Five revisions and two lifts later, do I remove implants?

Need advice: I am 62 years old and want to have my implants removed. Over the years I have had five revisions and two lifts. Two of the set ruptured and the others were distorted from scar tissue. Originally I was a small C cup and now a large C "275cc". I am a small frame and in great shape for my age. The size is not important to me as much as the shape. I have consulted with two surgeons; the first one said to remove them and let my body heal and if I am not happy with the outcome I should consider a lift. The second doctor "world known for fat transfer" said to remove and immediately do the fat transfer and that the capsule will close and heal the same with or without the fat transfer. I am worried about the blood supply more than anything since I have had so many surgeries. Can an MRI detect how much breast tissue I do have and can it also detect the amount of blood supply? Please advise.

Doctor Answers 7

Results after Explantation

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I encounter many patients in my practice with long-standing implants and a history of multiple surgeries for breast implants. Certainly it is quite feasible to have your implants removed. Ideally, a simultaneous breast lift will restore a more normal, age-appropriate breast shape. I agree that blood supply is a concern. The amount of breast tissue you have overlying your breast implants can be evaluated by physical exam. Typically, an MRI is not needed unless you are concerned about possible rupture. It is helpful to have previous operative reports if available to ascertain previous incisional approaches and subsequent blood supply to the nipple areolar complex and overlying tissue. The recommendations for scar tissue removal (capsulectomy) can be made after physical exam. To determine your candidacy for explantation and breast lift, I would recommend additional consultations with board certified plastic surgeons to clarify your decision-making. If your tissues are thin, or lacking, fat transfer works well to treat contour depressions that could result from implant removal.

Staged implant removal and breast lift

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You best option would be to removed the implants under local and wait a few months to see how things look.  Then consider a breast lift if you do not like the shape of the breasts.  The implant could be removed under local anesthesia.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Removing implants after several failed corrections.

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The goal to remember is the final shape of the breasts. I typically recommend staging this type of procedure - remove the implants first then perform any lifting or contour work secondarily. To remove the implants, both the actual implant and the capsule surrounding the implant are removed. Often, this is all that is necessary and patients are happy. If after 6 months or so, you are unhappy with the shape, a lift with or without fat grafting for contours can be performed to improve the overall shape. However, be advised - having had a previous 5 revisions and 2 lifts, those surgeries take their toll on the breast tissue and your ideal results may just not be realistic.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

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Too old for implants

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I tend to agree with the first surgeon.Since size is not important thenr emove them and see how you adjust and feel.If you want a lift then go for it or you can consider fat grtafts at that time.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 69 reviews

Removal of implants, then what?

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The MRI will show how much breast tissue there is, but so will a breast exam for about $2000 less. The MRI will not reveal anything about blood supply. 

Without a photo it is hard to make a suggestion about what to do here. If you are in good shape and are small framed I would wonder if there is enough fat to harvest to make a difference.

Usually the struggle for patients in this setting is whether or not to do a lift, and I note neither surgeon suggested that as a primary procedure. 

With all this limited info, I would favor removal alone. If you would consider attaching a photo, the responses you get might be more useful.

Thanks and best wishes. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Many surgeries impact blood supply

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It's great to see that you understand the concerns of multiple breast surgeries and are well-informed.  I agree that you should consider multiple consultations until you feel comfortable with the surgeon and the plan - it is important to visit with board-certified plastic surgeons who have considerable experience with breast surgery and breast revisions.   Your old operative notes may help if you are considering another breast lift.  A conservative option would be to remove the implants, let the tissue heal and then consider a lift or fat grafting down the road if you are unhappy with the shape or size.   If your breast tissue is very thin, stretched out, your nipples are positioned low, or you are unhappy with the shape now, it will be more likely that you will want another lift.  Fat grafting can help fill out volume and correct contour issues, but it will not raise the nipple up if it is very low.   It is not ideal to give advice without at least pictures much less a physical exam, however.  An MRI is not going to give us information about blood supply to the nipple areolar complex.

Concerns about Removal of Breast Implants?

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Thank you for the question.

Although it is not possible to give you precise/accurate advice without direct examination and a full  communication of your goals,  some general words of advice may be helpful to you. Given that you are most concerned about the shape of the breasts after breast implant removal,  your current breast shape and position of nipple/areola complexes will be of paramount importance in the decision-making  process. For example, if you are pleased with the current shape of your breasts, then you may want to proceed with breast implant removed only. However, if your breasts ( and the nipple/areola complexes) are too low on your chest wall, then some degree of  additional breast lifting may be helpful.

Generally speaking, whatyour 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.

You are correct, given your history of multiple operations,   that blood supply is also of critical importance. An MRI study will not help  to evaluate the nature of the blood flow of the breasts.

If in doubt about the best course of action to take, you may want to visit with a few more well experienced board-certified plastic surgeons. Ask to see lots of examples of their work  and communicate your goals clearly.

Best wishes.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.