Is it preferable to wait for a lift after an explant and why? Is there any way of knowing if you will need one? (photos)

Each surgeon will have different comfort levels with performing a lift at the time of explant or not. Personally I would not make a patient wait except in specific cases where it really doesn't look like they will need one, or in cases where the implants are oversized and the skin has stretched to the point that I am worried about the blood supply. These are both pretty rare circumstances so generally I feel it makes the most sense to have one procedure to remove your implants and lift your breasts so you can be done with it and move on with your life. Hope that helps! 

Hi, thank you for your question. Although a breast lift can be done at the same time as an explant, given that it’s hard to predict the perfusion to the nipple and provide an accurate prediction of the kind of lift required, my recommendation would be to wait 6 months before the lift. You may not need one. Always consult with a board certified plastic surgeon.I hope this helps. Best of luck! 

The technique I recommend is explantation and a 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.  At the same time or later, fat transfers can be performed if additional volume is desired.Best Wishes,Gary Horndeski, M.D.

Thank you for sharing your excellent question and photographs.  Waiting after removal allows your tissues time to heal and retract to their new shape/appearance.  This allows you to then consider the improvement that a lift would entertain, as well as allow for a more predictable result.  Although nothing replaces an in-person examination it appears that you will have some breast tissue sagging, along with a lower nipple placement with explant alone, but no one can offer certainty as to what your outcome would be with explant alone.  Hope this helps.

It is difficult to make 100% accurate predictions following explant. There are a number of factors to consider including age (the breast changes over time irregardless of augmentation), weight change, skin stretch and residual elasticity.
Following removal, one can expect:
-Loss of volume- Not an exact correlation between pre- and post augmentation due to the changes over time. You may be bigger or smaller than you remember.
-Ptosis/sagging-Ptosis develops over time and may be worsened by the presence of an implant. If a patient has pre-explant sagging, removal is likely to worsen this to a certain extent. If there is no ptosis, it does not necessarily mean there will be no ptosis after removal.
-Skin laxity/stretch- There is inherent skin elasticity which will allow for some measure of snap back. However, the greater the volume differential pre- and post- the more likely there will be excess skin.
In my experience, it is usually a safe assumption that there will be some changes post removal which oftentimes may necessitate further operative intervention (i.e. lift), however this is often a function of size and length of time post op. Small implants which have only been in place for a short period will lead to an improved response/recoil post removal.
With regards to your specific question, without an in-person exam it is difficult to make a prediction. Much will depend how long they have been in place, how large, and how much you have changed over time. Delay may allow you to avoid the additional scar burden. However, you run the risk of an additional procedure to reach your desired goal.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
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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.  
It is not unreasonable to remove the implants and then observe a waiting period of six months before the determination for breast lift or breast fat transfer is made. This will give your breasts time to bounce back and your PS time to determine what type of lift, if any, is needed. 

Dear Fearless7139,
both are valid options. If you decide to do staged procedures, you will have some time to see the final results after implants removal and decide whether you want to get breast lift. 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

If the lift can be done at the same time as the removal depend upon how much actual breast tissue is present to support the circulation to the nipple. If you are too thin, or it is questionable, it is best to wait six months and then do the lift. Sometimes, the final decision has to be made on the OR table once the implants are removed.

The biggest concern with a combined implant/mastopexy is the possibility of interfering with blood supply to the nipple or skin flaps and having necrosis or loss of these structures.  Some of the conservative surgeons do not wish to combine the two because of those concerns.  A good surgeon should be able to determine what you consider an acceptable breast shape and whether a lift is needed.  This is highly individualized but most of the time we can determine that pre-operatively.  i certainly would NOT do the combined operation on a smoker as they do not have good circulation.  Assuming you are not a smoker and you want to have a lift and everything else is acceptable, then there is no reason you cannot do it at the same time but please find a surgeon who has done this procedure a lot because you do not want to risk loss of a nipple/areolar complex!

Whether to lift breasts at the same time as removal of breast implants is a decision that is best individualized.  Every patient starts out with different anatomy, different goals/expectations, as well as different  preferences and goals.   
 Some general thoughts regarding breast implant removal and the need for breast lifting may be helpful to you:
Generally speaking, what your breasts will look like after explantation depends on several factors such as: the quality of skin elasticity (the better the elasticity the better the skin will bounce back), the size of the implants used (the larger the implant the more trouble you may have with redundant skin), and the amount of breast tissue present at this time (which may have changed since the time of your breast augmentation).
Life experience since your breast augmentation procedure, such as pregnancy or weight gain weight loss, will potentially influence the factors discussed above. If you take these factors into consideration and apply them to your specific circumstances you may get a good idea of what to expect after the implants are removed.
 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.
   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. The advantage of waiting. to perform a breast lift (staged approach): more accurate assessment of whether breast lifting is really necessary,  more accurate planning of the operation (based on measurements made without breast implants involved),  possibly shorter and more accurate scarring and less trauma to the breasts (in one setting).   The latter (trauma to the breasts) may be potentially dangerous, depending on the patient's circumstances, when it comes to  compromise of blood flow and healing complications.
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.