Explant with lift at the same time, or better to wait and do the lift later?

Question

Are there any benefits to just getting the implants out, then waiting to see how the breasts respond before doing the lift? Or is it better to just do the lift at the same time as the explantation, avoiding two surgeries?

Gregory A. Buford, MD, FACS · Answer

I completely disagree with the other physicians that recommend performing a lift at the same time.  When I first began removing implants, it was unclear how much the skin envelope would tighten and how much the breasts would contract.  But as I gained more experience, it quickly became evident that a majority of my patients would not require a lift and so by performing this procedure at the initial operation would expose them to a potentially unnecessary surgery.  As such, I now recommend to all of my patients that they wait for at least 6 months before performing a breast lift.  That way they have the opportunity to see their breasts change and decide if they really want to commit to the associated scarring.  To date, I have performed a total of ZERO breast lifts following implant removal and have a very high patient satisfaction rate.  I hope this helps!#breastimplantremoval #plasticsurgery #plasticsurgerydenver

Raffy Karamanoukian, MD, FACS · Answer

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

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Gary Lawton, MD, FACS · Answer

There is definitely a benefit to having the implants removed first and allowing things to heal before proceeding to the lift.

Alejandro Nogueira, MD · Answer

I don't see a reason or connection between an explantation and the need of an uplift; uplift should be done ONLY if the breasts are severely drooped, not as a complement to explantation.

John Michael Thomassen, MD · Answer

I would prefer to have everything performed at once.  If you are removing your implants and they are large, you will likely need a lift to address the excess skin.  This is a call your surgeon will have to make based on experience.  If the implants are not excessively large and you are not ptotic at present, it is possible to forego the lift.  You may have to leave this up to your surgeon's discretion at the time of the procedure.

Tom J. Pousti, MD · Answer

Thank you for the excellent question. Short answer: much will depend on your physical examination ( factors such as degree of breast ptosis, current position of breast implants, number of previous operations, assessment of breast skin quality/elasticity…) and your plastic surgeons' clinical judgment.Longer answer: in person consultation will be necessary to provide you with precise advice. The main issue of concern is adequacy of blood flow given the extensive breast surgery planned. In my opinion, if the degree of breast lifting ( distance of movement of the nipple/areola complexes) is significant, then you may be better off having the procedure performed in 2 stages. If the degree of breast lifting is relatively small ( shorter distance of movement of the nipple/areola complexes) then it is likely that the procedure can be performed in one stage. If in doubt, in my opinion, the two stage approach is safer.I hope this, and the attached link (dedicated to breast implant removal surgery concerns) helps. Best wishes.

Timothy Fee, MD · Answer

It depends. Sometimes removing implants can be complicated by rupture, infection, and capsule formation which is why they need removing. Otherwise, if it is for the reason of simply wanting them removed, then a lift can sometimes be required. It would all depend upon your surgeons comfort level as they would want to keep you free of complications.

Laura A. Sudarsky, MD (retired) · Answer

I think it is best to do them together. Your doctor should be able to tell how droopy you will be after the explant and can help you decide. If you can avoid to surgeries it is best. Remenber you will not only be droopy but much smaller.

Susan Kolb, MD - Account Suspended · Answer

In my experience with over 2000 explants, a lift at the time of the explant is usually needed unless the implant is less than 280 cc.  We do an internal lift to decrease the base diameter and increase projection, and if needed remove extra skin from the lower pole or around the NA complex.  It is very important to remove the entire capsule and use drains.

Explant with lift at the same time, or better to wait and do the lift later?

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