How will I achieve this look after explant? (Photos)

Question

I had no breast tissue before explant and then got 375cc under the muscle and I am now 30. Now after 3 years I would like to take them out but I am scared that I will be more flat that my pre op before augmentation. I know they will sag after, but considering these are high profile , will I still be flat? Ive attached my pre op before augmentation, my present pic, and what I wish to look like after explant. Is it possible to achieve this without getting smaller implants or fat graft? thank you!

Austin Hayes, MD · Answer

Thank you for your question. As you know, removal of a 375cc implants will lead to a significant decrease in your breast size. Fat grafting is the best way to restore some of the lost volume, but it's important to have enough fat available for transfer and you will require 2-3 sessions. As a first step, liposuction, fat grafting and breast implant removal can be performed. If you desire additional volume additional procedures can be scheduled 3-6 months later.

Alan Gonzalez, MD, FACS · Answer

Hi @mmggl, thank you for your question. It is important to keep in mind that after implant removal, the skin and breast tissues may be stretched or sagging, which can result in a less than ideal appearance. If you decide to undergo a lift, the most optimal and aesthetically appropriate option would be immediate reconstruction with the BRALAN technique (Breast Reconstruction Anatomical Lift Augmentation) combined with a breast lift where the tissue is reconstructed and repositioned, excess skin is removed and the position of the areopla is repositioned to provide a natural and elevated appearance. I link you to a video that sheds more light on the subject. If you are considering breast augmentation, consultation with a plastic surgeon experienced in this procedure is essential to ensure optimal results. I link a video that sheds more light. Best regards.

Alan Gonzalez MD, FACS. Member of the American Society of Plastic Surgery (ASPS), Member of the International Federation for Adipose Therapeutics and Science” (IFATS), Member of the Colombian Society of Plastic Surgery (SCCP).

Alan Gonzalez MD, FACS. Member of the American Society of Plastic Surgery (ASPS), Member of the International Federation for Adipose Therapeutics and Science” (IFATS), Member of the Colombian Society of Plastic Surgery (SCCP).

Sophie Bartsich, MD, FACS · Answer

Hi!
Everyone has a different response to removing implants. A lot of what you can expect depends on what the quality of the breast tissue is, how thick and elastic the skin is, and what size implant was placed. If the skin has little elasticity (which is the amount it springs back, not the amount it stretches when pulled),  it may sag after explantation. If the breast tissue is thin, underwent changes through weight variations or pregnancy, or was flattened by a large implant over a long period time, it may actually end up thinner than it was before the original augmentation. A large implant can also put pressure on the chest wall, and this can actually change the shape of the ribs, leading to a flatter chest form under the breast. In those cases, removing the implant can also lead to a flatter contour.
The first important question to ask is: Why do you want to remove the implant? For patients who are having issues because of implant size, then downsizing can be an alternative to pure explantation. For patients who are having issues with implants placed under the muscle, a change in plane can sometimes solve those problems. In many instances, doing both can be helpful, and can surprisingly lead to a completely different implant experience. 
Speak with an appropriately credentialed and experienced surgeon and assess all of your options against your current concerns. As a team, you should be able to make a decision about how to move forward, while understanding what to expect, as well as what cannot be predicted.
Good luck!

Pejman Aflaki, MD · Answer

Hello and thank you for your question and sharing your photo. Generally speaking, after removal of breast implants, breasts will look smaller and deflated. Patients with good skin elasticity have a better chance for skin contraction and breasts returning back to what they looked like prior to their augmentation. Implant size and the amount of time since implant placement are other key factors that determine how your breasts will look like after implant removal. Generally speaking, your options include removal and observation, or removal and fat transfer for a natural volume enhancement. You should discuss all these options with your surgeon. If you are unsure, you can just have the implants removed and decide what you would like to do after a period of observation. I would seek consultation with a board-certified plastic surgeon for a full evaluation and advice.
Best wishes and good luck,
  
Pejman Aflaki, M.D.
  
Johns Hopkins-trained double board-certified plastic surgeon

Leopoldo Baccaro, MD · Answer

Placing breast implants stretches the skin. Unless you've gained weight, it is unlikely that your breast volume has increased. If you remove your implants, you will likely have a size close to what you were pre-operatively, with somewhat looser skin.In order to achieve the volume you are looking for, you can have smaller implants placed. If you do not want smaller implants, you can have them removed, heal for about 6 months, then re-assess. Another option for small volume augmentations would be to perform fat grafting (liposuction fat from other parts of the body and inject into the breasts).Hope this helps.All the best, Dr. B

Gary M. Horndeski, MD · Answer

You have not told us your weight change in the three years you have had implants.  However, removing the implants causes three different changes:  the loss of volume, increased surface area and descent down the chest wall.  The technique I recommend is explantation and lift using a modified Benelli approach.  Using a circumareola incision, the implants are removed, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage.  At the same time, fat transfers can be performed if additional volume is desired.  Best Wishes,Gary Horndeski, M.D.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  Your best option would be an explant and series of fat transfers.  Hope this helps.

Kenneth Hughes, MD · Answer

The smaller the implant and the less the amount of time it has been since placement, the greater the chance the breasts 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. And you can research whether a breast fat transfer will provide the end result you are seeking.

Leland Deane, MD, FACS · Answer

All I can tell you is that my patients have been very happy with removal of the implant alone. It takes time for the breast tissue to contract and soften to its final state. Very rarely, a secondary lift is required but in your case I do not think it would be necessary.Best of luck and I hope this helps.I am available for virtual consult if you  would like.Leland Deane MD FACS

Finny George, MD · Answer

Hi, thank you for your question.After removing the implants, you will be left with a significant volume deficit. Without anything to fill that space, you will be left significantly smaller. Fat grafting is an option but will require multiple sessions and enough donor fat to harvest. Consult with a board certified plastic surgeon who does these procedures and can go over your options. I hope this helps. Best of luck!