People change their minds all the time, about everything, and for women, that sometimes means deciding to have their breast implants removed. It’s a timely topic: Chrissy Teigen recently revealed that she had her breast implants removed after 14 years, and other celebs—including Ayesha Curry—have spoken out about their reversals. “They’ve been great to me for many years but I’m just over it,” Teigen wrote on Instagram. “I’d like to be able to zip a dress in my size, lay on my belly with pure comfort!”
Of course, for implants to come out, they first have to go in, and surgery to increase breast size is still very popular: breast augmentation has been the number-one cosmetic surgical procedure for 14 years. But explanations are also on the rise: breast implant removal has been the eighth most popular cosmetic surgical procedure for the past two years, up from 10th place in 2015, according to The Aesthetic Society. “I removed more implants than I placed last year,” says Dr. Patricia McGuire, a board-certified plastic surgeon in St. Louis. “Breast aesthetics are changing, and large breasts and obvious implants are much less popular, at least in the Midwest.”
Dr. Melinda Haws, a board-certified plastic surgeon in Nashville, reports a similar trend. “I’m definitely seeing an increase in breast implant removals, for a variety of reasons.” That includes breast implant–associated anaplastic large-cell lymphoma (BIA-ALCL), a rare type of cancer of the immune system that can develop around textured breast implants, and breast implant illness (BII), the name for a constellation of symptoms that thousands of women have come to attribute to their breast implants.
But while BIA-ALCL and BII patients are a part of the trend, they’re definitely not all of it. “Just because someone loves her implants at 30, [that] doesn’t mean she will at 50,” says Dr. Haws. As she explains, women’s breasts change as they age—they may gain weight and their breasts become larger and they don’t need implants any longer. Or their lifestyle may change. “More and more women get fit later in life and want a more athletic breast profile than a curvaceous one,” says Dr. Haws. (Your implants can also be replaced with bigger or smaller ones if size is the main issue, a procedure that’s known as an exchange.)
Whether women have health concerns or have “outgrown” their implants, they’re understandably concerned about how their breasts will look once the implants are removed. The short answer is that everyone is different. Critical factors include skin laxity, the degree to which you were augmented, your age, the length of time the implants were in place, and whether you’ve gained or lost weight. In many women, the breast tissue will rebound somewhat and the skin can contract. “If a woman didn’t need a breast lift to begin with and just had implants, I am constantly amazed by how much her breasts will fluff up and the skin will shrink with implant removal alone,” says Dr. Haws. “Most women’s breasts go back pretty close to where they were before implants, unless there’s been some dramatic weight gain or loss.”
If your breasts sag after explantation, a breast lift can be performed. But unless it’s really obvious that you’ll need a lift (one sign is that your nipples fall below the bottom part of your breast), don’t rush to have the surgery done concurrent with the explantation, advises Dr. Allen Gabriel, a board-certified plastic surgeon in Vancouver, Washington. “Take a few months to get used to the new you and then decide,” he says. “You can have a primary augmentation and not much will have changed with your breasts, once the implants are removed.”
Though Teigen expressed interest in following up her explantation with a breast lift, plastic surgeons say that many women opt to go as they are afterward. “Many patients go through an adjustment period after implant removal, with initial concern about the size and shape, but within a few days of surgery, most are happy and comfortable with their smaller breasts,” says Dr. McGuire.
To get the scoop on downsizing, we spoke with three women* who recently had their implants removed. Read on to learn why they did it, how the surgery went, and how they feel about their breasts sans implants. Spoiler alert: Along with 98% of RealSelf members who have had their implants removed, all of them think the procedure was “Worth It.”
“I’m positive I made the right choice”
Julie Lowe’s sole reason for having her breast implants removed last summer was to see if it would help with the constant excruciating pain she was experiencing in her shoulder. “The pain had just come on. I hadn’t injured [myself]—it just developed,” says Lowe, who had a breast augmentation 14 years ago, when she was 33. “I’d always struggled with a negative body image, and after having my daughters, I looked a little deflated and didn’t feel good about my breasts,” she says. Her right breast was also smaller than her left breast, something that became more noticeable to her after having children.
With her augmentation, she went a little bigger than she’d been before having kids. “I was a full B cup before kids and a small B after the kids, and I became a small C with surgery.” Her plastic surgeon, she says, did a beautiful job. “He really listened to me, and it looked very natural.”
Though Lowe never had any problems with her implants, she does have Hashimoto’s disease, an autoimmune disease that results in low thyroid function. And after having the implants, she struggled to stabilize her thyroid levels. About four years ago, the disease—and her symptoms, including hair loss, constant fatigue, weight gain, skin sensitivity—became more severe and difficult to manage. Whether her implants had anything to do with that is unknown, but around the same time, Lowe began experiencing the pain in her right shoulder. “I’m right-handed, and I couldn’t do anything with my right arm,” she says.
After having exhausted all other possible explanations for the shoulder pain, Lowe’s doctor suggested that it might be due to her breast implants. “I was putting on a bit of weight at this time, and my breasts were bigger as well,” says Lowe. “My doctor wondered if my trying to work around that might be causing the pain.” With her life upended by the pain—she couldn’t sleep, exercise, or even open a sliding door—she decided to have her implants taken out.
The surgery was a success in many ways, says Lowe. Her plastic surgeon removed her implants and the surrounding capsule via the same incisions used to place them, she recovered really well, and her breasts “healed beautifully,” says Lowe. “I have an incredibly high tolerance for pain, so I didn’t take any pain medication—not even a Tylenol,” she says. “It sounds funny because I opted to have implants, but I prefer a more natural approach. I wanted to see if I could work through the pain rather than taking something.” That’s not to say it wasn’t painful: “It was, but as long I didn’t move, it was okay,” Lowe says. Two days after the surgery, she was back to work.
Most important though was that her thyroid issue leveled out within a few months and her shoulder pain is almost gone. “It’s not 100%, but I can carry boxes and reach above my head. I don’t even think about it now,” she says. For her own peace of mind, she paid extra for the capsule to be sent for pathology testing, to look for leaked silicone and any cancerous cells (the tests came back negative).
She was determined that she didn’t want or need a breast lift. “My breasts didn’t look bad at all before the implants, they were just too small in my mind—and I wanted to see what they would look like once the implants were removed,” she says. “I also wanted to give my body a chance to heal, so I didn’t want to do anything traumatic.” Plus her nipples are still “pretty perky,” which is a good indication that she didn’t need a breast lift. Surprisingly, the asymmetry that bugged her before she had implants is gone. “They’re both the same size now,” reports Lowe, who’s also thrilled to be able to wear tiny bralettes or to go without a bra. “It’s fabulous.”
Another unexpected benefit: the feeling of lightness on your chest after the removal. Breast implants, which add, on average, about two pounds of weight to your chest, can feel really heavy, says Lowe. “I remember coming out of anesthesia when I had the implants put in, and I felt very heavy on my chest—like I couldn’t breathe. I was scared I’d have that again with the explantation, but not at all. I can inhale so much deeper than I could before, and my [breathing] is so much [better]. It’s quite liberating.”
“I’m happy to be back to my natural self”
When Leslie Audino had a breast augmentation a year after breastfeeding her second son, “it was the best thing I ever did for myself,” says the 33-year-old. “Before I had kids, I was a full C. After nursing my two boys, I didn’t even fill an A cup, and it was all just loose skin.” The surgery, which restored her bustline to a 36C or 34D, depending on the bra, was very natural-looking, so most people didn’t even know she had them. But it made a world of difference to Audino: “I was self-conscious about being so small, and I felt so much better about myself with the implants.”
For eight years, she was nothing but pleased with her decision. “I had no concerns about my implants at all.” Then, in July 2019, the type of implants she had, Allergan’s Natrelle textured silicone implants, was recalled by the FDA due to the risk of BIA-ALCL. It was categorized as a Class I recall, the most serious type of recall. According to the FDA, “use of these devices may cause serious injuries or death.”
Per the instructions on the letter she received informing her of the recall, Audino saw her primary care provider, who did a breast exam and blood work. Because BIA-ALCL is a type of lymphoma (cancer of the immune system), all her lymph nodes were also checked. That’s when they found a lump in her groin. “It’s a pretty terrifying experience, because your mind goes right to the worst-case scenario,” she says. Though her blood work came back negative for cancer, she met with a general surgeon, who removed two lymph nodes from her groin for biopsies. They too came back negative.
Audino was relieved, but then she had to decide how to proceed. One option was to leave the implants in and monitor them—this is in keeping with the FDA’s recommendation not to remove implants in patients who weren’t experiencing symptoms of BIA-ALCL. That would mean having regular routine breast exams, MRIs, and blood work for the remainder of the time she had them in.
The other option was to have them removed, at her own expense, since Allergan doesn’t provide surgical fee assistance in asymptomatic patients. She could then have the implants replaced (Allergan would provide a smooth implant as a replacement) or not. “The options were to live with fear or pay, yourself, to have them removed,” says Audino.
The recall, however, indicated that the majority of women having issues were at the 8- to 12-year mark of the life of their implants. “I was right at eight years, and I didn’t want to wait until I had an issue, especially after the initial scare, so I decided to have them out,” Audino says. “I’m the kind of person who would have stressed about having them in.”
She returned to her original plastic surgeon for the explantation, which included her implants and the surrounding capsule of scar tissue, and decided to have a breast lift at the same time. “I would have been back to square one otherwise, and I didn’t want all the loose skin,” she says.
Her breast lift experience was much different from her breast augmentation. “Getting implants put in was no big deal—I bounced back like nothing,” Audino says. “But getting them removed and [having] the lift was probably the worst pain I ever put myself through.” While the implants were placed via small incisions underneath her breasts, the breast lift required nearly two feet of incisions altogether, including an incision around the areola and then down the middle to the base of the breast. The nipple was repositioned higher and the areola was reduced, to better match her new breast shape and size.
“To put it in perspective, when I had the implants put in, I only took Tylenol one or two times and it was fine,” Audino says. “With this surgery, I was on prescribed pain medicine ‘round the clock.” She barely got out of bed for the first five days and required help from her husband and sister. After that, she slowly eased back into things until returning to work after 10 days. “It was definitely a couple of pretty bad weeks,” she says.
In the end, they were worth it. “I wouldn’t change things either way,” she says. “If you asked me if I’d have implants again, I would. But now, given the circumstances—I’m older and don’t care as much about the size of my breasts—it’s less important to me.” Though she once again doesn’t quite fill an A cup, “I’m 100% okay with that,” she says. Nine months after her surgery, the scars underneath her breasts are still very present—her surgeon says they will take the longest to fade—but those around her nipple went away very quickly and the ones up the center are pretty faded now.
In retrospect, Audino wishes she’d given more thought to the idea of having a breast lift initially. “I’d encourage women to explore their options,” she says. “I was 24 when I did this, and I didn’t have any idea about getting a breast lift—I had no idea what that would be like.” She sometimes thinks that if she had taken that route from the get-go she could have avoided the situation with the implants, but she doubts she would have chosen to do so. “Back then, if I was going to be paying for surgery, I probably would have wanted to be put back more to my pre-kid state. I cared about that a lot more then,” she says. “Now I don’t mind. I actually feel really good. I’m happy with what I did. Even though the breast lift was super-painful, it was totally worth it. I literally feel a weight off my chest.”
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“I’ll be 69 soon, and I didn’t want to have to deal with a rupture or other problem in my 70s or beyond”
Carol Harper had a breast augmentation in 1984, when she was 33. All her sisters are small-breasted, and when her older sister’s initial experience with implants proved positive, Harper decided to size up too. The driving force behind her decision was how she looked in a swimsuit. “It’s hard to find a swimsuit when you’re really small,” she says. “I vividly remember going to the pool when I was young. This was when swimsuits had bra-like cups, and they would indent when I laid down on my stomach. I’d have to do this move when I got up where I’d squeeze the cups with my arms and they’d pop out. I was always horrified someone would notice that.” So,after having two kids, Harper had her breasts increased from “two peanuts on a board” to a B cup.
“I was pretty happy with my breast implants when I first had them put in,” she recounts. “It was the only time I had cleavage, other than when I breastfed, and I enjoyed that.” But in the ‘90s, with breast implants being linked to breast cancer, autoimmune diseases, and neurological problems, Harper became worried and talked to a few plastic surgeons about having her implants removed. “It came in waves—implants were in the news a lot, then out of the news, then back in the news, and that’s when I’d start worrying again and go see someone,” she says.
The first time around (and the second, 10 years later), all she heard from plastic surgeons was how disappointed she’d be if she had her implants removed. “Everyone was like, ‘It will be a disaster, you’ll be so disappointed with crepey skin and droopy boobs.’” One surgeon suggested taking out her double-lumen silicone implants, which had an outer layer of saline (saltwater) that had been (wrongly) thought to control rupture and capsular contracture, and replacing them with saline implants because, at that point, silicone implants had largely been taken off the market for augmentation purposes. “I thought that was nuts—I just wanted them out,” says Harper. “I knew women whose implants had ruptured, and my sister’s implants became encapsulated. She hates hugging people, because they feel so awful and hard.”
Because the surgeons she consulted were quite sure her implants hadn’t ruptured, Harper didn’t feel a sense of urgency to have the surgery. “It wasn’t front-page worrisome, but it was always there in the back of my mind,” she says. Then last September, 30 years after she’d first considered having her implants removed, Harper resolved to go forward with it. “This time, I was really serious,” she says. “I was concerned about the age of my implants—30-plus years is a long time to have them in—and my age as well. I’m almost 69, and I just didn’t want to have to deal with a problem and a surgery in my 70s or beyond.”
This time around, the plastic surgeons she saw were far more receptive to the idea of explantation, though two of them thought she’d need a lift and perhaps new implants. But the surgeon Harper chose to do her procedure was optimistic about the results of removing her implants and doing nothing else. “All throughout the years, I felt that I had to justify why I wanted to do it,” says Harper, who’s 5’1” and weighs 120 pounds. “With this surgeon, I felt validated. She said, ‘Oh, honey, you’re so small and you’re athletic, this will fit you’ and ‘I think you’ll be pleased.’”
The surgery was performed in a surgicenter under local anesthesia, which, in addition to avoiding the side effects of general anesthetic (grogginess, confusion, nausea, dizziness, and pain), can dramatically reduce the cost of the procedure—by half, in Harper’s case. That’s noteworthy, since explantation for strictly cosmetic purposes isn’t usually covered by insurance. Unfortunately, local anesthesia is usually available only if the capsules that surround the implants don’t also need to be removed, something that’s not usually the case with capsular contracture or concerns about BIA/ALCL or BII.
The same incisions used to place Harper’s implants—along the crease beneath the breast—were used to remove them. It turned out that one of her implants had ruptured, which just added to the relief she felt at having them removed. The extra work required to remove the silicone gel caused a lot of fluid to build up. “To relieve the swelling, they had to bind me up, which made me completely flat,” an irony that wasn’t lost on her, says Harper.
Once the bandage was removed, however, “my breasts were fairly plump, which made a nice transition,” she says. Still, “I was in tears, because it’s quite a change.” Today though, Harper is “just absolutely delighted” with her new breasts. “I’ve returned to my previous size—no more, no less—and I’m perhaps a bit droopier, but that might be more from breastfeeding and my age rather than a result of explant surgery,” she says. “With implants, I was only a B cup, and I’m barely a handful now, but I just feel like me again. I think that’s the best feeling.”
*All names have been changed.
