What are my options after Breast Explant Surgery, when my Breasts were Tubular Pre-Augmentation?

Question

Hello, About 12 years ago I had a breast lift and augmentation to correct my small tubular breasts. They were gel under the muscle. The results have been wonderful, however, I would like to have them removed, but I do not want implants again. I want my breasts to look good post explant without getting new implants. What are my options? If I choose to do a lift, will my breasts be tiny as hell because they were tiny pre-augmentation? Would getting a lift with fat transfer be my only option?

Leland Deane, MD, FACS · Answer

This is a great question, and one that I love to answer. As they say, 'it all depends'. For instance, have you had children and when? What do the breasts looks like now? How large were the implants? In general, I have had excellent results after removing implants (and not replacing them). If a subsequent lift/mastopexy is needed, then it becomes much more accurate, with better shape and less scarring, in my opinion. As to the question about being 'smaller' in size, I have found that the change is minimal and certainly worth the improved shape and not having to deal with implants. At this point, I have had a large experience with this and would be happy to do a virtual consultation with you. Hope this helps.

Chet Mays, MD · Answer

Thank you for your inquiry!  Fat transfer is a great way to add some volume to your breast.  We would love to sit down with you and discuss your options.  Schedule a consultation with a Board-Certified Plastic Surgeon to discuss your goals.

Daniel Barrett, MD · Answer

Dear swansandfrogs,

it is hard to tell for sure without an examination. 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

Mark K. Markarian, MD, MSPH, FACS · Answer

Hello and thank you for sharing your concerns about your breasts.
  
Typically, correction of tubular breasts involves not just placement of breast implants but also manipulation of the breast tissue, and potentially a lift.  Since it doesn't sound like you had a lift, you likely had some breast tissue manipulation in addition to your implant placement during your surgery to improve your tubular breasts.   As such, if you were to remove the implants, the appearance of your breast may not be exactly what they were before the implants were placed, but likely very similar.  The size would be very similar too.  If you're concerned about the breast size following implant removal, and planning a breast lift, please know that a breast lift will reduce your cup size about a third to half a cup, because a breast lift involves excising skin which makes the breast smaller overall.  Also, any decision to fat graft has to be made carefully as fat grafting can not only cause asymmetry (as fat necrosis and/or fat graft survival varies), but will only increase breast volume and not provide a lift, if that's what you're interested in...

The next step for you is to find the right board-certified plastic surgeon who specializes in aesthetic plastic surgery.  In your consultation, be sure your surgeon addresses all your concerns and discusses the surgery details including the position and size of the incision used, the type of breast implants available, the risks and benefits of the procedure, recovery time, and post-operative course.  Also, be sure to see plenty of before-and-after pictures in women who have a similar breast appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.

And lastly, I think the most important component of the consultation is to establish a good connection with your plastic surgeon.  It’s the connection that allows you to clearly define your desired breast outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you. 
For more information on Tubular Breasts, please refer to my link below.

Good luck. 
Mark K Markarian, MD, MSPH, FACS 
Harvard-trained Board Certified Aesthetic Plastic Surgeon

Farbod Esmailian, MD · Answer

It is very difficult to answer your questions without photos and a proper exam as well.  But in general, some patients will need a lift after explant, some will not.  Some patients benefit from fat transfer, in particular to the upper pole of the breast to help fill it some of the hollowing that is evident with implant removal.

I would recommend you see a board certified plastic surgeon that has a great deal of experience in revision surgery.  Breast revision surgery is significantly more difficult that primary breast surgery.

Hope that helps.

Gary M. Horndeski, MD · Answer

The technique I recommend explantation and lift 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 (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.

Connie Hiers, MD, FACS · Answer

If you were "tiny" before implants, you will be even more tiny after removal of implants since the implants stretched and thinned what tissue you had. If you want volume, the choices are smaller implants or fat.  If your tissue is very thin, a lift may not be possible since the main blood supply to your nipples is now through your skin. An examination can determine this. You might consider going down in size and having the lateral pockets tightened internally.  This decrease lets your tissue adjust some, and then later consider removing the implants. This option is dependent upon what size implants you have now. With large implants, it is best to go down in size.  Also, if you want fat, you need to have donor fat available.  Cadaver fat is being evaluated now, but is not yet FDA approved, and most surgeons cannot use it.

What are my options after Breast Explant Surgery, when my Breasts were Tubular Pre-Augmentation?

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