Implant removal and fat transfer done separately? Why?

Question

I recently reached out to the doctor, who did my original breast augmentation and lift because I am ready to have my implants removed. I requested an implant removal with a fat transfer, he’s recommending that I do an implant removal with a lift first, and if I’m happy with that then no fat transfer but if I am not then he’s wantin to do a second surgery that would be a fat transfer. Why 2 surgeries, when I see folks on here get it don’t all at once.

Alan Gonzalez, MD, FACS · Answer

Hello @KAMSeattle, thank you for your question. Everything depends on the surgical technique of the specialist performing surgery. Remember that any kind of explant must be complete, that is, the surgeon must remove the whole capsule out. Complete capsulectomy. Also it would be necessary to carry out a preventive biopsy on each capsule. In any case, I do not perform breast fat transfer during a breast implant removal procedure because for me, the breast explant must be performed with a breast reconstruction in which the mammary tissue is placed adequately in place again. If the fat seeding is done at the same time, it might get infected or die; there is no guarantee that the seeding will stick. If you are considering a breast explantation, consultation with a plastic surgeon who is experienced in this procedure is essential to ensure optimal results. Best wishes! Alan Gonzalez MD, FACS.

Raffy Karamanoukian, MD, FACS · Answer

Removal of breast implants, intact or ruptured, may have positive implications if patients are symptomatic. A constellation of symptoms associated with breast implant illness, and autoimmune disease are considered when treating patients who have breast implants and are concerned about foreign body reaction. In our office, we begin this journey with a consideration of symptoms and exclusion of obvious autoimmune problems. In many of our patients, en bloc removal of breast implants with capsulectomy is important and beneficial. Further clinical evidence about breast implant illness is evolving and will continue to guide treatment. I would suggest removal if there is a possibility of foreign body reaction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Shaher W. Khan, MD · Answer

Fat transfer is not recommended at all. At least 30-50% of the fat will inevitably die, and clumps of that fat may remain. This will certainly lead to change/loss of sensation, along with self monthly breast exam that may pick up on these hard masses that may result in unnecessary images, biopsies, and worry to rule out breast cancer. Your explantation surgery must completely remove not only the implant, but the capsule and all inflamed tissue which will take approximately four hours. This does not include time for lift, which should take at least two-four hours to complete depending on your exam.

Daniel Barrett, MD · Answer

Dear KAMSeattle,
I understand your concern. 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

Gary M. Horndeski, MD · Answer

Implant removal as well as a lift can sometimes cause a decrease of circulation to the breast tissue, particularly the nipple. If fat transfers are done at the same time, it may injury the blood supply and cause complications with the nipple. I have done both ways and recommend doing it in 2 surgeries.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Camille Cash, MD · Answer

These two procedures can often be performed at the same time.  It is important to understand the benefits and risks associated with fat transfer to the breast.  Microcalcifications can form as a result of fat transfer to the breast.  These can sometimes interfere with imaging when screening for cancer.  You may want to consider smaller implants as an alternative.

Connie Hiers, MD, FACS · Answer

If you have a small amount of breast tissue and need a lift, the fat needs to be done at a separate time. Otherwise, there is more risk to the fat dying with the lift being done at the same time. I usually always do the removal and lift first, and then come back later for the fat. Many times, patients are happy with just the removal and lift.

Eric Maiorino, MD · Answer

I can understand your frustration and hopefully this will help better explain the surgeon's thinking. When doing a mastopexy or breast lift, the breast tissue needs to be cut and rearranged into a more tightly packaged and lifted position on the chest wall. Because of the rearrangement of the breast tissue, the blood supply to certain parts of the breast and skin are changed and need time to enlarge and increase. By waiting on fat transfer for the second stage it should allow for better overall take/incorporation of the transferred fat. Also, many patients can be happy with their new size/shape after a lift is performed, saving them from a secondary procedure. Not every surgeon does it this way but there are many who do. Hope this helps.

James Hoyt, MD (retired) · Answer

Breast implant removal and fat transfer are often performed separately for several reasons:1. Safety: Separating the procedures reduces the risk of complications, such as infection or tissue damage, that can occur when multiple surgical interventions are done at once.2. Healing and Recovery: Performing the procedures separately allows for better healing and recovery between surgeries. This can result in a more comfortable and successful outcome for the patient.3. Control and Precision: Separating the surgeries allows the surgeon to focus on each procedure with more precision and control. This can lead to better results in terms of fat graft survival and contouring.4. Patient Preferences: Some patients may prefer to have a staged approach to their breast enhancement, giving them time to assess their results after implant removal before deciding on fat transfer.Overall, the decision to perform breast implant removal and fat transfer separately is often made to optimize safety, outcomes, and patient satisfaction. Patients should consult with their plastic surgeon to determine the best approach for their specific goals and circumstances.

Implant removal and fat transfer done separately? Why?

Answers (9)

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