Kare Plastic Surgery & Skin Health Center · Santa Monica & Los Angeles
Breast Implant Replacement After Capsulectomy in Los Angeles
804 7th Street, Santa Monica, CA 90403 · (310) 998-5533
Replacement of silicone breast implants after capsulectomy in patients who have experienced implant rupture or capsular contracture. Dr. Raffy Karamanoukian is an expert in breast implant exchange and revision breast surgery.
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UCLA EducationSchool of Medicine
Double Board CertificationBoard-Certified Plastic Surgeon
Breast Revision Surgery
Capsulectomy with Implant Removal or Replacement: A Decision That Deserves an Expert
When breast implants require removal — whether from capsular contracture, silicone rupture, saline deflation, breast implant illness (BII), anaplastic large cell lymphoma (BIA-ALCL) concern, or a desire to change size and profile — the surgical decision is rarely simple. The question every patient must answer with their surgeon is whether to remove the implant and capsule entirely and allow the breast to return to its natural state, or to perform capsulectomy followed by immediate placement of a new implant. Both are valid surgical choices. Neither is the right answer for every patient.
At Kare Plastic Surgery & Skin Health Center at 804 7th Street in Santa Monica — minutes from Beverly Hills and accessible from throughout Los Angeles — UCLA School of Medicine graduate and double board-certified plastic surgeon Dr. Raffy Karamanoukian, MD, FACS guides every breast revision patient through this decision with the clinical honesty, reconstructive expertise, and technical precision that outcomes at this level of complexity demand. His consultation evaluates the specific indication for surgery, the quality of the remaining breast tissue and skin envelope, the patient’s aesthetic goals, and the surgical risk profile to arrive at a clear, individualized recommendation.
His two decades of breast surgery experience encompassing primary augmentation, revision, explantation, en bloc capsulectomy, and post-explantation breast lift make him one of the most experienced breast revision surgeons in the Los Angeles and Beverly Hills area for exactly these complex re-operative cases.
Breast Revision Services at Kare Plastic Surgery
- Total capsulectomy
- En bloc capsulectomy with implant
- Partial capsulectomy
- Implant exchange — new size, profile, or material
- Pocket conversion — subglandular to submuscular or dual plane
- Post-explantation breast lift
- Silicone rupture removal
- BII-related explantation & capsulectomy
- BIA-ALCL evaluation & en bloc capsulectomy
The Core Decision
Removal vs. Replacement After Capsulectomy: Guiding this Difficult Decision for Breast Revision
The single most important conversation in the breast revision consultation is whether the patient wants to remove the implants permanently or replace them with new implants after the capsulectomy is complete. Dr. Karamanoukian presents both paths honestly, with a clear-eyed assessment of what each achieves and what each requires of the patient’s tissue and recovery.
Option One — Explantation
Remove Implants: No Replacement
Complete explantation removes the implant and its surrounding fibrous capsule without placing a new implant. The breast tissue is allowed to settle and remodel into its natural post-explantation shape — a process that unfolds over 3–6 months as swelling resolves and skin contracts.
Best suited for patients who:
- Are experiencing symptoms consistent with BII and want complete foreign body removal
- Have adequate natural breast tissue volume to achieve a satisfying result without an implant
- Want to eliminate the need for future implant-related revision surgery
- Have BIA-ALCL confirmed or suspected, requiring en bloc capsulectomy per oncologic protocol
- Have experienced recurrent capsular contracture after prior revision and want a permanent solution
- Simply no longer desire breast augmentation
A post-explantation mastopexy (breast lift) is frequently combined with complete removal when significant skin laxity would produce an aesthetically unsatisfying result from removal alone.
Option Two — Implant Exchange
Capsulectomy with implant exchange removes the diseased or failed implant and its surrounding capsule and places a new implant — often a different size, profile, or material — in the same or a repositioned pocket at the same operation.
Best suited for patients who:
- Desire breast volume after rupture or contracture
- Have Grade III–IV capsular contracture causing pain, distortion, or firmness and want a fresh implant
- Have saline deflation or confirmed silicone rupture requiring implant replacement
- Want to change implant size, profile, or material (saline to silicone)
- Want to correct position asymmetry, rippling, or implant malposition from the original surgery
- Have had a previous augmentation by a different surgeon and want revision to a more natural result
Pocket conversion from subglandular to dual-plane or submuscular positioning is frequently performed at implant exchange to reduce recurrence risk for contracture and improve long-term results.
Surgical Techniques
Capsulectomy Techniques Available at Kare Plastic Surgery
01
En Bloc Capsulectomy
The gold standard for BIA-ALCL and BII-related explantation. The capsule and implant are removed together as a single intact unit without opening or disturbing the capsule during removal. This technique requires precise dissection along the capsule’s outer surface to maintain the integrity of the capsule-implant assembly throughout the removal — demanding surgical experience that Dr. Karamanoukian brings to every case requiring this approach. En bloc capsulectomy is the oncologically appropriate approach when BIA-ALCL is suspected and is the preferred technique for BII patients who want complete removal of all foreign material.
02
Total Capsulectomy
Complete removal of the entire fibrous capsule in its entirety, with the implant removed separately. The capsule is dissected from the surrounding breast tissue and chest wall in complete segments until the entire capsule has been excised. Total capsulectomy eliminates the entire foreign body reaction shell, eliminates the most common source of bacterial biofilm in recurrent contracture, and creates a clean tissue environment for new implant placement or for natural tissue healing after explantation. The preferred approach for Grade III–IV capsular contracture, calcified capsules, and capsules with concerning characteristics on imaging.
03
Partial Capsulectomy
Selective removal of the portions of the capsule that are thickened, calcified, or adherent to the surrounding tissue, with preservation of the posterior capsule when it is densely adherent to the chest wall or ribs and complete removal would carry unacceptable risk of injury to adjacent structures. Partial capsulectomy is the appropriate technique when the risk of total capsulectomy outweighs the benefit. Less appropriate for BIA-ALCL, which requires en bloc technique.
04
Capsulectomy
When implant replacement is chosen, repositioning the implant from a subglandular (above muscle) to a submuscular or dual-plane pocket reduces the risk of recurrent contracture and provides better implant coverage in patients with thin overlying tissue. Pocket conversion at the time of capsulectomy and implant exchange is performed by developing a new tissue plane while simultaneously excising the old subglandular capsule — a maneuver that requires precise anatomical knowledge of the pectoralis major and serratus anterior anatomy in the re-operative setting.
05
Explant with Mastopexy
Many patients who choose complete implant removal without replacement require a concurrent breast lift (mastopexy) to address the skin laxity and ptosis that develops when an implant that has expanded and supported the breast skin envelope for years is removed. Dr. Karamanoukian performs explantation and mastopexy as a single combined procedure — reshaping, lifting, and tightening the breast tissue and skin envelope at the same time the implant and capsule are removed. The mastopexy scar planning is discussed at consultation, and Dr. Karamanoukian’s nationally recognized scar expertise is applied to every mastopexy incision design.
06
Silicone Rupture Removal
A ruptured silicone implant presents a specific surgical challenge depending on whether the rupture is intracapsular (silicone contained within the intact capsule) or extracapsular (silicone has escaped the capsule into the surrounding breast tissue). Intracapsular rupture is typically managed with en bloc or total capsulectomy that removes the capsule and silicone gel together. Extracapsular rupture — where free silicone is present in the breast tissue, axillary lymph nodes, or chest wall — requires more extensive removal of silicone-contaminated tissue. Dr. Karamanoukian’s expertise in foreign body removal, developed through his silicone removal practice, directly informs his management of extracapsular silicone.
Why Dr. Karamanoukian
Reconstructive Expertise in Breast Implant Revision
Breast revision surgery after capsulectomy is among the most technically demanding procedures in plastic surgery. The re-operative tissue is scarred, the anatomy is distorted, the capsule may be adherent to the pectoralis muscle or ribs, and the outcome must simultaneously achieve the functional goals of the surgery (removal of the disease process) and the aesthetic goals of the patient (a satisfying breast appearance after revision). This combination of reconstructive challenge and aesthetic standard requires a surgeon whose training encompasses both dimensions at the highest level.
Dr. Karamanoukian’s medical education and plastic surgery training encompassed the full reconstructive breadth of breast surgery, from primary augmentation to complex revision, post-mastectomy reconstruction, and management of implant complications. including rupture, contracture, malposition, and infection. His understanding of breast tissue anatomy, the mechanics of capsule formation and maturation, and the tissue behavior after implant removal provides the clinical foundation for consistently predictable outcomes in re-operative cases where less experienced surgeons encounter unanticipated intraoperative challenges.
Common Questions
Frequently Asked Questions — Breast Implant Removal
What is capsular contracture and when does it require surgery?
Capsular contracture occurs when the fibrous capsule that naturally forms around every breast implant thickens, hardens, and contracts — squeezing the implant and distorting the breast shape. It is graded on the Baker scale from I (normal softness) to IV (severe firmness and distortion with pain). Grade III and IV contracture typically require surgical treatment — either capsulectomy with implant exchange or capsulectomy with complete explantation. Massage, medication, and non-surgical treatments do not reliably resolve Grade III–IV contracture and are not a substitute for surgical correction.
How do I know if my implant has ruptured?
Saline implant rupture is immediately visible as deflation of the affected breast — typically over 24–48 hours as the saline leaks out and is absorbed by the body. Silicone implant rupture is often “silent” — the shape may appear unchanged because the cohesive silicone gel remains within or near the capsule. MRI is the most accurate imaging modality for detecting silicone rupture and is recommended for screening every 5–6 years for silicone implant patients. Ultrasound is a useful screening tool. Dr. Karamanoukian reviews all available imaging at consultation and examines both breasts clinically to assess the implant integrity before surgical planning.
Do I need a breast lift after implant removal?
Many patients who choose complete implant removal without replacement benefit from a concurrent mastopexy (breast lift) to address the breast skin laxity and ptosis that results when an implant that has expanded the breast envelope for years is removed. Whether a lift is necessary depends on the degree of skin laxity, the amount of natural breast tissue present, and the patient’s aesthetic goals for the post-explantation breast. Some patients with adequate natural volume and good skin elasticity achieve a satisfying result from removal alone. Dr. Karamanoukian evaluates the need for concurrent mastopexy at consultation and presents the options honestly, including the scars that mastopexy produces.
What is the recovery after capsulectomy and implant exchange in Los Angeles?
Recovery after capsulectomy with implant exchange or explantation is typically 2–4 weeks of activity restriction, with most patients returning to desk work at 7–14 days and full unrestricted activity at 4–6 weeks. Post-operative discomfort is managed with a combination of prescription analgesics for the first 3–5 days and over-the-counter pain medication thereafter. A surgical bra is worn continuously for 4–6 weeks. Patients who have concurrent mastopexy require slightly longer wound monitoring for the mastopexy incisions. Complete resolution of post-operative swelling and final breast shape assessment occurs at 3–6 months after surgery.
Find Us
Breast Revision Surgery Near Beverly Hills & Los Angeles
Kare Plastic Surgery & Skin Health Center is located at 804 7th Street, Santa Monica, CA 90403 — minutes from Beverly Hills, Brentwood, West Hollywood, and accessible from throughout Los Angeles. Patients seeking expert breast revision surgery, capsulectomy, and implant replacement from Beverly Hills, Bel Air, Pacific Palisades, Malibu, and the Westside choose Kare Plastic Surgery for Dr. Karamanoukian’s unique combination of academic surgical training, reconstructive expertise, and natural-result aesthetic philosophy.
Kare Plastic Surgery & Skin Health Center
Consultation Request
Schedule a consultation with Dr. Raffy Karamanoukian, a graduate of the UCLA School of Medicine and double board-certified plastic surgeon with two decades of experience in breast surgery, capsulectomy, implant revision, and complex breast reconstruction in Los Angeles.