In short
- There is no single answer. It is decided by the quantity, the area, the symptoms, the state of the tissue and your medical situation.
- Operating does not guarantee going back to how you were. In the available review, surgical excision achieved 48% complete responses and 50% partial ones.
- Surgery has complications of its own. In a series of 35 gluteal removals, 40% had a seroma and 42.85% had no complication at all.
- Waiting is not neutral either: the material is not reabsorbed and the reaction around it stays active. There are cases that show themselves twenty years later.
- 🔑 Monitoring is a legitimate decision, not a postponement out of fear, and for some people it is the right one.
- 🔑 In most cases, waiting does not make later surgery harder. It is not a guarantee — in medicine there are none — but fear of “leaving it too late” should not be what pushes you into theatre.
- Monitoring has a protocol: at ICPM, an annual MRI to check stability and to watch for migration of the product and of the involvement.
- The criterion for operating is specific: when it affects quality of life or causes significant discomfort or pain.
- There are people who cannot have surgery. In the review cited, many patients were not candidates for surgery because of contraindications or lack of access.
It is the hardest question in this whole subject, and the one answered worst on the internet, because it is almost always answered from one side only: either you are frightened into operating, or reassured into doing nothing.
The honest answer is uncomfortable: both options have a cost. Operating does not take you back to the starting point, and waiting is not free. This page puts the figures from both sides so that the decision is yours and not that of whoever is telling you about it.
The detail of the surgery is in the guide to biopolymer removal. If what you want is to avoid theatre, first look at what has been tried without surgery and what it achieved.
What you gain by operating, with the figure in front of you
Let us start with what almost nobody publishes, because it is what makes a real decision possible.
A 2023 systematic review on the management of silicone granuloma brought together 93 studies and 227 patients. Surgical excision was the treatment in 66.2% of cases, and its results were: 48% complete responses and 50% partial responses.
Read it twice, because it says two things at once:
- The vast majority improve. Adding complete and partial together, practically every patient operated on obtained some degree of response.
- Fewer than half were completely resolved. Surgery improves things a great deal; it does not always resolve them entirely.
To that must be added something the main guide already states clearly and which is worth bearing in mind: complete removal of the material is rarely achieved, because it does not form a pocket that can be emptied but infiltrates between the tissues. The realistic aim is not “to take it all out”.
What operating costs
The other side of the scales. In a series published in 2025 of 35 patients operated on for removal of gluteal biopolymers through an open paramedian approach, with mild to moderate involvement:
| No complication at all | 42.85% |
| Seroma (the most frequent complication) | 40% |
| Mean time to the seroma | 31 days |
| Wound dehiscence and infection | described, less frequent |
| Flap necrosis or haematoma | no cases |
The authors conclude that the technique is a safe alternative in mild or moderate involvement, with favourable aesthetic results, and that the complications described did not require further procedures.
It is a good result for surgery of this nature. But a 40% seroma rate and an average of a month before they appear is information you deserve to have beforehand, not afterwards.
What waiting costs
Monitoring does not mean nothing is happening. It means accepting three things:
- The material is still there. It is not reabsorbed. What today is a silent deposit is still a deposit tomorrow.
- The foreign body reaction continues. It is low-grade and can stay quiet for a long time, but it does not go away.
- A long interval does not protect you. In a case published in 2025, a patient with material injected twenty years earlier developed severe inflammatory lesions. Having been well for a long time is no guarantee of staying well.
To that is added what is described when complications do appear: in the review of the world literature on industrial silicone, among the published cases the most frequent were granulomatous reaction (41.5%), dermatological problems (41.5%), infection (35.9%) and pulmonary complications (34.5%). These are not the incidence among everyone who has had injections — that denominator does not exist — but they do describe what kind of problems appear.
And one thing waiting does not usually cost
It is worth saying plainly, because it is the fear that most pushes people into operating before they have decided: in most cases, waiting does not make later surgery harder. It is this practice’s view and it goes against what many people assume.
With the caveat that always has to be made, and which we prefer to write rather than leave implied: in medicine nothing can be stated categorically. This is what is observed in most cases, not a promise about yours. If there is something in your situation that argues against waiting — repeated infections, an area that is getting worse, compromised skin — then we are no longer talking about monitoring.
Outside those circumstances, the decision has no surgical expiry date. If you monitor for two years and then decide to have surgery, what you would expect is that you have not lost the chance of a good operation. What changes over time is usually not the technique but your situation: the symptoms, the area, your state of health.
That makes “monitoring” what it ought to be — a reversible decision — and not a gamble.
What tips the balance
Towards operating:
- 🔑 That it affects your quality of life, or causes significant discomfort or pain. It is this practice’s criterion and the one that weighs most: limitation in sitting, walking or sleeping, or pain that already shapes your day.
- Repeated infections or inflammatory flare-ups.
- Progression: the area is getting worse, deformity appears or the skin becomes compromised.
- An open wound, an ulcer or discharge, which does not allow waiting.
- An underlying autoimmune disease. In the case published in 2025, the coexistence of rheumatoid arthritis worsened the inflammatory response.
- A manageable quantity and location: the more contained it is, the more can be achieved.
Towards monitoring:
- An absence of symptoms and stability over time.
- A small amount of material, well localised and with no signs of inflammation.
- Medical circumstances that make the surgery riskier than the problem it would solve.
- Areas or a spread that greatly limit what can be removed, where the expected benefit does not outweigh what it leaves behind.
- The wrong moment in your life. It is not an emergency: if you cannot take on a recovery now, waiting under monitoring is an option.
What “monitoring” really means
So that it is not confused with doing nothing. Monitoring is:
- A baseline assessment with an examination and imaging, to know the starting point.
- An annual MRI. It is the schedule we recommend to anyone who decides not to have surgery, and it has two specific aims: to confirm that the situation remains stable and to watch for migration of the product and of the involvement.
- Knowing what to look out for between appointments, which is exactly what the page on symptoms and warning signs explains.
- Treating whatever appears when it appears, without that obliging you to have surgery.
- And being able to change your mind. Monitoring today does not close the door to operating tomorrow.
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Frequently asked questions
If they do not bother me, why have surgery?
It is a reasonable question and it has no automatic answer. The absence of symptoms is a genuine argument for monitoring. What weighs on the other side is that the material remains and the reaction stays active, and that there are cases that appear a long time later.
Will they be able to take it all out?
Complete removal is rarely achieved: these materials infiltrate between the tissues and do not form a pocket that can be emptied. The aim is to remove as much as possible and resolve the problem, not to leave the area as it was before the injection.
How much do people who have surgery improve?
In the available review, 48% achieved a complete response and 50% a partial one. That is: almost everyone improves; about half are fully resolved.
Is the surgery dangerous?
It has complications of its own and they are worth knowing. In the series of 35 gluteal removals cited, the most frequent was seroma (40%), there were no cases of necrosis or haematoma, and the complications described did not require further procedures.
And if I wait and it gets worse?
That is the reasonable underlying fear, and the answer is reassuring without being absolute: in most cases, waiting does not make later surgery harder. Individual progression cannot be predicted — in medicine nothing is ever stated categorically — and that is why monitoring is not sitting on your hands: it is starting from an objective assessment and repeating an MRI every year, so that any change is judged on data. What you do not usually lose by waiting is the possibility of a good operation later.
When is the decision to operate taken?
When it affects quality of life or when it causes significant discomfort or pain. That is the criterion, and it is why someone with no symptoms can monitor calmly even if they are carrying a lot of material.
How often should I be checked if I decide to wait?
The schedule we recommend is an annual MRI, to confirm stability and to watch for migration of the product and of the involvement.
I have an autoimmune disease — does that change anything?
It can change a good deal. The coexistence of an autoimmune disease is described as worsening the inflammatory response to the material, and management in those cases usually calls for a multidisciplinary approach.
Are there people who are not operated on?
Yes. In the review cited, many patients were not candidates for surgery because of contraindications or barriers to access. For them there is medical management, which controls the inflammation although it does not remove the material.
Can it be done in stages?
It is a possibility assessed according to the quantity, the areas and the state of the tissue. It is decided case by case.
Sources
- Mustin DE, Barrett DL, Gangal A, White MS, Yeung H. Management of silicone granuloma: A systematic review. JAAD Int. 2023;11. Ninety-three studies with 227 participants; surgical excision accounted for 66.2% of treatments, with 48% complete and 50% partial responses; overall, 41.8% complete and 51.6% partial; many patients were not candidates for surgery because of contraindications or barriers to access; the evidence is limited to case series and a single cohort study. https://pubmed.ncbi.nlm.nih.gov/36865613/
- Eusse Llanos JC, Posada López S. Paramedian open approach for gluteal biopolymers removal: a case series of 35 patients. JPRAS Open. 2025;45. A series of 35 patients with mild to moderate involvement; the most frequent complication was seroma (40%), followed by wound dehiscence and infection; there were no cases of flap necrosis or haematoma; the mean time to seroma formation was 31 days; 42.85% had no complication at all; the authors conclude that it is a safe alternative with favourable aesthetic results and that the complications did not require further procedures. https://pubmed.ncbi.nlm.nih.gov/40837208/
- Gerk A, Telles L, Carroll M, et al. Use of industrial liquid silicone: a scoping review. Acta Cir Bras. 2024;39. Among the published cases, granuloma (41.5%), dermatological problems (41.5%), infection (35.9%) and pulmonary complications (34.5%). https://pubmed.ncbi.nlm.nih.gov/39383418/
- Hormaza-Jaramillo A, Peñaloza Gonzalez D, Benavides-Ibarra SA, et al. Severe Complications Due to Biopolymers in a Patient With Autoimmune Disease: A Case Report and Review of the Literature. Aesthet Surg J Open Forum. 2025;7. A patient with material applied 20 years earlier and rheumatoid arthritis, with severe inflammatory lesions; the coexistence of autoimmune disease can worsen the inflammatory response and the management was multidisciplinary. https://pubmed.ncbi.nlm.nih.gov/40979311/
Book your consultation
If you have spent years turning over whether to have them removed, what settles the question is not more information: it is knowing how much material you have, where it is and what state the tissue is in. With that on the table, the conversation changes.
At the assessment you are taken through both options with what each can give you, including the possibility of not operating and reviewing.
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Last reviewed: 6 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.
