What size difference can I expect after explant?

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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