Breast Implant Removal and Hypertrophic Scar revision - what to consider?

Question

Hello - I had an anchor style breast lift and 350cc(L) 335(R) moderate projection Sientra breast implants placed in late April 2024. Unfortunately the surgery left me with hypertrophic scars. Despite being two years out, the scars on my R look like the surgery could have been yesterday, its also still very itchy, including around my areola, it looks so bad. Emotionally, I feel like Frankenstein's monster. Plus the implants look boxy and I am wildly physically uncomfortable. I have had one consultation for the removal and scar revision, and we also discussed options for requiring an additional lift, as well as fat transfer. Given my current status, I'm worried about doing too much. My question is given how my initial lift is relatively new (presurgery my ptosis was grade III) would I need an additional lift after taking the implants out? What would be the pros/cons of doing just the removal/scar revision, wait 6 months and see if I want to proceed with the fat transfer. Is the recommendation of the lift at the time of the removal necessary? (PS yes I've done everything for the hypertrophic scars, including the 5-FU injections by the original surgeon, I am not going back to him). Thanks in advance.

Frank Agullo, MD · Answer

Please stage this. You had grade III ptosis prior to your primary lift, so even modest 335/350 cc implants stretched your lower pole, and once they come out the gland will droop again, more aggressively at two years out. Yes, your envelope is going to need more support at some point, but the question is when. Performing an explant, scar revision, another lift and a fat transfer in one operative session puts a significant vascular insult on skin that has already shown you it is prone to hypertrophic scarring. Every new incision adds another scar that could thicken and raise. Given your history, that sounds like too much pressure on too many places to pile on.

Explant, revise the scars under low tension, and let your tissues reveal their ultimate form and position over the next six months. Many patients end up needing a smaller procedure than what gets penciled in pre-explant, because the breast falls differently than photos predict. The pros of combining are one anesthesia and one recovery, real but in your skin that benefit is outweighed by the scar cost and the higher likelihood of issues.

#StayBeautiful,

@RealDrWorldWide

Daniel Barrett, MD · Answer

Dear Cheerful595195,

it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you 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

Waylon Zeng, MD · Answer

Hi there thank you for your question, and I'm sorry you're having to go through all that! My understanding is that:1. you are still having hypertrophic (maybe even keloid) scars2. breast looks boxy3. debating whether you should have implants removed and whether lift would be needed4. considering fat transfer
If the scars are itchy, they may be turning into a keloid. In that case, only injecting 5 FU and/or steroid is the first treatment to consider, but often times, excision of the scar is needed in addition to the injection. This can be done under local anesthesia to reduce the chance of the scar coming back.
Boxy-appearing breasts may be a result of the anchor lift with the implants. An anchor lift will naturally make the breast more boxy as it flattens the lower part of the breast. Fixing a boxy appearing breast is possible, but it typically involves removing a bit more skin to form more of a cone-shaped breast as well as an implant with adequate projection to push against the tissue.
It's very difficult to say what you would benefit from without photos or a consultation, but I think it's also important to consider your goals. Do you want to take the implants out because you don't want larger breasts or because you don't like the overall appearance of the breast? The implants can still serve a good purpose to maintain a good shape. 
Fat transfer can be considered to the breast but results are very mild. It usually requires multiple injections, and you can typically go up 1/2 to 1 cup size. It's also done separate from a lift. Hope that helps!

Camille Cash, MD · Answer

You have several options depending on how much each concern bothers you.  Scar revision would be the most simple option.  The current scar would be excised with the intention that a new scar would heal more favorably since there will be less tension on it.  If you are concerned that your implants are too large, you can elect to remove them all together or exchange them for smaller implants.  The recommendation regarding a revision on your lift would need to be done after an examination.  The option you mentioned of removing the implants and waiting six months to see how you heal is possible.  The only drawback is that you will need to have two separate procedures.  Visit with a few board certified plastic surgeons near you to learn more.

Breast Implant Removal and Hypertrophic Scar revision - what to consider?

Answers (4)

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