Saline breast implant removal without lift. Will I be happy with the results? (Photo)

Question

55 years old. Saline implants under muscle 20 years ago. Fibrous Breasts. I am curious if I would be a good candidate for breast implant removal, local anesthesia with no lift. Will I be happy with the results? What can I expect?

Alan Gonzalez, MD, FACS · Answer

Hello @Harbor, thank you for your question. My opinion is that a breast implant removal should always be combined with an immediate breast reconstruction to reposition the tissue and improve the upper pole projection and medial areas using the BRALAN Technique (Breast Reconstruction Anatomical Lift Augmentation) as the results will be adequate in terms of aesthetics and will have a minimal L-shaped scar. In my experience, I prefer to perform this procedure under general anesthesia for my patients' safety. If you are considering a breast lift, consultation with a plastic surgeon experienced in this procedure is essential to ensure optimal results. 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).

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Jon Bradley Strawn, MD, MBA · Answer

The honest answer is that no one can know for certain until you go through the process, but there are several important factors that can help you make a thoughtful, informed decision before surgery.
First, capsule removal. Some patients feel strongly about removing the scar tissue (capsule) surrounding the implants, while others do not. There is currently no universal scientific consensus on this issue. That said, we do know that implant shells (including saline implants) can degrade over time, and that breakdown products may interact with the immune system. If you are experiencing unexplained symptoms, many of our patients do report improvement after implant and capsule removal.
Second, expectations about size and shape. Implants placed 20 years ago increased both the size and the shape of your breasts. Over time, gravity, aging, and tissue stretch often leave the breasts larger and lower than they were originally. Removing the implants will decrease volume, and without reconstruction, the breasts may appear flatter or more “pancake-shaped.” One helpful step is estimating how much of your current breast volume is implant versus natural tissue and how happy you are with the general shape of your current breasts; this gives a better sense of what your breasts may look like after explantation alone and if you will be happy with the results.
Third, reconstruction options. There are ways to improve both shape and contour after implant removal. A breast lift (mastopexy) can reposition and reshape the breast, though it does involve additional visible scars. Fat grafting can restore some lost volume and selectively shape areas that need fullness. Many patients benefit from one or a combination of these approaches, depending on their goals and anatomy.
The bottom line: you have options. A careful consultation focused on your priorities (scars, shape, symptoms, and recovery) is the best way to determine which path is most likely to leave you feeling comfortable and satisfied with your decision.

Emre Guvercin, MD, FEBOPRAS · Answer

Hi there &mdash; this is an important question, and I’ll be very honest so you can set realistic expectations.Will explant without a lift likely be satisfying in your case?Given your history &mdash; saline implants under the muscle for 20 years, fibrous breast tissue, and age-related skin changes &mdash; explant alone is very unlikely to give a result most patients are happy with.After long-standing implants, removing them without reshaping typically leads to:A flat or deflated breastExcess skin that doesn’t re-drape wellPoor upper-pole contourA breast that feels “empty” rather than naturalThis isn’t about aesthetics perfection &mdash; it’s about avoiding a result that feels worse than expected.Why a Push-Up Lift is important hereA Push-Up Lift is not the same as an aggressive, traditional lift. It’s designed to use your own tissue to rebuild shape after explant:Repositions remaining breast tissue upwardRestores a natural contour and upper-pole fullness without implantsProvides internal support, especially important with fibrous tissueUses strategic, minimal skin excision (often a small T-pattern)Preserves sensation and blood supplyIn patients with long-term implants, this approach dramatically improves how the breast looks and feels after removal.Can this be done under local anesthesia?Explant alone: often yesExplant + Push-Up Lift: typically requires deeper anesthesia (often general or deep sedation) for safety and precisionWhile local anesthesia sounds appealing, it should not limit you from getting the procedure that will actually give you a good outcome.What you can realistically expect with the right approachWith explant + Push-Up Lift, most patients experience:A lighter, more comfortable chestA breast that looks natural, balanced, and proportionalMuch higher satisfaction compared to explant aloneNo need to replace implants later to “fix” shape issues

Daniel Barrett, MD · Answer

Dear Harbor,

based on your photo, it looks like you would need breast lift after implant removal. My preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thats being brought together to support the breast and hence improves longevity.

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

Yucel Sarialtin, MD · Answer

Hello ,
Thank you for your question.
At 55 years old with 20-year-old submuscular saline implants and fibrous breast tissue, you may be a reasonable candidate for breast implant removal under local anesthesia without a lift&mdash;particularly if your overall health is good and you're seeking a lower-risk, less invasive procedure. However, the aesthetic outcome will depend heavily on your skin elasticity, the amount of natural breast tissue remaining, and whether capsular contracture or significant thinning has occurred over time. Without a lift, it’s common to experience some degree of breast deflation, ptosis (sagging), or asymmetry post-explant, especially after long-term implantation. While some patients are satisfied with a more natural, softer result, others may find the aesthetic change less favorable without additional surgical reshaping. A thorough in-person evaluation with your surgeon will help determine if your skin and tissue will retract adequately on their own or if a lift might ultimately be recommended for optimal contour.

Joel Patrick Maier, MD · Answer

Removal under local is a simple procedure with no down time and easy recovery. You can assess how your breasts rebound after and make a decision about a mastopexy (breast lift) later depending on what you’re expectations are. I would predict that you would want a lift to help reshape, tighten and lift you’re breasts. Thank you.

Shaher W. Khan, MD · Answer

Hello, thank you for your question. In my opinion, it is best to have breast implant removal completed under IV sedation anesthesia. It is not possible to remove the implant and capsule under local anesthesia to ensure you are rid of your signs and symptoms of breast implant illness. After implant removal, only time will tell if you need a lift. Removal of the implant and capsule with a lift poses risk for unnecessary lengthy surgery. It can take 12-18 months for the breast tissue to "fluff" after removal of implants. I hope this answers your questions.

Gary M. Horndeski, MD · Answer

If you remove your saline implants the skin will hang and you will be dissatisfied. The technique I recommend is 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 and the nipple sensation (in 95%) is 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.

Best Wishes,

Gary Horndeski, M.D.

Ramiro Morales, Jr., MD · Answer

Thank you for your question and picture.  Only you can answer if you would be happy.  It depends on the look you are willing to accept.  Based on your pictures, you would most likely end up with a very deflated and flat upper pole of your breast and quite a bit of droopiness, likely more than you have now. Otherwise, if you did a lift along with your explant you could avoid so much droopiness of the breast.
Be sure to see a Board-Certified Plastic surgeon with experience in explantation for your consultation.

Matthew S. Kilgo, MD · Answer

Hello. One of the benefits of saline implants is that they can be deflated easily in the office without implant removal. After adequate time is given for the breast skin to retract, you may have a better idea of what your breast will look like without the addition of the lift. It is possible that some of your glandular ptosis (excess skin below the nipple areolar complex) may improve. If you are satisfied with the appearance of the breasts after deflation, simple implant removal would suffice. If you would prefer more upper pole volume without the addition of an implant, I would recommend mastopexy with auto augmentation, a procedure that involves transfer of the lower breast tissue to the upper portion in order to provide more upper pole fullness. Fat grafting can also be performed to give additional volume. I hope this helps.

Saline breast implant removal without lift. Will I be happy with the results? (Photo)

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