Explant Surgery (Silicone Implant Removal) in Uberlândia, Brazil

These are the situations in which something about the implant or the breast calls for removal, regardless of what the patient would prefer aesthetically. The main ones are capsular contracture, when the capsule the body forms around the implant hardens and begins to cause pain or distort the breast; rupture; infection or implant exposure, which usually calls for more urgent management; malposition, when the implant shifts, rotates or settles outside the planned pocket; and the investigation of a late finding, chiefly swelling of one breast months or years after surgery. Each has its own management, and not all end in definitive removal — some are resolved with an exchange.

Every implant is enclosed by a capsule of tissue the body itself forms around it. That is expected and happens with any implant. Contracture is when this capsule thickens and tightens around the implant: the breast hardens, may ride higher, change shape and hurt. The usual classification is Baker I to IV — grades I and II are generally monitored, while grades III and IV, where there is visible deformity or pain, are the ones that most often lead to a surgical indication. Management may be capsule removal with implant exchange, or definitive removal, decided case by case.

Breast implant-associated anaplastic large cell lymphoma is a rare disease and needs to be understood for what it is: it is not breast cancer — it is a lymphoma arising in the tissue surrounding the implant. It is associated chiefly with textured-surface implants. The most frequent sign is a late seroma: swelling of one breast, months or years after surgery, with no trauma to explain it. In Brazil, Anvisa issued its first technovigilance alert on the suspected association in 2011, ordered a precautionary suspension of textured implants in 2018 and revoked that suspension in 2019, in line with other international agencies. What this means in practice: it is rare, it does not justify removing an implant that is doing well, and any late increase in volume in a single breast warrants assessment — most of the time it is not this, but it is the finding that gets investigated.

It is removal of the implant together with the entire capsule, without opening the capsule during surgery — the whole thing comes out closed. It is the established approach when there is suspicion or diagnosis of BIA-ALCL, where keeping the contents contained is part of treatment. Outside that indication, en bloc has become widely requested on the basis of information circulating outside the consulting room, and it is worth knowing what it costs: it requires wider dissection, increases operating time and, depending on where the capsule is adherent, brings the dissection closer to the chest wall. With a thin capsule it is not always technically possible to remove it in one piece. Dr. Lorena performs en bloc removal when the case calls for it; what the consultation establishes is whether yours does — a conversation about the findings, not about the name of the technique.

The usual order of magnitude: relative rest in the first days, with restriction of arm effort and lifting for some weeks; a surgical bra or compression band for the period set by the team; return to desk work at around one to two weeks, according to the extent of surgery; and physical activity resumed progressively, with upper-limb exercise last. Initial swelling subsides over the first weeks, but the contour keeps changing for months, because the skin is settling to a smaller volume. Those who combined mastopexy follow timelines closer to that operation. Time off is defined according to your actual job, so it is worth describing at the consultation what your days involve.

They are the risks of any operation under general anaesthesia — anaesthetic risks, bleeding, infection and thromboembolic events, whose prevention is part of the protocol — plus those specific to this surgery: seroma, fluid collecting in the space the implant occupied, which is the most frequent occurrence, particularly after wide capsulectomy; haematoma; altered sensation of the breast and nipple, usually transient; contour irregularity and asymmetry; and, when dissection approaches the chest wall in extensive capsulectomies, the rare risk of pleural injury. The likelihood of each varies with what is done — another reason why the extent of capsulectomy is not a decision to take as a generic precaution.

Yes, and it is a frequent path for those who want less volume without giving up having an implant. Exchanging for a smaller volume has one feature that must be stated beforehand: the skin and capsule accommodated the old volume, and a smaller implant in the same pocket tends to leave skin excess and loss of upper-pole projection. For that reason, downsizing is often planned alongside an adjustment — capsulorrhaphy, to reduce the pocket, or mastopexy, to redistribute the skin. Swapping only the implant for a smaller one, without accounting for this, is commonly the reason for later dissatisfaction.

In some cases yes, and in others it is safer to stage it. Doing everything in one go has the obvious advantage of a single anaesthetic and a single recovery. The caveat is technical: removing the implant and lifting the breast in the same operation means working on tissue whose final settling has not yet happened, and the lift is planned on a shape that is still going to change. In breasts with very redundant skin or a history of significant contracture, the two-stage approach — remove first, reassess after some months, then reposition — tends to give a more predictable result. Dr. Lorena performs both — explant with mastopexy in the same operation, and the two-stage approach. Which applies to you is defined at assessment, and it is a decision about predictability, not preference.

Explant surgery is performed under general anaesthesia, in a hospital setting, with an anaesthesiology team. The need for admission follows the scale of what is done: isolated removal, without extensive capsulectomy, usually allows same-day discharge; when there is wide capsulectomy, exchange, a drain or a combined mastopexy, the usual approach is to stay at least one night. As with every surgery, whether same-day discharge or admission applies is assessed case by case at the pre-operative consultation.

The reports exist and are taken seriously in consultation. They are grouped under the name breast implant illness and most often include fatigue, joint or muscle pain, difficulty concentrating, hair loss and mood changes. It is important to be exact about what is known: it is not a formal diagnosis — there are no established diagnostic criteria, no test that confirms or excludes it, and causation has not been demonstrated. What is official is the acknowledgement that the reports exist: since 2021, implant labelling in the United States carries a boxed warning and a patient decision checklist stating that some patients report systemic symptoms, that these can occur with any implant type, and that some report improvement after removal — without all of them improving. The approach is neither to dismiss the complaint nor to promise that removal resolves it. Before operating, other explanations for the symptoms are investigated, because attributing everything to the implant can delay another diagnosis.

It depends on what is done. With isolated removal and little dissection, generally not. When there is wide capsulectomy, the dissected area is larger and so is fluid production — in those cases a drain may be used for a few days to reduce the chance of seroma. When used, it is usually removed at the first follow-up visits, in the office, and it does not prevent discharge.

Most of the time, yes. When the previous scar lies in the inframammary fold or around the areola and allows adequate access, it is reused and no new scar is added. There are situations where this changes: when the capsule needs wider removal, when the previous approach was axillary — which does not give enough access for a capsulectomy — or when mastopexy is combined, which has its own markings and a longer scar. Bringing the report of the previous surgery to the consultation helps precisely with this: knowing how the breast was entered last time changes the plan.

Removing the implant itself does not take away breast tissue or ducts, so it is not expected to compromise breastfeeding. What may interfere is something else: the surgery that placed the implant, especially if the approach was periareolar, and a procedure combined with removal, such as mastopexy, depending on technique. It is also worth remembering that the ability to breastfeed varies between women independently of any surgery. If future breastfeeding matters to you, say so at the consultation — it is information that changes the plan.

A breast implant is a device, and a device requires follow-up. That means periodic consultation and breast imaging, with the method and interval set according to your age, your history and the implant type — the recommendation for screening silent rupture has itself shifted over the years between MRI and ultrasound, which is why the interval is agreed during follow-up rather than copied from a generic rule. Outside the schedule, some signs warrant assessment without waiting for the next appointment: a change in shape or consistency, new pain, and swelling of one breast.

Surgical fees are always private — Dr. Lorena does not operate through health insurance. What is possible, when a genuine, documented medical indication exists — such as correction after major weight loss, or breast reconstruction on clinical grounds —, is to guide the patient and attempt to have the health plan cover part of the hospital admission, which may include the operating room, the hospital stay and materials, according to the terms of her policy. Authorisation is the insurer's decision and cannot be guaranteed; the team advises on the documentation required and on how to proceed.

Yes, where there is a reconstructive or functional indication — for example breast reconstruction, or contour correction after bariatric surgery, on clinical grounds. Surgery for purely aesthetic purposes is not covered by the SUS. Dr. Lorena is a plastic surgeon appointed by public examination to the Hospital de Clínicas of the Federal University of Uberlândia (HC-UFU) and preceptor of its plastic surgery residency, and she operates on SUS patients there. The route, however, does not run through this site or the private practice: the patient must register at the primary care unit (Unidade Básica de Saúde) nearest to where she lives, be assessed by a doctor there and, if there is an indication, be placed in her municipality's regulation queue. The surgeon cannot choose who is operated on through the SUS — the order follows the queue and the rules of the system strictly.

We do not publish isolated before-and-after pairs. Resolution 2,336/2023 of the Brazilian Federal Council of Medicine allows results to be demonstrated, but only within a set that also includes unsatisfactory outcomes and the complications described in the literature, across different body types, age ranges and stages of healing, and with no editing of the images (art. 14, II). An isolated pair of photos does not meet those requirements and also implies a guaranteed result, which the same resolution prohibits (art. 11, XII). At the consultation the expected outcome is discussed from your own anatomy — what is reasonable to expect, what is not possible, and what the risks are.

That is reason enough, and it needs no clinical justification. A share of the patients who seek explant surgery have no complication at all: what they want for their own body has changed. The most common accounts are discomfort with the volume during sport, weight on the back and shoulders, a shift in aesthetic preference over the years, and the sense that the implant made sense at one stage of life and no longer does. The consultation does not exist to talk anyone out of it or to rush the decision — it exists to show clearly what the breast tends to become afterwards, so that the decision is made with that information.

Not always by how it feels. Rupture can be obvious, with a change in shape, hardening or discomfort, but it can also be silent — a cohesive gel implant ruptures and the gel stays contained by the capsule, with no external sign. Diagnosis is therefore by imaging: ultrasound, mammography or MRI, according to the case and what needs clarifying. This is one reason imaging follow-up is part of living with an implant, at an interval set during follow-up. A ruptured implant is an indication for removal — with or without exchange, according to the patient's decision.

Not in the sense of a printed date, and this is a common confusion. The implant does not expire on a given day, nor does it need replacing at a fixed interval simply because time has passed. What is true is something else: the chance of an event — rupture, contracture, malposition — rises over the years, which is why an implant is a device requiring follow-up rather than a procedure that ends at discharge. The decision to exchange or remove comes from a finding or from the patient's decision, not from the calendar.

It depends on what is found, and this is not a decision to be made by fixed routine. The capsule is the tissue the body formed around the implant; when it is thin and unaltered, part of it may be left and the body reabsorbs it over time. When it is thickened, calcified, contracted, or there is suspicion of change, removal becomes indicated. The extent ranges from partial to total capsulectomy, and each additional degree of removal means more dissection, more operating time and more bleeding risk — so it is not a neutral choice made “just in case”. Dr. Lorena performs partial or total capsulectomy as the case requires — what defines the extent is the finding, discussed at consultation and confirmed intraoperatively.

This is the central question of explant surgery, and the honest answer is that it depends on three things: how much breast tissue you have beneath the implant, how long the implant was in place, and how your skin responds. Someone who had her own breast tissue beforehand and used a moderate volume for a short time tends to return to something close to what she had, with some degree of laxity. Someone with little tissue, a large implant or many years of use tends to be left with skin in excess of the content — and in that case removal alone leaves the breast flattened and ptotic. Recognising this beforehand is what allows planning: either that result is accepted, or a procedure is combined to correct it. The immediate contour is not the final one: the skin takes months to settle, and assessment is made over that period.

It is a possibility assessed case by case, with calibrated expectations. Breast fat grafting uses the patient's own fat, harvested elsewhere, processed and reinjected into the breast. The volume gain is modest compared with an implant, part of the graft is reabsorbed in a proportion that varies between people, and more than one session may be needed. There is a further point that must be stated beforehand: fat that does not survive may evolve into oil cysts, fat necrosis or calcifications — benign findings, but ones that show on imaging and must be distinguished from other lesions, which is why it matters to tell the radiologist that grafting was done, and in which breast. Dr. Lorena performs breast fat grafting where indicated, including after explant surgery, with planning defined case by case. What it is not: swapping an implant for an equivalent volume — it is a different proposition.

Not always, and that expectation is common. Removing an intact implant with a thin capsule through an existing scar is indeed a smaller procedure. But when there is extensive capsulectomy, significant contracture, a ruptured implant with dispersed gel, or a combined mastopexy, the operation becomes equal to or greater than the original placement — more time, more dissection, sometimes a drain. The scale is defined by what needs doing, not by the fact that it is a removal.

It can, and it is not rare. Some patients remove, live without an implant for a period and decide to have one placed again; others remove definitively. The recommended interval depends on the reason for removal: when it was infection, for instance, a period is required before reintroducing an implant, and that is not negotiable. When removal was the patient's decision, the interval is more flexible, and what defines it is tissue settling. It is a conversation that can be revisited later — removal does not close the door.