Nipple and Areola Caved in After Explant Surgery. Permanent?

Question

I am three weeks post explant. I had silicone implants for 30 years and had them removed due to rupture. I am devastated with the outcome. I am 56 years old and my breasts now look deformed. The nipple and areola are caved in. I have just today stopped wearing the tight sports bra that I was told to wear for two weeks after surgery. Is there any hope that the look of the breast is temporary, the breast is still healing, etc.; or is this pretty much what I can expect to look like from now on?

Richard J. Bruneteau, MD · Answer

It’s
not unusual for patients to experience breast distortion following removal of
ruptured silicone implants, especially when calcified capsular contractures are
present.  Under these circumstances
patients are often emotionally devastated by breast distortion and associated
loss of breast volume.

When this situation arises in the
immediate post-operative period, it can be difficult to know if this distortion
is permanent.  In some cases
swelling resolves and tissue remodels over the course of 3-6 months with
significant improvement in the aesthetic result.  In other cases, the deformity may be permanent and secondary
surgery may be indicated.  This may
include implant replacement, breast lift and possibly fat grafting procedures.

If you’re concerned about the
appearance of your breasts following implant removal, consultation with a board certified plastic surgeon is appropriate.  This surgeon should be able to
formulate an appropriate treatment plan.

Gary Lawton, MD, FACS · Answer

Although 3 weeks after explantation is too early to judge the outcome, it is possible to have some deformity after this type of surgery.  The breasts will settle down over 6 months.

Jed H. Horowitz, MD, FACS · Answer

Good day! Generally, 3 weeks is too soon to see final results as bruising and swelling may persist. Nipple inversion may occur after trauma and can be corrected with a procedure performed in the office under local anesthesia which is commonly performed with breast revision surgery. In severe cases of nipple inversion the breast ducts may need to be severed or devices such as the Niplette by Advent can be used without surgery with some success. It is often used after surgery to create suction and maintain the correction.Do not hesitate to ask your doctor or find a board-certified surgeon that has extensive experience with this procedure. Best of luck! #RealSelf100

Raffy Karamanoukian, MD, FACS · Answer

The initial phase after surgery may be due to swelling. However, there is an absence of tissue after implant removal that can cause the caved in appearance to be permanent. You may consider a breast lift or reimplantation of breast implants.

Camille Cash, MD · Answer

You are still early in your recovery and can expect changes ahead.  Depending on the size of your implants, your skin elasticity, and the length of time the implants were in place a lift may be recommended for you which would address your concern.  I encourage you to speak with your surgeon who is most familiar with the details of your surgery and how you've been progressing through recovery.

Pramit Malhotra, MD · Answer

Breast fat grafting has evolved to be a very powerful technique for difficult cases like yours.You would be an ideal case for BRAVA external tissue expansion followed by breast fat grafting.You may need multiple sessions. The results can be outstanding. Don't give up hope!

Fredrick A. Valauri, MD · Answer

Following breast implant removal, you will have swelling that can cause irregularities of your nipples.  Most of the time this will improve when the swelling resolves after several weeks to months depending on individual variation.

	Some of these irregularities may not improve after the swelling has resolved and may require surgery for improvement.

	See a board certified plastic surgeon to be evaluated and to discuss your treatment options,

James Apesos, MD · Answer

The problem you are describing is usually more common when the nipple approach was used for implant placement. Nevertheless it is too soon to plan any more surgery yet. After discussing the problem with your plastic surgeon you may decide to leave it alone or place a new implant. Another approach, which no one has mentioned yet, is fat transfer to reconstruct the area. Fat transfers to the breast have been controversial but are now being utilized for some problems such as yours. Your doctor can refer you to a doctor who is skilled in fat transfers to fill in deficient areas such as you are describing.

Carmen Kavali, MD · Answer

Your breast shape may or may not improve over time. You are certainly going to do no harm by waiting, massaging, and giving the scars (both internal and external) time to soften and mature. The nipple depression you describe may be partially due to internal scarring which may soften over time, and it may be due partially to lack of support for the nipple complex, which can be fixed by adding a new implant or maybe doing a breast lift. Talk to your surgeon about your goals--I'm sure your surgeon wants you to be happy with your final results.

Pat Pazmino, MD, FACS · Answer

Your breast implants had stretched out the overlying tissue over 30 years. When these implants were removed, a portion of the breast caved in. It is possible that this depression around your areola will be permanent. However, there are options to correct this defect. You may elect to receive another breast implant to fill this volume or a small breast lift may address this issue as well.

Nipple and Areola Caved in After Explant Surgery. Permanent?

Answers (17)