It is hard to say what would be best for you without an exam. If you do not have a lot of breast tissue, I will often stage the implant removal and lift procedure so that the implant pocket space can shrink down.
Options after Breast Implant Removal
Yours is a frequent question, but not one which can easily be addressed online. Consult in person with an experienced and expert board certified plastic surgeon to understand your options.
Lift alone or lift with implant
This unfortunately is difficult to answer without an examination. I would bet you have enough breast tissue if you are a DDD, but that may be skin excess as well. Have a consultation with a board certified plastic surgeon who will assist in determining the best option. A 275 cc implant give you almost 2 cup size increase, so just your breast tissue alone should give you close to where your goal is.
Very easy solution and trick
My advice is since they are saline, have them
deflated in clinic. I do this all the time for my patients. You can
numb up the skin and insert a needle attached to a suction canister and remove
the saline from the implant. This allows your breast to start the process
of skin retraction and can better estimate what your shape and size will be
once you remove the implants. This lets us know if you might need a
breast lift to help your shape and breast appearance. It is really a
valuable tool that I use. Allow 6 weeks-3 months after deflation before
you have your formal surgery done. Hope
A lift with an implant is controversial for two reasons. First, when you perform a lift you are making everything tight and closing the wounds under tension. It you add the expansive forces of the implant at the same time, you are fighting against yourself. There are forces on the wound which try to make them separate, which results in wider, thicker, more irregular scars. In the worst case, the wounds will open. So compromises are usually made in the operating room by the surgeon because they cannot close the lift wounds over the appropriate sized implant. Either less of a lift is performed so that the skin is not as tight and therefore there is less tension on the closure. Or a smaller implant than would be appropriate is used so as to decrease the expansive forces. Either way, you are compromising the aesthetic outcome. Often the outcome is so compromised that a second revision surgery is required. If however, you plan to have the lift first and then the augmentation after everything has healed, then you have two operation that are planned, both with much lower risk than the combined mastopexy/augmenation. The outcomes of the two meticulously planned operations are much better and a more aesthetically pleasing, and a safer outcome is achieved.
The second reason the combination of mastopexy and augmentation is controversial is because of the risk of nipple necrosis (death of the nipple). By making the skin tight for the lift, you are putting external pressure on the veins that supply the nipple. By putting an expansive force on the undersurface of the breast with an implant, you are putting pressure on the thin walled veins that supply the nipple. If the pressure by squeezing the veins between the implant and the skin is greater than the venous pressure in the veins, the flow will stop. If the venous outflow stops, the arterial inflow is stopped. If the arterial inflow is stopped, there is no oxygen for the healing wounds and the tissue dies.
Placing the implant on top of the muscle in combination with a lift puts the blood supply to the nipple at a much higher risk because in addition to the issue of pressure on the veins, you have to divide the blood vessels that are traveling from the pectoralis muscle directly into the breast (and to the nipple) in order to place the implant between the breast tissue and the muscle. This adds a third element of risk to an already risky operation. Mastopexy/augmenation with sub glandular implant placement is by far the riskiest way to address your anatomic question.
#Explant #BreastImplantRemoval - full lift or implants also?
It's a good question (though not one that can be fully answered via this forum). If you have enough tissue so that you're considering not getting implants, then you may be a good candidate for a staged procedure. In that, the existing implants are removed and you have a lift. Some women are happy enough with that so that they don't go back and get implants, but if you decided after some time (6 - 12 months) that you want implants, they can still be done (and, arguably, somewhat better since there are advantages to doing the implants a few months after a lift; you give the tissues some time to settle and can assess that much better exactly what size and shaped implants you want). You should of course be assessed in person by one or more board-certified plastic surgeons for a full and complete assessment. I hope that this helps and good luck, Dr. Alan Engler, Member of #RealSelf500
You describe a situation that is frequently encountered. It is difficult to fully guide you without pictures, but if you feel you have enough volume, forgo implants and just do a lift. Meet with a surgeon and see if you are a candidate for a short scar technique. Best of luck.