Two distinct decisions, often confused
Patients researching breast implant removal sometimes assume the two main approaches — explantation only versus removal-and-replacement — are interchangeable. They are not. They involve different surgical decisions, different anaesthesia considerations, different recovery, and they suit different patient situations.
This article explains the difference, what Dr Konrat's practice covers, and what the consultation conversation focuses on.
What explantation only means
Explantation only is the removal of the breast implants without inserting new ones. The patient leaves with their own breast tissue, no implants, and (in some cases) a same-time breast lift if the skin envelope and breast position would benefit from repositioning.
Patients who choose explantation only typically have one of several reasons:
- Implants that have reached or exceeded their expected lifespan — usually 10 to 15 years for older silicone or saline implants, sometimes longer for newer-generation implants
- Capsular contracture — tightening of the scar-tissue capsule around the implant, sometimes causing firmness, distortion, or discomfort
- Implant rupture or leak — most commonly diagnosed at routine imaging
- Concerns about implant-associated illness — a contested clinical area where some patients have attributed symptoms to their implants; the conversation about evidence and individual presentation is part of consultation
- A decision that the implants are no longer wanted — for personal, lifestyle, or aesthetic reasons that have developed over time
- Concerns about specific implant types — certain textured implants have been associated with rare lymphoma (BIA-ALCL) and have been withdrawn in Australia
Dr Konrat's practice offers explantation without replacement as well as removal-and-replacement, also called implant exchange. The options involve different surgical planning and are discussed at consultation.
What removal-and-replacement involves
Removal-and-replacement (sometimes called implant exchange or implant revision) is the removal of the existing implants and the insertion of new ones in the same operation. Many of the implant decisions overlap with a first breast augmentation. It involves additional decisions:
- Selecting the new implant type, size, shape, and surface
- Planning the implant pocket (some patients have the implant moved from one anatomical position to another at the same time)
- Managing the capsule (similar considerations to explantation only)
- Anaesthesia considerations that account for the longer operation
- Recovery planning that accommodates the new implants
The replacement decision is discussed at consultation. Dr Konrat performs breast implant replacement and implant exchange, and explains how the planning, risks, recovery and costs differ from explantation without replacement.
Capsule management at explantation
When implants are removed, the question of what to do with the surrounding capsule arises. The capsule is the scar-tissue envelope that the body has formed around the implant. There are several approaches:
En bloc capsulectomy
The implant and capsule are removed as a single intact unit, without opening the capsule. This approach is often discussed for textured-implant patients (because of the historical BIA-ALCL association) and for patients who have specific concerns about capsule contents reaching the surrounding tissue.
En bloc is technically demanding because the capsule must be carefully dissected from the surrounding tissue without rupture. The incision needed is sometimes longer than for other approaches. Not every patient is a candidate for en bloc — the position of the implant, the capsule thickness, and the proximity to adjacent structures all affect whether it is appropriate.
Total capsulectomy
The entire capsule is removed, but not necessarily as a single intact unit with the implant. The capsule may be opened during removal but is fully excised by the end of the procedure. This is a common approach for patients who want capsule removal but for whom en bloc is not appropriate.
Partial capsulectomy
Part of the capsule is removed and part is left in place. Sometimes appropriate when the capsule is adherent to important adjacent structures and full removal would carry additional risk.
Capsule left in place
The implant is removed but the capsule is left intact. May be appropriate for patients with thin, non-contracted capsules and where there is no clinical indication for removal. The capsule typically settles down over time after the implant is removed.
The decision between these approaches is made at consultation based on the patient's history, the imaging findings (where relevant), and the patient's preferences after a full discussion of the considerations.
The same-time breast lift question
After explantation, the skin envelope is usually larger than the remaining breast tissue requires. This is normal — the skin has stretched to accommodate the implant over years.
Patients have three broad options:
- Explantation only, no lift — the breast tissue settles into the skin envelope over months. Some patients are happy with this result, particularly those with smaller implants, shorter implant history, or younger skin
- Explantation with a same-time breast lift (mastopexy) — the skin envelope is reduced and the nipple-areola complex is repositioned in the same operation. This adds to the operation length and produces additional scarring (typically a peri-areolar, vertical, or anchor scar pattern)
- Explantation now, lift later if needed — explantation alone, with the option of a delayed lift if the eventual result is not satisfactory after several months of settling
The conversation about the same-time lift happens at consultation. It is not a default add-on. Some patients arrive expecting a lift to be necessary and find that, given their anatomy and history, explantation alone is appropriate. Others arrive hoping to avoid a lift but discover that the skin envelope would benefit from one. The recommendation is made based on examination, not assumption.
What recovery looks like after explantation
Dr Konrat's written post-operative instructions for explantation set out the usual pattern:
First 2 days: Expect discomfort; the first night and the second or third day are usually the most uncomfortable. Rest for at least two days, getting up to move around every hour during the day. Sleep in your normal position; you do not need to sleep propped up.
From 48 hours: You can shower, taking the garment off to shower and putting it back on afterwards. No swimming, spa or bath for one month.
Week 1: Drains, if used, are removed and stitches are removed if required. You may be able to return to work about one week after surgery; for a job that involves strenuous activity, two weeks of light duties are recommended.
Week 2 onwards: In many cases, most normal activities, including some mild exercise, can resume after two weeks. Questions about exercise and housework are answered at your consultation and first post-operative visit. Bruising and swelling can take four weeks or more to resolve.
The months that follow: Healing varies between individuals, and it takes at least several weeks to get an accurate picture of the result. The 12-month explant recovery timeline explains how. Consented clinical photographs of breast appearance after explant surgery are in the breast implant removal gallery; results vary between individuals.
If a same-time breast lift is performed, the recovery is more involved, and the plan is discussed at consultation.
Risks specific to explantation
Beyond the general risks of surgery, explantation carries:
- Bleeding — uncommon but possible, particularly with extensive capsulectomy
- Infection — possible at the wound site
- Loss of breast volume — expected; sometimes more pronounced than the patient anticipates
- Changes in nipple sensation — temporary or longer-lasting
- Asymmetry — slight differences between sides are common after explantation, particularly if the capsules differed before removal
- Scarring — including the original implant scar (which may be reopened) and any additional incisions
- Fluid collection (seroma or haematoma) — sometimes requires drainage
- Need for further surgery — sometimes a lift is considered after initial settling
These are discussed in detail at consultation.
Key facts at a glance
- What this practice performs: explantation without replacement, with or without a same-time breast lift, and removal-and-replacement, also called implant exchange
- Anaesthesia: general anaesthesia
- Recovery: at least two days of rest; shower from 48 hours; return to work possible after about one week (two weeks of light duties for strenuous jobs); in many cases mild exercise after about two weeks; at least several weeks before the result can be judged (a lift adds to recovery)
- Who it suits: patients considering implant removal with or without replacement, with a GP referral and a sense of their implant history
- Rebates: no Medicare or private health insurance rebate at this practice
Notes from Practice
"The same-time lift question comes up at almost every explant consultation, and I treat it as a discussion, not a default add-on. Some patients arrive certain they need a lift and, given their skin and implant history, are fine with explant alone; others hoped to avoid one and find the skin envelope would benefit. I make the recommendation from examination, not assumption. I also explain the capsule options plainly, because patients often arrive having read about en bloc and assume it is always the right or possible choice." — Dr Georgina Konrat (MBBS, FACCSM)
Costs and Medicare
Medicare rebates and private health insurance rebates do not apply to procedures performed at Dr Konrat's practice. Explantation is generally classified as a cosmetic procedure, and no rebate is available.
For patients whose explantation is medically indicated (for example, in cases of confirmed implant rupture or capsular contracture causing significant clinical issues), there may be a different Medicare-funded pathway through a referral to another doctor. That pathway is separate from this practice and patients who want to explore it should discuss with their GP.
A personalised fee estimate is provided at the first consultation. Fees depend on the complexity of the capsulectomy, whether a same-time lift is included, and the facility used.
When the consultation is the right next step
The consultation is the right step when:
- You are considering breast implant removal with or without replacement
- You have a GP referral
- You have a sense of your implant history (when placed, what type, any complications)
- You have thought about whether you might also want a same-time lift, or are open to discussing it
If you are considering explantation in Sydney, the breast implant removal practice page outlines the consultation process and what information to bring on the day, including any implant cards or records you have from the original surgery.