I'm 37 with 1 child, I can't decide whether to explant with lift or exchange with lift? (photos)

Augmentation was 3 years ago, I think they are beautiful but to big & uncomfortable. Been considering explant with lift over exchange. Will be okay with no upper pole but concerned about being a lot smaller than I was. Will the size difference be very noticeable? I was a mid B cup prior would hope to be somewhat close but not an A. What are the chances I would still feel uncomfortable with a smaller implant would get a full B maybe very small C.

Doctor Answers 6

Explant with or without lift

Youpose a lot of very excellent questions . However the answers can only be  determined by a physical examination. Whether or not you do well with explantation only depends on how much breast tissue you have.  Based on my evaluation of your photos I think the best option for you would be removal of your current implants, replacement with significantly smaller implants and a lift, either Benelli or lollipop . I suspect that just implant removal and lift would leave you with a shape that is not pleasing  Your best option is a consultation with a board-certified plastic surgeon with considerable experience in breast surgery especially breast lifts 


Sacramento Plastic Surgeon
4.9 out of 5 stars 108 reviews

Explant with lift vs Exchange with lift

Great question!  Looking at the photos, it looks as if you have a large implant in place, especially if you started off as a mid-B cup.  Most likely your native breast tissue has attenuated (shrunk and flattened).  If you decide to explant with only a lift, understand that since your native breast tissue is smaller, and the lift requires excision of excess skin, your breast size will be smaller than the mid-B cup you were before.  If you desire to be a full B or a small C, then you will need to undergo an implant exchange with a lift.  If done correctly, patients are very satisfied with this procedure.  With that said, a physical examination in person will allow a more proper recommendation to be given.Best of luck and hope this information helps!- Dr. Roger Tsai

Roger Tsai, MD
Beverly Hills Physician
5.0 out of 5 stars 12 reviews

Lifts are not appropriate in this situation

A lift with an implant is controversial for two reasons.  First, when you perform a lift you are making everything tight and closing the wounds under tension.  It you add the expansive forces of the implant at the same time, you are fighting against yourself.  There are forces on the wound which try to make them separate, which results in wider, thicker, more irregular scars.  In the worst case, the wounds will open.  So compromises are usually made in the operating room by the surgeon because they cannot close the lift wounds over the appropriate sized implant.  Either less of a lift is performed so that the skin is not as tight and therefore there is less tension on the closure.  Or a smaller implant than would be appropriate is used so as to decrease the expansive forces.  Either way, you are compromising the aesthetic outcome.  Often the outcome is so compromised that a second revision surgery is required.  If however, you plan to have the lift first and then the augmentation after everything has healed, then you have two operation that are planned, both with much lower risk than the combined mastopexy/augmenation.  The outcomes of the two meticulously planned operations are much better and a more aesthetically pleasing, and a safer outcome is achieved. The second reason the combination of mastopexy and augmentation is controversial is because of the risk of nipple necrosis (death of the nipple).  By making the skin tight for the lift, you are putting external pressure on the veins that supply the nipple.  By putting an expansive force on the undersurface of the breast with an implant, you are putting pressure on the thin walled veins that supply the nipple.  If the pressure by squeezing the veins between the implant and the skin is greater than the venous pressure in the veins, the flow will stop.  If the venous outflow stops, the arterial inflow is stopped.  If the arterial inflow is stopped, there is no oxygen for the healing wounds and the tissue dies. Placing the implant on top of the muscle in combination with a lift puts the blood supply to the nipple at a much higher risk because in addition to the issue of pressure on the veins, you have to divide the blood vessels that are traveling from the pectoralis muscle directly into the breast (and to the nipple) in order to place the implant between the breast tissue and the muscle. This adds a third element of risk to an already risky operation.  Mastopexy/augmenation with sub glandular implant placement is by far the riskiest way to address your anatomic question.

Downsize vs removal and lift

hi and thank you for the question.  The kind of result you will get depends on the current size of your implants as well as the amount of breast tissue you have. If you have very large implants, then you could theoretically reduce your implant size by half and potential be happier with the result. On the other hand, if you have smaller implants, but a significant amount of breast tissue, a reasonable option can certainly be to remove the implants and do a lift of the tissue that you have. Removal with a lift really only works well when patients have a substantial amount of their own tissue. The only way to determine this is with a  consultation. My suggestion would be to see a few board-certified plastic surgeon's and get some expert opinions. Good luck to you.
Dr West 

Justin West, MD
Newport Beach Plastic Surgeon
5.0 out of 5 stars 25 reviews

Removal with or without a lift

Dear sjoyn,You haven't provided much information (like the size and type of your implant) so take any recommendations with a grain of salt. Hopefully you have access to your pre-op photos before your augmentation to refresh your memory, and that expect you will likely be more stretched out after having the implants. An exam will help to estimate how much is you and how much the tissue is you, and how much is implant. If your implants are pretty big you could also consider a downsize with a lift (optional). 

Stacey Folk, MD
Denver Plastic Surgeon
4.8 out of 5 stars 23 reviews

Explant

You are the only one to know if you will be comfortable without implants or with smaller ones.  I would recommend you have the implants removed and live with that for a while before deciding on smaller implants.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 55 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.