Could sutures from internal stitches come undone?

Question

I have Silicone breast implants size 600. I have had them for almost 2 years now. I am thin build and like to stay active. I want to remove them altogether,but am afraid of what the outcome will be. I have enclosed pictures ,so you can get a better idea of what I am talking about. My PS suggested smaller implants with internal stitching to make the pocket smaller? I just worry that the stitches could come undone and I would have to have another surgery. Please, if you have any ideas let me know.

Raffy Karamanoukian, MD, FACS · Answer

Breast volume and skin tone can affect the look of your breasts. If the volume is removed, the question is whether the skin will follow in terms of bouncing back to its pre-surgery state. As the implants get larger and the length of time that you have the implants gets longer, the skin becomes less and less likely to bounce back.

Norman Bakshandeh Day, MD, FACS · Answer

There is always a chance of the internal stitches coming apart however this is not very likely. It is impossible to predict outcomes with any great certainty.

Remus Repta, MD · Answer

Hello,

	Thank you for the question and photos.  This is a very challenging decision for you to make and it will be important that you take your time and consider your goals very carefully.  Removal of the implants, in part because of the size of the implants, will have a dramatic effect on the appearance of your breasts and body.  If you are ok with not having any breast volume and understand that you will also likely have some type of a contour indentation in the center of your breasts at least for a few months, then removal of the implants alone may be a reasonable decision for you.  

	First you will need to decide whether you want smaller breasts or whether you wish to have no implants at all.  Smaller breasts can be accomplished by replacing the implants and correcting the pocket or removing the implants, letting things heal, and coming back and starting over again.  The second option will allow you to see how you will look without an implant and actually make the process of putting in a smaller implant more straighforward.

	All the best,

	Dr Remus Repta

Steven Wallach, MD · Answer

I think that it is very hard to predict how the breasts will look after implant removal.  I always prefer to put smaller implants in and resuspend the fold.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures.

	I understand your concerns;  you face a very personal and difficult decision. Most likely, given the size of the breast implants  involved,  you will not be pleased with the results of surgery once they are removed. Although this is not universally true, most young ladies wish to have some volume/fullness…

	 On the other hand, I understand your concerns about capsulorraphy and the use of small breast implants;  the more complicated the operation,  the greater the chance that further surgery will be necessary in the future. Certainly, you can depend on the fact that additional surgery will be necessary in your lifetime if you choose to re-augment your breasts. If you do decide to proceed with downsizing of breast implants and capsulorraphy, make sure you select a plastic surgeon who can demonstrate significant experience helping patients in your situation.

	 Ultimately, as I mentioned above, this will be a very personal decision that only you can make after asking yourself whether you will be pleased with the relative paucity of fullness and the presence of some loose/empty skin on the chest wall.

	 Best wishes as you consider the options.

Vincent P. Marin, MD, FACS · Answer

From your photos, it appears that you will have a significant change with the removal of 600 cc implants. It is likely (if you are thin) that you will have almost no breast tissue after the removal. Some breast volume is feminine and I would encourage you to consider the recommendation of your physician of an "internal bra" type procedure and a smaller implant. You could delay the surgery, but it will guarantee two procedures to restore the volume.

Best of luck,

Vincent Marin, MD
San Diego Plastic Surgeon

Best of luck,

Vincent Marin, MD
	San Diego Plastic Surgeon

Samir Shureih, MD · Answer

If you are absolutely sure you no longer want implants, and do not want any surgery on the implants in the future, then you can remove the implants with capsulectomy. Your slin seems to be good, but pictures are not a substitute for actual physical evaluation.

	Your present implants have bottomed down, below the inframammary line, and are too close medialy, so a capsulectomy will assure adherance of the breast back on the muscle. Later if needed you can consider a breast lift.

Hilton Becker, MD · Answer

If you no longer wish to have implants,it would be best to remove them .Wait at least three months and assess how the tissues contract and settle,you can then consider the various options

Jourdan Gottlieb, MD · Answer

Thanks for attaching the photos. 

	If you really want these out. you may well need a breast lift, though it could be done at a separate setting, and you could see how much skin shrinkage occurs before deciding.

	Putting a smaller implant and suturing for smaller pockets is also an acceptable option. All depends on how much smaller you want to be. If you go to, say 400cc, your surgeon may not find in necessary to alter the pocket.

	Thank you , best wishes.

Stuart B. Kincaid, MD, FACS (in memoriam) · Answer

Thank you for the pictures, but it’s hard to be accurate without an exam. Being that you have had the implants for 2 years you will have big difference in skin laxity. You did not mention how old you are and breast size you started out with. Those are key factors in what you outcome would be.

Could sutures from internal stitches come undone?

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