Want to explant 420cc, under muscle saline implants - do I also need a lift?

As you have stated, you "don't mind a little sag and would rather not have all the scars and extra downtime," i would suggest just having the explantation and reserving the lift for a possible secondary procedure. I suspect that there is a very good chance you will find the appearance acceptable and not feel a need for the mastopexy.

Hi there. You will have some sagging with explantation only. Whether it is to a degree that is acceptable to you, that is dependent on your expectations. Since you have saline implants, an option is to have your implants deflated in clinic, and allow your breast several weeks to settle. After that, you can assess how you feel about the appearance of your breasts and will have a better idea of whether you want to proceed with explantation only or explantation with lift.

Dear dciam6,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

In my opinion, you will likely need a lift after explant. Because your implants are under the muscle, it is more safe to perform a mastopexy or lift at the time of implant removal. I would recommend seeing a highly trained plastic surgeon with experience in breast surgery.

Your breasts will have less shape and sit lower on your chest after implant removal. You can have the implants removed, wait a while to see how the breasts look, and then do a lift at a later date. A lift is a trade off, the breasts will sit a little higher than if you don't do a lift, but there will be scars that you may not like.