I had 410cc textured cohesive silicone gel implants placed above the muscle 5 years ago. I had grade 1 ptosis and was a 34c pre op. My surgeon said I had enough breast tissue to go over the muscle and correct the slight sagging to avoid a lift.I am now looking to explant and remove the capsule. - Am I likely to need a breast lift after? If so, what type of lift would be best for my breast? - Is it safe to remove the implant and do a lift in the one surgery? Many Thanks for any feedback.
February 2, 2016
Answer: Two separate surgeries recommended In general, I try to encourage patients to remove the implants and capsule at a first surgery and then consider a mastopexy 6 to 9 months later. Your breast skin will contract and shrink during that time. You obviously have some asymmetry, for example, the left nipple points much more to the side. By allowing everything to heal first, when you do the mastopexy at the second surgery the amount of skin to remove, nipple position, and scar quality are better. Sometimes you can use a smaller scar pattern because the skin has shrunk, such as a lollipop scar instead on a full inverted T scar. Sometimes the skin will shrink enough that patients elect NOT to have the mastopexy at all.Also, you may want to add some fat transfer to your breasts to help add some natural volume back to your breasts if you are unhappy with the size, shape or asymmetry after your implants are removed and everything is healed. By separating the surgeries, you are maximizing the positives of what is often a very difficult decision. In a perfect world, your skin would shrink nicely after the first surgery and at the second surgery you perform a minor lift with some fat transfer to get a reasonable result with your own tissue and minimize scars as much as possible.This is my personal philosophy. It's OK to do them at the same time but I always inform patients that revision surgery may be necessary to provide the best symmetry in size and shape, scar quality and nipple position. A lot of patients do not like the thought or the cost of having two surgeries but the cost may not as much as you think and you should also budget for the higher possibility of needing some touch up surgery when you do them at the same time.Good luck.
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February 2, 2016
Answer: Two separate surgeries recommended In general, I try to encourage patients to remove the implants and capsule at a first surgery and then consider a mastopexy 6 to 9 months later. Your breast skin will contract and shrink during that time. You obviously have some asymmetry, for example, the left nipple points much more to the side. By allowing everything to heal first, when you do the mastopexy at the second surgery the amount of skin to remove, nipple position, and scar quality are better. Sometimes you can use a smaller scar pattern because the skin has shrunk, such as a lollipop scar instead on a full inverted T scar. Sometimes the skin will shrink enough that patients elect NOT to have the mastopexy at all.Also, you may want to add some fat transfer to your breasts to help add some natural volume back to your breasts if you are unhappy with the size, shape or asymmetry after your implants are removed and everything is healed. By separating the surgeries, you are maximizing the positives of what is often a very difficult decision. In a perfect world, your skin would shrink nicely after the first surgery and at the second surgery you perform a minor lift with some fat transfer to get a reasonable result with your own tissue and minimize scars as much as possible.This is my personal philosophy. It's OK to do them at the same time but I always inform patients that revision surgery may be necessary to provide the best symmetry in size and shape, scar quality and nipple position. A lot of patients do not like the thought or the cost of having two surgeries but the cost may not as much as you think and you should also budget for the higher possibility of needing some touch up surgery when you do them at the same time.Good luck.
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February 2, 2016
Answer: Dr Kayser Thank you for your question Pisces. Implant removal is actually not that uncommon. An implant is a volume device which necessarily makes your breasts larger. Unfortunately, it is not a substitute for a breast lift. Many surgeons will use an implant in an attempt to increase upper pole fullness, however, long-term results often result in a larger breast that is droopy, especially if the original breast was droopy in the first place. This occurs because the implant eventually falls right back into the breast over time.In your situation, removal of the implant would result in volume depletion and, since your skin envelope was stretched from the implant, this may be more obvious than if you never had the implant placed at all. You certainly have the opportunity to simply have the implant removed and see if that would be a satisfactory appearance to you. This would avoid the scars of a breast lift. However, if for minimizing surgery and cost, you desire to have a breast lift performed at the same time, restoration and improvement of your breast to a more youthful position would likely occur from a breast lift.One concern to keep in mind is, that because the implant was placed above the muscle, there is a higher potential for vascular injury if a breast lift is performed as well since the blood supply to the breast and nipple were possibly compromised to some degree,during the original surgery.Removal of the implants in a single stage without any further surgery would allow observation to determine whether or not the results would be satisfactory to you. If you felt that there were deficiencies and contouring irregularities, you could come back and have a lift and even fat grafting. Fat transfer allows the removal of fat from one part of your body to be transferred into the breast. This would allow volume restoration and fill any contour irregularities that may exist. Finally, unlike an implant which must occupy a fixed pockets, fat is placed as millions of seeds which can be distributed throughout the entire soft tissue envelope, even in a breast that is droopy. Fat is natural, yours, and has the potential to last a lifetime. Of course I would recommend a consultation with a board certified plastic surgeon who is experienced in all these techniques. I hope this helps and have a wonderful day. Dr Kayser - Detroit. PS I suspect that a happy birthday wish is an order too!
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February 2, 2016
Answer: Dr Kayser Thank you for your question Pisces. Implant removal is actually not that uncommon. An implant is a volume device which necessarily makes your breasts larger. Unfortunately, it is not a substitute for a breast lift. Many surgeons will use an implant in an attempt to increase upper pole fullness, however, long-term results often result in a larger breast that is droopy, especially if the original breast was droopy in the first place. This occurs because the implant eventually falls right back into the breast over time.In your situation, removal of the implant would result in volume depletion and, since your skin envelope was stretched from the implant, this may be more obvious than if you never had the implant placed at all. You certainly have the opportunity to simply have the implant removed and see if that would be a satisfactory appearance to you. This would avoid the scars of a breast lift. However, if for minimizing surgery and cost, you desire to have a breast lift performed at the same time, restoration and improvement of your breast to a more youthful position would likely occur from a breast lift.One concern to keep in mind is, that because the implant was placed above the muscle, there is a higher potential for vascular injury if a breast lift is performed as well since the blood supply to the breast and nipple were possibly compromised to some degree,during the original surgery.Removal of the implants in a single stage without any further surgery would allow observation to determine whether or not the results would be satisfactory to you. If you felt that there were deficiencies and contouring irregularities, you could come back and have a lift and even fat grafting. Fat transfer allows the removal of fat from one part of your body to be transferred into the breast. This would allow volume restoration and fill any contour irregularities that may exist. Finally, unlike an implant which must occupy a fixed pockets, fat is placed as millions of seeds which can be distributed throughout the entire soft tissue envelope, even in a breast that is droopy. Fat is natural, yours, and has the potential to last a lifetime. Of course I would recommend a consultation with a board certified plastic surgeon who is experienced in all these techniques. I hope this helps and have a wonderful day. Dr Kayser - Detroit. PS I suspect that a happy birthday wish is an order too!
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