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West Palm Beach Plastic Surgeon

Breast Removal, Explant Surgery, and Total Capsulectomy

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

According to the American Society of Plastic Surgeons (ASPS), breast augmentation surgery is the most popular cosmetic procedure among women. Nearly 300,000 breast augmentation procedures are performed each year.

Unfortunately, breast implants do not last forever, and several complications can result from the procedure, leading many women to remove their implants.

Breast implant removal is a reversal of breast augmentation. If you have breast implants, keep reading to learn more about breast implant removal, what the surgery involves, and why you might want to consider this procedure.

Breast Implant Removal with Total Capsulectomy

In addition to removing the implant, Dr. Barr can also perform a total capsulectomy (removal of the capsule). The capsule is the scar tissue that develops around the implant.

Reasons to Remove Breast Implants

Women choose to reverse their breast augmentation procedures for several reasons:

  • Personal reasons: An individual may feel that augmentation was not the right choice for them or that the implants don’t have the right shape or size
  • Implant complications such as implant deflation or rupture
  • Complications such as infection, silicone leakage, or tension bands asymmetry
  • Capsular contraction, which is the tightening of the scar tissue around the implant
  • Breast implant illness (BII)
  • Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)

BII and BIA-ALCL are potentially debilitating conditions. In most cases, healthcare providers recommend a total capsulectomy to mitigate the risks and side-effects associated with BII and BIA-ALCL.

Breast Implant Illness

Breast implant illness is a cluster of symptoms that some women experience after undergoing breast reconstruction or augmentation surgery with breast implants. Any implant can result in BII, including implants containing saline and silicone.

BII affects individuals in different ways, but some symptoms generally include but not limited to

  • Hormonal problems
  • Joint pain
  • Vision issues
  • Sleep problems and chronic fatigue
  • Concentration and memory difficulties
  • Anxiety and depression
  • Breathing difficulties
  • Skin conditions such as rashes
  • Hair loss
  • Headaches
  • Dry mouth and eyes
  • Gastrointestinal health issues

There appears to be a link between BII symptoms and those of autoimmune and connective tissue disorders such as scleroderma, lupus, and rheumatoid arthritis. To date, the medical community has not scientifically established this association, and the U.S. Food and Drug Administration (FDA) does not recognize BII as an official medical diagnosis.

However, the administration is increasingly paying attention to BII and looking for ways to help women make informed decisions.


Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a type of non-Hodgkin Lymphoma that develops inside the scar tissue and fluid surrounding the implant. BIA-ALCL is a rare form of cancer, but it is not the same as breast cancer.

In 80% of cases, BIA-ALCL presents as a late seroma 8 to 10 years after breast augmentation. A seroma is the collection of fluid around the breast implant. Other symptoms of BIA-ALCL may include palpable mass, lymphadenopathy, skin rash, or fever.

However, the lack of a seroma does not rule out the condition. BIA-ALCL can also present as a late-developing capsular contraction with evidence of swelling, rupture, or fluid collection around the implant.

In most cases of BIA-ALCL, textured implants or textured expanders are involved. The higher risk associated with textured implants may result in tissue irritation, which, in turn, leads to malignancy.

According to the ASPS and FDA, the incidence rate of BIA-ALCL is very low, and the condition has a high cure rate. Conventional treatment of BIA-ALCL involves an implant removal with a total capsulectomy.

Contact Dr. Fredric Barr

Undergoing breast implant removal surgery has risks and benefits. If you are experiencing BII symptoms or want to prevent BIA-ALCL, it is critical to gather information and make a calculated decision.

Contact Dr. Fredric Barr at Palm Beach Plastic & Cosmetic Surgery to schedule a call with a patient counselor and gain insights into the condition of your breast implants. The patient counselor will also listen to your concerns and schedule a call or an appointment with Dr. Barr, who will provide you with safe, informed solutions to resolve any issues you may be experiencing related to your implants.

If you want to choose the best course of action for your health, a consultation with a patient counselor at Palm Beach Plastic & Cosmetic Surgery is the first step.


Please understand Dr. Barr will do his very best to achieve a pleasing result – HOWEVER, due to the unknown effects of tissue damage caused by the implant and its removal, cosmetic results are unpredictable and cannot be guaranteed. 

Private Insurance Considerations for Breast Implant Removal Procedures

If you plan to cover your breast explant procedure using private insurance, prepare with these helpful resources — many of which have been collected and contributed by women in our community that have faced or are facing a similar situation. It is empowering to learn from others who have secured the coverage necessary to follow through with their choice to remove their breast implants in pursuit of a healthier future. Review the information at the links below that apply to you:

  • Guide to Seeking Private Insurance for Breast Implant Removal – A step-by-step guide highlighting the information you must file to secure insurance coverage for your breast implant removal procedure.
    • You will need to determine whether your insurance considers the procedure “medically necessary” before pursuing a strategy for pre-authorization.
    • You should coordinate with your medical care provider to have them file the claim following your procedure.
  • Sample Letters of Medical Necessity – If you seek insurance coverage for explantation, you must have your doctor send your insurance company a letter indicating your need for an explant procedure.
    • The sample letters available at the link above are general examples, and your letter of medical necessity must be specific to your needs.
  • Steps To Follow to Appeal a Denial – You have the right to appeal your insurance company’s decision if they choose to deny coverage for your breast implant removal procedure.
    • While your healthcare provider may handle some appeals, you can also personally handle an appeal.
    • Be aware of the appeal deadline for your policy.
    • First, learn the reason(s) cited for the denial. Then, gather the information you submitted with your claim, review the Evidence of Coverage document (also known as the Benefit Policy Document), and call your insurance company’s member services phone number for additional clarification, if needed.
    • Your insurance company may have a standardized appeal form, or you may need to prepare an appeal letter. You may add additional evidence supporting your claim. This process would be an internal appeal, and you may seek an external appeal through a third party if insurance denies your claim again.
    • The Department of Insurance in your state may also be able to help you through the appeal process. Review the information at the link above for additional details and steps if you seek to appeal a denied insurance claim.
  • See a Sample Appeal Letter – Review the format of an example appeal letter, which may be downloaded as a Word document file (.docx) and used as a rough template.
    • This sample is from the doctor of a real woman whose claim was denied for a breast implant removal procedure as she suffered from a severe capsular contracture and a ruptured implant.
    • Of course, your letter would need to carefully replace names, policy number, insurance company name, addresses, and other information with the details involving your claim, procedure, and condition. Maintain the general format while explaining why your insurance company should cover the procedure under your policy.
    • Your health provider may be able to assist you and prepare the letter on your behalf based on this template.
  • Consider the Affordable Care Act (Obamacare) for Breast Explant Coverage – While breast implants were considered a previously-existing condition before the Affordable Care Act (ACA, or “Obamacare”) and had, therefore, often been denied coverage for problems involving the breast implants or the breast tissue itself, under the ACA, insurers must pay for “medically necessary” services that are required to keep you healthy or improve your health.
    • Be sure to carefully review individual policies to avoid choosing one that would not cover your procedure because they only consider it a “cosmetic” need.
    • Note when “Open Enrollment” is in effect each year, which is the window of time during which you may choose a plan through the health insurance marketplace.

If you have additional questions regarding private insurance or related communications involving coverage, claims, or appeals for your breast implant removal procedure, our supportive staff is happy to help you.

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Our Faqs


If I am seeking to undergo a combination of procedures, will they be done together or consecutively? What is the timeline for multiple procedures?


The answer depends on multiple factors, including the specific combination of procedures, your recovery rates, your age and health status, and your behaviors or habits. More invasive surgeries typically require recovery time ranging between 6 and 12 weeks to 6 months, and surgeries to the same area of your body will also generally require recovery time between procedures.

However, if you are in good health and the combination of procedures in question will be performed on different parts of your body and are not especially invasive, a combination of procedures could potentially be approved together on a case-by-case basis. It is imperative that the combination of procedures does not compromise your healing, and your attention to prescribed pre-operation and recovery habits also plays a significant role. Schedule a consultation for an assessment and guidance regarding the procedures you are considering.


Will it be obvious that I “got work done” after my procedure?


While aging affects us all, there are steps we can take to put forth a more vibrant appearance. We seek to perform subtle adjustments to address imperfections and the wear of time while retaining your natural look. While you should notice an improvement, the glaring changes or distortions in appearance you are concerned about and may have seen from other surgeons’ work do not meet the standard of quality plastic and cosmetic surgery we perform in our office.

Dr. Frederic M. Barr is a board-certified Plastic & Cosmetic Surgeon with over 30 years of experience performing Plastic Surgery in South Florida. We enhance and refine your appearance according to your goals. Review our Gallery of Before & After Photos to see some examples of our work.


What does Breast Explant Surgery entail, and will my breasts be “back to normal” after the surgery?


For patients with Breast Implant Illness (BII), which can include allergy, auto-immune, and thyroid hormone issues, this has been an emerging topic with significant press coverage in recent years. Although numerous medical professionals have demonstrated varying responses to these women’s concerns, we believe in addressing these women’s experiences and symptoms. In response to this phenomenon, we have also chosen not to perform new breast implant surgeries. We perform Total Capsulectomy on patients with breast implants, which involves the removal of both the saline or silicone implant and the capsule around it.

Removal of the implants and surrounding scar tissue has been shown to improve women’s health concerning these symptoms. While some women choose no further procedure following Breast Explant Surgery, some patients elect to have a Mastopexy procedure that involves reshaping the breast tissue for a pleasant cosmetic breast appearance. We welcome your specific questions regarding these procedures and their anticipated effects for your situation. See our Breast Implant Explantation (Total Capsulectomy) page for more detailed information, including before-and-after photo examples.