Tuberous breasts with implants, wanting explant, what will I need for reconstruction? (Photo)

Question

Hello. I had 390 and 400 cc saline implants under the muscle 19 yrs ago. I had very little breast tissue, asymmetric, tuberous breasts, misshapen and aerola hernia. I have a full circular incision around my right nipple, & half moon incision on my left nipple. I have a ledge under my right breast. What will I need to achieve natural looking, well- shaped breasts without implants? Should I wait until I’m done breastfeeding? I’ve breastfed 5 babies so far. Thank you!

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.  Lactation should have been completed six months before considering breast surgery.
Usually removing the implants and performing the lift at the same time makes the most sense as some patients clearly need a lift and only want to go through one surgery.  If you are borderline, it is not unreasonable to remove the implants and then observe a waiting period of six months before the determination for breast lift is made. This will give your breasts time to bounce back and your PS time to determine what type of lift, if any, or a breast fat transfer is necessary for you to reach your goals.

Gary M. Horndeski, MD · Answer

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, 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 katfried,
if you are planning to get pregnant and breastfeed, then it is better to postpone the surgery. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs. Nothing replaces an in-person examination but it appears implant removal and a full breast lift +/- fat grafting should afford you a nice improvement to address all of your concerns.  You should certainly wait at least 3-6 months after the cessation of nursing to have any surgery however.

Ben Gbulie, MD, FACS · Answer

HiThanks for the question and pictures.With the size of implants you have and knowing you had very little breast tissue I would review your reasons for explantation before committing to it - you likely have even less tissue now so your breasts would be smaller than you were prior to the augmentation.If you do decide to undergo explantation a breast lift would help rejuvenate the breasts though would not add volume to the breasts. Another option for augmentation without implants would be fat grafting.Please see a board-certified PS for an in-person consult to discuss these options.I hope this helps!

Connie Hiers, MD, FACS · Answer

I would suggest having all the children you want, then consider removing your implants or going down in size and a lift. Your surgeon can measure you and help show you how much actual breast tissue you have compared to implants to help you choose what size you wish to be.

Camille Cash, MD · Answer

Thank you for your photos and questions.  You will want to wait until you have finished breastfeeding for 6 months before considering surgery.  A breast lift will likely be advisable after the implants are removed in order to give a nice shape.  Depending on how much natural breast tissue you have, you may want to consider adding a small implant as well.

Lisa F. Schneider, MD · Answer

Thanks so much for your question! Plastic surgery has come a long way in 19 years, and there are techniques that we use now (like fat grafting) that weren’t commonly used back then. However, I would recommend you finish breastfeeding first, since the cycle of pregnancy and breastfeeding will change your breasts for sure. hope this helps!Take care and stay safe,Dr. Lisa

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