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
RealSelf Top 100
RealSelf Hall of Fame

Hello! Thank you for your question. Unfortunately it is difficult (if not impossible) to determine exactly how much breast tissue you will be left with without doing a physical exam. Your plastic surgeon will be able to give you a "best estimate". I hope this answers your question. Best of luck!
Matthew A. DelMauro, M.D.

Your plastic surgeon who has examined you will be the best one to tell you how much actual breast tissue you have. Removing 350 cc's implants will take you down about 2 cups in size. If you are a true DD now, you have probably gained some tissue.

Thanks for your question! Unless your breasts have noticeably grown in volume well after the implant placement it is likely that you will return to your original size, however with more 'droop' resulting from the stretched out skin envelope. Skin doesn't readily 'snap back' from being stretched out, especially over time. Best of luck! 

Thank you for the question.  I suggest that you submit  photographs, side and frontal views, taken by a second party with your arms by your side.
 Generally speaking, what your breasts will look like after explantation depends on several factors such as: the quality of skin elasticity (the better the elasticity the better the skin will bounce back), the size of the implants used (the larger the implant the more trouble you may have with redundant skin), and the amount of breast tissue present at this time (which may have changed since the time of your breast augmentation).
Life experience since your breast augmentation procedure, such as pregnancy or weight gain weight loss, will potentially influence the factors discussed above. If you take these factors into consideration and apply them to your specific circumstances you may get a good idea of what to expect after the implants are removed.
 In "borderline" cases where there is doubt whether breast lifting is necessary or not, I advise patients to undergo explantation only and to give their breasts the benefit of the doubt  before deciding whether breast lifting would be beneficial.  
Patience is definitely indicated after removal of breast implants; it will take many months/year for the skin to “bounce back” and for you to see the final appearance of the breasts.  Ask your surgeon to show you examples of previous patients (demonstrating what he/she expects your breast to look like after breast implant removal and breast lifting surgery.   Seeing these visual representations (of similar patients), will likely help you make an informed decision as to how to proceed.
 I hope this helps. Best wishes.

It is difficult to estimate the amount of native breast tissue you have without an exam.  If you were an A cup prior to surgery it is likely you will have approximately the same amount of tissue, though it may have thinned over the years.  The skin will have stretched to accommodate the implants over the years, so a breast lift will probably be indicated.  Very little breast tissue is lost during the removal process.  It typically would not be enough to notice any difference in breast size.