Planning en bloc surgery for severe capsular contractor - Best lift for a perky end result? (Photos)

Question

I am planning enbloc surgery for my severe capsular contracture on both sides that has changed the shape and position of my under muscle implants. I was a small A cup before implants a D with them (implants in 23 years). I was never looking to be this large. I would like to return to an A cup size, or small B. I will seek fat transfer if I need additional fullness. I do not want to have any sag. I would like to have a very perky shape and nipple position. What type of lift is best for me?

Michele A. Shermak, MD · Answer

Hello!
As long as you are healthy and a nonsmoker (including not vaping) you should be a fine candidate for the removal of implant and capsule with a breastlift . It is also most optimal that there is no history of augmentation above the muscle in the past. You should have good blood supply to the breast and therefore lift may be performed safely if connection between the breast and pectoralis muscle has been maintained. Lift may either be performed through an anchor incision or lollipop incision - whichever will give you the best lift and symmetry.
It is extremely difficult and dangerous to plan on en bloc removal of capsule with under the muscle implants as the "backwall" of the capsule is on your ribs. You are at risk for lung collapse if the capsule is adherent to your ribs and attempt is made to remove that capsule. There will be no increased symptomatic benefit if some of the capsule is maintained.

Alan Gonzalez, MD, FACS · Answer

Hello @BlessengsTX, thank you for your question. You can have the results you want with an explantation with a capsulostomy, that 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. 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.

Finny George, MD · Answer

Hi, thank you for sharing your question. You are a good candidate for a breast lift however, I would recommend staging this procedure with your implant removal being done first. I hope this helps.

Dhaval M. Patel, MD · Answer

Thank you for sharing your photos and for your questions. From your photos, you are a good candidate for enbloc and breast lift with fat transfer to bilateral breast. Breast lift will elevate & reshape your breast. Fat transfer will add upper pole fullness to 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

Eric Wright, MD · Answer

Several factors determine the need for a breast lift following implant removal. The amount of projection will depend on the how much breast tissue you have. Due to the capsular contracture, you are able to see the implant (very high on your chest) and the breast tissue (lower). The upper breast will not have the fullness or projection after implant removal, regardless of the type of lift performed. Fat transfer will help with providing more projection in this area. The type of lifts varies depending on measurements but based upon the photos, I would recommend a vertical lift. Discuss your goals with a board certified plastic surgeon who specializes in breast surgery. Good luck with your recovery.

Dr. Eric J. Wright

Dr. Eric J. Wright

Constance Chen, MD, MPH, FACS · Answer

If you were a small A cup before implants and a D cup with them, then your skin has stretched a fair amount and your breast tissue is compressed. In addition, if it was 23 years ago, and you are the same weight that you were when your implants were placed, you may not have a lot of additional breast tissue. Your best result would likely be a staged procedure. First, remove your breast implants and allow your skin to contract and your breast tissue to decompress (I.e., "fluff"). You breasts may look deformed, empty, and droopy for at least part fo this time. I would wait 6 months to a year to see how much your skin contracts and how much breast tissue you have to work with. Once things have healed, then you can undergo bilateral breast lifts with or without fat grafting - I would re-evaluate at that time. If you try to do everything at once, your breast skin will be very stretched out and your breast tissue will be very thin - it will be difficult if not impossible to create attractive breast mounds with basically thinned out and stretched out skin. You will also have permanent scars with this effort to create breasts from thin skin. Fat graft does not take as well in an inflammatory environment, so that may not be helpful either - not to mention all of this is pretty hard on the body. Although it is hard to live with breasts that don't look great for several months, I think you will ultimately have a better result if you do this. Of course, if on physical examination it seems that you actually have more breast tissue than a small A cup or you have gained 20-30 pounds in the intervening 23 years, then it may be possible to do everything in one surgery and have a reasonable result. The important thing is to think of the best long-term result and not sabotage yourself by trying for a quick fix that may make it difficult to have a nice result in the long term.

Scott Kreitzberg, DO · Answer

Thank you for your question! Following removal of the implant and all the implant capsule, I would recommend a short scar (lollipop) breast lift. This lift will tighten the lower breast, improve upper breast fullness with tissue auto-augmentation, and offer a perky appearance. Fat transfer 6-9 months following implant removal will add volume if needed for a full B.

Connie Hiers, MD, FACS · Answer

First, en bloc surgery is for cancer surgery only and not for removal of the capsules. Have the implants and capsules removed first and give your breasts time to heal. Then, if you have enough blood flow to the nipples from breast tissue and not skin, a lift could be done. You do need donor fat to have a fat transfer. If you have little breast tissue, you will only have a small amount of fat that can be transferred.

Jorge Galaz, MD · Answer

I believe it will depend on the technique your surgeon likes best and the assesment he makes at the OR once your breast implants are out.
Best wishes, Dr. Galaz

Camille Cash, MD · Answer

From your photos it appears you are a good candidate for implant removal and a lift.  Depending on the amount of natural tissue you have a small implant may be recommended to shape the breasts.  See a board certified plastic surgeon near you for a personalized consultation.

Planning en bloc surgery for severe capsular contractor - Best lift for a perky end result? (Photos)

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