The Ultimate Guide to Removing Textured and Silicone Breast Implants
What You Need to Know About Textured Breast Implant Removal
Textured breast implant removal is a surgical procedure to take out implants with a roughened surface — and in many cases, the surrounding scar tissue capsule — due to complications, health concerns, or personal choice.
Here’s a quick overview of the key decision points:
| Situation | Recommended Action |
|---|---|
| No symptoms, textured implants | Regular monitoring; removal not required by FDA |
| Allergan Biocell implants (recalled 2019) | Consult your surgeon; removal may be appropriate |
| Swelling, lumps, or seroma 8+ years post-op | Evaluate for BIA-ALCL immediately |
| Capsular contracture, rupture, or pain | Removal likely medically indicated |
| Breast implant illness (BII) symptoms | Discuss explant options with your surgeon |
The removal method matters. Surgeons can choose between en bloc capsulectomy (implant and capsule removed together), total capsulectomy (capsule removed in pieces after implant), or partial capsulectomy (only part of the capsule removed). The right approach depends on your specific situation.
Since 2019, when Allergan voluntarily recalled their Biocell textured implants due to a link with a rare cancer called BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma), many women have been understandably anxious. Media coverage has added to the confusion about what to do next.
The good news: most women with textured implants and no symptoms do not need immediate removal. But staying informed and working with an experienced surgeon is essential.
I’m Dr. Mark Anton, founder of OC Breast Surgery in Newport Beach, CA, with over 33 years of experience performing thousands of breast surgeries — including complex textured breast implant removal cases. In this guide, I’ll walk you through everything you need to make a confident, informed decision.
Textured breast implant removal terminology:
Understanding Textured Implants and the BIA-ALCL Risk
Textured implants were originally designed with a sandpaper-like surface to help them “grip” the surrounding breast tissue. This was intended to prevent the implants from shifting or rotating, which was particularly useful for teardrop-shaped (anatomical) implants. However, this unique surface has since been linked to a specific medical concern.
What is BIA-ALCL?
Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is not breast cancer. Rather, it is a rare type of T-cell lymphoma (a cancer of the immune system) that develops in the fluid or scar tissue capsule surrounding the implant. According to Scientific research on BIA-ALCL risk, the risk is quite low, with an incidence of approximately 0.3% per 100,000 women per year.
While rare, the link to textured surfaces—specifically macro-textured brands like Allergan Biocell—is significant. Statistics show that the average time between the initial implant surgery and a BIA-ALCL diagnosis is about 13.3 years, with a median range of 7 to 12 years.
The Allergan Biocell Recall
In 2019, the FDA requested a voluntary recall of Allergan Biocell textured implants and tissue expanders. This was a regulatory move to prevent new implants from being placed, but it does not mean every woman with these implants needs them out immediately. Current FDA guidance on textured implants states that if you are asymptomatic (meaning you have no swelling, pain, or lumps), prophylactic removal is not strictly required.
Breast Implant Illness (BII)
Beyond the specific risk of lymphoma, some patients seek textured breast implant removal due to a collection of systemic symptoms often referred to as Breast Implant Illness (BII). While not yet an official medical diagnosis, many women report symptoms like:
- Chronic fatigue and “brain fog”
- Joint and muscle pain
- Hair loss and skin rashes
- Autoimmune-like flares
Research indicates that a significant number of patients—anywhere from 70% to 96% in some small studies—report an improvement in these systemic symptoms after undergoing explant surgery.
Surgical Techniques for Textured Breast Implant Removal
When we perform textured breast implant removal at our Newport Beach, CA practice, the technique we use to handle the “capsule” (the layer of scar tissue your body naturally forms around the implant) is the most critical part of the surgery.
| Technique | What Happens? | When is it used? |
|---|---|---|
| En Bloc Capsulectomy | The implant and the entire capsule are removed together as one single, unopened “package.” | Suspected BIA-ALCL, ruptured silicone, or severe BII. |
| Total Capsulectomy | The entire scar tissue capsule is removed, but it may be taken out in pieces after the implant is removed. | Capsular contracture or when en bloc is surgically difficult. |
| Partial Capsulectomy | Only a portion of the scar tissue is removed; some is left behind. | When the capsule is dangerously thin or stuck to the ribs/lungs. |
For more detailed information on these techniques, you can visit our page on capsulectomy in Newport Beach.
The Importance of Pathology
Regardless of the technique, we believe in being thorough. During textured breast implant removal, we often send the removed capsule tissue and any surrounding fluid for pathology testing. This includes checking for CD30 markers, which are specific indicators used to rule out BIA-ALCL. Documentation through photography is also a standard part of our process to ensure you have a clear record of what was found inside.
When is En Bloc Recommended for Textured Breast Implant Removal?
The “En Bloc” technique is often considered the gold standard for textured breast implant removal, particularly when there are concerns about safety or contamination. By removing the implant and capsule as one intact unit, we ensure that if there is any microscopic malignancy, leaked silicone, or biofilm (bacteria) inside the capsule, it does not spill into your chest cavity.
According to Scientific research on long-term implant outcomes, meticulous surgical precision is key to a successful outcome. However, while en bloc is highly desirable, it is not always possible. If the scar tissue is paper-thin or firmly adhered to the underlying chest wall or ribs, attempting to peel it off “en bloc” could risk a pneumothorax (collapsed lung). In these cases, a total or partial capsulectomy is a safer, more appropriate choice. You can learn more about the specifics of breast explant surgery on our dedicated service page.
Comparing Total vs. Partial Capsulectomy
A total capsulectomy involves the removal of 100% of the scar tissue. This is our goal in most textured breast implant removal cases in Newport Beach, CA, as it leaves the breast pocket “clean.”
A partial capsulectomy is reserved for situations where the risk of removal outweighs the benefit. If a small piece of the capsule is fused to the intercostal muscles (between the ribs), leaving that tiny fragment behind is often safer than risking a surgical complication. Our priority is always your safety and long-term health. For more on the nuances of the procedure, see our guide on breast implant removal.
Medical Indications and Insurance Coverage
Many patients ask us if their insurance will cover the cost of textured breast implant removal. The answer depends largely on “medical necessity.”
Common Medical Indications for Removal:
- BIA-ALCL Diagnosis or High Suspicion: If testing confirms the presence of lymphoma cells.
- Severe Capsular Contracture: This is when the scar tissue tightens so much it distorts the breast and causes chronic pain (typically Baker Class III or IV).
- Implant Rupture: Specifically for silicone implants, where the shell has failed.
- Persistent Seroma: A collection of fluid around the implant that does not go away.
- Infection or Extrusion: When the implant becomes infected or begins to push through the skin.
Insurance and the WHCRA
WHCRA insurance protections (Women’s Health and Cancer Rights Act of 1998) require group health plans that cover mastectomies to also cover breast reconstruction and surgeries to “fix” complications from that reconstruction. This often includes implant removal if it is medically necessary.
However, insurance rarely covers removal for “cosmetic dissatisfaction” or for Breast Implant Illness, as many insurers do not yet recognize BII as a covered diagnosis. To navigate this, we focus on documenting functional impairments like pain or restricted movement. You can find more details on explant surgery cost and how we help patients understand their financial options on our website.
Recovery and Aesthetic Options After Explantation
What happens after the implants are gone? This is often the biggest concern for our Newport Beach, CA patients. You have several paths to choose from:
- Aesthetic Flat Closure: For those who want to be completely “flat” and free of foreign objects. We focus on creating a smooth, contoured chest wall.
- Breast Lift (Mastopexy): Since implants stretch the skin, removing them often leaves the breasts looking deflated or sagging. A lift can reposition the nipple and tighten the skin for a more youthful, natural shape.
- Fat Grafting: We can harvest fat from other areas of your body (like the thighs or abdomen) and inject it into the breast to restore some volume without using an implant.
- Replacement with Smooth Implants: If you still desire the volume of an implant but want to avoid textured surfaces, replacing them with smooth silicone or saline implants is a popular option.
For a deeper dive into these choices, check out our information on breast revision surgery and removal and replacement.
Recovery Expectations After Textured Breast Implant Removal
Recovery from textured breast implant removal is generally straightforward, though it varies depending on whether a lift or fat grafting was performed.
- Timeline: Most patients return to light activity within 1 week and full activity within 2–6 weeks.
- Drains: In some cases, especially with total capsulectomy, surgical drains are used for a few days to prevent fluid buildup.
- Support: You will likely need to wear a surgical bra or compression garment to help the skin adhere to the chest wall.
- Results: While there is immediate relief for many, it can take up to a year for the tissues to fully settle and for systemic BII symptoms to resolve.
You can view breast explant before and after photos to see the real-world results of our patients in Newport Beach, CA.
Frequently Asked Questions about Textured Breast Implant Removal
Do I need to remove my implants if I have no symptoms?
The official stance from the FDA and the American Society of Plastic Surgeons (ASPS) is that prophylactic removal is not required for asymptomatic patients. However, we believe in shared decision-making. If having textured implants causes you significant anxiety or “surgical stress,” removal may be the right choice for your peace of mind.
What are the symptoms of BIA-ALCL to watch for?
The most common sign is a “late-onset seroma,” which is sudden swelling in one breast that occurs years (average 8–10) after surgery. Other signs include:
- A palpable lump in the breast or armpit
- Changes in breast shape or significant asymmetry
- Skin redness or a persistent rash
Does insurance cover the cost of textured implant removal?
As mentioned, coverage is usually tied to medical necessity. Under the WHCRA of 1998, if your implants were part of a post-mastectomy reconstruction, you have stronger legal standing for coverage. For cosmetic patients, coverage is hit-or-miss and usually requires proof of rupture or severe contracture. According to ASPS cost statistics, the average surgeon’s fee is several thousand dollars, not including anesthesia or facility fees.
Conclusion
At OC Breast Surgery, we understand that the decision to undergo textured breast implant removal is deeply personal. Whether you are motivated by safety concerns regarding BIA-ALCL, a desire to resolve symptoms of Breast Implant Illness, or simply a wish to return to a more natural look, we are here to support you.
Dr. Mark Anton and our specialized team in Newport Beach, CA, combine decades of surgical expertise with a warm, patient-centered approach. We don’t just remove implants; we help you reclaim your health and confidence with results that look and feel natural.
If you have questions about your textured implants or are ready to discuss your options, we invite you to schedule a consultation for textured breast implant removal today. Let’s work together to create a plan that prioritizes your safety and your aesthetic goals.