Need to Stage Explant, Lift, and Breast Implant Replacement?

My lift with aug was only 4 yrs ago. I believe he put in 300 cc implants & they are above the muscle. Although I had tremendous scarring, they were perky, full & a beautiful 38DD!! Happy girl! Within 18 months...gravity! Now I've lost 10 lbs & am a 36C. They look like empty sacks with buckling skin!! Completely visible in tops. One surgeon said I needed to have 2 surgeries. 1)remove the implant, wait for the muscle to reattach, then 2) another lift (UNDER THE MUSCLE) with bigger aug. 6 wks later!!! Really?! I have b4/ after pics

Doctor Answers 8

Implant exchange and lift

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Photos would be helpful, but if you have really loose skin envelopes this certainly would impact the surgery. However, I often do the two together.

New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Need to Stage Explant, Lift, and Breast Implant Replacement?

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I would be reluctant to avoid any further enlargement to the implants becasue this will increase the proclivity for recurrent swelling.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Staging and revision after breast augmentation

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From what you are describing, it seems there are two issues to address. One is the visibility of the implant due to thinning of the skin and the sub glandular location. The other is the loosening and sagging of the skin.

I agree with removing the implant first and let the breast reattach to the muscle. Also you must wait about 3 months for the swelling to resolve. Then you can try different implant sizes and see what fits your body. There is NO WAY to predict what size implant will please you if you already have implants. The worst thing you can do is pick an implant size and then be unhappy with it.

I also agree with placing the implants under the muscle, for two reasons. First, there is more "padding" over the implant and the chance of implant visibility (especially on top as you have described) will be much less. Second, with one out of seven women developing breast cancer in their life time, placing the implant under the muscle makes a lot of sense from a mammography stand-point.

If you now have very thin skin, you may consider silicone implants as the feel is much more natural than saline, especially in patients with thin skin.

Good Luck.

Michael A. Jazayeri, MD
Santa Ana Plastic Surgeon

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Exchange of Breast Implants

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I agree that this surgery could be done staged but it can also be done in one setting. The reason that your surgeon wants to do it staged is because currently there is the subglandular pocket. When the muscle is cut along its inferior border the subpectoral pocket is developed. The problem is that the breast tissue is not attached to the muscle and when the implant is placed it can flip out from the subpectoral pocket to the subglandular.

To prevent this I will close off as much of the subglandular pocket as I can with stitches. In addition I put stitches from the muscle to the skin to help prevent this problem.

So it can be done in one setting but it is more time consuming and more difficult.

Single or multiple staged breast augmentation lift revision

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In most instances, a single staged procedure can be done.  There are some circumstances where two stages are better but these are rare and pretty specific. Without examining you I can't advise you more.  Don't try to fix this with going bigger however.  

Common problem

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"Bottoming out" is common if the skin alone is the support for the implant. I would seriously consider some kind of acellular matrix sling to hold up the implant and keep it from "bottoming out again" or a smaller implant and layered closure with long acting sutures.

Edward S. Gronka, MD
Fayetteville Plastic Surgeon
4.7 out of 5 stars 13 reviews

Revision breast augmentation and breast lift can be done in one stage.

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Of course, I have not examined you. In Manhattan, we have had two patients who had such a difficult problem that we treated them in two stages. But for most women, revision breast lift with breast implants can be done safely in one operation.

Don't go too big with the implants, and I am not sure they need to go under the muscle.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Repeat breast augmentation with a combined breast lift: One stage or two stages

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 There are multiple ways to correct the problem you're experiencing, but your surgeon's plan sounds reasonable and conservative.  The reason to do this in 2 procedures is to protect the blood supply to the nipple, which may be at risk if you try to do it all in one procedure.  Depending on your anatomy, it is possible that it could be done in one operation, but in my opinion the safest plan is the one your surgeon has given you.

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 155 reviews

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