Breast Explant Procedures: Current Opinions and Practices Among Specialist Surgeons in Australia

Demand for breast implant removal and capsulectomy has increased significantly. There is a lack of consensus on optimal surgical approach and a lack of quantified risk estimates associated with capsulectomy.

To understand the current state of practice in Australia, highlight practice variations, and to identify perceptions of surgical risk and the existing literature.

A direct online survey of Australian Plastic surgeons and general breast surgeons, who were contacted between November 2024 and April 2025 via society communication and direct email communication (following assessment of online presence to determine applicability). 191 surgeons were identified as possible responders.

There was a 34% response rate. A substantial majority of surgeons have seen an increased demand for capsulectomy (71%), perform capsulectomy infrequently (85%), generally do not perform total capsulectomy (65%), consider total capsulectomy for sub-pectoral devices to be a "high risk" procedure (71%), and agree that there is inadequate education on the topic of explant procedures (69%, increasing to 76% among those who consider capsulectomy high risk).

This is the only comprehensive, contemporary survey that has been conducted to assess the attitudes, risk perceptions, and practices of specialist surgeons regarding explant procedures. Most surgeons perform explant infrequently and continue to approach capsulectomy as a high-risk procedure. Risk perceptions may not be supported by published evidence. Explant surgery techniques are not standardized and the link between technique and aesthetic outcome is poorly defined. There is clear demand for evidence-based approaches to explant procedures.

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .