I am considering having my implants removed. If I do not have them replaced, what if any downside is there?

After explantation alone, many women are dissatisfied because of the hanging skin, empty appearance and often require a lift.  I recommend explantation and a lift simultaneously using the no vertical scar technique.  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 and nipple sensation (in 95%) is maintained, if not injured during your previous surgery.  Later, fat transfers can be performed if additional volume is desired.  Implants are not lifetime devices.  8% fail within the first year and 30% fail within six years.  Fat transfers are permanent and incorporated into the body.Best Wishes,Gary Horndeski, M.D.

The downsides of removal are primarily aesthetic.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. Whereas larger implants which have been in for several years will often necessitate a lift.
With regards to your specific question, the recall does not require explantation in asymptomatic patients. If you are not having issues, you do not have to have the devices removed.
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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Dear Neat8522,
If you don't have any symptoms with your breasts, FDA does not recommend removal of your implants. However, if you want to remove them, you can do it. There are some options for patients to try to restore some of the fullness, like fat transfer or breast lift. 
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

The FDA has not recommended removal or replacement of textured breast implants or tissue expanders in asymptomatic patients.  Textured implants could be more difficult to remove because of the friction caused between the implant and the muscle surface.  Leaving a capsule behind is preferred if it is thin and pliable. If there are calcific components, or silicone granulomatous material, or if the capsule is deforming the breast tissue, then removal of the capsule may be warranted.  If the capsule is left behind, the body will break down and remodel the scar tissue on its own.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 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. 
Consult in person with a board certified PS who can examine you, order tests if necessary, and determine if you need to remove the implants and which implant removal procedure would be best

Removing implants without replacing them can have various effects depending on the type of implants and your individual circumstances. Here are some potential downsides to consider:1. Change in Appearance: If you have breast implants, for example, their removal can result in a change in the size and shape of your breasts, potentially causing sagging or loss of volume.2. Psychological Impact: Some individuals may experience emotional or psychological effects, especially if they had implants to enhance their self-esteem or body image. Be prepared for potential emotional adjustments.3. Scarring: Implant removal typically requires incisions, which can leave scars. The extent of scarring will depend on the surgical technique and your body’s healing process.4. Cost: Removing implants involves a surgical procedure and associated costs. If you don’t replace them, you won’t have the benefits of the original surgery, but you’ll still incur removal expenses.5. Recovery: Recovery time varies, but you’ll likely need some downtime for healing and may experience discomfort or pain during the recovery period. 6. Changes in Sensation: Depending on the procedure and the type of implant, you may experience changes in sensation in the area where the implant was removed.7. Health Considerations: If you’re removing implants due to health concerns or complications, it’s crucial to follow your doctor’s advice and closely monitor your health afterward.It’s essential to consult with a board-certified plastic surgeon who can provide personalized guidance based on your specific situation and goals. They can discuss the potential downsides and benefits of implant removal, as well as alternative options like replacement or revision surgery if necessary.

You can elect to have your implants removed at any time.  Based on the information given you will likely have loose skin  when the implants are removed.  If desired you may choose to have a lift to improve shape.  I encourage you to meet with a board certified plastic surgeon near you to learn more.

Once removed, you will not have to worry about needing another surgery to exchange or remove your implants. You will probably have some sagging once removed. A lift might be possible at the same time, or using ThermiTight, radiofrequency treatment, at the time of removal to minimize sagging. I would suggest meeting with a board certified plastic surgeon and discussing your options.

Your breasts will likely sag after implant removal. That is the downside. You can always opt for a breast lift following implant removal, if you so choose.Best of luck!

Thank you for the question.  You are not alone: many women considering breast implant removal have the same concerns when it comes to what their breasts will look like without breast implants.  There are maneuvers such as breast lifting that may be helpful at the time of breast implant removal surgery.  
 
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.
 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.
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.  
I hope this helps. Best wishes.

The removal of breast implants without replacement may lead to changes in breast shape and size. Some downsides may include sagging or loss of volume in the breasts. It’s essential to discuss your concerns and expectations with a skilled plastic surgeon to fully understand the potential outcomes and make an informed decision based on your individual circumstances.