Removal of 800cc implants (over the muscle) I'm really interested in a lift fat transfer? Would this be do-able? (Photo(

You
are an excellent candidate for explantation using The Bellesoma Method.  This will reshape your breast tissue creating
upper pole fullness without implants, elevate them higher on the chest wall and
more medial to increase your cleavage. 
Vertical scars are avoided, nipple sensation 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.

You may find a lot of different recommendations on how to proceed, but based on my experience, I think you would have better results with a staged procedure. I would remove the implants first, and capsule if needed, and allow your tissue to heal and contract, and see what you are left with. Sometimes the issues patients see with extremely large implants go away even with downsizing the implants, but it is also reasonable to remove them entirely if that is what you prefer. I think the next step would be to do a lift, and then fat transfer assuming you have enough fat somewhere to transfer. Implants this large placed over the muscle take a toll on all of the surrounding tissue, including not just the skin but also the breast tissue and even the chest wall. It can cause thinning of your breast tissue from the pressure, and also deform your ribs from the pressure. While a lift could be done at the same time, there are natural tissue dynamics that will cause the skin and tissue to contract once the large volume stretching them out is removed, so if the lift is done at the same time, these healing forces may alter the final result and leave asymmetry or result in a less predictable lift that could require a revision at a future date. Please be sure to see a board certified plastic surgeon who has experience with breast implant removal and breast lifts.

This would depend upon the type of breast lift performed and the areas into which fat is injected.  Staging is probably more reasonable.  Fat graft take should always be optimized with the best blood supply available.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.  The fat must be injected through multiple planes in small amounts to the tissue through one tiny incision under each breast.  If you are comfortable with about a one cup size increase, fat transfer would be reasonable. About 50% of the fat obtains permanence.Kenneth Hughes, MDLos Angeles, CA

If you have firmness in your breast, you may have a capsular contracture.  In that case both the implants and capsules should be removed.  At that point you may consider staging the surgeries.  You can allow the breasts to heal and then determine if you want to proceed with a fat transfer or a small implant.

You might consider removing your implants, doing a lift, and replacing with smaller implants, maybe 400 cc's. The implants may need to placed behind the muscle to help give them support and better upper breast fullness.  Smaller implants will not be so heavy on your neck and shoulders. Also, it won't be such a dramatic change as opposed to removing your implants. With a fat transfer, you may get up to one cup increase in size. If your own breast tissue is very thin from having such large implants, you may get less increase with fat. I would suggest meeting with a board certified plastic surgeon and discussing all your options.

Sorry you have experienced problems with your implants.  I would recommend having them removed, and heal before considering another surgery.  You may want to go with a smaller implant.  I do not recommend fat transfer to the breast as this is confusing on a mammogram.  Discuss your options with your surgeon.