Explant with mastopexy. Any recommendations? (Photo)

Question

I have 420cc high profile saline mentor smooth subglandular implants that were placed in 2002 with rippling, sagging and mild capsular contraction. From the surgeons I've consulted some just want to deflate in the office, then lift later if needed. Some say en bloc and lift, others can't guarantee total capsulectomy. I am really looking for the best looking outcome. I'm tired of implants and want to be natural but not deformed and flat. Any recommendations?

Richard Baxter, MD · Answer

With little breast tissue and large implants, it is important to not try to do too much all at once. Percutaneous deflation will allow time for the skin to retract and plan for the lift that you will certainly need. Do not do en bloc as it is unnecessary and will leave very little tissue to work with after.

Alan Gonzalez, MD, FACS · Answer

Hello @mcandts, thank you for your question and showing your pictures. An explantation with a capsulostomy would require a breast reconstruction to ensure that the breast doesn't look deflated, since removing the prosthesis will result in repositioning of the mammary tissues. In this way, you would achieve an aesthetic result you would be happy with. I link a video to shed more light, I hope it helps. The most appropriate course of action is to consult one or several board certified plastic surgeons. This will allow you to get more information and options tailored specifically to your needs. Best wishes! Alan Gonzalez, MD FACS.

Shaher W. Khan, MD · Answer

I prefer to have my patients explant only and I will close with a psuedo lift at the same time. This way the contour is natural looking. After a years time is when you see how the breast tissue fills out and fluffs. My patients are very happy with their outcome after the fact.

Dhaval M. Patel, MD · Answer

Thank you for sharing your photos and for your questions. From your photos, you are a good candidate for removal of breast implants, breast lift with fat transfer to bilateral breast. Breast lift will elevate & reshape your breast. Fat transfer will give your breast more volume and shape. Your expectations and health will dictate the best procedure(s) for you. I suggest a consultation with a board certified plastic surgeon to go over the options that best address your goals. Best of luck!

Dhaval Patel MD
Double Board Certified Plastic Surgeon
Chicago
South Barrington
Oakbrook
Orland Park

Dhaval Patel MD 
Double Board Certified Plastic Surgeon 
Chicago 
South Barrington 
Oakbrook 
Orland Park

Thomas Trevisani, MD · Answer

Based on your photos, it appears that you would benefit from Explantation with possible capsulectomy. I'd recommend a waiting period 3-6 months to allow for skin shrinkage to occur. If shrinkage is inadequate - then a breast lift may be indicated

Daniel Barrett, MD · Answer

Dear mcandts,
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

Gary M. Horndeski, MD · Answer

The technique I recommend is 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.

Camille Cash, MD · Answer

Based on your photos it appears you would benefit most from an en bloc implant removal and breast lift.  An examination would be necessary to determine if you have enough native tissue to reconstruct the breast or if a small implant is indicated.

Connie Hiers, MD, FACS · Answer

You would probably do much better with implants placed behind the muscle for better coverage and upper breast fullness, and going down in size, perhaps 250 to 300 cc's, that fits your frame and tissue better. Gel implants would feel more natural and not have ripples.  What you have is too large for your tissue and is sagging from the weight. En bloc surgery is used only for cancer surgery and certainly not required for removal of saline implants.  If the capsules are thin, they do not need to be removed, but dissolve with time with no implants.  An examination is needed to see if you are a candidate for a lift or just removal.

Peter Andolina, DO · Answer

In cases such as yours I typically like to perform a two stage surgery. During the first stage the implants would be removed +/- capsulectomy (partial vs complete). Sometimes capsules around saline implants are less thick than those around silicone implants. Once the implants are removed I like to give the breasts time to heal before performing the lift. In doing so I believe you will get the best outcome and it is the safest way to proceed. Typically patients would wait 6-12 weeks before the second stage surgery where the lift would be performed.

Explant with mastopexy. Any recommendations? (Photo)

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