Going from 36C back to AA: How much sagging should I expect? Can I expect to be completely flat again?

Question

Hi. I am 5'5, 115 pounds, 29 years old. I had my implants in for almost 6 years and am scheduled to remove them. I was an AA before and went up to 36c. I want to be completely flat again. I know there will be some initial sagging since I was completely flat and went up to a 36c, but since I was flat before can I expect after months of healing to be flat again? How much loose skin should I be expecting? Thanks for the help.

Wayne I. Yamahata, MD · Answer

Unless you have gained weight or have had hormonal changes, it is likely that your volume will return to your preoperative state following explantation. Most women your age will not require a mastopexy or breast lift.

Gary M. Horndeski, MD · Answer

At size 36, each 200 cc of implant corresponds to 1 cup size change. You will go down about 400 cc to size A. It is most likely that you will have excess skin and can possibly contract. If the skin does not contract then you will need a lift. The technique I recommend is a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Hakim Said, MD, FACS · Answer

Hi Powerful, 
There are many options for you, so the answer really depends on you. At your young age, unless you have had tremendous weight changes, I would generally expect the skin to spring back fairly well. Just removing the implant and leaving the capsule behind will likely give you the look of a very small implant as your body's natural fluid fills the remaining pocket. You certainly have natural fluid collections elsewhere, like in all your joints and your eyes, so that is one option to avoid breast lift incisions and implant issues. If you have a saline implant, you can ask to have that deflated in the office to get a sense of that look before surgery. 
Breasts have a trajectory over your lifespan; they tend to be larger every decade or so until about 60. You will likely be slightly larger than you were when they were placed, and the skin will certainly be looser. If after explant, the skin is not tight enough, then adding breast lift incisions can remove the extra skin, even down to a flat, ballet look if you want. That can be done at the same operation, or later on, after a spring-back period to see how your skin behaves. Find a surgeon who can assess your skin, talk through the pros and cons of those options, and make a plan that is right for you. 
Hope that helps!

Vasileios Vasilakis, MD, FACS · Answer

Hello and thank you for the question. Most likely, you will go back to your pre-augmentation size. However, you should expect loose - and to a degree sagging - skin due to the weight and stretch effect of the implants for the past 6 years. The degree to which the loose skin retract and corrects over time is hard to predict without photos and in-person examination as there are several factors influencing this process. I wish you the best of luck. Vasileios Vasilakis, MD. Fellowship-trained plastic surgeon. Houston, TX.

Nelson Castillo, MD · Answer

Thank you for sharing your question.  Hard to say without photographs or an in-person examination but you should anticipate some loose skin being present but overall an appearance similar to your chest before implants.

Daniel Barrett, MD · Answer

Dear Powerful244385,
it is hard to tell for sure without an examination. You can get implant removal and wait to see the final results. Later breast lift might be an option if there is sagging. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

Having implants does not increase, but rather decrease your breast tissue since they do stretch and thin your tissue. If you had little prior to surgery, you will still have little, unless you have gained weight.  You will have some loose skin and may need a lift, or may can have minimally invasive radiofrequency tightening. You might consider going down in size and tightening your pockets internally. Remember, you were not happy before getting implants and may not be happy once removed. Going down to a B cup may be the best solution.

Camille Cash, MD · Answer

Once the implants are removed you will have approximately the same amount of breast tissue you had prior as long as your weight is about the same as when you had augmentation.  There will likely be some sagging of the skin when the implants are removed.  It will retract to some degree based on the elasticity of the skin.  Your surgeon will be able to give you a better idea of what you can expect after an examination.

Going from 36C back to AA: How much sagging should I expect? Can I expect to be completely flat again?

Answers (8)

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