Should I have explant and lift in 1 procedure or 2? (Photos)

Question

I'm confused. 63 y/o with 30 y/o Meme Implants. I have Meme textured implants for 30 yrs. Went from a 36C to a 38DD after menopause. Would like to explant and lift. Had consults with 3 surgeons. Two wanted to perform a 2 stage surgery removing implant en bloc doing lift 3 months later. 3rd surgeon would do one surgery: explant leaving capsule in and lift with nipples being slightly lower (less aggressive lift) What are advantages/disadvantages to both? If capsule is left in what happens to it over time?

Daniel Barrett, MD · Answer

Dear Southshore12,some plastic surgeons may want to split this into two operations depending on the time needed. Its best to see a board-certified plastic surgeon to determine your options and whether it would take too long, more than 4 hours, to do all.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. 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

Jed H. Horowitz, MD, FACS · Answer

Good day! Generally after explantation, the shape and size of the breast will be unpredictable. Result varies between patients and it will largely depend upon their age, duration and size of the implant, or previous state of their breasts like existing anatomy, deformity, previous surgeries, underlying personal and family medical conditions, nicotine use, pregnancy and other factors. That's why it is suggested to wait for explantation results to show before deciding for a lift, but yes, you may also do the lift with the explantation to save time and money. Do not hesitate to contact your surgeon about this and discuss realistic goals and expectations. Best of luck! #RealSelf100

Kenneth Hughes, MD · Answer

Usually removing breast implants and performing the lift at the same time makes the most sense as some patients clearly need a lift.  Because you have Meme implants which have been taken off the market, removal followed by a waiting period is more reasonable.  If you decide to replace your breast implants, I recommend that you replace them with either Allergan, Mentor, or Sientra that typically carry a lifetime warranty for mechanical disruption or rupture. But don’t confuse the warranty time-frame, with the life of your implants.  Find a board certified plastic surgeon who is an expert at all aspects of breast surgery.

Gary M. Horndeski, MD · Answer

Explant
alone results in the highest patient dissatisfaction and most patients require
a 2nd operation.  It is easier
to do both at the same time and I recommend explantation using The Bellesoma
Method.  The implants are removed, your
breast tissue is reshaped created upper pole fullness, elevated higher on the
chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation
and the ability to breast feed are maintained, if not injured during your
previous surgery.  The capsules can be
removed if there are indications such as infection or calcification but often they
are left in place to preserve breast volume and minimize complications.  Best Wishes,Gary Horndeski, M.D.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  Nothing replaces an in-person examination but it appears that you have enough tissue present to safely perform an explant and lift in the same setting.  After 30 years your implant capsule tissues have likely thickened and hardened and would benefit from removal to restore your pre-implant tissue quality.  Hope this helps.

Nandi Wijay, MD · Answer

The advantages of 1 stage procedure is that you only have to have general anesthesia once!   The advantage of 2 stage procedure is that you can see how the breast settle after implant removal. Then weeks later you can perform the lift.  Also, in a 2 stage procedure you can "delay" this skin flaps which may provide a safer breast lift.  
  
In regard to the capsule, if the capsule is firm and painful we recommend removing the entire capsule.  If the capsule is soft, we can sometimes preserve the capsule and use the capsule to our advantage.

Khashayar Mohebali, MD, FACS · Answer

I do many en bloc implant removals and always encourage doing everything in 1-stage. I don't think there is a benefit for 2 stage unless you are not sure you want the lift at all.  It is one surgery and one recovery and an experience surgeon can safely perform both at the same time. Good luck.

Camille Cash, MD · Answer

Based on the information provided it is advisable to have the implants and capsules removed at the same time and return for a lift once healing is complete. The risk of doing the lift at the same time is that the risk of wound complications is higher.  The implant and capsule removal could be tricky in your case, especially if there is leakage of the implants.  So in order to lower the risk of issues and increase your chances of optimal results, it is safer to have the procedures performed in two stages.

Tom J. Pousti, MD · Answer

You will find that there is no "standard" practice; in other words, opinions and practices will vary. For this reason, best to clarify the planned procedure directly with your (carefully selected) plastic surgeon.

Generally speaking (in my opinion), unless the breast implant capsules have thickened (and/or are otherwise symptomatic),  are associated with the ruptured silicone gel breast implants, or if the patient has concerns about "medical conditions" related to the breast implants, capsulectomy is not universally necessary.  For these patients, en bloc removal of breast implants is a good procedure.

On the contrary, capsulectomy can expose you to additional risks, such as bleeding and minimal size loss.  In other words, any maneuver performed during surgery exposes patients to additional risk (morbidity).

Similarly, whether to lift breasts at the same time as  removal of breast implants or "stage" the procedures is a decision that is best individualized.   Every patient starts out with different anatomy, different goals/expectations, as well as different  preferences…
 I have found in my practice, that when breast lifting surgery is definitely going to be necessary in order to achieve an aesthetically pleasing outcome, MOST patients prefer to have the breast lifting performed at the time of breast implant removal.   Most patients simply do not wish to undergo two operations, if avoidable.

On the other hand, there are patients who (where safety considerations such as potential for loss of blood supply to tissues…), benefit from a two-stage approach.   For example, there are patients who benefit from the following operation: removal of breast implants and capsulectomy surgery,  if indicated based on the patient's clinical situation and examination (in the first stage).  A second stage breast lift may be more accurately planned and more safely executed.
 
  In "borderline" cases where there is doubt whether breast lifting is necessary or not, I advise patients to undergo explantation only and to give their breasts the benefit of the doubt  before deciding whether breast lifting would be beneficial.  Patience is definitely indicated after removal of breast implants; it will take many months/year for the skin to “bounce back” and for you to see the final appearance of the breasts.
 
 As you can see, there is much to consider (which is why nothing replaces individualized care,  centered on good communication and good judgment, provided by a well experienced board-certified plastic surgeon). 
My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as well. Working together you will come up with a good plan to achieve your goals.

I hope this helps. Best wishes for an outcome that you will be very pleased with.

Milind K. Ambe, MD · Answer

Thank you for your photos and question.  I often do explantation with a lift at one sitting.  Many times the patients condition doesn't require an en bloc.  If an en bloc is necessary then often a two staged approach is best.  In your situation it is likely that a rupture has occurred so en bloc might be the best for you, followed by a second surgery for the lift.  Best of luck to you.

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