Allergan 415cc Over Muscle - Considering explant and lift but do not want to look deflated. What would be recommended? (Photos)

Question

I’m 5’3” and around 130lbs. I had 415cc over-the-muscle Allergan TSF implants (now recalled) placed 11 years ago. Before surgery I wore a 34C (though I was likely in the wrong band size) and afterwards measured around a 34E. I’ve felt they were too big from the start and have spent the last decade trying to hide them. I’ve wanted to be smaller almost since they were placed. I’ve since had two children and breastfed both. I now measure around a 30F and the volume hasn’t reduced at all. I feel at a crossroads. Because they are Allergan implants, I feel anxious leaving them in. I also likely need a lift and would want to be smaller. Over the past 18 months I’ve seen several surgeons and feel increasingly confused. The original plan was explant and lift, but I’m worried about looking very deflated. Fat transfer was suggested and I even booked surgery, but cancelled after researching risks. I’m concerned about fat necrosis and don’t want to create new problem areas by taking fat from my legs (though I wouldn’t mind some abdominal tightening). I’m hesitant about replacing with smaller over-the-muscle implants due to my wide-set breasts and desire for a more natural size and shape. I don’t think I could cope with explant alone without a lift. I feel stuck and anxious and don’t want another summer feeling overwhelmed by my chest.

Laura Roider, MD · Answer

@Help_Me_Decide Thank you for sharing photos and your story. 
You have lots of options in terms of treatment and ultimately the decision should be based on your goals. The options you have include: - Remove old implants & capsule and mastopexy (Anchor pattern Lift) - Remove old implants & Capsule, fat grafting, and mastopexy (Anchor pattern Lift) - Remove old implants & Capsule, smaller volume implant and mastopexy (Anchor pattern Lift) 
There are pros and cons to all of these options (many you've outlined in your question). During a consultation, a surgeon should be able to estimate how much of your current breast volume is implant vs natural breast tissue. This will give you an idea of how much breast tissue you'll have following removal of the implants. One thing to note is if you proceed with removal and a breast lift w/o fat transfer or a smaller volume implant you'll lack the upper pole volume/cleavage that an implant can provide.

Daniel Barrett, MD · Answer

Dear Help_Me_Decide,

it is hard to tell for sure without an examination. My preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thats being brought together to support the breast and hence improves longevity.  If you are considering surgery, I would suggest you 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

Gary M. Horndeski, MD · Answer

You would benefit from explantation and lift using the Bellesoma. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Gerald Minniti, MD, FACS · Answer

Your best way to fix the problem is remove implants and capsules, replace with new, smaller implants and mesh, preferably with Motiva, and perform lift. You'll get everything you ever wanted and remain safe.

Vasileios Vasilakis, MD, FACS · Answer

Hello,
Thank you for the question. You would benefit from a breast lift and removing the implants. Once the breast lift is healed, at a later/second stage, you can decide whether you want new implants placed. I wish you the best.
Vasileios Vasilakis, MD, FACSDouble Board-Certified Plastic SurgeonHouston, TX

Kamol Pansritum, MD · Answer

Given your concerns about size and anxiety regarding your current implants, a breast lift combined with a smaller implant (approximately 200–300 cc, over the muscle) would provide a lighter, more proportionate result while maintaining upper fullness.Alternatively, a breast lift with fat transfer (around 300 cc per side) can restore volume in a more natural way, without significantly increasing the risk of fat necrosis when performed with proper technique.

Darryl J. Blinski, MD · Answer

Based on the 1 posted photo I agree with explant ave capsule removal with full lift. I personally recommend fat grafting under ultrasound guided injections of the fat. That way the surgeon can see layers and levels the fat is being placed to help avoid fat grafting issues. Expect fee to range from $12,000 to $24,000.

Allergan 415cc Over Muscle - Considering explant and lift but do not want to look deflated. What would be recommended? (Photos)

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