25 y/o saline implants - what's the benefit of waiting to lift vs. doing it at time?

Question

25 year old saline over the muscle implants. Would love to remove. What is the benefit of waiting to lift vs doing it at time Of explant. And there's a lot of talk about fluffing. Is existing breast tissue more damaged by over the muscle implants vs under?

Alan Gonzalez, MD, FACS · Answer

Hello @mikey1, thank you for your question. The surgical procedures vary from surgeon to surgeon. In case of an explantation with capsulostomy, the surgical procedure would imply a breast reconstruction not only a lift, 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.Due to the experience of so many explantation surgeries practiced in these 21 years I consider that the L-shaped incision is the minimum and smallest scar possible in this surgery. Remember that every 10 years the prostheses must be changed. Is important that you consult with several board certified plastic surgeons. Best wishes! Alan Gonzalez MD, FACS. 
In case of an explantation with capsulostomy, the surgical procedure would imply a breast reconstruction not only a lift, 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. Take into account that 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

Stanley Okoro, MD · Answer

Thanks for your question! It is a difficult one to answer without examining you myself. However, many patients choose to stage their procedures so they can see how much skin retracts after breast implants are removed. The theory is that your skin retracts and you may not need as big as a lift, or possibly no lift at all. Good luck!

Anna Steve, MD · Answer

Explant and lift can safely be performed at the same time for implants placed above and below the muscle. One of the benefits of waiting to do the lift at a second stage is the ability to decide whether or not you are satisfied with your breast aesthetics after explant-only. 
If you have had your implants for 25 years, there is a good chance you would benefit from a lift as well. Your nipple position and breast shape can be used to help predict this pre-operatively.

Daniel Barrett, MD · Answer

Dear mikey1,
I understand your concern. Generally speaking, it is possible to get implant removal at the same time as explant. 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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

Lifts cannot always be done at the same time as the removal, especially in women who have little breast tissue. If the circulation to the nipple area is mainly from the skin, then a lift cannot be done. If the tissue is present but thin, then the lift needs to be postponed to see if more blood flow increases once the implants are removed. If in doubt, surgeon's choose to wait.  Usually there is less damage to the circulation of the nipple with implants behind the muscle, especially if the capsule needs to be removed.

Peter Andolina, DO · Answer

Basically waiting to do a lift after removal of your implants is just safer for you and your breasts. Implants place some strain on your native breast tissue. When doing doing a lift, your surgeon is rearranging your breast tissue in order to get it into a better position and there are certain cuts made through the breast tissue that can damage the blood supply to parts of the breast. I prefer having patients wait in between surgeries because it's safer and allows your breast tissue some time to heal before putting them through another surgery.

Camille Cash, MD · Answer

If a lift is recommended it is often done at the same time as implant removal.  This allows the patient to have one surgery and one recovery.  Typically if you have had implants for 25 years you will likely benefit from a lift.  With saline implants you can consider having them drained in the office and allow the breasts to start to adjust to the implant volume being gone.  Then at a later time you can have the implant shells removed and a lift performed.

Constance Chen, MD, MPH, FACS · Answer

The benefit of waiting to lift is that you may never need to undergo a secondary lift procedure, and you will spare yourself unnecessary scars. In addition, a straightforward removal of your saline implants with en bloc capsulectomy will be an easier recovery than removal with a breast lift. At 25 years old, your skin should still have a fair amount of elasticity, so the shape will likely return. The implants have stretched out your skin and compressed your breast tissue, but over time your skin should contract and your compressed tissues should "fluff" back up. Finally, existing breast tissue is definitely more damaged by under the muscle implants. Thus, you are fortunate in that your saline implants are over the muscle, so you should have a relatively simple removal of your implants with complete en bloc capsulectomies via your existing scars.

Douglas Taranow, DO, FACOS · Answer

Yours is a common question.  Each surgeon has their own techniques. I like to combine the two procedures so there is only one recovery. 
I’m not aware of the atrophy (loss of breast tissue) being higher with a subglandular vs a submuscular placement. The larger the implant or tighter the breast pocket, the more pressure on existing breast tissue and the potential for atrophy.

25 y/o saline implants - what's the benefit of waiting to lift vs. doing it at time?

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