11 year old breast implants in need of exchange? Removal with fat transfer? Lift with implants? (Photo)

Gel implants under the muscle 11 years ago. Revision months later due to falling. 3 breast fed children later now wear DD bra. Looking into getting a mommy makeover next year. Would like end result to be perky natural looking full D breasts. Is this possible without getting a lift? Really do not want vertical scar! Interested in fat transfer without replacing implants. Can you please tell me what's the best option with the results that I'm looking for!

Doctor Answers 8

Exchanging 11 Year Old Submuscular Implants and a Lift May be Beneficial

If breast implants either are either #ruptured, or, more than 10 years old, #consideration should be given to #replace them. A Breast #Lift to #tighten loose skin is usually recommended to better optimize the end result of an #augmentation or #revision. I prefer to use a #shortscar technique, #LollipopScar or #DonutLift” rather than the majority of surgeons in the United States that use an anchor pattern lift which involve more significant scarring.

It is not uncommon to change positions if you are deemed a candidate to do so per the condition of your current implants and pocket. There are some studies that report a lesser incidence of firm capsules with placement behind the pectoralis muscle. If you developed firm capsules and your implants were submammary (behind the breast tissue) then conversion to a #submuscular position should be considered. This #placement is particularly better for the very thin patient who has little breast or fat in the upper part of their chest. In most circumstances, those patients with #ptosis (#sagging) require placement above the muscle in a #submammary position or under the muscle combined with a mastopexy (breast lift) for #contour purposes.

Other factors which contribute to the outcome are #shape and #profile.  The #profile is determined by the amount of #projection versus roundness that the you desire, as well as the #size of the implant and size of your chest. Also, the placement or incision location will also have an effect on profile. 
Also, the right implant for the revision is contingent on shape of body and your desired outcome. Another element to a satisfying result of your #augmentation is realistic #expectations. Talk to your surgeon at greater length and be sure to view before and after pictures and reviews beforehand to gain more reassurance of the procedure.

Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

Augmentation Mastopexy

Hello,You will need a mastopexy or breast lift, and that will involve vertical scars.  You will not be able to achieve your goal results without it. Done by an ABPS certified/ASAPS member surgeon who specializes in breast surgery, you will likely have very inconspicuous scars. Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 89 reviews

Breast lift with vertical scar for best shape

Based on the pictures, a lift with a vertical scar will give you the best result. The reason for doing it is to give projection to the breasts, which is part of a "perky" look. The implants may need some additional support too, perhaps with a Galaflex or SERI internal bra.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews


Thank you for the photos and from them without an examination (which is needed) it would appear that you would benefit from a lift to give you the desired result.

Dr. Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 61 reviews

Perky Breasts d implantpost Implant Replacement/Removal

Fat grafting after removal of your breast implants and capsular contracture is just another way of replacing the volume of the removed implant. The other is to place another implant. Neither, by themselves will give you perky breasts. To achieve that , you will need a lift. A vertical lift should do quite well, but does entail a vertical scar, though this usually almost disappears,

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews


Unfortunately I think breast lift is the only option here. If you look at the profile view you can see that the breast tissue is actually falling below the level of the implant. That tissue has to be elevated and placed over the implant Center to have a good aesthetic outcome and breast lift is the only way to do that that I know of.

Edward S. Gronka, MD
Fayetteville Plastic Surgeon
4.7 out of 5 stars 13 reviews

11 year old breast implants in need of exchange?

Thank you for the question.  Based on your photographs, breast lifting is certainly indicated. The type of breast lift indicated for a specific patient will depend on how much breast lifting is necessary. In other words, if a patient has minor "sappiness" (ptosis) an incision around the variable may suffice. On the other hand, if a patient has a significant amount of breast ptosis, a vertical or "anchor" skin/tissue excision may be necessary. In your case specifically, I do not think that an "donut" breast lift will be powerful enough to achieve an outcome that you will likely be pleased with; a more powerful breast lift such as a vertical or "anchor" pattern will likely necessary.

For some patients the necessity of additional scars associated with breast lifting is a “dealbreaker” ; for these patients it is better to avoid breast surgery altogether.
On the other hand, many patients (If properly selected and who are doing the operations at the right time of their lives psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry. This acceptance of the scars is the essential “trade-off” associated with many of the procedures we do in the field of plastic surgery.
 In my hands, the most predictable and long-term outcome will be achieved with breast augmentation utilizing breast implants along with breast lifting. Some general thoughts regarding this combination may be helpful to you:

Generally speaking, patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, the combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately.
Furthermore, the potential need for revisionary surgery is increased with breast augmentation / mastopexy surgery done at the same time. This revisionary rate may be as high (or higher) than 20%.  
Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand, when performing breast augmentation/lifting surgery we are increasing the breast size with breast implants; on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic; removing too little breast skin/tissue can also be problematic. Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate.
To achieve a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve. Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit) as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane) and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key.
Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would; therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur and may be a reason for returning to the operating room for revisionary breast surgery. I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer. The use of the tailor tacking technique is very helpful. Breast lifting involves removal of skin ( and tightening of the breast skin envelope) while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other. Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications.
Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts. Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only.
For example, some patients who wish to maintain long-term superior pole volume/"roundness" or "implanted look" may find that this result is not achieved after the initial breast augmentation/lifting operation.
An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness). It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation. The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery, Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia, lateral displacement etc).
Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues to causing skin or tissue necrosis. Poor scarring, pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc. Patients may also be dissatisfied with breast size, shape, and/or how the breast implants and overlying breast tissues “interface” with one another. Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least. Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved.
Given the complexity of the combination breast augmentation/lifting operation and the greater risk of revisionary breast surgery needed, there are good plastic surgeons who will insist on doing the procedures separately. For me, if I see a patient who needs a great degree of lifting, who has lost a lot of skin elasticity, or whose goal is a very large augmentation then I think it is best to do the procedures in 2 stages (in order to avoid serious complications). However, doing the procedure in one stage does increase the risks of complications in general and the potential need for further surgery. This increased risk must be weighed against the practical benefits of a single stage procedure (which most patients would prefer).
Conversely, if I see a patient who requires minimal to moderate lifting along with a small to moderate size augmentation (and has good skin quality), then doing the procedure one stage is much safer. Nevertheless, the potential risks are greater with a 1 stage procedure and the patient does have a higher likelihood of needing revisionary surgery.
Having discussed some of the downsides and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry.
I hope that this summary of SOME of the issues surrounding breast augmentation/lifting surgery is helpful to you and other women considering this procedure in the future.
The attached link may also be helpful. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews


Breast lift surgery reshapes the breast for a pleasing cosmetic result.  Implants add volume.  I truly do not think you will get the result you are looking for with a fat transfer.  The vertical scar would be the trade you will make for prettier shaped breast.  Consult with board certified plastic surgeons for an in person exam.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 60 reviews

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.