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Implant removal without lift

Q:

23 years ago had McGhan implants. Size B & saggy. Had 320cc implanted. Contracture grade 3 & 4. Weighed 120 now weigh 145. Breasts went from C to DD. Would like to be full C or small D. Surgeons will not remove them without a lift. Wanted them exchanged because I am not concerned about saggy breasts. Would consider removing them but I am concerned about psychological problems. One surgeon suggested having them lifted and removed , leaving me with a B cup. I don't like that idea.

A:

Please keep in mind that no one can give you specific advice without personally seeing you, but here are a few general points: If a lift is needed in order to get the shape right, then it is worth doing whether or not the implants are replaced. Otherwise you are asking a surgeon to do an operation that will produce an unsatisfactory result. Cup size is also very difficult to predict because it isn't just a volume measurement.

Richard A. Baxter, M.D.
Mountlake Terrace, WA

A:

You sound to have old breast implants (not mentioned silicone or saline) with capsular contracture, and breast ptosis (saggy), probably a double bubble effect.

Very old implants tend to have a thick capsule, and may be a calcified capsule, so you need a capsulectomy.

To exchange the implants with saggy breasts,  you will continue to have a saggy breasts after revision which is not cosmetically appealing, and not the optimal results. That is why some of your surgeons are saying you need a  lift to get the best results possible.

I am concerned when you say no explant because of concern about psychological problems. Then a sub optimal result with saggy breasts may also cause psychological problems. If you do not like the results then you will need another surgery, with all the added risks of surgery, expense, and recovery time needed. Your surgeons are being responsible and show care for your physical and psychological care.

The question you pose is: do we do the surgery the patients ask for regardless of the quality of outcomes, or we should do the surgery that is appropriate to the particular patient to achieve the best results we can  give and achieve?

 

A:

 

 It it a bit safer to just remove the implants and have a breast lift. Issues like capsular contracture, ball in sack, infection, etc. could be a bit more common in just removing/ replacing the implants. 

 Remember the two components of the appealing breast: The size of the breast in relation to your body size & The position of the nipple. A large breast with a nipple pointing down at the ground is usually not as appealing as a breast with the nipple in a youthful position. 

 The removal of the implants and breast lift should place the nipple in the correct more youthful position. Latter you can have a breast augmentation if you are not satisfied with the size. Yes, many patients like to get everything done at once but, this not always the safest path. Best,

 

 

Gary R Culbertson, MD, FACS

A:

There is no point in exchanging your implant to a smaller size. If you want to be smaller breasted, you should remove your implant. Implants are chosen to fill an individual's breast dimension. You need to provide a certain diameter of implant to allow appreciable fullness at the periphery of a breast mound. Think of roughly 200 cc as a cup size. Downsizing your implant to say 100-150 cc will not provide you any shape, and the smaller diameter implant will fall to the outer aspect of your pocket. Think of this like a golf ball floating around in your pre-exisiting pocket dimensions. In removing your implant, expect more apparent sagginess to your breast, especially once your contracture is released and your capsule is removed. To re-contour your breast, a breast lift is usually the best option. I would not necessarily expect a 'B' cup after explantation. If you are a DD, and simply the 320 cc implant is removed, you may have a considerable amount of overlying breast tissue to maintain a full cup breast. 23 years have passed, and your body changes. Certainly, this can all be estimated at the time of your surgical consultation.

 

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