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Also known as
Implant removal, device extraction, hardware removal, prosthesis removal, implant explantation, device explantation, hardware explantation, extraction of hardware
Definition
Explantation refers to the surgical removal of an implanted medical device from the body1. This procedure is performed when an implant is no longer needed, has malfunctioned, or is causing complications2. Explantation involves careful extraction of the device, which may include removal of surrounding scar tissue (capsule) that naturally forms around implants3. The procedure’s complexity varies depending on the type of implant, its location, how long it has been implanted, and the degree of tissue integration with the device4.
In medical contexts, explantation serves multiple purposes: resolving complications, replacing failed devices, removing temporary implants once they’ve served their purpose, or addressing patient concerns about implant safety5. The decision to perform explantation requires careful risk-benefit assessment, as the procedure itself carries potential surgical risks that must be weighed against the benefits of device removal6.
Clinical Context
Explantation is performed across multiple medical specialties, with varying indications, techniques, and considerations depending on the implant type and patient factors1.
In cardiology and cardiac surgery, explantation may be necessary for transcatheter aortic valve replacements (TAVR) due to structural valve degeneration (23.5%), severe paravalvular leak (41.2%), procedural complications (23.5%), endocarditis (5.9%), or as a bridge to definitive surgery (5.9%)2. The procedure becomes more complex when the implant has been in place for over a year, as neoendothelialization can occur, requiring intense aortic endarterectomy and potentially unplanned aortic root repair3.
In plastic surgery, breast implant explantation may be performed due to complications such as capsular contracture, implant rupture, infection, or patient preference4. The procedure may involve different techniques including total capsulectomy (removing the implant first, then the capsule in pieces) or en bloc capsulectomy (removing the implant and capsule as one unit)5. En bloc capsulectomy is particularly indicated when silicone implants have ruptured, biofilm is present, or the patient has been diagnosed with breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)6.
In orthopedics, explantation of hardware may be necessary due to infection, mechanical failure, pain, or once the device has served its purpose in guiding bone healing7. Similarly, in urology, devices such as penile implants may require explantation due to infection, mechanical failure, or patient dissatisfaction8.
Patient selection for explantation requires careful consideration of surgical risks versus benefits, especially in high-risk patients9. The Society of Thoracic Surgeons Predicted Risk of Mortality score is significantly higher at the time of explantation than at the time of original implantation (9.9% vs 3.5%)10, highlighting the increased risks associated with these procedures.