Explant w/ Capsule Removal - Can I Get Fat Transfer at the Same Time? (photo)

Question

I need an explant w capsule removal is there any doctor that will do a fat transfer to breast at the same time? Also what could be done to my belly button to not have that dent on top. I'm healthy n weigh 129. I have saline 270 cc under muscle implants.

Alan Gonzalez, MD, FACS · Answer

Hello @pichy2010 thank you for your question and showing your picture. Every specialist has different and follow diverse protocols. For me explant or remove breast implants definitely involves a reconstruction of the mammary tissue, is not ideal because the fat may not adhere since there is such a large swelling or the fat can get infected. Best wishes! Alan Gonzalez MD FACS

Raffy Karamanoukian, MD, FACS · Answer

Removal of breast implants, intact or ruptured, may have positive implications if patients are symptomatic. A constellation of symptoms associated with breast implant illness, and autoimmune disease are considered when treating patients who have breast implants and are concerned about foreign body reaction. In our office, we begin this journey with a consideration of symptoms and exclusion of obvious autoimmune problems. In many of our patients, en bloc removal of breast implants with capsulectomy is important and beneficial. Further clinical evidence about breast implant illness is evolving and will continue to guide treatment. I would suggest removal if there is a possibility of foreign body reaction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Dhaval M. Patel, MD · Answer

Thank you for your question and photo! We regularly remove breast implants with en bloc capsulectomy, fat transfer and breast lift at the same time with beautiful results. Your expectations and health will dictate the best procedure(s) for you. I suggest a consultation with a board certified plastic surgeon to examine the areas you would like addressed and go over the options that best fit your goals. 
Best of luck!

Dhaval Patel MD 
Double Board Certified Plastic Surgeon

Chicago 
South Barrington 
Oakbrook 
Orland Park

Gary M. Horndeski, MD · Answer

At the time of capsule removal, the blood supply to the remaining breast tissue can be injured.  Fat transfers depend on having good blood supply so this may not be the optimal time for transfer.

Best Wishes,

Gary Horndeski, M.D.

Adam Tattelbaum, MD · Answer

Thanks for your question. When an implant is removed a large space is left behind. You would not want that space to fill with fat. Fat grafting only works when the fat is embedded within the existing fatty tissue of the breast. Fat in the old implant pocket would not survive and likely cause issues. Best to heal for a while after the implant removal and come back later for fat grafting when the risk of entering the old pocket is lower. Fat could likely be place in the unbilical area at the same time if thesre is enough existing fat there to support it.

Best Wishes.

Best Wishes.

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. My advice is to delay the fat grafting procedure. To understand why, you have to understand how fat grafting works. You cannot just remove an implant (and/or capsule) and then just fill that space with fat, it would all die. You have to carefully and precisely inject the fat into living viable soft tissue in the breast. And when you do that, you have to have a space to graft into that holds the fat. So you can imagine that when you remove the capsule, then there is nothing to hold the fat in place because as you inject into the deeper tissue, the fat just comes out and does not stay. There are a lot of specifics in an explant case that is too much to get into in this answer (and would be best served by a consultation with a board certified plastic surgeon) and you might be able to do some fat grafting at the time of removal, but I would advise that if you only get once chance at fat grafting (looks like you are fairly petite), your choices are to do it at the same time and do not do a capsulectomy (thereby retaining the "floor" of the fat grafting space), or to delay the fat graft procedure until 6-12 months after the explant.

Hope this helps!

Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Hope this helps!

Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Daniel Barrett, MD · Answer

Dear pichy2010,
I understand your concern. It is best however that you consult with a board certified plastic surgeon to determine whether you can have several aesthetic surgeries in one session, as this would depend on various factors including but not limited to your general health condition, the type of anesthesia that will be used, and the type of surgeries that will be performed among others.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

An examination is needed to see if you have enough breast tissue to do the fat transfer at the same time, or need to wait.  Implants have stretched and thinned your own tissue over time. Fat is placed inside breast tissue and not in the space of the implant.

Douglas Taranow, DO, FACOS · Answer

There are several thigs to consider.  
First, better photos of you with your arms at your sides from front and both side views.
Second, there is a chance you may require a lift.
Third, after you perform an explantation with capsulectomy (why a capsulectomy, it is not required??), there is a larger open pocket left that may allow some of the fat to travel into which can lead to a seroma or loss of the displaced fat.
An implant is always best for replacing breast volume, but I understand patients desiring fat transfer to attempt volume enhancement.  Fat transfer to the breast usually leads to a HALF SIZE increase in cup size....RARELY a full cup size increase.  In your case, it appears that you will lose more than one cup size from the explantation.
Best wishes.
Dr. Taranow

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