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What the FDA Recommends About Implant Removal
The FDA's position is that asymptomatic women with recalled Allergan BIOCELL implants do not need to have their implants removed prophylactically. The FDA's reasoning is that the absolute risk of BIA-ALCL, while elevated compared to other implants, remains low in absolute terms — and explant surgery itself carries surgical risks (anesthesia, infection, scarring, and the psychological impact of losing reconstruction results). The FDA recommends that women with BIOCELL implants monitor with regular follow-up visits with their plastic surgeon and report any new symptoms immediately. However, women with symptoms consistent with BIA-ALCL — particularly late-onset seroma, breast swelling, or a new lump — should seek prompt medical evaluation and not delay out of reluctance to undergo surgery.
Explant Surgery Costs and Insurance Coverage
Explant surgery for breast implants typically costs $3,000 to $10,000 out of pocket depending on whether implant replacement is performed, the need for capsulectomy, anesthesia and facility fees, and geographic location. Insurance coverage for recall-driven explantation is inconsistent: some insurers cover it as medically necessary when documented with a BIA-ALCL symptom or diagnosis; others classify cosmetic explant surgery as elective and deny coverage. Post-mastectomy reconstruction patients often have stronger insurance coverage arguments under the Women's Health and Cancer Rights Act (WHCRA). Out-of-pocket explant surgery costs related to the Allergan recall are recoverable as economic damages in MDL 2921 claims, in addition to non-economic damages for distress and the disruption of undergoing an unplanned surgical procedure.
En Bloc Capsulectomy — What to Request If You Are Removing BIOCELL Implants
If you are proceeding with explant surgery for Allergan BIOCELL implants — whether due to BIA-ALCL symptoms or personal decision — the FDA and ASPS recommend requesting en bloc capsulectomy: removal of the implant together with the entire surrounding capsule as one intact specimen. This approach is important if BIA-ALCL is suspected or present, as it ensures complete removal of any potentially malignant capsule tissue and allows the pathologist to evaluate the intact specimen. Even without a BIA-ALCL diagnosis, en bloc removal and pathological examination of the capsule can identify early-stage disease (Stage IA in seroma fluid or on the inner capsule surface) that might be missed with simple implant removal. Request that the explanted implant and capsule be sent to pathology for analysis. Keep copies of all surgical and pathology reports — these are critical evidence for any legal claim.
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