Breast Implant Removal with Fat Transfer: Who Is It For?

Yes, breast implants can be removed and the breast partly refilled with your own fat in the same operation, but fat transfer replaces only a modest part of the implant's volume. It suits women who want to live without implants, accept a smaller and more natural breast, and have enough spare fat; when the skin has stretched, a lift is often needed as well.

Removal of implants (explantation) is one of the options we discuss within breast implant exchange and revision surgery at Op. Dr. Göktuğ Esmer's clinic in Istanbul. This guide explains why women choose removal, what "with or without the capsule" really means, what fat transfer can and cannot do, and how recovery is usually planned.

Why do women have their implants removed?

The reasons are a mix of medical findings and personal choice. Common ones include:

• Capsular contracture: the scar capsule that forms around every implant thickens and tightens, making the breast firm, distorted or painful.
• Rupture: a silicone implant can rupture without any visible change. The FDA, the regulator that oversees breast implants as medical devices, describes MRI as the most effective way to detect silent rupture, with ultrasound an acceptable alternative for screening patients without symptoms.
• Changed wishes: the size chosen years ago no longer fits the body or lifestyle, or the patient simply no longer wants a device in her body.
• Systemic symptoms: some women report fatigue, joint pain, "brain fog" or rash and relate them to their implants, often called breast implant illness. The FDA notes that these symptoms may be associated with breast implants and that in some cases removal without replacement is reported to reverse them; how and why this happens is still poorly understood, so no surgeon can predict an individual outcome.
• BIA-ALCL concerns: breast implant-associated anaplastic large cell lymphoma is a rare T-cell lymphoma that appears more often with textured implants. The FDA advises anyone with persistent swelling, pain or other changes around an implant to seek evaluation. It does not recommend routine removal for women without symptoms.

If your main question is whether your implants need to come out at all, our article on when breast implants should be replaced covers the medical triggers in more detail.

With or without the capsule? Capsulectomy types explained

One of the most searched questions is whether implants should be removed with or without the capsule. The FDA describes both routes: the surgeon may remove the implant alone and leave the scar capsule, or remove part or all of the capsule at the same time, which can be a more extensive operation. It advises patients to discuss with their surgeon which method suits their situation.

The terms are often used loosely, so in 2024 a consensus statement published through the plastic surgery society ASPS defined them:

• Partial capsulectomy: part of the capsule is removed and some is left behind.
• Total capsulectomy: the whole capsule is removed, not necessarily in one piece.
• Total intact capsulectomy: the whole capsule is removed as a single unit, usually with the implant still inside.
• En bloc capsulectomy: removal of the capsule together with a margin of surrounding tissue, reserved for suspected or established implant-associated cancer.

The same statement stresses that the only absolute indication for an en bloc capsulectomy is suspected or confirmed breast implant-associated cancer after proper work-up, and that the risks of removing the capsule must be weighed against its expected benefit. In everyday conversation "en bloc" is often used for any one-piece removal, which is why it is worth asking your surgeon exactly which technique they mean.

How the decision is made

Leaving a thin, soft capsule may be reasonable in some patients; a thickened, calcified or contracted capsule, a ruptured silicone implant or fluid around the implant usually points towards removing more of it. Because the capsule may lie against the chest wall and ribs, a more complete removal can mean a longer operation and, often, a drain. The choice is made after examination and imaging, not as a fixed rule.

What fat transfer can and cannot replace

Fat transfer means harvesting fat by liposuction, usually from the abdomen, flanks or thighs, purifying it and injecting small amounts into the breast. After explantation it can soften the step at the upper breast, thicken thin tissue and restore some of the lost volume. Its limits should be clear before you decide:

• Volume is limited. The breast after removal has less room and less tissue than with an implant. Fat restores a modest amount of fullness, not the size of a typical implant.
• Not all the fat survives. The NHS explains that some of the injected fat is lost during the first few months and that around half may not survive, so further surgery may be needed or the desired volume may not be achievable in one operation.
• Results settle slowly. According to the NHS, a fat transfer can take up to six months to fully take effect, so the shape you see in the first weeks is not the final one.
• You need donor fat. Very slim patients may not have enough fat to harvest; in that case removal with or without a lift may be the more realistic plan.
• Staging is sometimes wiser. Some surgeons prefer to remove the implants first and add fat in a later session once the tissues have settled. Whether a single-stage or staged approach suits you is decided individually.

Liposuction of the donor area is part of the operation, so you will also wear a compression garment there; our guide on how long to wear a compression garment after liposuction explains why.

Will I need a breast lift after removal?

Implants stretch the skin over the years. When they are taken out, the FDA notes that women who do not replace them may be left with dimpling, chest wall concavity, puckering or sagging of the natural breast. How much this happens depends on implant size, how long it was in place, skin quality and the amount of your own breast tissue.

If the nipple sits low or the skin envelope is loose, adding a breast lift in the same session tightens the skin and raises the nipple, and fat can then shape the upper part of the breast. A lift adds scars, whose pattern depends on the degree of sagging. Our comparison of a breast lift and implants may help you picture what each step contributes. When the breast is small but the skin is firm, removal with fat transfer alone may be enough.

Who is a good candidate?

Removal with fat transfer tends to suit women who:

• are in good general health and do not smoke, or can stop well before surgery (see our guide on smoking and blood thinners before surgery);
• have enough fat in donor areas such as the abdomen or thighs;
• prefer a natural breast and accept that it will usually be smaller than with implants;
• have up-to-date imaging, and an implant card or previous operation report if available.

Women with a suspected implant-related cancer need a different, oncological work-up first; cosmetic fat transfer is not part of that initial treatment.

Imaging, planning and the operation

Planning starts with a face-to-face or online consultation. Breast ultrasound is the usual starting point, with MRI added where silent rupture is suspected or the implants are older. Bring any previous reports, and tell your future radiologists that you have had fat transfer, because the NHS lists fat necrosis (death of some fat cells), which can form lumps, among its risks; such lumps may need assessment on later scans.

The operation is performed under general anaesthesia in a fully equipped hospital with anaesthesia and intensive care backup. The surgical plan is tailored to you: the previous incision is usually reused, the capsule is handled as agreed, and fat is harvested and grafted in the same session if a single-stage plan was chosen. The length of surgery depends on whether capsulectomy and a lift are added.

Recovery and risks

Recovery combines breast surgery and liposuction. The NHS notes that treated areas are often bruised and swollen for a few weeks and that people may take a couple of weeks off work. Typical steps include a support bra worn day and night for several weeks, a drain for a short time if a capsulectomy was done, and avoiding heavy lifting and strenuous upper-body exercise until your surgeon clears it. Timelines vary, and yours is confirmed individually.

Possible risks include bleeding or haematoma, infection, fluid collection, changes in sensation, asymmetry, contour irregularities at the donor site, fat necrosis and blood clots, plus the general risks of anaesthesia. Removing the capsule from the chest wall adds its own risks, which is why it is weighed rather than done automatically.

How long to stay in Istanbul

For implant revision surgery our procedure page suggests around 5 to 7 days in Istanbul, usually with one night in hospital; adding capsulectomy, a lift and fat harvesting can change this, so your surgeon confirms the exact plan. Our article on how many days to stay in Turkey for breast surgery explains how the days are typically used.

Aftercare once you are home

While you are in Istanbul you have daily dressing changes and checks. After you return home, follow-up continues by WhatsApp and video, and a coordinator is reachable 24/7. Practical details for travelling patients are on our international patients page, and for a wider view of surgery abroad you can read how to choose a surgeon in Turkey. More about all breast procedures is on our breast surgery page.

If you are considering implant removal, with or without fat transfer, send your photos, implant details and medical history via WhatsApp for an assessment, or reach us through our contact page.