Explant 550cc - What can I expect? (photo)

The smaller the implant and the less the amount of time it has been since placement, the greater the chance the breasts will return to their preoperative state. It is very difficult to predict breast size following explant b/c breast implants and weight fluctuations over time tend to thin tissues, cause a decrease in size, and create more droop.  
Usually removing them and performing the lift at the same time makes the most sense as some patients clearly need a lift and only want to go through one surgery.  If you are borderline, it is not unreasonable to remove the implants and then observe a waiting period of six months before the determination for breast lift is made. This will give your breasts time to bounce back and your PS time to determine what type of lift, if any, is needed.
Breast fat transfer is a great tool to balance breasts, improve symmetry, and gain up to one cup size in volume.  In general, 200 cc per breast is typically the upper limit of fat injection recommended by most plastic surgeons.  It is not that more cannot be injected; but on average, this has been determined to be the most that can be expected to live during one transfer.  Multiple transfers would be required for additional cc's.  In general, the abdomen and thighs are preferred donor sites but fat from other areas can be used.
Some of the retention rate will depend upon the amount of fat transferred, as smaller volumes will likely have a higher survival.  Occasionally, a patient can resorb a great deal of the fat despite optimal transfer procedures. I typically transfer from 250 cc to 400 cc or so per breast.  
Results are largely dependent upon the skill of the surgeon, his/her ability to remove fat without creating contour deformities, and your expectations. You would need a consultation with a board certified PS to determine your available fat stores.

Removing 550 cc implants will take you down 5 cup sizes.  Many women are dissatisfied after explant alone because of the hanging skin, empty appearance and require a lift.  The technique I recommend 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.  At the same time or later, fat transfers can be performed if additional volume is desired.Best Wishes,Gary Horndeski, M.D.

Thank you for sharing your question and photographs. Unfortunately without being able feel the relative ratio of your breast tissue to implant it is difficult to offer definite advice.  Most likely removal will leave you a good overall result, but if the skin does not fully retract, you may require a small lift to achieve a tighter skin look and feel. 

The downsides of removal are primarily aesthetic.
It is difficult to make 100% accurate predictions following explant. There are a number of factors to consider including age (the breast changes over time irregardless of augmentation), weight change, skin stretch and residual elasticity.
Following removal, one can expect:
-Loss of volume- Not an exact correlation between pre- and post augmentation due to the changes over time. You may be bigger or smaller than you remember.
-Ptosis/sagging-Ptosis develops over time and may be worsened by the presence of an implant. If a patient has pre-explant sagging, removal is likely to worsen this to a certain extent. If there is no ptosis, it does not necessarily mean there will be no ptosis after removal.
-Skin laxity/stretch- There is inherent skin elasticity which will allow for some measure of snap back. However, the greater the volume differential pre- and post- the more likely there will be excess skin.
In my experience, it is usually a safe assumption that there will be some changes post removal which oftentimes may necessitate further operative intervention (i.e. lift), however this is often a function of size and length of time post op. Small implants which have only been in place for a short period will lead to an improved response/recoil post removal. Whereas larger implants which have been in for several years will often necessitate a lift.Based on your photos and narrative, larger 550 cc implants will likely lead to some degree of tissue stretch (not to mention pregnancy). You may want to consider a lift in conjunction with removal.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
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Dear Thriving1864,
it is hard to tell for sure, but your implants are pretty big so you might have some sagging of skin on your breasts after implant removal. You might need a breast lift in order to make them perkier. If you are considering a surgery, I would suggest you to 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

Explanting large implants will leave your skin stretched out and has thinned your own breast tissue. You may consider going down in size with internal tightening, and a lift if needed. A consultation will determine how much actual breast tissue you have left.

You can elect to have your implants removed at any time.  Your skin will have stretched from accommodating the implants.  You will lose the volume and upper pole fullness that implants provide.  You may wish to consider a breast lift to improve overall shape.  You can also consider smaller implants.  I encourage you to meet with a board certified plastic surgeon near you to discuss your goals for surgery.

Since you have large implants, you might experience some sagging.  Hopefully, with the use of a good compression bra your breast will recovery well.  Otherwise, you might need a breast lift in order to make them perkier.  Allow time for healing to before making any decisions.