for removal?
There is no single "explant operation". The right approach depends on why the implants are coming out, the state of the capsule, and the result you want. The main options are:
Removal alone, capsule left in place: suitable when the capsule is thin, soft and healthy. It is the simplest operation with the lowest risk, usually through the original scar in the fold beneath the breast.
Removal with partial or total capsulectomy: the capsule is partly or fully removed. This is advised when it is thickened, calcified or contracted, or contains silicone from a rupture.
En bloc capsulectomy: the implant and its intact capsule are removed together in one piece. This is the standard approach for confirmed BIA-ALCL and is sometimes used for ruptured silicone. It is a more extensive operation, often needing a longer scar, and where the capsule lies against the ribs it carries a small risk of injury to the chest wall or lung. The current evidence does not show that it gives better results than other techniques for breast implant illness.
Exchange for smaller implants: for women who want less, but some volume, or who want a fresh, intact implant.
Removal with a breast uplift (mastopexy): excess skin is removed and the nipple and breast tissue repositioned higher on the chest. This is commonly advised when the nipple sits at or below the fold beneath the breast, or when there is a lot of loose skin.
Fat transfer: fat taken by liposuction from elsewhere can restore a modest amount of volume and soften hollows. It cannot replace a large implant.
Should an uplift (mastopexy) be done at the same time or later?
It depends on your tissue. A single-stage operation means one operation and one recovery, and suits women with good tissue thickness and a moderate amount of excess skin.
A staged approach, removing the implants first and planning the uplift three to six months later once the skin has settled, is often preferred when the tissue is thin, a large implant is involved, or a full capsulectomy has been needed. Blood supply to the nipple and the final shape are both more predictable that way, and some women find they no longer want an uplift once they see how their breasts have settled.
An uplift leaves permanent scars, typically around the areola and often down to the fold, so it is worth seeing photographs of realistic results before deciding. Almost all scars fade somewhat over time.
What is the recovery like, and what are the risks?
Removal is usually performed under general anaesthetic, either as a day case or with one night in hospital. Removal alone is often simpler than the original augmentation, especially if the implants sat above the muscle. Most women take one to two weeks off work and avoid strenuous exercise for around six weeks.
More extensive capsule removal, or a simultaneous uplift, lengthens recovery and adds risk. Possible complications include bleeding, fluid collection (seroma), infection, changes in nipple sensation, asymmetry and, rarely with capsules under the muscle, injury to the chest wall.
Will the NHS pay for removal?
Generally not when the original operation was cosmetic and private. NHS funding is usually limited to specific clinical problems, such as confirmed or suspected BIA-ALCL, and policies vary between areas. Most cosmetic explants in the UK are self-funded.
So, should I have my breast implants removed?
It is worth seriously considering if you have capsular contracture causing pain or distortion, a confirmed rupture, new swelling or a lump that needs investigating, symptoms you believe are linked to your implants, or simply no further wish to have them. It is not necessary purely because of their age, or as a precaution against BIA-ALCL when you have no symptoms.
A sensible next step looks like this:
Find your implant details: manufacturer, filling, surface (smooth or textured), size and date of surgery.
Have them assessed: a clinical examination and, if they are more than a few years old, an ultrasound or MRI.
See your GP about any whole-body symptoms, so treatable causes are not missed.
Consult a plastic surgeon on the GMC specialist register, ideally a member of BAAPS or BAPRAS, who performs explantation regularly and can show you results in women with a similar starting point.
Ask specifically about the likely shape afterwards, whether an uplift is advisable, and whether it should be done at the same time or later.
Consider Your Next Step
A consultation is where every good treatment starts. A consultation with Ms McEvoy will give you an assessment of your implants, your own tissue and the result you are likely to see, including whether you need an uplift at all, or whether removal is the right step for you.
There will be no obligation to proceed. The aim is to provide information and clarity, not pressure to have an operation. To arrange a consultation with Ms McEvoy please use the links below to telephone or email, or to fill out our contact form click here.