Explant and wait or having fat transfer simultaneously?

Question

I'm interested in having my saline implants removed and having fat transfer to my breasts. Should I have them removed and wait for a few months (3-6 months) before having the fat transfer or should I have them deflated and have fat transfer a few weeks later or have all done simultaneously at the same time? Is there any differences in the results in terms of safety and fat survival rate? Thanks in advance!

Elizabeth Kiwanuka, MD, PhD · Answer

When considering fat transfer to the breasts, especially after explantation (removal of breast implants), the timing of the fat transfer is crucial. Some surgeons prefer to perform fat transfer simultaneously with the explant procedure, as it allows for immediate reshaping and volume addition. However, others recommend waiting after the explant to allow the breast tissues to heal and settle, which can provide a clearer understanding of the final shape and size needed for the fat transfer. The best approach depends on individual circumstances and should be discussed with a qualified plastic surgeon to determine the most suitable plan for your specific needs and desired outcomes.

Chet Mays, MD · Answer

Thank you for your inquiry! An explant and fat transfer can be done simultaneously in the same procedure. I recommend consulting with a board certified plastic surgeon to create a surgical plan targeted towards your specific goals.

Daniel Barrett, MD · Answer

Dear Awesome29471,
both options are doable. Some patients want to avoid two procedures and get it all done at the same time. Fat viability depends a lot of surgeon technique. The fat has to be placed back into the buttocks as soon as possible so that it has a greater chance of survival. It has to be placed carefully so that not too much fat is placed in only one area. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Joshua T Halka, MD · Answer

It is possible to perform fat grafting after implant removal. Sometimes if you are performing a total capsulectomy and the tissue is thin it might not be a good idea though. If it is just a simple implant removal it is ok to perform at the same time but it can be hard to know how the breasts will contract back down after the implant removal and will be hard to predict where to best place the fat to achieve the look you are hoping for. You would likely get a better result if you first had the implants removed, waited roughly 6 months for the breasts to contract and settle after the implant removal, then your surgeon would know exactly where to place the fat to give you the result you are looking for. Again, you can definitely do them at the same time, but you could probably get a better result by performing them at different times.
Hope this helps!

Jeffrey Lisiecki, MD · Answer

Without any photographs or further information, explantation and fat transfer simultaneously is typically the best option.  Your skin is already expanded from the implants, so immediate fat transfer takes advantage of that.  Also, if you explant and then wait to transfer, sometimes the skin and soft tissue scar down which makes it harder to fat transfer and gives a less aesthetically pleasing result after fat transfer.

Wayne I. Yamahata, MD · Answer

Most surgeons would favor staging the procedures, i.e. have the explantation first and follow with the fat transfers 6 months later. Allowing time before the fat transfer will increase the "take" or survival of the fat and working with more mature tissue allows for a more reliable shaping of the breasts.

John L. Burns Jr., MD · Answer

I prefer to do the explant and fat transfer in a single procedure.  When the implants are removed the skin and tissue will scar down making a delayed fat transfer difficult to get a good shape.  If you do it immediately the skin and tissue is already in the shape of an implant/expanded breast and will hold the fat in that shape which is much more aesthetic.

Gerald Minniti, MD, FACS · Answer

Please don't expect fat to look anything like implants, either in size or shape. If you think so, you will be sorely disappointed. If you are removing your implants because you think you have systemic symptoms from breast implants (SSBI, formally BII), I can assure you that there is no medical or pathophysiologic relationship, and breast implants are simply scapegoats. Three ongoing studies can't identify any potential agent that could somehow lead to a syndrome or illness; not 20 various heavy metals, silicone (that's right silicone, which is found in the control groups who never had breast implants), bacteria, bacterial endotoxins, or immune related compounds known as interleukins. To illustrate my point further, why aren't people with other types of implants of identical composition having this problem? Why isn't there testicular implant illness (the first cosmetic device used 20 years before breast implants), cerebral-peritoneal shunt implant illness, anti-foaming agent illness (its in our food), permanent urinary bladder catheter illness, or finger joint implant illness, etc? Same material material, no illness. If that's your reason, than reconsider.

Gary M. Horndeski, MD · Answer

Unfortunately, you have not provided photographs or told us the size of your implants. However, fat transfers is usually not effective for replacing the volume lost by explantation. 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 done. The reason why I recommend waiting on the fat transfers is because more can be done in the 2nd procedure than at the 1st procedure. The reason being is at the 1st procedure it is important at the time of lifting not to injure the blood supply to the nipple and fat transfers could do this, if done simultaneously.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ronald J. Edelson, MD · Answer

You can get fat transfer at the time of e plant. Just don’t expect much to be transferred and expect a second round of fat transfer later

Explant and wait or having fat transfer simultaneously?

Answers (16)

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