Conflicted over lift vs no lift with explant. Is there hope without a lift?

Question

I have an upcoming explant and am conflicted between lift vs no lift. I got implants (dual-plane position) to correct constricted breasts. I had tissue expanders first, for 8 months. My implants are 370cc textured cohesive gel. I am worried about excess sagging skin. Without a lift, is there a chance my breasts might "fluff" over time? Or, given my pre-implant breasts, will I left with excess saggy skin if I don't lift? Is there hope without a lift?

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.
With regards to your specific question, without an in-person exam it is difficult to make a prediction. Much will depend how long they have been in place, how large, and how much you have changed over time.
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
RealSelf Top 100
RealSelf Hall of Fame

Leila Kasrai, MD, FRCSC · Answer

It is difficult to give you an opinion without knowing more details and seeing photos. It is common for the breasts to sag with an explant, however it is not always the case. Please ask your surgeon for their opinion. They are in a better position to provide a response to your question.

Mathew A. Plant, MD, FRCSC · Answer

Without examining you or seeing photos its difficult to give specific advice so you will have to trust the advice of your surgeon who is familiar with your case. Best of luck!

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.  
It is not unreasonable to remove the implants and then observe a waiting period of six months before the determination for breast fat transfer 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. Fat graft take should always be optimized with the best blood supply available.

Results are largely dependent upon the skill of the surgeon, his/her ability to remove fat without creating contour deformities, and your expectations.

Joshua Cooper, MD, FACS · Answer

Without seeing any photos of your breasts currently, it's difficult to say for sure what you might expect after your implants are removed. If you are concerned about the scars from a lift, there isn't much of a downside to simply having the implants removed, and then wait and see what you think of your results a few months down the road. If you do not like the sagginess that you are left with, you could always have a breast lift performed at that time. Thanks for sharing, and best of luck to you!

Farbod Esmailian, MD · Answer

It all really depends on the individual.  I have removed implants without a lift and patients look great afterwards, and some have needed a lift and some lift with fat grafting.  It really depends on the individual and without an exam and/or photos it is really difficult to say.I would recommend either posting some photos here or seeing a board certified plastic surgeon to discuss your surgical options.Hope that helps.

Gary M. Horndeski, MD · Answer

Thank you for your question.Using The Bellesoma Method breast lift, I will need more information from you to answer this question with accuracy. I need to know your age, your breast size before implants, how long you've had implants, nipple sensation, pictures to see significance of ptosis, etc. The Bellesoma uses your own breast tissue to create an inner cone that is supported by your chest muscles to provide elevation and shape. The lift was developed for long term results without needing the vertical scar component. So, your scars are less visible and the lift is perkier and long lasting. You are welcome to visit my gallery on this site to view my results after breast implant removal and The Bellesoma Method lift. You are also welcome to contact me to discuss your case in detail to see if you are a candidate for this procedure. I hope this information helps.Best wishes and kind regards,

Daniel Barrett, MD · Answer

Dear ReadyToExplant,
You always have an option to remove implants and wait to see how will your breasts look after you remove implants. If they remain saggy, you have an option to do breast lift. 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 that's being brought together to support the breast and hence improves longevity. 
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Nelson Castillo, MD · Answer

Thank you for sharing your question. Unfortunately without photographs or an in-person examination it is difficult to offer advice.  Remember you can always perform the explant first and fully heal, allowing your tissues to shrink to their new "normal" before entertaining a lift.  Hope this helps.

Camille Cash, MD · Answer

The longer the implants have been in place the more likely a lift will be needed.  One option is to have the implants removed and allow the breasts to fully heal.  If you are happy with the result then you have avoided the lift.  If you are unhappy you can return for a lift when you are ready.