Would it be possible to have an explant (with capsulectomy) and fat transfer done at the same time? (photo)

I would be extremely cautious when considering a fat transfer to the breast following an implant removal with capsulectomy. First, You will not achieve nearly the volume that you were able to have with the breast implants. Second, realize that although fat transfers to the breasts are becoming more acceptable, there is a large contingency of surgeons who believe that only a small percentage of the fat will survive. The fat that under goes necrosis (dies away) will frequently leave behind microcalcifications. Although there are scientific papers that have stated that the microcalcifications associated with fat necrosis and breast cancer can be distinguished on mammograms, radiologists today will frequently suggest a biopsy be performed. Therefore, subjecting patients to biopsies that could have been otherwise avoided had they not had fat transferred to their breasts.

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

Yes, this is a common optionCAPSULECTOMY/CAPSULOTOMY

One of
the most common problems with #cosmeticsurgery is #breast #capsularcontracture
or the development of thickening, and contracture of the capsule that exists
around the breast implants. Severe capsule contracture probably occurs in less
than 15% of augmentation patients. Every woman has a breast capsule around
their #implant and this is a normal phenomenon. The capsule itself could be as
thin as Saran Wrap but may also become calcified and thickened. As it thickens
and shrinks, the patient may develop a feeling a firmness of the breasts and in
its worst situation, the breast may become painful and abnormal in appearance,
achieving a very round, hard, and uneven appearance. There may be distortion
and possible breakage and leakage of an older implant, but may also include a
newer implant. Nicotine users, such as smokers, have up to a 30x increased risk
of capsular contracture.

#Salineimplants
may deflate spontaneously. When the patient has significant symptoms, complete
or partial leakage of their saline implant, or concerns regarding silicone
leakage, it is recommended that the implant is removed and exchanged.
Frequently, this is performed on both sides depending upon the age of the
implant. #Capsulotomy or opening of the capsule may be required or frequently #capsulectomy,
which is removal of the scarred capsule, is recommended to ensure adequate
pocket dimensions.

New
implants may then be placed in the same existing position or may undergo a
change of placement frequently from submammary to subpectoral position and, on
occasion, the other way around.

EXPLANTATION
OF IMPLANTS

Explantation
is the term that has been given to describe the removal of the breast implant.

What
does explantation involve? Two choices exist for explantation:

1.
Implant removal while leaving the capsule. This is a simple procedure and
requires local
anesthesia, IV sedation, or (uncommonly) general anesthesia. It is relatively
inexpensive. Microscopic amounts of gel may remain in the capsule.

2.
Capsulectomy: This will enable the surgeon to remove as much silicone as
reasonable without creating significant deformity. This operation may require a
larger incision. The surgery and recovery time will be longer. General
anesthesia is usually necessary and subsequently all of the costs associated
with this operation will be higher.

What
if you choose to leave the implant out?
This is a consideration for women who have had repeated encapsulation of their
implants, silicone related concerns, other chronic and recurrent problems
related to their implants. The shape and size of the breast will be unpredictable
after explanation. The breast will be smaller and possibly sag more. Patients
who already have ptosis (drooping) should think about mastopexy at the time of
explanation.

NATURAL
Breast Augmentation can be performed with fat grafting. This
requires liposuction to obtain the fat, and then the fat is transferred into
the breast tissue. It is usually possible to achieve at least one half cup size
increase. Additional fat transfer procedures to increase your volume can be
done subsequently.

If your problems requires explantation and capsulectomy,
then you will need a simultaneous lift.
I recommend a new technique called The Mini Ultimate BreastTM,
which uses a circumareola incision to reshape your breast tissue creating upper
pole fullness, elevate them higher on the chest wall and more medial to
increase your cleavage. This technique
will also excise the excess skin after implant removal and allows access for
implant removal. Fat transfer can only
be done in small quantities and you will not achieve the results you desire, so
a lift would essential. I would not
recommend simultaneous fat transfer. Best Wishes,Gary Horndeski, M.D. 

I would have reservations about fat grafting getting you the volume you have right now with implants.  The breast will settle and heal after the old implants and capsule are removed, and re-augmentation will probably be easier then with fat. My big reservation about fat grafting, though, is that I can hardly find any photos amongst the many experts that show anything other than a very modest increase in size. 

BUT if your tissue layer is thin, it will be quite challenging to place the fat in the right place.  If not done, it will simply be a reservoir of fat that will slowly degrade.  If you really do not want implants, explant, heal and then consider fat grafting or BRAVA/fat grafting.

Thank you for the picture.In your case, I suggest a replacement of implants instead of fat grafting. The fat transferred will be absorbed by your body and you'll be left with un even breast.Dr. Campos

Mrs/Miss Shante,Well without a physical exam it is difficult to discuss this topic.  It all depends on your tissue quality, the size of the implants that are currently in place, the amount of breast tissue remaining behind after explant and your desired aesthetic goals.  WIthout a phyiscal exam it is difficult to give you an honest opinion as to whehter it would be possible.