Look Normal After Breast Implant Removal?

Explantation or removal of breast implants often leaves stretched out tissues. Traditionally, a breast lift or mastopexy is done to reshape the breast and take out extra skin. How much surgery is needed is very individual and depends on the size of the implants, the shape of your body, the condition of your skin.
I have found that some women do remarkably well with implant removal without an immediate lift procedure. A patient encouraged me to do just this as she wanted the least surgery possible. Remarkably, although the breasts looked extremely unattractive initially postoperatively, within 2 weeks, the skin had contracted and the breasts looked fine.
I now explain to patients that we can take out the implants and do an immediate lift, or we can take out the implants and wait and see what happens. If the skin does not tighten enough over time, a lift can be done as a secondary procedure. With this approach, even if a second procedure is needed, the skin removal will be smaller and the incisions shorter than if the lift were done at the time of implant removal. And so far, I have not had to do a secondary procedure. Everything has come back to shape when the pressure of the implants has been removed.

Unfortunately, your breasts will probably be sagging since they are already with the implants. Removing the implants will make it worse. To correct this, a lift may be performed at the same time as removal.

most of the time, with breast implant removal, the implants are replaced.   that being said, some patients do not feel the need for the added volume but instead are more interested in improving the shape.  those patients would benefit from a lift.  finally, there are those who want the implants completely removed without replacing them.  honestly, 450cc implants are pretty big, and without retailoring the skin (with a lift) there will be a large amount of sag. 

After removing large implants that have been there for years, you will experience severe sagging and most surgeons will recommend a lift at the same time.I personally refuse to remove large implants without a lift unless the patient does not have much sagging and has enough breast tissue left which is rare and you already have a lot of sagging as you described.you can also try a smaller implant below the muscle along with the lift because a lift alone rarely provides much upper pole fullness.

Hi there-
When relatively large implants are placed on top of the muscle, the skin and breast tissue will indeed be subject to more of gravity's pull, usually leading to stretching and sagging over time.
If you have decided you are no longer interested in having implants but would like to have the most natural, attractive result possible after their removal, I would suggest first and foremost, that you find a surgeon certified by The American Board of Plastic Surgery who has a great deal of experience doing complicated breast surgery. We are NOT all created equal, and your outcome will depend on this person's judgment and skill.
In my practice, we have achieved excellent results in cases like yours through implant removal and concurrent breast lift (I actually prefer to call it a breast re-shaping) procedure.
The approach is different, however, than for a more routine breast lift patient- in order to achieve the pleasing- long lasting shape we want.
Here's some advice on finding a surgeon you like and can trust:

Large implants above the muscle can be particularly problematic in terms of the way they affect the breasts. The weight of the implants without any support other than the skin leads to stretching and so when the implants are removed the look can be quite a bit different. It is usually a better idea to replace with smaller implants and go under the muscle, and perhaps a breast lift to deal with the extra skin.