Implants 2.5 years ago. Would like them removed. Would I need a lift? (Photos)

Question

I have had issues with my left breast since 2 weeks after getting them. I had follow up appointments for discomfort in left breast, felt like implant was flopping when I bent over. I've had mastitis in the left breast. My health has gone down hill since having surgery. Severe fatigue, depression, coughing, feelings of chest pain & burning sensation. Trouble with inflammation systematically. Am I crazy? Can these implants cause these symptoms?

Gary M. Horndeski, MD · Answer

Your breasts are too low on the chest wall.  After removing the implants, you will have excess hanging skin, empty appearance and you will need a lift.  The technique I recommend is explantation and lift using The Bellesoma Method.  The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained, if not injured during your previous surgery.  Later, fat transfers can be performed if additional volume is desired.  Best Wishes,Gary Horndeski, M.D.

Donovan Rosas, MD · Answer

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, issues related to BII and associated symptoms are difficult to predict. While there are no studies linking silicone implants to the phenomenon of BII, many seek explant as a solution to these problems. Some patients do feel better, others do not.
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
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Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  It is difficult without being able to feel how large your implant is whether or not a lift will be required to give the best shape.  If you don’t mind a slightly lower nipple position then removal alone should afford you a good result.  Hope this helps.

Kenneth Hughes, MD · Answer

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.

Daniel Barrett, MD · Answer

Dear Newboobs48,
it is hard to predict how will your breasts look after removal of implants. You have an option to remove implants and wait to see the shape of your breasts once you are fully healed. If they remain saggy, then you can get breast lift to improve their shape. 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

Tracy Kayan, MD · Answer

I am sorry to hear about your complications after you had your implants placed. While you do have some extra skin which will likely exacerbate with the removal of your implants, whether or not you want a lift now depends on how happy you were with your breast position before you had your implants placed. If back then prior to your implants, the thought crossed your mind to have a lift, then now is a good time so you would only need 1 recovery from surgery rather than doing lift surgery at a later time.

Garrett A. Wirth, MD, MS, FACS · Answer

The size of the implant, any capsular contracture issue, skin changes since the implants had been placed, etc. are all part of a list of factors that will need to be considered in order to fully answer your question as to whether or not you would benefit from a mastopexy (breast lift) after implant removal.  It is best that you start getting as many answers as possible with a few consultations with a Board Certified Plastic Surgeon on your way to making a final decision.  Best wishes. WirthPlasticSurgery.com

Daniel Zeichner, MD · Answer

Hi and welcome to our forum!Breast implant illness is a controversial topic as there are no proven studies to demonstrate the association between the implant and illness and yet there are a small number of individuals who have developed symptoms similar to yours who experience improvement following implant removal. Idiosyncratic implant hypersensitivity is a diagnosis of exclusion after every other known cause has been ruled out. The need for a lift depends upon the size of the implant, its duration of implantation, and your skin quality. If with stretch marks, it would suggest that the dermal elastic fibers have ruptured due to overstretching, limiting the skin's ability to remodel and contract after explantation. An in-person evaluation is required to determine the need for a lift.Best wishes...

Camille Cash, MD · Answer

There are many factors that go into determining how your breasts will appear after implant removal.  Some are the size of the implant, the length of time they've been in place, and elasticity of the skin.  I encourage you to visit with a board certified plastic surgeon near you for a consultation.  After an examination and discussion your surgeon will better be able to give an opinion on what you might expect in terms of results after explant.

Connie Hiers, MD, FACS · Answer

If you have had mastitis in your left breast, you may still have some low grade residual infection, and your implant might need to be removed and later replaced. Your surgeon can discuss this with you.

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