Lift with my total capsulectomy explant? (photos)

Thank you for your question and I'm sorry to hear about the issues that you have been experiencing. I think there are two issues. The first is determining the cause of the mass. If there is no fluid present around the implant, then BIA-ALCL is unlikely but the mass requires more investigation. Certainly you should discuss the mass specifically with your surgeon. The second issue is whether you truly needed a lift. Based on your photos it appears that you may benefit from a lift, but could also be borderline. The decision depends on your goals, but it's reasonable to remove your implants/capsules + fat grafting (restore volume) as a first step, followed by a lift six months later only if needed. It's important to find an experienced board-certified plastic surgeon who will take the time to discuss all of your goals and options. Good luck with the process.

En Bloc breast implant removal is the gold standard for all explants, even saline implants.  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.  
Usually removing them and performing the lift at the same time makes the most sense as some patients clearly need a lift and only want to go through one surgery.  If you are borderline, 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.

Dear surgeryregretgirl,
based on your info, it is a good option to remove implants and capsules. IT is hard to predict how will they look after removal of implants. But you have option to remove them and wait to see the final shape of your breasts and decide whether you want breast lift or other procedure such as fat transfer in order to improve your results. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

The removal with an enbloc capsulectomy can be performed and that is the easy part.  To tell you if you need a lift or simply reduce the areola again is difficult to say without an exam.  You may benefit from a lift, perhaps a full lift with fat transfer to the upper pole of the breast to help replace some of the upper pole volume that will be lost with the implant removal.I would recommend you see a board certified plastic surgeon to discuss your options.Hope that helps.

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, removal and capsulectomy may be done in concert with a lift. However, having had multiple lifts in the past, staging may be an option (considering concerns for bloodflow to the areola has been altered repeatedly).
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
RealSelf Verified Member
RealSelf Top 100
RealSelf Hall of Fame

Thank you for sharing your question and photographs.  Based on your narrative I would expect you to need a more formal lift at the time of capsulectomy.  This will minimize the risk of aesthetic complications from explant alone while also help to resize your nipple and areola to more symmetrical sizes.  Hope this helps.

Whether or not you want to do a lift with your explant depends completely on your goals. With explant alone, you can likely expect the areolas will shrink (because they are no longer being stretched out by the implant), so any asymmetry that you see now will become less obvious. Your nipple position is only slightly low, and you do appear to only have a minor excess of skin, so a lift would be completely up to you at this point. A benelli would not give you a very dramatic result. If you are unsure if you want an anchor pattern scar, which is much more visible, I would advise just having the explant at this point - you can always then consider your options at a later time. 

Your surgeon who has examined you will be the best one to see if a lift could be performed at the same time as the removal. Sometimes, the lift has to be done later to ensure proper circulation to the areolae.

Based on these limited information in your pictures, I believe that you would be better off getting the breast lift procedure at the time of the capsulectomy and explant.  Work with your surgeon To evaluate the risks associated with a third lift procedure.  Best wishes. Wirth Plastic Surgery

Total capsulectomies on both sides with implant removal without replacement is a good idea. You will also need a complete mastopexy on both sides for the best shape. The previous peri-areola mastopexy will probably have no effect on blood supply to the nipples, but it would be a good idea to review the operative report from your previous surgeries to be sure. You do not give details of the mass in the right breast. This will need to be evaluated.
This is a very common procedure in my practice. Please look for a Board Certified Plastic Surgeon who is very experienced in this procedure.