You might have recently found out about Breast Implant Illness (BII), and perhaps you’ve been sick for a while and just figuring out your implants are most likely the cause. The desire to get them out of your body as soon as possible can be very strong – and for good reason.

It is so important to do your research and make sure you choose a surgeon who is qualified, and will do your surgery right the first time. You also want to make sure a second surgery is not needed.

Why would a second surgery be needed?

One of the most important things when explanting is that all of the scar tissue (capsules) is removed along with the implants. Capsules are formed by your body as an immune system response, because your body sees the implants as foreign objects (which they are).

Capsules can retain toxins leached from your implants, and if your capsules aren’t removed these toxins are left behind and can, and probably will, keep you sick.

There are many women who weren’t informed that capsules had to be removed, and when they remained sick after explanting, they had a second surgery and finally gained their health back.

There have even been many women who were told their capsules would be removed, only to find out after surgery that the surgeon felt it wasn’t necessary or would be too dangerous in their opinion. I can’t imagine what I would feel if I was told that!

Do your research now to make sure the surgeons you consult with and the one you ultimately choose has a proven track record of removing the entire capsule, and will even put it in writing. If you join the Facebook support groups that I list here in the resource section, you can search the name of a surgeon to see how people’s experiences were, and you can also see before and after photos in some cases.

Choosing a surgeon

I feel there are 3 main priorities to consider when choosing a surgeon. All 3 are important, but the order of your priorities will help you determine which surgeon is right for you.

• Enbloc removal (likelihood that it will be achieved by a surgeon)
• Cost
• Aesthetic outcome
  

Enbloc removal

Let me just say straight off the top it’s ALWAYS important to have the capsules removed entirely during surgery. If you have recalled implants or a rupture, enbloc removal becomes even more important.

An enbloc removal is when the capsule is removed intact, encasing the implant. This prevents silicone, as well as other chemicals and bacteria from leaking into your body during surgery.

Recalled implants have been linked to cancer (BIA ALCL), and ruptured implants will have leaked silicone inside your capsules, so you want to minimize contamination to your body. When the implant is removed with the capsule fully intact, the chances are much higher of the toxins leaving your body.

No surgeon can guarantee enbloc removal, because your capsules may be very thin and tear, or stuck to your ribs or elsewhere and have to be cut away. But some surgeons have a track record for a high success rate, while other surgeons don’t achieve them very often.

Looking for a micro surgeon can increase the likelihood of a successful enbloc. They are more skilled with intricate surgeries, and generally take more time on the surgeries as well.

A surgeon should be able to show you photos of many capsules with enblocs they were able to achieve. If a surgeon isn’t willing to show you photos, I would take that as a big time red flag.

A total capsulectomy is when all of the capsule is removed, but it wasn’t able to be removed intact. If enbloc can’t be achieved, you want to make sure a total capsulectomy will happen.

If you are in one of the Facebook support groups you can search for particular surgeons you are interested in and there’s a good chance other women will have asked about their success rate with enbloc. I highly recommend these groups for support and for educating yourself!

When you are at your consultation, ask the surgeon what his/her success rate has been for enbloc removal. Is it 20%? 50%? 99%? This is important to know if this is your highest priority.

Cost

While no one wants to pay for a surgery they weren’t expecting to have, paying for a surgery may be out of the question for some women. 

I see countless posts from women asking if surgery is covered under OHIP or other province’s or country’s equivalent to health coverage. And many posts asking if it’s covered under medical insurance as well.

Each province and medical provider is different, so it’s good to find out details for the one that pertains to you.

In Ontario some surgeons say you need to meet certain criteria to be covered by OHIP, such as having a rupture or grade 3-4 capsular contracture. And there are a couple of surgeons who always explant under OHIP, whether you have those criteria or not.

What is incredibly important to keep in mind is that even though you might not have to pay for your explant surgery if your surgeon goes through a medical plan or health insurance, that doesn’t mean the outcome will be one that you’re hoping for.

I don’t say this to scare you, but because it is a problem that I’ve seen time and time again. Women are choosing based on cost (or lack of it), and then having really poor outcomes. This doesn’t happen in every case, but I’ve been seeing it happen to many women.

Some issues have included capsules not being fully removed, little experience removing implants, photos not being taken when it was promised they would be, and terrible aesthetic outcomes with jagged stitching, square boobs, bad infections requiring wound care from the hospital, and uneven breasts even though they were even before explant.

Do your research. If there are people saying that a particular surgeon is great, look to see if they have actually explanted with him/her, or if they are basing their opinion on a consult only.

I have seen praise for a surgeon spread like wildfire after women have their consultation, and after surgery when outcomes aren’t what they expected (infections, awful incisions, poor aftercare, etc.), they don’t share their bad experiences.

This leads other women to think the surgeon is great, but they aren’t seeing the full picture. If you see someone’s explant date in a post, look up their other posts after surgery and see if they mention issues they’re having.

Private message (PM) women who have explanted with that surgeon and ask them if they will tell you the good and bad, and if they are willing to share their photos. It’s amazing how much more you find out through PM.

Paying for surgery might seem out of reach, but going with someone just because they are covered under your health plan might not turn out how you hope.

There are many ways to get creative to either raise the funds or save the money. I wrote a post with a list of several ideas to get you started. In the end, it’s your body and it’s with you for life. Make an informed decision that you feel a peace about.

Aesthetics

The main reason you are considering or have decided to remove your implants is probably for your health, but that doesn’t mean that the aesthetic outcome isn’t important to you.

The reason most women get implants is because they feel it will improve their appearance. I got mine because I became deflated and saggy after breastfeeding two kids. They were also supposed to help correct my asymmetry (one side was much bigger than the other). They ended up making everything a whole lot worse ☹

Aesthetics were important to me, but I went into surgery prepared that my boobs had been through a lot and probably weren’t going to come out looking ideal. I think it is key to go in with realistic expectations.

I researched each surgeon I was considering extensively, and tried to find as many before and after photos as I could. My surgeon’s before and afters had a consistent great aesthetic, which gave me a lot of confidence and peace about my decision.

When my bandages were taken off I was shocked that everything looked a lot better than I expected. Despite everything I’ve put myself through because of implants, I actually like my boobs more now than I have in decades. I credit the skill of my surgeon for that, and also careful research.

My best advice is research, look at before and after photos, and private message women who have already had surgery with a surgeon you are considering.

Additional thoughts and considerations

Can implants be removed under local anesthesia?

The answer is yes – but don’t do it! If a surgeon says that they remove this way, RUN! If they do removal this way they are removing the implant and leaving the capsule in your body. I have already gone into detail above about why this is not a good situation.

Getting a lift at the same time as surgery

Some surgeons recommend waiting to do a lift until 6-12 months after your explant. They feel doing both at once is too much for your body, and if you wait you can see if you really need the lift.

Other surgeons are fine with doing them at the same time, and even recommend it for a better aesthetic outcome. Extra skin is removed, and droopy/saggy boobs can be made perkier.

An important consideration is if you want to have one surgery instead of two. If you do the procedures separately you are going under anesthesia twice, having to take time off of work twice (or arrange help with your kids if you are a stay at home mom), and recover two times.

Time off work is typically a minimum of 2 weeks, but at least 3 is ideal. It is about 8-12 weeks until you’re mostly able to do the things you would normally do.

If it’s a good surgeon, and the patient takes it easy and let’s her body recover without doing too much and delaying recovery, I think it’s usually fine doing both at the same time. I had a full lift done when I explanted and I’m so glad I don’t have to go through another surgery and recovery. You have to make the right decision for yourself.

Special procedures such as fat transfer and flap

Some women want to have a special procedure done to try to increase their breast size and volume. One option for this is a fat transfer and another option is a flap.

A fat transfer is when fat is removed from one area of the body (liposuction) and injected into the breasts. Some or most of the fat is reabsorbed by the body, with women usually retaining 20-80%. There are risks with having a fat transfer done, so do your research before deciding.

A flap is when fat is taken from underneath or beside the breast, and it remains connected to the blood supply and moved to the breast area. The benefit is that it can add more volume, and the fat doesn’t die since it’s still connected.

For women who want more volume, this procedure is pretty enticing, but it can have issues as well. In my research on it, I have noticed that it can give boobs a bit of a square look. Recovery seems to take a lot longer, and some women have issues like hardness and pain in that area, even several months after surgery. Again, do your research and see how you feel about it for yourself.

If you are interested in one of these procedures, you’ll need to look into it because some surgeons offer them and many don’t.

Questions for consultation

Whether you have your consultation in person, or via Skype or Facetime, it’s important to have a list of questions ready. I have compiled some questions here and included a printable pdf so you can take it with you.

Final thoughts

The fact that you’re reading this post means that you are already on your way to researching your options. I hope you’ll join some of the support groups I have provided links to, and if you have any questions please post them in the comments below or feel free to email me and I’d be glad to help!