Implant removal with lipo?

Question

Hello. I have extracapsular ruptures of 19 year old implants which need removing so considering myoptions. Not keen on the idea of new implants but also don’t want to lose my size. I had seen the idea online of removal combined with lipo which sounded quite appealing but I had a cconsultation with a consultant who advised that patients are often unhappy with the results as 1 litre of fat reduces down to an average of about 250ml between the 2 breasts. Is this standard industry advice please?

Gary M. Horndeski, MD · Answer

After implant removal, many women are dissatisfied with the hanging skin and loss of volume. Approximately 25% of women who undergo explantation want some additional volume. I traditionally use fat transfer. Not all of the fat from fat transfers takes but about 60% of the fat does take. However, you have not provided photographs of told us your bra size. You may or may not be a candidate for fat transfers. You may also need a breast lift. 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.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Alan Gonzalez, MD, FACS · Answer

Hello @Kat_99999, thank you for your question! Everything depends on the surgical technique of the specialist performing surgery. Remember that any kind of explant must be complete, that is, the surgeon must remove the whole capsule out. Complete capsulectomy. Also it would be necessary to carry out a preventive biopsy on each capsule. In any case, I do not perform breast fat transfer during a breast implant removal procedure because for me, the breast explant must be performed with a breast reconstruction in which the mammary tissue is placed adequately in place again. If the fat seeding is done at the same time, it might get infected or die; there is no guarantee that the seeding will stick. with breast fat transfer is posible to go up one size. If you are considering a breast explantation, consultation with a plastic surgeon who is experienced in this procedure is essential to ensure optimal results. Best wishes!

Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), Colombian Society of Plastic Surgery member (SCCP).

Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS),   International Federation for Adipose Therapeutics and Science” Member (IFATS), Colombian Society of Plastic Surgery member (SCCP).

Shaher W. Khan, MD · Answer

Hello, thank you for your question. It sounds like you’re in a challenging situation with your ruptured implants and are weighing your options for removal and potential breast size preservation. I have attached a video with a breakdown of the considerations regarding extracapsular ruptures, implant removal, and the possibility of combining removal with liposuction. While combining implant removal with liposuction for breast augmentation can be appealing, it’s essential to have realistic expectations regarding the volume retention and potential outcomes. The industry standard acknowledges significant fat absorption post-transfer, and patient satisfaction can vary widely. Discussing your specific concerns and options with a qualified plastic surgeon will help you make an informed decision that aligns with your desires for breast size and overall aesthetic goals.

Benjamin Baker, BMBS MBA FRCS(Plast) · Answer

Dear Kat_99999, thank you for your question. An implant removal can be combined with an uplift procedure in the first instance to maintain an optimal breast shape and make sure the breast volume that is remaining is best placed. Fat transfer can be a useful additional adjunct to this procedure if you wish to enhance your volume whilst avoiding an implant, with added benefits of improving contour in other areas where fat is harvested (by liposuction). However, it may be advisable to do this as a separate procedure to implant removal and uplift (to ensure that the tissue that fat is transferred into is healthy and maximise the volume of fat transferred that will remain). When fat is harvested, it is filtered prior to injection, and this is what your surgeon may be referring to. The volumes achievable will depend on the technique used and what you have available, considered as part of a face to face consultation.

Connie Hiers, MD, FACS · Answer

Liposuction of the breast only removes excess fat and no breast tissue. It also does not provide any skin tightening.  However, removing the implants and the capsules causes a fair amount of swelling to the breasts. I recommend doing the fat transfer, if desired, once healed after the removal to get a better success rate. You might fine that you are happy with your new size without implants, or you might want a different size.

Camille Cash, MD · Answer

When considering fat transfer it is important to understand the risks and benefits.  When fat is removed from one area the fat must be spun down before it is grafted to another area.  This volume grafted is quite reduced from the volume harvested.  In addition not all fat in the grafted area will "take" which can lead to asymmetries.  It's best to look at all options as well as the pros and cons of each before making a final decision.

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment, we need quality information. If you want to maintain anything resembling your current breast volume then you need to consider re augmentation with new implants.
Liposuction alone will not augment your breast. While it’s true, that fat removed, using liposuction can be grafted into breast tissue, referred to, as either breast fat, transfer or breast fat grafting can be done and typically delivers results that are very subtle compared to what implants can create. There’s no set number of milliliters of fat that can be grafted into breasts. It depends on how much tissue you have available to support the grafted fat. I have grafted breasts using as much as 1500 mL per side down to as little as a 50 mL per side.
If you expect your breast to look anything like they do with implants using fat transfer, and the procedure will most likely leave you pretty disappointed. I generally do not prefer to do a fat transfer at the same time as explantation. Doing the procedures at the same time eliminates the ability to judge the improvement from the fat transfer.
On top of this, the number of plastic surgeons, who have truly mastered, both Liposuction and fat transfer, are in a small minority. Doing these procedures, well on a consistent basis, is far more difficult than most people realize. Being board-certified and plastic surgery with years of experience, and an overall good reputation does not mean somebody has mastered any one single procedure, especially not Liposuction and fat transfer. Most plastic surgeons think they’re better at Liposuction than they actually are. 
Poorly done Liposuction can leave people disfigured. Correcting poorly done cosmetic procedures, especially Liposuction can be very difficult and sometimes not possible.
Fat transfer can increase breast size by 1/2 cup or about 50% of the breast volume. The procedure does not change breast shape in any meaningful way. The results a fat transfer a radically different than breast, implant augmentation which radically changes the shape of the breast. Fat transfer does not give forward projection, and does not contribute significantly improvements in volume in the upper half of the breast. The shape of the breast remains relatively. The same only increases slightly in size.
The procedure is quite subtle in comparison, to what implant augmentation can deliver. 
If you want to maintain similar size as what you can’t have then you should probably consider replantation after managing the ruptured implants and potential capsular contracture if you have that condition.
To make an individual quality assessment, we need quality information at minimum including current pictures.
Best,
Mats Hagstrom, MD

Implant removal with lipo?

Answers (7)

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