Do you advise getting an explant and lift at the same time?

Question

I have saline breast implants under the muscle that are about 20 years old. If I take them out I will almost certainly need a lift. Do you advise getting a lift at the same time as the explant?

Gary M. Horndeski, MD · Answer

The technique I recommend is explantation using The Bellesoma Method.  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 and the ability to breast feed are maintained, if not injured during your previous surgery.  At the same time or later, fat transfers can be performed if additional volume is desired.  Best Wishes,Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear Jdennen,
if you want to remove implants and get breast lift, then you have two options. One is to perform both surgeries at the same time or you can remove implants now and later get breast lift. 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

Christopher J. Davidson, MD, FACS · Answer

Great question!  The quick answer is yes, the long answer is probably yes.  In most cases this can be done, however, of course it is important to have a thorough discussion with your plastic surgeon regarding the specific details relating to your previous surgery, your aesthetic goals, and of course, your medical history.  Factors that can be relevant is your smoking history, how much lift is needed, among others.  I wish you the very best of luck!

Kenneth Hughes, MD · Answer

Breast implants over time tend to thin tissues, cause a decrease in size, and create more droop. Usually removing them and performing the lift at the same time makes the most sense as some patients clearly need a lift.  If you are borderline, removal followed by a waiting period is more reasonable.Kenneth Hughes, MD, ABPS Board Certified Plastic SurgeonLos Angeles, CA

Lewis Albert Andres, MD · Answer

Hello! Thank you for your question! It is a matter of surgeon preference as well as what is seen during your procedure that will determine whether or not a complete capsulectomy is performed. I have always favored a complete capsulectomy vía en bloc method.  Although a more complex and skilled procedure, I believe it to be the best method, especially given concerns today  A true en bloc will keep the implant and all contents within as one piece throughout the removal without violating the capsule and opening it up during the procedure.  
If significant capsule formation is seen intraoperatively, a full capsule removal may be warranted with a drain in order to completely remove all of the tissue and allow better adherence of your breast back to its normal anatomic position down on your chest wall. If minimal contracture is seen, it may be possible to leave the capsule, or place cuts within the capsule to allow better adherence.  It is still not completely understood what forms the capsule, but the popular theory would lead most to removing it entirely. It truly is dependent on what is seen with your capsule and the issues that may be causing you to have such a procedure (e.g., contracture from rutptured implant vs pain vs simple pocket adjustment, etc).  
But, I completely believe in removal of the entire capsule, en bloc, for several reasons - removal of entire capsule that wasn’t there to begin with, adherence of tissue back to where it started, improved breast contour for revision, and not exposing the body to any implant material or periprosthetic fluids/contents that are within the capsule and in vivo.  These are just a few important that en bloc addresses. Drains should be used to remove the fluid that will inevitably develop in the potential space.   Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I favor performing capsulectomies (in an en bloc fashion) in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast, and suturing the muscle back to where it started from. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you. Given the capsule formed from the foreign object and was not there to begin with, as well as some theories of what exactly is a capsule and what causes it to form...I favor complete capsule removal.  I would expect a somewhat similar appearance as if you have not had implants, as your breasts have also aged over the past few years. The decision on whether a lift may be performed depends on how much of a lift is needed and ultimately vascularity to the breast.  Otherwise, consideration as a staged procedure with/out fat grafting may be done then or at same time.  Most are back to regular things within a week. Activity restrictions for ~6 weeks along with a compression bra.  Cost will vary amongst surgeons. Discuss with a surgeon who is knowledgeable, skilled, and experienced with this technique. Hope that this helps!  Best wishes!

Matthew A. DelMauro, MD, FACS · Answer

Hello, and thank you for your question. (Keep in mind that an in-person consultation is necessary for the best advice.) The ability to get a lift at the same time as explanation depends on your physical exam. If your breast tissue isn't thick enough, the lift should be delayed (to reduce the risk of surgical complications).
If you decide to pursue surgery it’s very important that you find a surgeon whom you are comfortable with and trust and who evaluates you in-person and tailors an individualized treatment plan for you and your aesthetic goals. Best of luck!
Matthew A. DelMauro, M.D.

Khashayar Mohebali, MD, FACS · Answer

Implant removal and lift is the most common surgery we perform and can be safely perform with great outcomes.  It allows for one surgery and one recovery to get the look you desire.  Select an experienced surgeon in that procedure and good luck.

Camille Cash, MD · Answer

It is possible to remove implants and have a lift in the same day, but not everyone is a candidate for this.  An examination is needed to determine what is best for you.  I encourage you to meet with a board certified plastic surgeon near you to determine what is best for you.  Some factors  your surgeon will be looking at are the elasticity of the skin, amount of breast tissue, and determining if capsular contracture is present.

Connie Hiers, MD, FACS · Answer

You will need to be examined to see if a lift is needed, if it can be done at the same time, or if you need to wait. Women who have little breast tissue may not be a candidate for a traditional lift once the implant is removed. I would suggest meeting with a board certified plastic surgeon and discussing your options.

Johnny Chung, MD, FACS · Answer

Thank you for your question. This is a difficult question to answer without first having an examination. Some patients do well with explantation alone. Some patients require a lift after explantation. I recommend consulting with a board-certified plastic surgeon in your area who is a member of the American Society of aesthetic plastic surgeons. Best of luck with your procedure.

Do you advise getting an explant and lift at the same time?

Answers (12)

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