Implant removal, best place for incision?

I have 15 yo saline implants, the right side has a leak and is mostly deflated. My original surgery included a lollipop lift, what is the best location for a incision with the least amount of damage to the breast tissue ,will going in under the breast ( crease) be a better choice than through the original incision which would require going through more breast tissue ? My breasts are fairly saggy again and I'm not having a lift now but may in a few years when I'm done having kids.

Doctor Answers 8

Periareolar

Periareolar incision is the only real option that will give full visualization.

For explant surgery, it is almost always best to remove the capsule in its entirety. This will allow the space to heal. If you leave the capsule in place, it does not heal. Fluid can accumulate in the space. The situation that brings the patient to implant removal will have an affect on the decision. This is a surgery which requires discussion with the plastic surgeon about the problem, the goals, and the technical concerns. The body does not re-absorb the capsule. Revision surgery requires drains because the fluid is going to be generated when you operate on the scar capsule. If you provide a mechanism for the fluid to be removed (i.e. drains), the risks are lower. If the fluid accumulates because there were no drains, it will most certainly cause problems in the future.

Scar position

I suppose the biggest question is the quality of your current vertical scar. Some surgeons would recommend only opening this scar whereas others would suggest an IMF incision. There are pros and cons of each. Personally if the vertical scar is well healed then an IMF incision may be better as it gives better access. However if you have limited breast tissue and there may be a chance of an IMF incision becoming visible then opening the vertical scar may be better. 

Gary L. Ross, MBChB, FRCS
Manchester Plastic Surgeon
5.0 out of 5 stars 142 reviews

Incision for breast implant removal

The short answer is for an incision in the center of the inframammary crease. For saline-filled implants this only needs to be 2 cm (just as for putting them in) because they can be drained in place and the shell removed through that small an incision in a simple removal. If the implant is gel-filled it is harder to know if the implant is intact from the outside and a larger incision is needed to remove the implant and any loose gel in the pocket. If the capsule needs to be modified or removed because it is abnormal, then a larger incision in the inframammary crease is also best. 
In your case I would use the lower end of the lollipop incision which is in or near the inframammary crease. This can be done with local anesthesia alone for a saline-filled implants and a simple removal (nothing done to the capsule) via this route. 

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

Implant removal, best place for incision?

Thank you for your question.  In general for my practice, I try to go through previous scars and try not to create any new scars.  So if your original surgery gave you a lollipop scar, that's where the incision would go through, at least part of it.  Be sure to consult with an experienced board certified plastic surgeon.  Good luck!

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 16 reviews

Crease incision gives the best exposure

Thanks for your question. I'm sorry about your deflation. The IMF crease incision gives the best exposure and has the least incidence of injury to breast tissue or sensation to the nipple. Best of Luck!

M. Scott Haydon, MD
Austin Plastic Surgeon
4.9 out of 5 stars 84 reviews

Implant removal, best place for incision?

Thank you for your question.  If one has an existing inframammary incision then this is my first choice.  However, the decision is best left to the surgeon performing your operation.  As you mentioned you may consider a lift in the future.  The inframammary incision would not limit one's options in the future.  Please discuss this with your surgeon.  

David J. Wages, MD
Peabody Plastic Surgeon
5.0 out of 5 stars 19 reviews

Implant removal, best place for incision?

The incision I use most frequently for breast implant removal is the infra mammary fold incision.  Sometimes, if additional work is necessary, I utilize an infra areolar approach.  In your case, the previos vertical scar is also an option.You may find the attached link, dedicated to breast implant removal surgery concerns, helpful to you as you learn more. Best wishes.

Removal

I would suggest using part of your original incision to minimize damage to your tissue and numbness. Probably the vertical portion of your scar would be good to use. However, I would suggest meeting with a board certified plastic surgeon and discussing all your options. Your surgeon, after looking at your scars, might suggest a different incision than the vertical portion due to scarring that could be improved. Remember, replacing the deflated implant is an option.

Connie Hiers, MD
San Antonio Plastic Surgeon
4.6 out of 5 stars 13 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.