Plastic Surgery: Breast Implant Removal

Home » PLASTIC SURGERY » BREAST IMPLANT REMOVAL

Kare Plastic Surgery & Skin Health Center  ·  Santa Monica + Beverly Hills

Breast Implant Removal
Explant Surgery Los Angeles

If you are seeking a plastic surgeon with exemplary experience in breast implant removal, our luxury plastic surgery office offers explantation options with capsulectomy, en bloc removal, breast lift, or fat transfer reconstruction. Dr. Karamanoukian is a graduate of the UCLA School of Medicine, a double board-certified plastic surgeon, and a Fellow of the American College of Surgeons. We treat Breast Implant Illness, ASIA, and Silicone Disease. 

Call (310) 998-5533 Book a Consultation
UCLAeducated Plastic Surgeon
FACSDouble Board-Certified
En BlocCapsulectomy Specialist
BIICompassionate Expert Care

 

Comprehensive Explant Surgery

 

Breast Implant Removal in Los Angeles
Safety, Precision & Compassionate Surgical Care

The decision to remove breast implants is often driven by a combination of health concerns, systemic symptoms, cosmetic changes to the breast, or a fundamental shift in body health. In some cases, autoimmune disease can impact your decision to keep your implants in place.  At Kare Plastic Surgery & Skin Health Center in Santa Monica, Dr. Raffy Karamanoukian approaches breast implant removal with forethought, surgical precision, and patient-centered empathy that this decision demands. If you are dealing with fibromyalgia, Sjogren's, Autoimmune disease, or foreign body reaction with ASIA or Breast Implant Illness, it may be time to remove your implants. 

As a board-certified plastic surgeon with over two decades of experience in breast augmentation, revision breast surgery, and breast implant replacement, Dr. Karamanoukian brings a complete surgical perspective to implant removal. He is experienced in all capsulectomy techniques including simple implant removal, partial capsulectomy, total capsulectomy, and true en bloc capsulectomy. He performs simultaneous mastopexy (breast lift), fat transfer reconstruction, or implant exchange when indicated, and submits all removed tissue — implant, capsule, and periimplant fluid — to independent pathology for comprehensive histologic, microbiologic, and PCR analysis.

Whether your implant removal is driven by breast implant illness symptoms, silicone rupture, capsular contracture, BIA-ALCL concern, or a personal decision to restore your natural body, Dr. Karamanoukian provides a consultation process that is honest, medically thorough, and free of the commercial bias toward any particular outcome. His commitment is to your health and your goals — not to whether the procedure involves implants or not.

Why Patients Choose Dr. Karamanoukian for Explant Surgery

  • Board-certified plastic surgeon with full breast surgery expertise
  • En bloc capsulectomy to remove breast implants
  • Total capsulectomy with complete periimplant capsule excision
  • Working partnerships with dermatopathologists
  • BII and ASIA syndrome — compassionate, scientifically informed care
  • Breast Lift options available at time of explant
  • Fat transfer breast Reconstruction Expertise
  • Implant exchange with or without capsulectomy
  • Ruptured silicone implant removal with soft tissue silicone management
  • BIA-ALCL evaluation and lymph node assessment when indicated
  • Complete implant removal without reconstruction for those who prefer natural
  • PPO insurance accepted for medically indicated indications

Surgeon Expertise

 

Dr. Raffy Karamanoukian: Expert in Breast Implant Removal & En Bloc Capsulectomy in Los Angeles

Dr. Raffy Karamanoukian, MD, FACS is a UCLA-educated, double board-certified plastic and reconstructive surgeon and Fellow of the American College of Surgeons with over twenty years of dedicated breast surgery experience. His expertise spans the complete spectrum of breast implant surgery — from primary augmentation to complex revision and comprehensive explantation — placing him among the most complete breast surgeons available to Los Angeles patients seeking implant removal.

His approach to explant surgery reflects a clinical philosophy built on three principles: surgical completeness, diagnostic rigor, and patient autonomy. Surgical completeness means that when a patient requires en bloc capsulectomy, the operation is performed with the true en bloc technique — maintaining the capsule boundary intact throughout the dissection, removing the implant and capsule as a unified specimen, and confirming by visual inspection that no breach of the capsule occurred during removal. This is technically more demanding than simple implant removal or even total capsulectomy, and requires the surgical skill and experience that a high-volume breast surgeon brings to the operation.

Diagnostic rigor means that removed tissue is not discarded. Every explant at Kare Plastic Surgery includes submission of the implant, capsule, and periimplant fluid to an independent pathology laboratory for histologic analysis, culture and sensitivity (microbiology), and PCR testing — the complete diagnostic workup that provides the definitive characterization of the tissue environment around the implant and establishes a documented medical record of the removal.

Patient autonomy means that Dr. Karamanoukian does not have a stake in whether a patient keeps or removes her implants. He provides the clinical information, surgical options, and honest assessment of expected outcomes that allow each patient to make a fully informed decision about her own body — and then executes that decision with the highest level of surgical craftsmanship available in Santa Monica.

“When a patient comes to me concerned about her implants — whether from physical symptoms, imaging findings, or a deeply felt sense that something is wrong — she deserves to be heard, evaluated thoroughly, and treated with the completeness her situation demands. Explant surgery is not a minor procedure. It is a significant surgical decision that deserves a surgeon’s full expertise and attention.”

— Dr. Raffy Karamanoukian, MD, FACS — Board-Certified Plastic Surgeon

Clinical Indications

 

Why Patients Seek Breast Implant Removal in Los Angeles

Breast implant removal is sought for a wide range of medical, symptomatic, and personal reasons. Dr. Karamanoukian evaluates each patient’s specific indication and tailors the surgical approach accordingly.

Breast Implant Illness 

Breast Implant Illness describes a constellation of systemic symptoms — chronic fatigue, brain fog, joint and muscle pain, hair loss, skin rashes, sleep disturbance, and autoimmune-like reactions — reported by patients with breast implants. While causation is still being formally established in peer-reviewed literature, the clinical evidence is compelling: a significant proportion of patients with BII symptoms experience substantial or complete resolution after en bloc or total capsulectomy. Dr. Karamanoukian treats BII patients with the same clinical seriousness he brings to any defined pathological condition, providing a comprehensive explant operation and full tissue analysis.

Autoimmune ASIA disease

ASIA syndrome — Autoimmune/Inflammatory Syndrome Induced by Adjuvants — is a recognized clinical entity defined by Professor Yehuda Shoenfeld describing immune system activation triggered by foreign substances including silicone. Patients with ASIA present with a spectrum of autoimmune symptoms that overlap significantly with BII: fatigue, myalgia, arthralgia, cognitive impairment, and dysautonomia. In silicone-implanted patients, the silicone polymer and its breakdown products are the hypothesized adjuvant. Removal of the implants and complete capsulectomy removes the implicated foreign material and may allow immune system normalization. Dr. Karamanoukian is knowledgeable about ASIA in the context of breast implants and coordinates with immunologists and rheumatologists when appropriate for complex ASIA presentations.

Silicone Implant Rupture

Silicone gel implant rupture — whether intracapsular (contained within the fibrous capsule) or extracapsular (with silicone migrating beyond the capsule into breast tissue or regional lymph nodes) — is a definitive indication for implant removal. Modern cohesive gel implants have lower rupture rates than older liquid silicone devices, but no silicone implant has an unlimited lifespan. Intracapsular rupture is often asymptomatic and detected by MRI (“linguine sign” on imaging). Extracapsular rupture may cause palpable silicone nodules, axillary adenopathy, and inflammatory symptoms. En bloc capsulectomy is the preferred surgical approach for ruptured silicone implants, minimizing the risk of silicone spread during removal. Dr. Karamanoukian has extensive experience managing both intracapsular and extracapsular silicone rupture, including management of free silicone in regional lymph nodes.

Capsular Contracture

Capsular contracture occurs when the fibrous scar capsule that naturally forms around any breast implant thickens, hardens, and contracts around the implant, distorting the breast shape and causing pain. It is the most common complication of breast augmentation, classified by the Baker grading system from Grade I (soft, natural) through Grade IV (hard, painful, severely distorted). For Grade III and IV capsular contracture, surgical intervention is required. Treatment options include capsulotomy (releasing the capsule without removing it), total capsulectomy (removing the capsule completely), or en bloc capsulectomy combined with implant removal or exchange. Dr. Karamanoukian selects the approach based on the Baker grade, the implant status, and whether the patient wishes to retain or remove her implants.

BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma)

BIA-ALCL is a rare but serious T-cell lymphoma associated specifically with textured-surface breast implants. It typically presents as a late-onset seroma (fluid accumulation) around the implant, capsule thickening, or a palpable mass. When diagnosed early and confined to the capsule, BIA-ALCL is treated with en bloc capsulectomy and has an excellent prognosis without chemotherapy. Advanced or extracapsular disease requires oncologic management. Dr. Karamanoukian evaluates patients with late seroma or breast mass in the context of implant history for BIA-ALCL, sends periimplant fluid for cytology and CD30 staining, and coordinates with oncologic colleagues when BIA-ALCL is confirmed. All patients with textured implants seeking removal receive counseling about BIA-ALCL risk at their consultation.

Implant Malposition, Rippling & Aesthetic Failure

Many patients seek implant removal for aesthetic rather than medical reasons: implant malposition (the implant has shifted from its original pocket), visible rippling or edge palpability, size dissatisfaction, double-bubble deformity, or simply a change in personal aesthetic goals. After years of living with implants, many women prefer to return to a natural appearance — a decision that is entirely valid and deserving of the same surgical thoroughness as medically driven explantation. For these patients, Dr. Karamanoukian offers implant removal with or without simultaneous mastopexy or fat transfer, designing the most aesthetically pleasing result achievable with the native breast tissue available.

Capsulectomy Techniques

 

Choosing the Right Approach for Capsulectomy and Explant

Not all breast implant removals are identical — and the choice of surgical technique has significant implications for patient safety, completeness of removal, and the risk of leaving behind biological material that could perpetuate symptoms. Dr. Karamanoukian discusses each technique’s indications, advantages, and limitations with every patient before surgery.

Technique What Is Removed Capsule Integrity Primary Indication Complexity
Simple Implant Removal Implant only; capsule left in place Capsule opened Asymptomatic patients with no capsule pathology; early exchange Lower
Capsulotomy Implant remains; capsule released (not removed) Capsule scored/released Early capsular contracture (Baker III) with implant retention Lower
Partial Capsulectomy Implant + partial capsule removal Partially breached Capsular contracture where complete removal technically difficult Moderate
Total Capsulectomy Implant + entire capsule (removed separately) May be partially breached BII, capsular contracture Grade III–IV, calcified capsule Moderate–High
En Bloc Capsulectomy Implant + entire capsule as single intact unit Completely intact — never breached Silicone rupture, BII/ASIA, BIA-ALCL, maximum removal completeness Highest

True en bloc capsulectomy — in which the capsule is removed without any breach of its boundary — is technically feasible in most patients with intact, thick capsules. In patients with very thin, calcified, or posteriorly adherent capsules (particularly when the posterior capsule is adherent to the pectoralis muscle or the chest wall ribs), complete en bloc removal may not be achievable without unacceptable risk of injury to underlying structures. Dr. Karamanoukian will discuss the feasibility of en bloc removal for your specific anatomy at consultation and will convert to total capsulectomy if en bloc cannot be safely maintained during surgery. He will not compromise patient safety to achieve a technically perfect en bloc specimen.

Reconstruction After Explant

 

Your Options After Breast Implant Removal

After breast implant removal, the breast may have varying degrees of ptosis (sagging), volume loss, and skin excess depending on the size of the removed implants, the duration of implantation, and the quality of native breast tissue. Dr. Karamanoukian offers the complete range of reconstructive options.

01

Complete Removal Without Reconstruction

Many patients choose to remove their implants without any form of reconstruction — embracing their natural breast appearance after implant removal. This is a completely valid choice, particularly for patients whose health is the primary motivation for explantation and who wish to remove all foreign material from their bodies. The native breast tissue that remains after implant removal will contract and remodel over 3–6 months. The degree of ptosis and volume after simple removal depends on the native breast tissue volume, skin quality, implant size, and duration of implantation. Dr. Karamanoukian prepares every patient for a realistic expectation of their post-explant appearance before surgery, using photographs and physical examination to project the likely natural result.

Best For: Patients prioritizing health above aesthetics; those with adequate native breast tissue; BII/ASIA patients who want complete removal of all foreign material; patients with small pre-augmentation breast size who have adapted to a natural appearance
02

Breast Implant Removal with Mastopexy (Breast Lift)

Simultaneous mastopexy at the time of explantation is one of the most commonly performed and most satisfying combined procedures in breast surgery. When implants are removed — particularly large implants that have been in place for many years — the breast skin envelope is stretched and the nipple-areola complex is typically displaced downward, creating significant ptosis. Without a concurrent lift, the deflated, ptotic appearance that results from large-implant removal can be deeply distressing. Mastopexy performed simultaneously with explantation reshapes and elevates the native breast tissue, repositions the nipple to a youthful location, and removes the excess skin envelope — creating a natural, lifted, and aesthetically pleasing breast shape without any foreign material.

Dr. Karamanoukian performs periareolar, vertical (lollipop), or anchor mastopexy simultaneously with en bloc or total capsulectomy, selecting the technique based on the degree of ptosis and the amount of skin excision required. His reconstructive breast surgery background ensures that the mastopexy tissue management and the capsulectomy are planned as an integrated operation rather than two separate procedures combined.

Best For: Patients with significant breast ptosis after large implant removal; those with adequate native breast tissue to support a pleasing post-lift shape; post-pregnancy or post-weight-loss patients; BII patients who wish an aesthetically complete result
03

Breast Implant Removal with Fat Transfer Reconstruction

Autologous fat transfer — harvesting the patient’s own fat by liposuction, processing it, and injecting it into the breast — is an increasingly popular option for patients who want to restore modest breast volume after implant removal without returning to synthetic implants. Fat transfer reconstruction eliminates the foreign body completely while providing natural-feeling, natural-appearing volume using tissue the patient already has. The transferred fat integrates with the native breast tissue and is typically long-lasting once graft survival is established — usually 60–70% of transferred volume survives permanently.

Fat transfer reconstruction is best suited for patients who have donor site fat available (typically the abdomen, flanks, or thighs), who are seeking a modest volume enhancement rather than a large cup-size increase, and who do not have significant active breast pathology that would contraindicate fat grafting near the breast parenchyma. It is frequently combined with simultaneous mastopexy for patients with both ptosis and volume deficit after implant removal. All fat transfer at Kare Plastic Surgery uses the BRAVA-assisted or standard structural fat grafting technique for maximum graft viability.

Best For: Patients who want some volume restoration without new implants; those with adequate donor fat; combined with mastopexy for comprehensive natural reconstruction; BII patients who want implant-free volume restoration
04

Breast Implant Removal with New Implant Placement

Some patients seek implant removal not because they want to be implant-free, but because their current implants have a specific problem — rupture, capsular contracture, malposition, size dissatisfaction, or implant generation obsolescence — and they wish to have the problem corrected with new, modern implants. Implant exchange with capsulectomy offers a comprehensive solution: removing the problematic implants and their associated capsule, and placing new implants in a fresh, clean pocket. Depending on the indication, this may involve a pocket change (moving from subglandular to dual-plane or vice versa), a size change, or a transition from textured to smooth implant surface.

For patients with capsular contracture, Dr. Karamanoukian performs total capsulectomy to remove the contracture-associated capsule before placing new implants — significantly reducing the risk of recurrent contracture compared to implant exchange without capsulectomy. He also performs simultaneous mastopexy with implant exchange when the breast position requires correction alongside volume restoration.

Best For: Ruptured implant replacement; capsular contracture correction with new implants; size change or style upgrade; transition from textured to smooth; aesthetic revision with implant exchange
05

Capsular Contracture

In early or mild capsular contracture (Baker Grade II–III) where the patient wishes to retain her implants, capsulotomy — surgical release of the contracted capsule without removing it — may provide relief of the firmness and discomfort without the complexity of full capsulectomy. Internal capsulotomy involves scoring the contracted capsule radially to break its tension and allow the implant to re-expand. While capsulotomy carries a higher recurrence risk than capsulectomy (the capsule remains and may re-contract), it is appropriate in specific clinical circumstances where the degree of contracture does not yet warrant complete capsule removal and the patient strongly prefers implant retention.

Dr. Karamanoukian counsels capsulotomy patients about recurrence risk and the possibility of progression to total capsulectomy with implant exchange if contracture recurs after capsulotomy. He does not perform external (closed) capsulotomy, a historical technique of manually squeezing the breast to rupture the capsule that has been abandoned due to its high complication rate including implant rupture.

Best For: Baker Grade II–III capsular contracture with implant retention desired; first-line surgical management of early contracture; patients who are not candidates for full capsulectomy for medical reasons
06

En Bloc Capsulectomy 

For patients with BII, ASIA, silicone rupture, suspected BIA-ALCL, or those who simply want the most complete and thoroughly documented removal of all implant-associated material, en bloc capsulectomy with comprehensive tissue analysis is the definitive surgical option. The removed en bloc specimen — implant, capsule, and periimplant fluid preserved together — is submitted to an independent laboratory for histopathology (tissue architecture), immunohistochemistry (CD30 and ALK-1 staining for BIA-ALCL), microbiology cultures and sensitivity, PCR for biofilm detection, and silicone particle analysis when indicated.

This comprehensive pathologic workup provides both a definitive diagnosis of any capsule pathology and a documented medical record of the tissue environment at the time of removal — information that is valuable for the patient’s long-term health management and provides the data that physicians coordinating her post-explant care need to understand the clinical picture. Tissue analysis results are reviewed with each patient personally by Dr. Karamanoukian at a follow-up appointment after surgery.

Best For: All BII and ASIA patients; ruptured silicone implants; suspected BIA-ALCL; patients who want maximum removal completeness and comprehensive tissue documentation

Who We Treat

 

Who Should Seek Breast Implant Removal in Los Angeles?

✓   Patients Who Benefit from Consultation with Dr. Karamanoukian for Explant Surgery

  • Women experiencing systemic symptoms they believe are related to their breast implants — including chronic fatigue, brain fog, joint pain, hair loss, skin rashes, sleep disturbance, or autoimmune-like reactions — who have been diagnosed with or suspect Breast Implant Illness (BII) and want a comprehensive explant evaluation with a surgeon experienced in en bloc capsulectomy
  • Patients with known or suspected silicone implant rupture on MRI or ultrasound — whether intracapsular or extracapsular — who need consultation about en bloc removal, silicone management, and options for reconstruction after the ruptured implant is removed
  • Women with capsular contracture (Baker Grade III or IV) causing breast hardness, distortion, or pain, who have not responded to non-surgical management and require evaluation for surgical correction by capsulotomy, total capsulectomy, or en bloc capsulectomy with or without implant exchange
  • Patients who have received a diagnosis of BIA-ALCL or who have been evaluated for BIA-ALCL due to late periprosthetic seroma, breast mass, or lymphadenopathy in the setting of textured implants — requiring en bloc capsulectomy coordinated with oncologic care
  • Women with textured-surface implants who have concerns about BIA-ALCL risk and wish to discuss implant removal prophylactically before any symptoms develop — Dr. Karamanoukian provides a balanced, evidence-based discussion of individual risk and options
  • Patients who have had multiple capsular contracture episodes and are seeking definitive management that prevents recurrence — including total capsulectomy with pocket change and new implant placement using the most current smooth-surface implant technology
  • Women who have decided to remove their implants for personal, lifestyle, or aesthetic reasons — wanting to return to a natural appearance — and who need a surgeon who can perform the explantation with or without simultaneous mastopexy or fat transfer reconstruction
  • Post-pregnancy or post-weight-loss patients whose implants were placed years ago and whose breast anatomy has changed significantly — with ptosis, changes in implant position, or aesthetic concerns that require revision or explantation with concurrent reshaping
  • Patients who have had implant removal at another facility and are dissatisfied with the aesthetic result — whether due to excessive ptosis, asymmetry, or insufficient skin redraping — seeking revision mastopexy or fat transfer reconstruction
  • Women with saline or silicone implants of any generation who simply have concerns about their implants and want a consultation with a board-certified plastic surgeon who will provide honest, unbiased information about their options without commercial pressure toward any particular choice

On BIA-ALCL awareness: Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare but serious condition linked to textured-surface breast implants. The most common presentation is a late-onset seroma (fluid accumulation) around the implant, typically developing more than 1 year after implantation. Any patient with textured implants who develops new-onset breast swelling, fluid accumulation, breast mass, or axillary lymph node enlargement should seek urgent evaluation. Dr. Karamanoukian evaluates these patients with periimplant fluid cytology (CD30 immunostaining), imaging, and coordination with oncologic colleagues when BIA-ALCL is suspected. Early-stage BIA-ALCL confined to the capsule is curable with en bloc capsulectomy alone in most cases.

Your Surgical Experience

 

The Breast Implant Removal Process at Kare Plastic Surgery

 

Comprehensive Consultation & Surgical Planning

Dr. Karamanoukian reviews your complete implant history — implant type, generation, surface texture, size, fill material, placement date, and any prior revision procedures. He performs a thorough breast examination, evaluates the Baker grade if contracture is present, assesses the degree of ptosis and native breast tissue available for reconstruction, and reviews any relevant imaging (MRI, ultrasound). He discusses each surgical option with the clinical context for his recommendation and allows sufficient time to answer all questions. You leave the consultation with a clear surgical plan and realistic expectations for your post-explant appearance.

 

Pre-Operative Evaluation & Preparation

Pre-operative blood work, medical clearance, and breast imaging (when indicated) are arranged. Patients are advised to stop blood-thinning medications and supplements for one week before surgery. Smoking cessation for a minimum of four weeks before and after surgery is required. For patients with BII or ASIA symptoms, coordination with their internist, rheumatologist, or immunologist is offered to establish pre-operative baseline labs and post-operative follow-up planning. Insurance pre-authorization documentation is prepared for patients seeking PPO coverage for medically indicated procedures.

 

Surgery Under General Anesthesia

Breast implant removal with capsulectomy is performed under general anesthesia at Kare Plastic Surgery’s accredited Santa Monica surgical facility. Incisions are placed within or adjacent to the original augmentation scar whenever possible, minimizing the addition of new incision lines. The explant technique (en bloc, total, or partial capsulectomy) is executed as planned, with the surgeon confirming at each stage that the capsule boundary is being maintained intact for en bloc cases. When simultaneous mastopexy or fat transfer is performed, these steps follow capsulectomy completion. Drains may be placed for large capsulectomy specimens; most mastopexy-combined cases do not require drainage.

 

Tissue Submission & Pathology Analysis

The explant specimen — implant, capsule, and periimplant fluid — is labeled and submitted to an independent pathology laboratory immediately after removal. The standard tissue analysis protocol at Kare includes histopathology with hematoxylin and eosin staining, CD30 and ALK-1 immunohistochemistry for BIA-ALCL screening, aerobic and anaerobic microbiology cultures, biofilm PCR, and silicone particle quantification when indicated by the clinical presentation. Results are communicated to the patient within 1–2 weeks at a follow-up appointment with Dr. Karamanoukian.

 

Recovery & Post-Operative Care

Most patients take 1–2 weeks away from desk work after explant surgery, with longer recovery for combined mastopexy procedures. A surgical support bra is worn for 4–6 weeks. Strenuous exercise and heavy lifting are restricted for 4–6 weeks. Drains, if placed, are removed at 1–2 weeks based on daily output. BII and ASIA patients are advised that systemic symptom improvement typically occurs gradually over weeks to months after surgery as the immune system normalizes following removal of the implant material. Post-operative visits are scheduled at 1 week, 4–6 weeks, 3 months, and 6 months to monitor healing, review pathology results, and track symptom resolution.

2–4 hrsTypical duration for en bloc capsulectomy + mastopexy
GeneralAnesthesia for all capsulectomy procedures
1–2 wksReturn to desk work post-explant
100%Tissue submitted to pathology at Kare Plastic Surgery

Common Questions

 

Frequently Asked Questions About Breast Implant Removal in Los Angeles

What is the difference between en bloc and total capsulectomy?

En bloc capsulectomy removes the breast implant and its entire surrounding capsule as a single, intact, never-breached unit — the capsule boundary is maintained throughout the entire dissection and the specimen exits the body with the implant sealed inside. Total capsulectomy removes the implant and capsule completely, but the capsule may be opened (breached) during removal, allowing the implant to be extracted separately before the capsule is removed. En bloc provides the highest level of containment of implant material; total capsulectomy achieves complete capsule removal with slightly less strict containment requirements. For ruptured silicone implants and BIA-ALCL, the true en bloc technique is preferred. For BII without rupture, total capsulectomy achieves the same therapeutic goal in most cases.

Will my breast implant illness symptoms improve after removal?

Many patients with Breast Implant Illness report significant improvement or complete resolution of systemic symptoms following en bloc or total capsulectomy. Published patient-reported outcomes data — including a 2020 survey of over 750 BII patients — showed that 89% reported improvement in symptoms after explantation, with fatigue, brain fog, and joint pain among the most commonly improved complaints. The improvement is typically gradual, occurring over weeks to months as the immune system normalizes following removal of the implant and capsule. Dr. Karamanoukian does not guarantee symptom resolution, but he provides the most complete surgical removal available to maximize the probability of improvement for his BII patients.

What will my breasts look like after implant removal?

The post-explant appearance depends on the size of the removed implants, the duration of implantation, the native breast tissue volume, and the skin elasticity at the time of removal. Patients with smaller implants and good skin elasticity often heal to a natural, modestly deflated appearance that resolves toward a natural contour over 3–6 months. Patients with large implants, long implant duration, or poor skin elasticity typically experience significant ptosis (sagging) and skin excess. For the latter group, simultaneous mastopexy is recommended and produces a dramatically more aesthetically pleasing result than simple removal alone. Dr. Karamanoukian uses clinical examination and photographs at consultation to project the expected appearance after removal with and without concurrent mastopexy.

Is en bloc capsulectomy always possible?

True en bloc capsulectomy — in which the capsule is removed without any breach — is achievable in most patients with intact, thick capsules but may not be technically feasible in all cases. The posterior capsule, which lies against the pectoralis muscle or the chest wall, can be very thin and densely adherent to underlying structures in some patients — particularly those with long implant duration, calcified capsules, or prior radiation. When maintaining capsule integrity would require excessive dissection risking injury to the chest wall or pectoral muscle, Dr. Karamanoukian converts to total capsulectomy, which removes the entire capsule completely (just not as a single unit). He will discuss the feasibility of en bloc removal for your specific anatomy at consultation based on imaging and examination findings.

Can I have a breast lift at the same time as implant removal?

Yes — simultaneous mastopexy with explantation is one of the most commonly performed and most clinically appropriate combined procedures in breast surgery. Performing the lift at the same operation eliminates the need for a second procedure and recovery, allows the surgeon to design the mastopexy skin excision pattern in the context of the explant access incision, and achieves a more complete aesthetic outcome than sequential procedures. Dr. Karamanoukian performs periareolar, vertical, or anchor mastopexy simultaneously with en bloc or total capsulectomy as an integrated single procedure. The specific mastopexy technique is selected based on the degree of ptosis and the amount of skin to be excised.

How do I know if my silicone implant has ruptured?

Silicone implant rupture is frequently asymptomatic — meaning patients may have no awareness of it, particularly with intracapsular rupture where the silicone is contained within the fibrous capsule. MRI with and without gadolinium is the most sensitive imaging modality for detecting silicone implant rupture (the “linguine sign” on MRI indicates the collapsed shell floating within the retained silicone). Ultrasound can detect rupture but with lower sensitivity. The FDA previously recommended surveillance MRI beginning 3 years after silicone implant placement and every 2 years thereafter, though this recommendation has evolved. Extracapsular rupture may be suspected clinically when new breast firmness, shape change, palpable nodules, or axillary lymph node swelling develop. Any patient with silicone implants and new breast changes should seek evaluation.

Is breast implant removal covered by insurance in Los Angeles?

Many PPO insurance plans provide coverage for breast implant removal when the indication is medical — including documented implant rupture, capsular contracture causing pain or functional symptoms, BIA-ALCL, or infection. Coverage for BII-motivated removal is more variable and requires documented clinical presentation. Our office assists patients with insurance verification, pre-authorization documentation, and clinical letter preparation for coverage requests. Cosmetically motivated removal — where the indication is aesthetic preference rather than medical necessity — is typically self-pay. Simultaneous mastopexy performed at the time of medically indicated explant may or may not be covered, depending on the specific plan and the documented clinical necessity.

How soon after implant removal can I have fat transfer to restore volume?

Simultaneous fat transfer at the time of explantation is technically feasible and performed by Dr. Karamanoukian in appropriately selected patients. However, some surgeons prefer to perform fat transfer as a staged procedure 3–6 months after explantation, allowing the breast tissue to normalize and the post-explant contraction to complete before placing fat. The staged approach provides a more accurate view of the final post-explant volume deficit and allows more precise planning of the fat grafting volume. Dr. Karamanoukian discusses both approaches at consultation and recommends based on the degree of expected post-explant deflation, the available donor fat volume, and the patient’s preference for simultaneous versus staged reconstruction.

Schedule Your Breast Implant Removal Consultation in Los Angeles

Whether you are living with symptoms you believe are related to your implants, managing a complication, or simply ready to return to your natural body, Dr. Karamanoukian at Kare Plastic Surgery in Santa Monica provides the surgical expertise, diagnostic thoroughness, and compassionate care your decision deserves. Contact our office today.

(310) 998-5533 Request a Consultation

Kare Plastic Surgery & Skin Health Center  ·  804 7th Street, Santa Monica, CA 90403  ·  (310) 998-5533

Dr. Raffy Karamanoukian, MD, FACS — Double Board-Certified Plastic Surgeon  ·  UCLA-Trained  ·  En Bloc Capsulectomy Specialist  ·  RealSelf 100  ·  PPO Insurance Accepted