Implant Removal or Revision? Need Advice Please 41YO Slim Build 600CC? (photo)

I had silicone implants a year and a half ago and I was told they bottomed out and one seems to have shifted toward my middle. My PS suggest a 475 cc implant and the internal stitch procedure. Does the Internal stitch last or do I have to watch it when I run and be like very careful so they don't come undone? They are suppose to be permanent?Would they look normal if I removed completely?? I am insure how to proceed. I appreciate your advice. Scared and not sure which way to turn.

Doctor Answers 8

Best to Remove or Downsize Breast Implants?

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Thank you for the question and pictures.
I understand your concerns;  you face a very personal and difficult decision. Most likely, given the size of the breast implants  involved,  you will not be pleased with the results of surgery once they are removed. Although this is not universally true, most young ladies wish to have some volume/fullness…
 On the other hand, I understand your concerns about capsulorraphy and the use of small breast implants;  the more complicated the operation,  the greater the chance that further surgery will be necessary in the future. Certainly, you can depend on the fact that additional surgery will be necessary in your lifetime if you choose to re-augment your breasts.
 Ultimately, as I mentioned above, this will be a very personal decision that only you can make after asking yourself whether you will be pleased with the relative paucity of fullness and the presence of some loose/empty skin on the chest wall.
 Best wishes as you consider the options.

Implant Removal After Bottoming Of Breast Implants

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Thank you for sharing you photos along with your post.

Unfortunately, the bottoming of your implants is mainly due to the work of gravity over large implants from the first place. Therefore, it won't be a good approach to consider larger implants like the 600cc you have mentioned.

Removing your implants at this point is a viable option but your breasts will not be EXACTLY the same they were before the surgery.

Considering smaller implants with an internal lift may be another solution to consider given that the capsulorrhaphy holds successfully.

That being said, please remember that commendable results require an exceptionally skilled surgeon to perform the surgery and settling for anything less than that increases the chances of additional corrective surgeries dramatically.
I hope this helps and please feel free to check the website below.

Thank you for your inquiry.
The best of luck to you.

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 205 reviews

Bottomed out bre

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Your breasts bottomed out mainly because you had implants placed much larger than I would have placed.  The problem with correcting the situation is that the weight of new implants, even if smaller,  will tend to make the problem recur.  Also, it,is difficult to do the correction and achieve lasting symmetry.  If removing the implants completely is a consideration, your breasts will probably end up,looking the same as they did before the original surgery, so is actually not a bad choice at all and is  worth considering.  in many women, once they have made the decision that they are done with implants and do not want to deal  with them anymore, they usually have a sense of relief.  Been there, done that, get on with life is sometimes the best thing.  Good luck!

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

You need much smaller implant

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To solve a problem ,you need to understand the reason  for the problem. Your breasts could not handle 600 cc implant . The  reason for the bottoming out is that there were no other spaces that your implant could expand to. You have few options. You can remove your implant and give your breast a break and try again in six month with a smaller implant or no implant at all. You can down size your implants to 350- 375 cc and do capsulorrhaphy at the same time  .The final option would be implant removal and fat grafting .

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 152 reviews

Changing Implants

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The internal lift, called a capsuorrhaphy, is permanent if it works. It works better when the implants are smaller since there is less weight pushing against the sutures. Since you have had the implants only a year and you have young looking tissues, you may look pretty much like you used to if you remove the implants without replacement. But that can be better answered after an examination to determine the degree of elasticity in the skin.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Implant Removal or Revision?

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Great question! This is a tough problem to deal with, we are not quite sure what causes the bottoming out that some people experience, but I assume that it is usually caused by a patients own tissue unable to support the implant. I usually recommend a strattice lift in this situation, it will take the tension/support off of the body and place it on the strattice and "lift" your implants and keep them in the proper place. Be sure to discuss this with your PS, it may not work for you, and tough to tell by just a few pics, but definetly worth a discussion, good luck

Jonathan Weiler, MD
Baton Rouge Plastic Surgeon
4.9 out of 5 stars 93 reviews

Implant revision

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Implant pocket revision can be a bit tricky, but can certainly be done well and leave you with a permanent improvement in the shape of your breasts.  Lowering an implant pocket is usually easier and more predictable than raising the pocket because you are fighting the forces of gravity and depending on your stitches to do the job for you while the scar capsule matures.  But, it is frequently successful.  It depends on careful marking and treatment of the inner scar capsule (or pocket).  Most of us use at least one row of permanent suture if not 2 or 3 rows.  I personally like to oversew the row of permanent suture with a row of absorbable suture in an effort to keep the implant from contact with the more stout and bradided permanent suture while the scar capsule is reforming in the new position.  But, no matter the technique, it can be done well in experienced hands.  There is usually an effort to maintain the shape with some taping and an underwire bra (worn nearly continuously) for 6-8 weeks for external support.  At that point, I let my patients get back to jogging and other more strenuous exercise.  Until then, I have them walk or do moderate stationary bike only for exercise. 

If you elected to have your implants removed and not replaced, you would certainly lose a great deal of volume and shape and you may look deflated.  A breast lift may be necessary if your breast does droop to an extent beyond your liking.

Internal sutures defintely hold, if done correctly.

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It will be important to avoid lifting until the sutures develop scar tissue around them, usually six weeks.  Best to review pictures of similar cases your surgeon has done to evaluate what your long term results are likely to be.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.