Breast implant removal via areola incision and periareolar lift at the same time? (Photo)

Good afternoon!
My approach in almost all cases is the following:
1) en bloc capsulectomy/explant
2) drain for five days
3) tight compression bra for 12 weeks
With this approach I almost never have to go back and perform a lift because the skin has such an amazing ability to "shrink back down" to your preop size and shape.

As you have such a significant asymmetry I would advise explantation followed by 6-12 months of waiting, and then mastopexy/mastopexies as needed. Certainly the 2 could be done at the same time, which we’ve all done many times, but from experience I’d say there is a relatively high chance of need for revision in that scenario. Best of luck to you. 

Dear Optimistic981,
my preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thats being brought together to support the breast and hence improves longevity. 
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

The technique I recommend is explantation 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 and the ability to breast feed are maintained, if not injured during your previous surgery.  At the same time or later, fat transfers can be performed if additional volume is desired.Best Wishes,Gary Horndeski, M.D.

The lift you describe is helpful when only a minimal lift is needed. As you have had your implants for 18 years a donut lift may not be powerful enough to get you the shape you want.  See a board certified plastic surgeon in your area for a consultation.  Together you can create a surgical plan that's best for you.

Thank you for the question.  
 
Generally speaking, what your breasts will look like after explantation depends on several factors such as: the quality of skin elasticity (the better the elasticity the better the skin will bounce back), the size of the implants used (the larger the implant the more trouble you may have with redundant skin), and the amount of breast tissue present at this time (which may have changed since the time of your breast augmentation).
Life experience since your breast augmentation procedure, such as pregnancy or weight gain weight loss, will potentially influence the factors discussed above. If you take these factors into consideration and apply them to your specific circumstances you may get a good idea of what to expect after the implants are removed.
 Patience is definitely indicated after removal of breast implants; it will take many months/year for the skin to “bounce back” and for you to see the final appearance of the breasts.In "borderline" cases where there is doubt whether breast lifting is necessary or not, I advise patients to undergo explantation only and to give their breasts the benefit of the doubt  before deciding whether breast lifting would be beneficial.  In your case specifically, I doubt that a circumareolar breast lift would be sufficient or powerful enough when it comes to achieving enough of a breast lift to improve your outcome, in terms of overall breast positioning and/or symmetry.
I hope this helps. Best wishes.

Thank you for your question as well as the photos. Circumareolar lifts are very popular, especially for a patient who has minimal skin laxity. It's rare that I perform a circumareolar lift without an implant, and typically if I'm removing an implant, a patient is either deciding they are ok with the laxity of the skin when the implant is removed, or they're moving forward with a full Anchor Scar incision lift to put the breast "back where they are suppose to be". There is breast and nipple asymmetry in your situation so removal of implants and a circumareolar lift will not give you a good cosmetic result. I understand a minimal scar is everyone's goal but if the scar is worth the result, you just need to decide whether or not it's worth it for you. I would recommend visiting a Board Certified Plastic Surgeon. If you're not comfortable moving forward with an anchor scar, you can always have the implants removed, see what your results are with no implants, and make a decision on the lift from there. Good luck and best wishes!

I think you will have significant enough breast ptosis or sagginess after removal of your implants that you will need more lift than what the peri- areolar lift can give you.  It just does not remove enough loose skin or raise the nipple/ areola enough to reshape the breast adequately (especially when it's done after removal of implants without replacement).  I feel the vertical/ lollipop lift will give you a much better breast shape.  While it does involve the vertical scar that you really can't hide discreetly, it's a much more powerful lift that usually gives you a much more perky shape than the peri- areolar lift.  You also have significant asymmetry in your breast sagginess and shape.  The peri- areolar lift is just not able to address these issues adequately.  Best wishes.

It is impossible to say what your residual breast volume is without
1) knowing your size of implants
2) examining to determine residual volume of breast 
These factors are very important.  This will give your surgeon an idea of how much volume is left to work with. 

Small volume and large skin envelopes really need a big removal of skin and I prefer a wise pattern lift.  If your surgeon removes the implants and you still have residual shape and volume, you may get away with a peri-areolar mastopexy.  This scenario is unlikely.  

Your surgeon may need to make this decision on table.
Good luck

I do a fair number of periareolar lifts for patients but it is a very poor choice unless accompanied by implants, so definitely not a good idea for you. I encourage patients to avoid a lift until at least 6 weeks after explant. At least 1/2 of my patients decide at that point that a lift is unnecessary thus saving thousands of dollars and the scars of a lift.