Explant and Breast Fat Transfer - one procedure or two?

Calcific capsules or capsules that are distorting anatomy should probably be removed during the implant removal procedure. Leaving a capsule behind is preferred if it is thin and pliable. Removing a capsule unnecessarily could result in bleeding and slight tissue loss. If your implants are silicone, your PS may suggest that both the capsule and implant be removed en bloc.
I usually perform the explant and lift first. The fat grafting I typically perform in about 3 months. Some of the success will depend upon existing tissue available for receiving the fat. Fat grafts should always be optimized with the best blood supply available. Fat is injected through multiple planes in small amounts to the tissue through one tiny incision under each breast. In general, the abdomen and thighs are preferred donor sites. The fat grafting will likely take several sessions to produce a similar result unless the breast implants were extremely small

For best fat survival, I would suggest first having your implants and capsules removed, and then doing the fat transfer at a second surgery once healed and the swelling has subsided. You might decide that you don't want any fat grafting.

Hi! Based on your story, it sounds like a capsulectomy will likely be needed if you have capsular contracture. Although it is nice to have the anterior capsule to sandwich the fat grafting between the skin and the capsule, it is still very possible to fat graft without the capsule, especially if you have a decent amount of soft tissue under the skin. I would generally recommend a one stage explant, capsulectomy (if needed) and fat grafting, understanding that the amount of fat that will be safe to graft might be more limited than in a 2 stage repair or a 1 stage with the capsules left in. With a potential lift (again, if needed), this one stage repair would probably get you a very nice result. If more volume is eventually desired, you could consider a second round of fat grafting in the future once you have fully healed from the first surgery.