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Would you choose the same breast implants today? For some patients, the answer changes after pregnancy, weight loss, or years of living with a size that no longer feels right. Others start thinking about removal when one breast suddenly looks smaller, an implant feels firm, or the breast sits lower than it used to. In this episode of Fuller Butz: A Behind the Scenes Plastic Surgery Podcast, Dr. Sam Fuller and Dr. Daniel Butz walk through what brings patients in for a breast implant removal consultation and how they decide what to do next.

The conversation starts with a question the surgeons ask in consultation: what would you most like to change? Maybe you want less volume because running feels different or clothes fit differently than you’d like. Maybe your own breast tissue has changed with age, pregnancy, or weight fluctuations, and you still like the volume but want a different shape. Dr. Fuller and Dr. Butz explain ptosis, the surgical term for breast droop, and why they look at the nipple position, skin, breast tissue, and implant position separately. A breast can look lower even when the implant itself is intact.

Then they get into rupture and deflation. When a saline implant ruptures, the breast typically loses volume as the body absorbs the saline. A silicone gel implant can rupture without an obvious change in size or shape, and imaging can help identify it. The surgeons explain how the implant type, exam, and imaging findings guide the conversation. They also discuss capsular contracture, when the scar tissue around an implant tightens and can make the breast feel firm, look distorted, or become uncomfortable.

The episode also covers two topics that often come up together online. Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is a rare, recognized lymphoma associated primarily with textured implants. The doctors explain why persistent new swelling or a lump years after surgery needs evaluation before an operation is planned. Breast implant illness (BII) is a term patients use for symptoms such as fatigue, brain fog, and joint pain. Some patients report feeling better after implant removal. The cause of these symptoms and who is likely to improve remain uncertain, which makes it important to hear the patient’s concerns and consider other possible causes.

What can the surgery actually involve? Implant removal alone may mean less dissection and lets patients go without another device, though they may notice less upper breast fullness, loose skin, or more visible asymmetry. Removal with a capsulectomy takes out some or all of the scar tissue surrounding the implant. The surgeons explain when a tight or abnormal capsule can change the plan, why taking out more scar tissue can add surgical risk, and why the term “en bloc” has a specific meaning in cancer surgery. Implant exchange can preserve fullness or allow a patient to downsize, with the ongoing possibility of future implant-related surgery.

For patients who want to go without implants but still want to change their breast shape, the doctors discuss a breast lift and fat transfer. A lift can remove excess skin and reposition the nipple, with scars that vary according to how much reshaping is needed. Fat transfer can add some volume using fat from elsewhere on the body. It requires enough donor fat, and some of the transferred volume is lost as healing progresses. Depending on the exam and the patient’s goals, these procedures can be combined with removal or considered later, once the breast has settled.

Along the way, Dr. Fuller and Dr. Butz share the questions they want patients to ask. How much fullness am I comfortable losing? What scars would I trade for a lift? Is there a reason to remove my capsule? And what might my breasts look like if I simply take the implants out? The answers depend on what brought you in and which changes matter most to you.