Considering explant, with a fat transfer. Can they be done at the same time?

Question

4yr implants (under muscle, combined w/fat transfer), I strongly feel I suffer from BII. Considering getting removed but don't want to look completely deflated. Is it possible to do fat transfer when the explant surgery is performed? I understand they will not look as full as with the previous implants, I just would like to avoid looking completely flat. Also, should I go to my original aug PS, as I feel my results (other issues) were not met in a chance to have them fix error.

Raffy Karamanoukian, MD, FACS · Answer

Removal of breast implants, intact or ruptured, may have positive implications if patients are symptomatic. A constellation of symptoms associated with breast implant illness, and autoimmune disease are considered when treating patients who have breast implants and are concerned about foreign body reaction. In our office, we begin this journey with a consideration of symptoms and exclusion of obvious autoimmune problems. In many of our patients, en bloc removal of breast implants with capsulectomy is important and beneficial. Further clinical evidence about breast implant illness is evolving and will continue to guide treatment. I would suggest removal if there is a possibility of foreign body reaction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Daniel Barrett, MD · Answer

Dear pamann83,
I understand your concern. It is best however that you consult with a board certified plastic surgeon to determine whether you can have several aesthetic surgeries in one session, as this would depend on various factors including but not limited to your general health condition, the type of anesthesia that will be used, and the type of surgeries that will be performed among others.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Jeffrey Lisiecki, MD · Answer

Yes, it is very possible and often preferable to explant and fat transfer simultaneously.  You should of course be seen in person to ensure that this is the most appropriate plan and that you don't require a simultaneous breast lift.

Shaher W. Khan, MD · Answer

Hello thank you for your question! The goal is to remove the entire implant, capsule, and all inflamed tissue and to have it tested for malignancy. Fat transfer is not a good idea, especially when 50% of the fat with inevitably die and leave clumps of “dead” fat and nodules. This may complicate a mammogram read or self monthly breast exam when screening for breast cancer causing unnecessary worry. Please get explant surgery from someone who explants exclusively to ensure complete removal of all capsule and implant.

Alan Gonzalez, MD, FACS · Answer

Hello @pamann83, thank you for your question.  In case of an explantation with capsulostomy, the surgical procedure would imply a breast reconstruction, because taking out the volume that the prosthesis gave will require repositioning of the tissues. In this way, you would achieve an aesthetic result you would be happy with.   If what you want is to do an explantation with capsulostomy is not convenient to have fat transfer to breasts in the same procedure, it is advisable to wait 3 to 4 months to avoid the fat to die or risk of infection. In this case the incision would be periareolar in a L shaped to avoid making a T. The best course of action is to consult one or several board certified plastic surgeon for more information and options tailored specifically to your needs.  Best wishes!  Alan Gonzalez MD, FACS.  Best wishes! Alan Gonzalez MD, FACS.  American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP)

Camille Cash, MD · Answer

It is possible to have fat transfer at the time of implant removal, but an exam and discussion of your goals is needed to know if it is recommended for you.  Fat transfer also comes with risks and benefits and it is important that you are aware of them prior to surgery.  If you are unhappy with the care provided by your prior surgeon I encourage you to visit a different board certified plastic surgeon for a consultation.

Connie Hiers, MD, FACS · Answer

An examination is needed to see if fat should be done at the time of explant, or if time is needed to let your breast tissue settle and then get fat.

Douglas Taranow, DO, FACOS · Answer

I have done this exact surgery several times, however, I ran into the issue of the old breast pocket left behind by the explantation and capsulectomy filling up with some fluid and fat when I did both procedures at the same sitting.  
I now do the explantation followed by the fat transfer several months later.
Best wishes,
Dr. Taranow