Breast Implant Removal & Revision Sydney

Quick Summary

Procedures. Implant removal (explant), removal with a breast lift, implant exchange, capsulectomy, pocket revision and internal support
Surgery time. 1 to 3 hours, depending on the combination of procedures
Anaesthetic. General anaesthetic at an accredited Sydney private hospital
Hospital stay. An overnight stay is generally recommended, with drains
Recovery. Most patients return to desk-based work at one to two weeks; upper body exercise resumes from around six weeks
Medicare. Items may apply where a medical complication is documented. Cosmetic size change does not qualify
Consultation requirements. Referral, minimum two consultations, psychological screening, and a seven-day cooling-off period before surgery can be booked (three months for patients under 18)

Removal or Revision: Which Applies

Two different decisions sit behind most enquiries about implant surgery after a first augmentation.

Removal means taking the implants out. Some patients do not replace them at all. Others have removal combined with a breast lift to deal with the loose skin left behind. Reasons vary: a complication, discomfort, a change in how someone feels about having implants, or questions about implant-related health conditions.

Revision means keeping implants but changing something about them. A different size or type, a different pocket, repair of a fold that has stretched, or treatment of a capsule that has tightened.

The two overlap in practice. A patient who arrives wanting smaller implants may be better served by removal with a lift. A patient who arrives wanting them out may find that exchanging them solves the problem that prompted the enquiry. The decision guide sets out the factors, and the assessment at consultation is what settles it.

Breast Implant Removal (Explant)

Breast implant removal, also called explant surgery, removes the implants and, where indicated, some or all of the surrounding capsule.

Removal Without Replacement

How the breasts look after removal depends on the volume of your own breast tissue, skin quality, and the size of the implants and how long they were in place. Larger implants held for longer tend to leave more loose skin, because the tissue has been stretched for longer.

Immediately after surgery the breasts look flatter and often sit lower on the chest than they did before the implants were placed. That is expected. The skin retracts over the following months, and the final shape is usually assessed at six to twelve months. Some patients are content with the result at that point. Others go on to have a lift or fat grafting.

Removal With a Breast Lift

Where skin laxity is significant, a breast lift at the same operation, or as a second stage, repositions the nipple and reshapes the remaining tissue. Doing both at once means one anaesthetic and one recovery. Staging them allows the skin to retract first, so the lift is planned against the shape the breast has actually settled into rather than a prediction of it. Which suits you depends on how much laxity is expected and on tissue quality.

Fat grafting can add some volume in selected patients, taken from another body area by liposuction. It suits patients who want a modest amount of fullness restored without returning to implants.

Managing the Capsule

The capsule is the scar tissue the body forms around every implant. It is a normal response, not a complication in itself.

Depending on its condition, the capsule may be left in place, partly removed, or removed completely (total capsulectomy). A thin, healthy capsule often needs nothing done to it. A thickened, calcified or contracted capsule is usually removed. Removing a capsule that is adherent to the chest wall or the ribs adds operating time and carries its own risks, which is why the decision is made on the findings rather than by routine.

En bloc removal, taking the implant and capsule out together as one unit, is reserved for confirmed or suspected breast implant-associated anaplastic large cell lymphoma. Removed capsule tissue is sent for histopathology.

The capsulectomy guide compares the approaches and what the evidence supports, and recovery after breast implant removal covers the practical side.

Breast Implant Illness

Breast implant illness describes a cluster of systemic symptoms, such as fatigue, joint and muscle pain, cognitive symptoms and skin changes, that some patients experience and attribute to their implants. It is not a formal diagnosis, and no test confirms it.

Explant is the intervention with the most consistent reported reduction in symptoms, but that reduction is typically partial rather than complete and cannot be predicted for an individual. The evidence does not show en bloc capsulectomy to be better than less extensive capsule removal for symptom relief. The breast implant illness guide reviews the evidence.

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

BIA-ALCL is an uncommon cancer of the immune system that develops in the fluid or capsule around an implant, almost always a textured implant. It most often presents as persistent swelling from a fluid collection, years after surgery.

Treatment is removal of the implant and the entire capsule, with the fluid and tissue sent for testing. Removing textured implants in patients without symptoms is not generally advised on that basis alone. The BIA-ALCL guide explains the risk and the signs to watch for.

Why Revision May Be Needed

Breasts change over time, and breasts with implants are no exception. Ageing, weight change, pregnancy and hormonal change all continue to affect the tissue around an implant. There are several distinct reasons revision surgery may be appropriate.

1. Size Change

Preferences shift. Some patients seek smaller implants because of discomfort or a change in preference; others want more fullness than they have.

Dr Turner uses tissue-based planning and 3D imaging to guide implant size against chest wall dimensions and skin elasticity, which may lower the risk of bottoming out or rippling.

Size change alone is a cosmetic procedure and does not qualify for a Medicare rebate.

2. Implant Rupture

Rupture occurs when the outer shell of an implant breaks and the contents leak.

Saline implants. Rupture is usually obvious, because the breast deflates quickly as the saline is absorbed.
Silicone implants. Modern cohesive gel may stay contained within the capsule, producing a silent rupture with no visible change.

Imaging, usually ultrasound or MRI, can confirm rupture. Medicare’s MRI items for implant integrity were created for patients with PIP implants, so check with your referrer whether a scan will be rebated. Revision involves removal of the ruptured implant, with replacement if you choose it.

3. Capsular Contracture

Capsular contracture is the most common complication after breast augmentation. The capsule tightens around the implant, which can make the breast firm, painful or misshapen.

Severity is graded with the Baker system:

Grade I. Breast soft, implant not palpable
Grade II. Breast somewhat firm, implant palpable but not visible
Grade III. Breast firm, with visible firmness and distortion
Grade IV. Breast hard and painful, with significant distortion

Published studies suggest that between 5 and 15 per cent of patients with implants develop some degree of contracture over the life of their implants. Risk factors include smoking and other nicotine products, including vapes, which impair wound healing, along with prior radiation and complications such as haematoma or infection.

Dr Turner typically performs a total capsulectomy combined with a plane change, placing the new implant in a fresh, unscarred tissue plane to lower the risk of recurrence. The capsular contracture guide covers the Baker grades and treatment.

4. Implant Malposition

Malposition means the implant has shifted out of its intended position within the pocket, producing an abnormal shape or asymmetry. It can follow from how the pocket was created, from implant characteristics, from tissue change over time, or from the weight of the implant.

Revision repositions the implant and rebuilds the pocket. Internal support may be used to hold the implant in its new position.

5. Symmastia

Symmastia occurs when the implant pockets extend too far toward the midline, so the skin across the breastbone lifts away and the breasts appear joined. It is usually related to how the pocket was created, or to implants too wide for the chest. Revision rebuilds the inner wall of each pocket, often with internal support, and may involve narrower implants or a new pocket. The symmastia guide covers causes, congenital symmastia and treatment.

6. Wide Cleavage

Wide cleavage occurs when implants sit too far apart, leaving a noticeable gap. It may follow from natural anatomy, from where the pockets were made, or from an implant too narrow for the chest wall.

Options include repositioning the implants closer together, or adding fat grafting to the cleavage area to add fullness.

7. Double Bubble

A double bubble occurs when the implant sits below the natural inframammary fold, creating a visible second crease and changing the contour of the lower breast.

Treatment typically involves adjusting the implant position, rebuilding the fold with internal support, and sometimes fat grafting to soften the second crease.

8. Waterfall Effect

The waterfall effect occurs when the breast tissue descends over the implant, so the tissue and the implant sit at different levels. It usually follows ageing, weight change or pregnancy.

Revision often involves a breast lift to reposition the tissue, combined with adjustment of the implant so the two sit together again.

9. Animation Deformity

Animation deformity occurs when implants placed under the chest muscle move or distort visibly when the pectoral muscles contract. It can be uncomfortable during exercise as well as visible.

The usual approach is plane conversion from submuscular to prepectoral placement: releasing the pectoralis major from the implant, creating a new pocket in front of the muscle, and placing the implant there with appropriate support.

Surgical Techniques

Revision surgery combines several techniques, chosen for the specific findings in each case.

Implant exchange. Removing the existing implants and placing new ones, which may differ in size, shape, surface or plane.

Capsulectomy. Partial or total removal of the capsule, depending on its condition and on why the revision is being done.

Pocket revision and plane change. Rebuilding the boundaries of the pocket where it has stretched or been over-dissected, or moving the implant to a different plane entirely, such as submuscular to prepectoral.

Internal Support of the Pocket

Where the tissues no longer hold an implant in position, as in bottoming out or malposition, internal support can reinforce the pocket and the fold. It uses either sutures that tighten the capsule and define the fold, or a resorbable surgical mesh that the body gradually absorbs as it lays down supportive tissue. Whether support is needed, and which form, is decided from the tissue findings during surgical planning.

Breast lift. Where the tissue has descended over the implant, or where removal leaves significant laxity, a breast lift is combined with the revision.

Fat grafting. Fat taken from another body area can add volume, soften rippling or add tissue cover over the implant.

Implant Selection

Where implants are replaced, the new implant is selected for your anatomy. The main choices are shape (round or anatomical), surface (smooth or textured, including micro- and nano-textured surfaces), fill and size, weighed against chest wall width, tissue cover and the condition of the pocket. Textured surfaces carry a higher association with BIA-ALCL than smooth surfaces, and that forms part of the discussion.

Medicare

Medicare rebates apply to implant removal and revision only in defined circumstances. Size or shape change for cosmetic reasons does not qualify.

Item 45548. Removal of an implant as an independent procedure.
Item 45551. Removal with excision of at least half of the capsule, without a new implant. The specimen is sent for histopathology. The MBS explanatory note ties the item to a medical indication such as capsular contracture, a mass in the capsule, or BIA-ALCL.
Item 45553. Removal and replacement following a medical complication, which the item names as rupture, migration of prosthetic material or symptomatic capsular contracture.
Item 45554. As for 45553, with excision of at least half of the capsule or formation of a new pocket, or both.

Items 45553 and 45554 also require one of two things: intra-operative photographs showing that removal alone would cause unacceptable deformity, or evidence that the original implant was placed in the context of breast cancer or a developmental abnormality. In practice this excludes most implants first placed for cosmetic augmentation. Photographic or imaging evidence of the clinical need must be documented.

The Medicare breast implant removal guide sets out each item in full.

Cost

Because implant removal and revision vary so much in complexity, fees are quoted individually after consultation, once the surgical plan is set. The fee depends on whether the implants are replaced, how much of the capsule is removed, whether a lift, internal support or fat grafting is added, and the operating time. Where a Medicare item applies and your hospital cover includes the relevant category, out-of-pocket costs can be lower. A written quote is provided after your consultation.

Recovery

An overnight stay is generally recommended, with drains. When the drains come out depends on how much fluid they collect.

The first few days involve swelling, tightness and discomfort managed with prescribed pain relief. A support garment is worn continuously. Most patients return to desk-based work at one to two weeks, though this depends on how much was done: a straightforward exchange is easier than a total capsulectomy with a lift.

Lifting and any activity engaging the chest is restricted for six weeks. Upper body exercise resumes from around six weeks, and full activity between six and eight weeks.

The breasts continue to settle over six to twelve months, and scars mature over a similar period. Detail is in the recovery after breast implant removal guide.

Risks and Complications

Revision surgery carries the risks of any breast operation, and some that are specific to operating on previously treated tissue. These are discussed in detail at consultation.

General risks include bleeding and haematoma, infection, fluid collection (seroma), wound healing problems, scarring, changes in nipple or skin sensation, blood clots in the legs or lungs, and the risks of anaesthesia.

Risks specific to removal and revision include:

recurrent capsular contracture, reported in around 15 to 30 per cent of patients within one to two years of revision surgery
asymmetry, malposition or rippling after implant exchange
loose skin, folds or reduced projection after removal without replacement, which may lead to a lift at the same time or later
palpability or infection of internal support mesh
seroma after capsulectomy, sometimes requiring drainage
with textured implants, BIA-ALCL
the need for further surgery

Consultation Requirements

The Medical Board of Australia’s cosmetic surgery guidelines, in force since 1 July 2023, apply to implant removal and revision, including when a Medicare item applies.

A referral is required, preferably from your usual GP, or from another GP or specialist medical practitioner. You will have a minimum of two consultations with Dr Turner before surgery; the first can be by video, and the second is in person. Every patient is screened for psychological factors, including body dysmorphic disorder, with referral for independent evaluation where indicated. After the second consultation and signed consent, a cooling-off period of at least seven days applies before surgery can be booked or a deposit paid. Patients under 18 have a cooling-off period of at least three months and a mandatory evaluation by a psychologist, psychiatrist or GP who works independently of the surgeon.

Frequently Asked Questions

What happens when breast implants are removed?

The breasts are smaller and, depending on skin quality, implant size and how long the implants were in place, may look deflated or sit lower on the chest. The skin retracts over the following months, and the final shape is usually assessed at six to twelve months. Where significant laxity is expected, a lift at the same operation or later is discussed at consultation.

Is breast implant removal a difficult operation?

Removing the implant alone is usually straightforward. Operating time and complexity increase when the capsule is removed, particularly if it is thick, calcified or adherent to the chest wall, and when removal is combined with a lift or fat grafting. Complexity, anaesthetic and recovery are assessed for your case at consultation.

Does Medicare cover breast implant removal?

Sometimes. Medicare items apply where a medical indication is documented, such as symptomatic capsular contracture or rupture. Removal alone and removal with capsulectomy have their own items, while the items that include replacement exclude most implants first placed for cosmetic augmentation. The Medicare breast implant removal guide sets out the criteria.

How do I know if I need breast implant revision surgery?

Signs that warrant assessment include firmness or hardening of the breast, pain, a visible change in shape or position, rippling that has become noticeable, or persistent swelling. If you notice any of these changes, a consultation with examination and, where needed, imaging is the appropriate step. Some patients seek revision without a complication, simply because their preferences have changed.

Can I change my implant size during revision surgery?

Yes. Both larger and smaller are possible, though the tissue sets limits. A substantially larger implant needs the pocket enlarged and enough tissue cover to support it. A substantially smaller implant may leave loose skin that needs a lift. Tissue-based planning and 3D imaging guide the choice of implant for your current anatomy.

What is the difference between capsulectomy and capsulotomy?

Capsulotomy releases the capsule by cutting it, leaving the capsule in place. Capsulectomy removes capsule tissue, either partly or completely. Which applies depends on the condition of the capsule and the reason for surgery.

Will I need drains after revision surgery?

Drains are generally used after implant removal and revision, and an overnight stay in hospital is recommended. When the drains come out depends on how much fluid they collect, and Dr Turner advises on this after surgery.

How soon after my original surgery can I have revision?

For a complication such as rupture or symptomatic contracture, revision is timed on clinical need. Where the reason is preference rather than complication, waiting until the breasts have fully settled, generally at least twelve months after the original surgery, gives a more predictable result.

Can capsular contracture recur after revision surgery?

Yes. Recurrence is reported in around 15 to 30 per cent of patients within one to two years of revision. Total capsulectomy with a plane change lowers the risk compared with releasing the capsule alone, but no technique removes it.

How long will I need to take off work?

Most patients with desk-based work return at one to two weeks. Physically demanding roles need four to six weeks. Where a lift or extensive capsulectomy is involved, expect the longer end of each range.

How long do breast implants last before needing replacement?

Modern implants have no fixed expiry date and are replaced when clinically indicated rather than on a schedule. Many patients keep the same implants for 15 to 20 years or longer. See the implant lifespan guide.

Can I breastfeed after breast implant revision?

Most patients retain the ability to breastfeed, particularly where the incision avoids breast tissue and milk ducts. No surgical approach can assure preservation of breastfeeding capacity.