Explant or revision - Worried about size and multiple revisions (photo)

Question

I had a breast augmentation in 2015 with Mentor 400cc silicone implants. Since then, I’ve had two children—one in 2018 and another in 2023—which has led to significant weight fluctuations. I’m 33 years old, 5’5”, and 129 lbs. Before my augmentation, I was an A cup, and now I’m a D cup. Over time, my implant pockets have stretched and bottomed out, making my breasts uncomfortable. When I lie on my back, my implants fall into my armpits, making my chest look flat. When I lie on my side, I constantly have to readjust due to discomfort. Additionally, my chest is naturally bony, particularly in the cleavage area, and my breasts have always faced slightly outward. Before my augmentation, my A-cup breasts had a conical shape, which makes me apprehensive about getting an explant with a lift—I worry I’ll return to an A cup and won’t be happy with the results. I recently had a consultation with a surgeon who specializes in explants and he recommended an explant with a lollipop and anchor lift, all done in the same procedure. While I’m open to revisions, I’m also concerned about the possibility of needing multiple revisions as I get older.

Gary M. Horndeski, MD · Answer

I recommend explantation and lift using The Bellesoma Method.  The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery.  Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear elena19921992,

breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.
Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.
While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.
If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Jeffrey M. Darrow, MD · Answer

There are many options for you, and the ultimate decision is up to you and what would make you the happiest.   The simplest option is to only remove your implants with or without a breast lift.  You would be 400 cc’s smaller but if you have gain some weight since your augmentation your breasts will be some larger than they were before your augmentation, depending on how much weight you’ve gained.  If you are concerned about the deflation of your breasts after implant removal, adding a breast lift to your implant removal will elevate your breasts in addition to making them appear more full. This choice is the least expensive/shortest recovery and  leaves you with only your tissue so you never have to worry about implant malposition, implant rupture, or any other issue associated with your implants and your risk of needing an additional revision is very low.  You would just need to be OK with your volume reduction.
Other options that include exchanging your implants for same size or a different size, modifying your capsule so your implants don’t displace toward your armpit, performing a breast lift with an implant still in, all increase your cost, your recovery time and possibility of future revisions.
I hope this was helpful. Best wishes.

Camille Cash, MD · Answer

You have several options to consider.  If you remove the implants you will lose the volume they provide and will return to a size similar to what you used to have, but your skin will likely be loose as well.  You can consider removing the implants and getting a lift which would result in small, lifted breasts.  If you like the volume of the implants but just not the issues you described you can keep the implants and have a lift.  The pockets could be tightened as well.  There is no way to guarantee that another procedure will not be in your future no matter what you choose as you (and your breasts) will continue to age.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Dear Elena ,

Thank you for your pictures and your detailed history. I know that you’re not quite happy with where you are with your breast shape and your implants.  Overall based on your history, your results are still good. Nonetheless, if you’re considering explantation, I think is a great idea to prevent you from having multiple revisions in the future.

I would recommend removal of the implants only. Allowing the breast to contract and heal over a minimum of three months. This will give you time to evaluate your new shape and size. At that point, you can determine if you desire more fullness which means or return to implants and/or you desire more perkiness which means having a lift. Those procedures are performed a secondarily. 
You may decide that after three months of healing that you are quite fine with your shape and size thus avoiding any additional operations.

Continue to seek council from board certified plastic surgeons.

Best wishes,

Earl Stephenson, JR, MD, DDS, MBA

ESJ aesthetics

Explant or revision - Worried about size and multiple revisions (photo)

Answers (6)

Answer: Options

Answer: Options

Answer: Give Serious Consideration to Explant

Answer: Give Serious Consideration to Explant

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Explant or revision - Worried about size and multiple revisions (photo)

Answers (6)

Answer: Options

Answer: Options

Answer: Give Serious Consideration to Explant

Answer: Give Serious Consideration to Explant

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Recommended reading

Everything you need to know about Breast Implant Removal

Our mission is to create a world where every investment in modern beauty is Worth It.