How to Pick an Explant Surgeon: What I'd Look for as a Patient

A great question came in: "What do you look for when shopping for an explant surgeon?"

This matters because women getting explants deserve the same high-quality care that patients in every area of medicine deserve, and unfortunately, not every surgeon offering explant surgery practices that way.

Here's the honest checklist I'd use if I were vetting a surgeon for my own implant removal.

This is the foundational layer. Before anything else, your surgeon should be:

Not a cosmetic surgery board. The American Board of Plastic Surgery (ABPS) is the board recognized for plastic surgery by the American Board of Medical Specialties (ABMS), and you can verify certification through the ABMS lookup tools.

Your plastic surgeon should have hospital privileges at a local hospital for the procedures they're performing. This is a meaningful, independent credentialing step.

Specifically:

• American Society of Plastic Surgeons (ASPS): the major specialty society
• Aesthetic Society (American Society for Aesthetic Plastic Surgery / ASAPS): for aesthetic-focused practice

Membership in these societies isn't a guarantee of skill, but lack of membership in a surgeon who focuses on cosmetic and aesthetic work is genuinely informative.

If a surgeon can't check all three of these boxes, the rest of the checklist is moot. Start there.

This is the critical filter that separates good explant surgeons from problematic ones.

A surgeon practicing evidence-based care will tailor the operation to the patient. A surgeon with a marketing-driven practice often does the exact same procedure on every patient.

Red flags:

• Every explant gets a capsulectomy regardless of indication
• Every explant gets an en bloc capsulectomy, an operation meant only for a documented capsule cancer
• Every patient gets a fat grafting "package" regardless of whether they need it
• Every patient gets a lift, regardless of whether their tissue actually requires one
• Every patient gets the same array of pre-op tests, supplements, and "detox" protocols

A good explant surgeon will:

• Examine you carefully
• Discuss your specific health problems and concerns
• Assess whether your capsule is actually abnormal
• Build a plan specific to your anatomy, indication, and goals
• Explain why each component of the plan is being recommended for you

When you look at a surgeon's gallery, ask yourself:

If the captions on the before-and-afters say "explant with capsulectomy, fat grafting and lift" on every single case, that's the cookie-cutter pattern showing up in the gallery.

A surgeon practicing individualized care will have galleries that show:

• Some patients with simple removals
• Some patients with capsulectomies
• Some with lifts, some without
• Some with fat grafting, some without
• A range of approaches matched to a range of patients

Make sure the surgeon does the kind of explant you need, with enough volume to be experienced. Multiple examples in their gallery of patients with similar pre-op anatomy and goals to yours is the right signal.

Honest self-check: would you be satisfied with the outcomes shown in the gallery? If their before-and-afters look like results you'd be unhappy with, that's informative regardless of how good they sound in consultation.

I think this is important because so much surgeon information now comes from social media.

A surgeon practicing evidence-based care will:

• Discuss the actual literature on explant outcomes
• Acknowledge what we know and don't know
• Push back on misinformation in their own specialty
• Reference real studies and data in their content

A surgeon who tries to scare patients into seeing them is a flag, not a feature. Watch out for:

• Content emphasizing extreme risks of leaving implants in
• Claims about toxins in implants that aren't supported by evidence
• Pushing en bloc capsulectomy for everyone
• Promoting heavy metals or toxins as causes of BII, claims that don't hold up to the actual research
• Aggressive marketing of "detox" protocols
• Old "dinosaur egg" implant photos used to scare patients

If their public content is built on fear rather than evidence, that surgeon is probably not the right choice for you.

Make sure your surgeon isn't doing weird things that are out of the norm without evidence to back them up. Watch for:

• EKGs done for dubious reasons
• Tests for breast implant illness that only their office offers, that aren't verified and aren't covered by insurance
• Very expensive supplements sold as a "detox" for dubious reasons
• Detox protocols after implant removal that haven't been studied or verified

If your surgeon recommends things like this and isn't honest with you about what evidence supports them, keep looking.

A reasonable, evidence-based explant surgeon will:

• Take BII symptoms seriously as a patient experience
• Acknowledge that patients improve after explant in meaningful percentages
• Be honest that we don't fully understand the mechanism
• Be honest that removing the capsule isn't needed for symptom improvement
• Recommend the least invasive procedure that addresses the indication
• Not pathologize patients who decide to keep their implants
• Not require purchase of supplement packages or "detox" protocols

Treating BII as a disease with a known cause, insisting on capsule removal for every patient with symptoms, or selling detox products around the surgery goes beyond what the evidence supports.

Honestly, if a close friend asked me how to pick an explant surgeon, my short version would be:

1. ABMS board-certified plastic surgeon with hospital privileges and society memberships
2. Practices evidence-based, individualized care: different patients get different operations
3. Beautiful, varied before-and-afters
4. Public content that educates rather than fear-mongers
5. Doesn't sell expensive supplements or "detox" protocols
6. Has integrity when discussing what we do and don't know about BII

If a surgeon checks most of those boxes but fails on the "fear-mongering" or "evidence-based" criteria specifically, I'd keep looking.

Look for the same things you'd want in any plastic surgeon: board certification, evidence-based care, an individualized plan, and honesty about what we know and don't know.

Women getting explants deserve the same high-quality, evidence-based, individualized care that patients in every other area of medicine deserve. Make sure you're getting that. Go see someone who practices evidence-based care and will give you an individualized plan.