Will I need a lift if I remove breast implants? If so, is it best to do at the time of removal or at a later date? (Photo)

Breast implant removal should be performed with complete en bloc capsulectomy without lift.  The capsule should not be left in place or the space will not heal.  In patients that believe that their implants are causing them illness, leaving the capsule behind will not result in any improvement in their symptoms. Because the removal of the capsule and lift performed together can compromise the blood supply to the skin, breast and nipple to a potentially devastating degree, they should never be performed together.  After the explantation with capsulectomy is healed, you can develop a plan for further surgery if it is warranted and is safe from a technical standpoint.  

I would recommend waiting to evaluate if a lift is necessary. It is unlikely that a lift would be needed.    I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified Beverly Hills Plastic Surgeon

hello boucher3  The removal of breast implants that have been placed either for cosmetic or reconstructive purposes is a surgical operation.  Breast implant removal may be performed as a single surgical procedure or combined with additional procedures, as follows:

Simple breast implant removal, without removal of capsule tissue around implant
Removal of tissue surrounding the breast implant (capsulectomy)
Removal of escaped silicone gel in breast tissue (extracapsular, outside of capsule layer) from silicone gel-filled implants (breast biopsy)
Breast lift (mastopexy following breast implant and/or capsule removal) #lift #post-op

Great question!  There are basically two ways to approach your situation, depending on which one is more advantageous for you.  What is important to understand is that there is a volume and skin issue.  When the volume is removed, the question is what do we do with the excess skin that has been stretched out.  Just like in pregnancy, the skin itself will retract to a certain point - depending on age and quality of skin.  If you are looking for the least amount of scarring, then the best approach maybe to remove your implants first, and see how much the skin retracts.  After 6-12 month, you can undergo a lift if necessary.  However, this involves 2 surgical procedures.  The other alternative is to perform the implant remove and lift at the same time which will save you an extra surgical procedures.  However, the scarring maybe more in this situation.  As far as your areola is concerned, an areola reduction can be a very good procedure.While the above are just general considerations, only with an in person consultation and physical examination can an appropriate recommendations be provided and tailored for your specific needs.  Best of luck and hope this information helps!- Dr. Roger Tsai    @DrRogerTsai

Without an exam, I can only provide general comments.  It is not unreasonable to remove the implants and then observe a waiting period before the determination for breast lift is made.  With implants placed for extended period of time, the skin envelope almost always stretches and some type of lift is needed. A lift would not usually be required after three years.  Leaving a capsule behind is preferred if it is thin and pliable. If there are calcific components, or silicone granulomatous material, or if the capsule is deforming the breast tissue, then removal of the capsule may be warranted.   A number of scientific studies have demonstrated the safety of silicone implants; yet, many patients continue to have anxiety about their use. You should consider that the type of breast lift performed may only involve a scar around your areola but it may need to be more extensive as in a full breast lift. I typically start with the smallest incision and custom tailor each breast lift to the shortest scar possible.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

It is hard to predict how your tissue will respond after the removal of implants however it is always worth a shot to give it 6-12 months to see if your skin retracts and you are happy.  If not then you can have a vertical lift.  Hope that helps.

Thank you for your picture and questions. Usually with removal of implants, some type of lift is required to address the extra skin. However, if you are concerned, then I think you should just have the implants removed and see how things go. You may be very happy with the outcome. If you are not, you can always go back and add the lift later and the interval time may allow for some shrinkage of the skin so less lifting will be needed. Hope this helps!

These are great questions, and it helps that you posted the photo. After doing a lot of implant removals, I have found that it's often better to remove them and let the body heal, and then determine if a lift needs to be done. In patients that are young, have not had pregnancies, and do not have stretch marks, the breast tissue does shrink down to some extent to accomodate the smaller size. The areola will likely be the same size as they were before the implants (unless you have had kids in the meantime) but again, only time will tell. You could use either periareolar incision or inframammary fold (IMF) incision to have the implants removed, and my preference is the IMF incision. The IMF incision is less likely to create visible scarring like you describe, where it can look like the nipple is caving in. Another consideration is whether or not to remove the breast capsule. Aggressive capsule removal is typically unnecessary and can actually create visible scarring in patients who have minimal breast tissue or did not have any capsular contracture to begin with. Also, regarding a lift- if later after the breasts heal you decide you do want a lift, or reduction in areola size, the resulting scars and shape will be more predictable since the breasts are at a steady state to begin with. Doing a lift in the setting of removal can actually be tricky since the tissues will contract while healing, and this does not always happen in a symmetric fashion. If the breasts were in worse shape, a lift at the time of removal may still be a good idea, but I would not recommend it in your case, at least just based on this photo. An in person consultation with a board certified plastic surgeon is the best way to get the most accurate advice, though hopefully this helps answer some of your questions. 

Dear BoucherB,it is hard to tell how will your breasts look like after implants removal. Your implants can be removed using the same incision. I would suggest you to consult a board-certified plastic surgeon. You will get the best recommendations after a thorough examination.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

You will be fine with implant removal only. It will take at least 2 weeks for the breast tissue to go back to before surgery size and shape. i offer my patient fat grafting at the same time to help with cleavage. Please see the link