Removal is a specialty. Not a formality.
Breast implant removal has grown from a footnote in a broader revision practice into a specialty category of its own. There are now entire plastic surgery practices devoted almost exclusively to explant surgery and en bloc capsulectomy. That growth reflects real patient demand: women who have decided to remove their implants for symptoms they attribute to their implants, for capsular contracture, for the desire to age without them, or simply because they are done with implants and want them out.
Those patients often report frustrating experiences seeking care — surgeons who argue with the decision, minimize the concerns, or lack the technical experience to execute the specific technique the patient wants (particularly true en bloc capsulectomy).
NCSS is not one of those places.
At NCSS, Drs. Toohey, Nichter, and Bernett perform this procedure often — and the approach here is straightforward: respect the decision, execute the operation well, and provide honest information about what is known and unknown medically. The technical choices matter. So does the surgeon's willingness to perform the specific technique the patient has researched and requested. Both are treated as the point — not as inconveniences to be talked around.
Who this procedure is designed for.
Explant is appropriate for a wide range of patients and reasons. No justification is required beyond the decision itself.
Symptoms attributed to implants (Breast Implant Illness)
A constellation of systemic symptoms — fatigue, brain fog, joint pain, skin issues, hormonal irregularities, anxiety — that some patients report improving substantially after explantation. The medical evidence around Breast Implant Illness continues to evolve; the ASPS has acknowledged the reports without yet defining a formal diagnostic category. What we tell patients is honest: if you want your implants removed, we will help you do that. We will not argue with your decision or attempt to minimize what you are experiencing.
Capsular contracture
Firm, painful, or distorted scar capsule tightening around the implant. Baker grade III or IV typically indicates surgical intervention, and explant with capsulectomy is one appropriate response (implant exchange with capsulectomy is another; the choice is yours).
Textured implant recall / BIA-ALCL concerns
Allergan's Biocell textured implants were recalled globally in 2019 following the association with breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) — a rare but serious lymphoma. Patients with these implants often want them removed even without symptoms. BIA-ALCL is distinct from Breast Implant Illness; if diagnosed, en bloc capsulectomy is the standard of care.
Aging with implants
Breasts continue to age around implants. Some patients reach a point where they no longer want implants that suited them 15 or 20 years ago. Explant with mastopexy is a common combined procedure at this stage.
Rupture or leak (silicone or saline)
Confirmed by imaging (silicone) or visible deflation (saline). Removal is indicated; whether to replace or explant permanently is a separate decision.
Simply done with implants
A legitimate reason on its own. No further justification required.
Preparation for other reasons
Medical reasons (planned imaging that would be complicated by implants, upcoming treatments), lifestyle changes, personal preference evolution.
Realistic expectations about outcome after removal
Breast tissue changes after years with implants. The breast will not return to its pre-augmentation appearance. Depending on your anatomy and how long the implants were in place, you may want to consider mastopexy (lift) or fat transfer at the time of explant.
Smoking status matters — and approach varies by surgeon
Every surgeon at NCSS strongly recommends smoking cessation for at least 4–6 weeks pre-operatively. Some of our surgeons, Dr. Nichter among them, will not perform surgery on patients who continue to smoke. Others will proceed with candid discussion of the elevated risks.
Every scheduled surgical patient is offered a free Rest-Assure pre-operative consultation with Dr. Rand Scott personally — medical history, medication planning, and discharge coordination before surgery day.
Three stages, one procedure.
Several distinct technical approaches exist for implant removal, and the choice matters. Patients who have researched their options often arrive with a specific technique preference; we respect that.
En bloc capsulectomy
The implant and its surrounding scar capsule are removed together, in a single unit, with the capsule kept intact throughout removal. Nothing from inside the capsule — including any silicone that may have escaped a ruptured implant — is released into the surgical field. Some patients specifically request this technique; some clinical situations (confirmed BIA-ALCL, silicone rupture with concerns) specifically indicate it. It is technically more demanding than other techniques and takes longer to perform. Our surgeons who list explant as a frequent part of their practice are experienced with true en bloc.
Total intact capsulectomy
The entire capsule is removed, but the implant is removed first and the capsule follows. Achieves complete capsule removal without the technical constraints of keeping the implant enclosed throughout. For patients whose primary goal is complete capsule removal (rather than the specific en bloc technique), this is often the appropriate approach.
Partial capsulectomy
Only the abnormal or symptomatic portions of the capsule are removed. Appropriate in specific clinical circumstances; not appropriate when the patient has requested complete removal.
Capsulotomy without capsulectomy
The capsule is scored or released but not removed. Rarely appropriate for explant patients; primarily used for specific implant exchange scenarios.
Reconstruction options at time of explant
Several choices — discussed in consultation and decided together: flat closure (removal only, no volume restoration; the breast heals as it will), mastopexy (lift) (repositioning the breast tissue and skin envelope after removal for a lifted, natural appearance), fat transfer (autologous fat placed at the time of removal or in a staged second session to restore volume biologically without a new implant), or, less commonly, replacement with a new implant (if the patient decides during the process that a smaller or different implant is what they actually want).
Pathology of the capsule
Standard practice at NCSS: the capsule is sent to pathology for analysis. Results are shared honestly with the patient regardless of what is found.
Drains
Sometimes used, particularly for extensive capsulectomy or combined procedures. Removed when output diminishes below a threshold value.
Explant procedures are often longer than primary augmentation; the sustained physician-anesthesia standard matters more for these cases, not less.
Two sites. One recovery.
Recovery from explant is often better-tolerated than patients expect — removing an implant is generally less painful than placing one. When combined with mastopexy or fat transfer, the recovery follows the additional procedure's timeline.
Discharged the day of surgery with your dedicated nurse. Surgical bra worn continuously. Multimodal pain protocol. Drains occasionally used for extensive capsulectomy or combined cases.
Restricted arm movement (particularly overhead reaching). Most patients return to desk work at day 5–7. Emotional response is often significant — both relief and a period of adjustment to the new appearance. This is normal.
Progressive return to normal activity. Surgical bra continues. Drains removed when output diminishes. Sutures typically removed at 10–14 days.
Return to full exercise once your surgeon confirms complete healing. Combined procedures (mastopexy, fat transfer) may extend this timeline slightly.
Final result becomes apparent as swelling fully resolves and tissue settles. Fat transfer results settle at three months. Mastopexy scars are pink and prominent at this stage but will fade substantially over the next year.
Many patients report symptom improvement in the weeks to months following explantation. Timelines vary substantially between patients. We track your experience honestly — whether symptoms improve dramatically, modestly, or not at all.
Results are durable. Aging continues normally without implants in place. Some patients pursue a staged second session (typically fat transfer) if additional volume restoration becomes desired later.
Every Breast Implant Removal patient at NCSS is covered by our Rest-Assure program: physician anesthesia on the day of surgery, one nurse from arrival through discharge, and post-operative direct access to your surgeon — not an answering service.
Three surgeons. Removal expertise.
Explant is a specialty. These three affiliated surgeons perform it often as part of their broader practices — and each is experienced with true en bloc technique.
Dr. Toohey
Explant · Frequent PracticeAll-UC training; three decades of breast work; substantial explant and capsulectomy practice as part of his broader breast focus.
View surgeon →Dr. Nichter
Explant · Frequent PracticeTriple-boarded; four decades in Newport Beach; substantial explant practice as part of full breast continuum.
View surgeon →Dr. Bernett
Female Surgeon · Frequent PracticeUC Irvine trained; female surgeon offering substantial explant practice; fluent Spanish and Italian.
View surgeon →The right starting point is a conversation.
Every consultation at NCSS begins with time — time to understand your goals, your health history, and which of our affiliated surgeons is the right fit for your specific situation.
Call (949) 644-8182Monday–Thursday, 8am–3pm · Friday by appointment only.
Related procedures.
Breast Revision
The broader category of revising prior breast work — implant exchange, size change, and other modifications short of removal.
Learn more →Fat Transfer to Breast
Volume restoration using your own tissue — frequently combined with explant to restore breast volume biologically without a new implant.
Learn more →Breast Implant Removal & Replacement
The exchange pathway — when you want the old implants out but new ones in. One of our most commonly performed procedures.
Learn more →