Explant is specialist work. Removing an implant is straightforward; deciding whether the capsule should come out, doing it safely when it is stuck to the chest wall, sending the right tissue to pathology, and shaping the breast that remains are not. Five questions separate surgeons who do this routinely from those who do it occasionally. Ask them of every surgeon you consult, including Dr. Itay Wiser; his answers are below as facts you can check.
The five questions
- Where do you hold hospital privileges, and what is your breast-specific training? Hospital privileges and fellowship training in breast surgery mean oversight and experience you can verify.
- How many explants have you performed, and how often do you perform capsulectomy and en bloc? Expect a number and an explanation of how the decision is made, not a promise that everyone gets en bloc.
- What is your pathology protocol? Which capsules and fluid go to the pathologist, what they are tested for, and how results are reviewed with you.
- Can I see before-and-after photos of removal without replacement? Not only lifted or re-augmented results; cases that resemble your starting point.
- What will my breasts look like afterward, and how will you decide about a lift? A specific answer based on your skin, implant size and nipple position, with the option of staging.
How Dr. Wiser answers them
- Training and hospital appointment. New York-licensed plastic surgeon; Associate Clinical Professor of Surgery at Mount Sinai Elmhurst Hospital. Details on the About page.
- Experience. The practice reports more than 200 explant surgeries. Capsulectomy is performed by indication, and en bloc when rupture, a thick or calcified capsule, or a pathology need calls for it; see en bloc capsulectomy explained.
- Pathology. Capsules and fluid go to pathology whenever there is rupture, a suspicious capsule, chronic fluid or a BIA-ALCL concern; fluid is tested for CD30-positive cells; results are reviewed with you.
- Photos. The before-and-after gallery includes removal without replacement, and matched cases are shown at the consultation.
- The breast afterward. Assessed by skin, implant size, years implanted and nipple position, with removal alone, removal with lift, or a staged lift recommended accordingly; see what your breasts will look like after explant.
Red flags
- En bloc promised to every patient before examination.
- No mention of pathology, or pathology described as unnecessary in a rupture or BIA-ALCL concern.
- Before-and-after photos that show only lifted or re-augmented breasts.
- Pressure to decide at the first visit, or a discount that expires.
- A guarantee that explant will cure systemic symptoms. Published evidence shows frequent improvement and no guarantee.
Training that matters for explant
Dr. Wiser's fellowship training is breast-specific: reconstructive microsurgery in aesthetic and reconstructive breast surgery at Lenox Hill Hospital, and lymphedema surgery at Memorial Sloan Kettering Cancer Center. His PhD in epidemiology and public health shapes how he reads the evidence on breast implant illness and explains it to patients. The American Society of Plastic Surgeons' guidance on choosing a plastic surgeon sets out the certification and privileges questions in general terms; the breast implant removal (explant) in NYC page covers his approach to the procedure itself.
Frequently asked questions
Should my explant surgeon be the one who placed the implants?
Not necessarily. Many women choose a different surgeon, especially when the reason for removal is a complication or a change in what they want. What matters is breast-specific training and explant experience, including capsulectomy.
How many explants should a surgeon have done?
There is no magic number, but ask directly and expect a plain answer. Dr. Wiser's practice reports more than 200 explant surgeries. Ask also how often the surgeon performs capsulectomy and en bloc, and how the decision is made.
Is a surgeon who always recommends en bloc a good sign?
No. En bloc has specific indications and is not always possible. A surgeon who promises it in every case before examining you is selling a technique, not evaluating a patient.
What should I see in before-and-after photos?
Removal without replacement, not only lifted or re-augmented results. Cases resembling your starting point in implant size and skin quality. Consistent lighting and angles between before and after.
Bring the five questions
Ask them at the free virtual consultation. Dr. Wiser expects them, answers them plainly, and would rather you ask them of every surgeon you consider than choose without them.