What size difference can I expect after explant?

Unfortunately, you have not provided photographs or told us your current chest measurement.  If you are a 32 or 34, each 100 cc corresponds to 1 cup size change.  If you are 36 or 38, each 200 cc corresponds to 1 cup size change.  Removing 350 cc implants will results in 3 ½ cup size reduction (32 or 34) or 2 cup size reduction (36 or 38).  However, en bloc takes the surrounding breast tissue with the capsule that may result in even further tissue loss.  Also, having explant alone may be unsatisfactory.  The skin envelope may hang and you may need another lift, even though you have already had one.  The technique I recommend is explantation and a lift using The Bellesoma Method.  The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation and the ability to breast feed are maintained, if not injured during your previous surgery.  At the same time or later, fat transfers can be performed if additional volume is desired.  Best Wishes,Gary Horndeski, M.D.

The smaller the implant (350cc) and the less the amount of time (33 years) it has been since placement, the greater the chance the beasts will return to their preoperative state. It is very difficult to predict breast size following explant b/c breast implants and weight fluctuations over time tend to thin tissues, cause a decrease in size, and create more droop.  
It is not unreasonable to remove the implants and then observe a waiting period of six months before the determination for breast lift or breast fat transfer is made. This will give your breasts time to bounce back and your PS time to determine what type of lift, if any, is needed. Fat graft take should always be optimized with the best blood supply available. If capsules are very thick, some small amount of breast tissue might inadvertently be removed with the capsule (10 - 20 grams max).  
Kenneth Hughes, MD, ABPS Board Certified Plastic Surgeon
Los Angeles, CA

Dear jill0786,
it is hard to tell for sure, but you will most likely be close to the A cup you were before the surgery. Also. there will probably be some sagging. Regarding the en bloc removal, your plastic surgeon will try to remove implants and capsules around them together and leave the breast tissue intact. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Thank you for sharing your excellent question. Unfortunately without being able to see or feel your breast tissue it is difficult to offer advice on your final size.  For most patients you can anticipate a couple of cups but this is variable. Although the en bloc will remove the implant and surrounding scar tissue it does not lead to significant loss of breast tissue and since you had a lift four years ago, hopefully little skin removal will be required.  Hope this helps.

It is difficult to make 100% accurate predictions following explant. There are a number of factors to consider including age (the breast changes over time irregardless of augmentation), weight change, skin stretch and residual elasticity.
Following removal, one can expect:
-Loss of volume- Not an exact correlation between pre- and post augmentation due to the changes over time. You may be bigger or smaller than you remember.
-Ptosis/sagging-Ptosis develops over time and may be worsened by the presence of an implant. If a patient has pre-explant sagging, removal is likely to worsen this to a certain extent. If there is no ptosis, it does not necessarily mean there will be no ptosis after removal.
-Skin laxity/stretch- There is inherent skin elasticity which will allow for some measure of snap back. However, the greater the volume differential pre- and post- the more likely there will be excess skin.
In my experience, it is usually a safe assumption that there will be some changes post removal which oftentimes may necessitate further operative intervention (i.e. lift), however this is often a function of size and length of time post op. Small implants which have only been in place for a short period will lead to an improved response/recoil post removal.
With regards to your specific question, your options will be entirely dependent upon the response of the tissue to the loss of the implant. Some patients will have very little laxity and good nipple position. They may be able to forego a lift and instead may fat graft for some volume (or do nothing at all). Others may need multiple interventions to reach a look with which they are comfortable.There is no calculation. However, after 33 years and a significant upsize (barring any significant weight gain) I would assume that you can expect both ptosis and deflation. The extent of these is difficult to predict without photos.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
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