A 20-Year Experience with Round Smooth Saline Breast Implant Explantation: Reasons, Trends, and Management.

[BACKGROUND] Recent literature has identified a rising trend in breast implant explantation, frequently attributed to concerns about implant safety and long-term health risks. The purpose of this study is to analyze patient-reported reasons for explantation and to share the senior author's experience with implant removal and postoperative management over a 20 year period.

[METHODS] A retrospective review was conducted of 4909 patients who underwent primary cosmetic breast augmentation between 2005 and 2024. Of these, 77 patients elected to undergo explantation. All explanted patients had round, smooth Mentor saline implants. Only four patients had their original augmentation performed by another surgeon. Post-explantation management included placement of two 6-inch compression bandages for one to three weeks, followed by aesthetic reassessment at an average of two months. Patient demographics-including age, height, weight, pregnancy history, implant size, tobacco use, and pertinent medical history-were recorded. Time from implantation to explantation and patient-reported reasons were also documented.

[RESULTS] A total of 77 patients underwent bilateral explantation, representing 1.57% of the 4909 augmentations performed by the senior author. The average duration from implantation to explantation was 12 years, and the average patient age at explantation was 43 years. The average implant volume was 413 cc. Between 2016 and 2024, there was a 382.9% increase in explantation procedures, consistent with global trends. The most common reason for explantation was weight gain and the perception of breasts being too large (n = 27, 35.06%), followed by implant deflation (n = 24, 31.17%). One patient underwent implant replacement with a smaller volume at 9 months, another opted for larger implants 5 years later, and one patient underwent mastopexy 3 months after explantation.

[CONCLUSION] While the trend in breast implant explantation continues to rise, the findings in this study contrast with current literature citing implant safety concerns as the primary motivator. In this cohort, the most common reasons for removal were significant weight gain resulting in dissatisfaction with breast size, implant deflation, and a history of multiple prior cosmetic breast surgeries. Postoperative management with simple explantation and compression bandaging yielded satisfactory aesthetic outcomes.

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