Out But Not Down

Women may choose to explant or remove breast implants for a variety of reasons. They may be experiencing problems related to the implants, such as leakage or deflation, capsular contracture or excessive firmness of the breasts, the implants may cause the breasts to appear asymmetric, or the implants may not be in the proper position relative to the breast tissue. In some cases, the breasts may have enlarged as a result of pregnancy and breast feeding, or through aging and weight gain, and the extra volume of the breast implants is no longer necessary or desirable.

Whatever the reason for explantation, the end result does not necessarily mean that the breasts will sag. If the implants were placed relatively recently, the breast envelope will have stretched very little, and the breasts should return to "normal" relatively soon after the implants are removed, if the skin elasticity of the breasts is good.

If, on the other hand, the implants were placed many years earlier, and if the breasts have been stretched as a result of age, gravity, weight gain, pregnancy, as well as the implants, explantation may result in a breast that appears "deflated". In these cases, the nipple/areola falls below the fold beneath the breast, the breast lacks projection, and the upper portion of the breast above the areola appears flat against the chest wall.

In cases where explantation makes the breast appear deflated, patients will require a Mastopexy or Breast Lift. This procedure is designed to correct the disproportion between the volume of the remaining breast tissue (now without the implant), and the excessive skin envelope which makes the breast appear droopy and deflated. The excess skin is removed, along with lifting the nipple/areola, allowing the breast to be re-packaged into a tighter skin bra. This lifts the breast and restores the projection of the nipple and upper breast, placing the breast in the proper and more youthful position on the chest wall.

So, although a woman chooses to have the implants out, this does not mean she must live with the breasts "down" or sagging.

A Mastopexy or Breast Lift, in conjunction with Explantation, can insure that you will not feel "Down and Out" about your breasts without implants.

The most important factors that will determine if you will require a lift after explant are:

1) SIZE of your current implants.

2) Amount of BREAST TISSUE that you had before.

3) TIME interval since your augmentation.

4) Degree of BREAST SAGGING that has occurred since your augmentation.

5) POSITION OF YOUR NIPPLE in relation to the lower breast fold.

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Breast implants will expand the volume of the breast as well as the skin envelope.  In most cases, simple explantation of an implant will result in loose or excess skin. Discuss your aesthetic goals with a plastic surgeon prior to proceeding.

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If you have breast implants and would like them removed, it's possible you may need a breast lift (mastopexy). This depends on several factors such as the size of the implants, the position of your nipple and the amount of breast tissue you had before the implants were inserted. This is difficult to answer without seeing photos or examining someone. The safest way to approach this issue is to remove the implants then wait about six months to allow for skin shrinkage and contraction to see where the nipple position ends up. This may be all that is needed if your breast shape and nipple are in a favorable contour/position. If after six months the skin is still sagging and/or the nipple position is too low, then at a second surgery, the breast lift (mastopexy) can be done more safely-due to a more reliable blood supply to the breast tissue and skin.

Please consult with a board certified plastic surgeon prior to planning your breast implant removal surgery.

Best wishes,

Dr. Bruno

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