Updated: Sep 22, 2020
Written by Board Certified Plastic Surgeon Nima Naghshineh, MD, FACS on July 8th, 2020.
Many of the women that come to me asking for removal of their implants are often motivated by health concerns or alleviating pain and discomfort. These are the number one concerns on their minds, however, most are also aware that removing implants can have a dramatic effect on the appearance of their breasts. When faced with severe pain or systemic symptoms, aesthetic appearances are often secondary however do not need to be ignored altogether.
So, how do you safely address aesthetic issues after removal of breast implants?
Well, it comes down to two factors:
Volume Restoration and Removing Excess Skin
I must first start by saying the simplest way to address your breasts after implant removal and En-bloc total capsulotomy is to do nothing. For some women, that maybe the best option and it truly rests on your preference. However, much like my mastectomy patients, many women after implant removal would like to avoid breast or chest wall deformity and would ideally like to have some restoration of their breast volume and shape.
Removing your implants means removing volume and decreasing size. Some women will have a fair amount of their own breast tissue, and removing implants simply means becoming smaller and perhaps a little deflated. Yet in very thin women and in women who have very little breast tissue, removing implants could mean being flat or potentially indented. That is because breast implants over time can leave an indentation in your rib cage. Breast implants can also atrophy or thin out the existing breast tissue, which becomes more obvious after implant removal.
As expected, most explant patients would not choose to restore their volume with another implant or foreign material that their body could react to. Fortunately, your body already has the best material for restoring volume to your breasts. Your FAT. Using your own fat, you can restore a significant amount of volume in just one procedure at the time of explant. In order to collect the fat, liposuction is performed from an area of your body where you would like some fat removed. The fat is purified (excess fluid is removed) and transferred to the breasts without additional incisions or scars. This fat will now live on in your breasts and will grow and shrink just like fat would anywhere else in your body. Typically, 60 to 80% of the fat volume transferred to your breasts will survive permanently. This is by far the best method of restoring volume without an implant. Of course, there are some details and considerations about fat grafting that can vary from patient to patient that should be discussed with your reconstructive surgeon.
Removing Excess Skin
The weight and size of implants will often stretch breast skin. Even with volume restored to your breasts using your own fat, most women tend to go smaller than their original size with implants. This will lead to extra skin and droopiness of breasts. For a minority of women, the breast skin will contract sufficiently after implant removal. This is especially likely in younger woman with healthy skin and a significant amount of breast tissue of their own. But for many women whose implants account for a vast majority of their breast volume, removal often means extra skin. The general rule is that the larger the breast implants, and the less there is native breast tissue, the greater the deformity or sagginess after removal. Fortunately, there are techniques adapted from breast reconstruction and breast lift procedures that can be used to address this problem. Which technique is best for you will depend on how much breast tissue you have and how much extra skin there will be after removal of the implants and each individual scenario should be discussed with a plastic surgeon, preferably one with breast reconstruction expertise.
Ultimately, it is usually the combination of restoring the volume with your own fat and implementing breast lift techniques that will avoid disfigurement after explantation and give you the best possible aesthetic result.