What Would Happen if 20 Year Old Breast Implants Were Removed?

Hi, there are a number of options you can choose from if you want your implants to be removed. In our office, there is regular breast lift, natural breast augmentation, or California Lift. The last two is almost the same in the sense that they both uses fat transfer.Procedure will involve rinsing of fat removed with sterile saline solution and then packaged into syringes and prepared for transfer. Approximately 20% of fat removed is suitable and available for fat grafting. The prepared fat is injected in small amounts at a time and widely distributed within the layers of the breast so that these living fat cells can pick up a healthy new blood supply. Find a  board-certified plastic surgeon that has extensive experience with your case and discuss realistic goals and expectations. Best of luck! #RealSelf100

When removing 20-year-old breast implants, several factors influence the outcome. Many women may experience sagging or deflation of the breasts due to the lack of volume and support once the implants are removed, especially if the skin has lost elasticity over time. The extent of this depends on the size and position of the implants, as well as the natural breast tissue and skin quality.
A breast lift (mastopexy) is often recommended to restore the shape and position of the breasts, especially if there is noticeable sagging. For those who are not interested in replacing the implants, a lift can be performed on its own to enhance the appearance of the breasts.
It’s important to consult with an experienced plastic surgeon who can assess your specific situation and recommend the best course of action, whether it involves an implant removal with or without lift. The surgeon will consider factors like the skin's elasticity, the degree of sagging, and your personal goals.
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

Thank you for your question. The questions you ask depend on a variety of factors.  How large are your implants?  What is your skin like?  Do you have ptosis?  This will help determine if you need a lift or not.  As far as finding a Board Certified Plastic Surgeon, a good place to look is the website for ASPS or ASAPS.  Discuss with them your goals.  Together you will come up with a plan.

Yes, you may need a mastopexy if the implants are removed. You can determine this preoperatively, as your surgeon should have experience with this type of procedure .

If the implants are removed with the capsules, the skin may retract enough to give you an acceptable outcome.  It depends on the anatomic factors.

                  Plastic
surgeons occasionally see women who request removal of their breast
implants.  In many cases these
implants have been present for many years.  Patients may request removal for a variety of medical,
surgical and aesthetic reasons.  In
your case, distortion of your breasts from capsular contracture may be a
contributing factor in your decision to have them removed. It’s not unusual for
women to be concerned about the appearance of their breasts following implant
removal.

                  In
any particular case it’s virtually impossible to know if breast sag will
develop without pictures or a physical examination.  The presence of a nipple areola complex that sits below the
infra-mammary fold, poor skin tone and a high ratio of implant volume to native
breast tissue volume all suggest that breast sag is likely. 

Breast sag following explantation
is more likely in patients who have had multiple pregnancies, have breast fed,
have had weight fluctuations and have had implants for
longer periods of time.  When
implants are large and placed on top of the muscle the incidence of breast sag
following implant removal is higher as well.

Your history suggests that a
capsulectomy will probably be required at the time of breast implant
removal.  This may cause flat saggy
unattractive breasts.  Under these
circumstances breast lift surgery will probably be necessary to address these
aesthetic concerns.

                  If
you’re considering removal of your breast implants, consultation with a board
certified plastic surgeon is appropriate. 
This surgeon should be able to indicate the magnitude of the breast
deformity caused by explantation.

There are so many factors that will effect the ultimate outcome and appearance of your breasts following implant removal. These include:

1.Age (yes, over 40 does mean less elasticity/contractility than a 25 year old but usually more than a 60 year old)
2.Size of implant
3.Number of years implant is in place
4.Over or under the muscle placement
5.Length and duration of nursing while implants are in place
6.Natural volume of breast tissue


In summary, it is my experience that If you go with a conservative volume implant (that is a subjective and not objective term) relative to your breast tissue, it is likely that you will have some loss of upper fullness with implatnt removal but not a drastic amount of sag (ptosis).

I have prepared a video on youtube entitled Breast Augmentation Overview in which I show the consequences of two patients who have undergone implants removal:

1.Scroll to 1 min into the video and you will see a 40 year old who underwent implant removal 1 year after placement. I do not have the pre implant photos because the augmentation was performed elsewhere and the patient preferred to have me remove the implant rather than the initial surgeon

.
2.Scroll to 1 min 30 sec into the video and the second patient is a 42 year old who had implants in place for 20 years.

Occasionally, it is obvious that a person will need a lift and implant removal and replacement can be performed simultaneously although there are some concerns about the circulation to the nipple areolar complex. I generally prefer a two stage approach with implant removal followed b 6-9 months of observation and then decide on a lift at that point in time. If there is a question about the need for a lift, saline implants can be deflated with a needle to get a rough idea bout the degree of sagging or droop (ptosis) followed by observation for 1-2 weeks to observe the effects of immediate contraction

Petey60,

The answer to your quesiton really depends on your goals.  If you never want to have another breast surgery, take them out, get a lift, and be happy with smaller, perkier breasts.  If you enjoy a fuller look, consider a capsulectomy and replacement of implants.  Many things have changed in breast surgery  over the last 20 years.  Implants are now idealy placed in the submuscular or subfascial plane.  You can also visit the FDA's website (fda.gov) regarding the findings of breast implant studies:

Seek the opinions of several board certified plastic surgeons.  More information is always better than less.

Good luck!

The breast skin may be excessive when compared to the deflated breast implant. In these cases, a breast lift procedure is warranted to restore the cosmetic contour and shape of the female breast.

Dear Petey60, The implants can be removed- ultimately the volume of the implant and possiby some of you breast tisssue will be removed- this depends on the degree of capsule formation and the implants- whether they are intact or not.
You may have a breast lift at the same time and also include micro fat grafting (your own fat used to add volume to the breasts) to achieve a nice shape and size of breast.
With Warm Regards,
Trevor M Born MD