Should I do an explant and lift in one or two operations? (Photo)

Removal of breast implants, intact or ruptured, may have positive implications if patients are symptomatic. A constellation of symptoms associated with breast implant illness, and autoimmune disease are considered when treating patients who have breast implants and are concerned about foreign body reaction. In our office, we begin this journey with a consideration of symptoms and exclusion of obvious autoimmune problems. In many of our patients, en bloc removal of breast implants with capsulectomy is important and beneficial. Further clinical evidence about breast implant illness is evolving and will continue to guide treatment. I would suggest removal if there is a possibility of foreign body reaction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Hi and thanks for the question. As you have already seen in the consults you have gone to and from the answers in this forum, you are going to get different answers from different doctors. A question that has not been addressed is why you want your implants removed. Based on the photos you provided, your implants likely make up 50% or more of the breast volume you have. It can be challenging to make breasts look full and pretty when you take implants out and don't have a lot of breast tissue to work with. This is something the surgeons you have seen should be able to assess and explain to you. In my own practice I almost always perform the lift at the same time as the implant removal, whether the implants are above or below the muscle. It depends on the tissue you have and the technique the surgeon uses. The thing we worry about as surgeons is making sure we don't hurt the blood supply to the nipples/areolas which could result in tissue loss. Both the options are reasonable, you just have to decided which makes sense for you. Good luck.Dr J

This is an often debated question amongst plastic surgeons. I would go with whichever surgeon you feel most comfortable with and what he/she suggests. You certainly do not want to force a surgeon to do what he/she is not comfortable with. That said, my opinion is that if you remove the implant and lift all at once, there is a chance that you will need a revision later. However, by staging the surgery, you are guaranteeing that there will be a "revision" in a second stage of surgery later. I personally, would take the gamble and so both at the same time - with a surgeon who is comfortable with that. 

This is one of the most pertinent questions that have been asked, simply because the answer to your question fully depends on two factors: Whether your implants are under the pectoralis major muscle and you have excellent tissue thickness between the implant and your nipple-areola complex, and whether your surgeon understands the importance of this fact and can safely perform a breast lift in this context.If your implants are over the muscle or your tissue envelope is very thin under the nipples, I would perform your lift in two stages - one for implant removal and one for the lift.  If your implants are under the muscle, I would probably perform your explantation and lift in one operation . The reason is that the incision required for a lift can endanger the blood supply to the nipple-areola and result in necrosis or loss of part or all of the nipple-areola complex.  When the implant is under the muscle more of the blood supply perforators to the nipple are preserved and the one stage procedure is safer to perform. Regardless, the technique is also very important to preserve as many subdermal perforators during the breast lift while getting a good aesthetic result. Best of luck. Daniel Golshani, M.D., Beverly Hills.

I have had excellent uncomplicated results on many occasions with the combined explant and mastopexy lift.  The decision is partially based on the size of the patients breast without an implant.  Smoking is strictly prohibited.  The answer to your situation can only be assessed by examination and history.  Your goals are important.

In my opinion it is never a good idea to lift at the same time as the implant removal. ABreasts always change significantly for 6-12 weeks after removing breast implants. Why would you do a lift knowing things are going to change? A lift as a pretty precise operation so it makes no sense to do it before the tissue changes have stabilized.