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Have you considered removing your breast implants? If so, you aren’t alone. I see many patients in my Seattle-based Plastic Surgery practice trying to figure out if their breast implants still work with their lives and their bodies. And it makes sense. Many of the decisions we made for ourselves years ago don’t necessarily fit who or where we are today. If this is the case, then you have probably thought about the bigger question at hand– what will your breasts look like without implants and does that look also fit where you are today. The truth is, even as a Board-Certified Plastic Surgeon, I do not have a magic ball that can show you the answer. I do, however, have a few key factors that can help me to predict how the loss of implant volume will affect the appearance of your breasts, and if I think combining implant removal with procedures such as a breast lift or fat grafting is something we should also consider.
SIZE MATTERS
The first consideration is size— what size your breasts were before you had your implants placed and how big your implants currently are. Let’s tackle the importance of each of these individually. How much breast tissue you had before your implants were placed will help me to gain a sense of what your baseline breast proportions are. This not only can help me to predict how much breast tissue will be present upon implant removal, but it can also help me gain a sense of what a patient is willing to accept in terms of size. For example, I find that women who were relatively flat-chested before implants are much more likely to accept being flat after the implants are removed simply because they have spent a large part of their lives living as such. Now, it is important to mention that in the case of longstanding implants, a woman’s breast composition may change drastically over the course of her life due to the changes of pregnancy, breast feeding, weight fluctuations, perimenopause/menopause, or just normal aging. In these instances, how much tissue was present before breast augmentation will have much less bearing on predicting post-explantation volume.
The size of your current implants is also an important factor in determining how much change to your native breast tissue and, more importantly, the skin has taken place as a direct result of your breast augmentation. I like to think about this in terms of two factors– tissue stretch and tissue strain over time. In its most simple terms, the bigger the implant, the bigger the stretch on the tissue. During the initial augmentation, the skin was forced to immediately stretch and expand in order to fit the implant. In the weeks and months after implant placement, the skin will actually remodel itself secondary to the strain, changing the orientation of tissue components and permanently altering the skin and soft tissue. These chronic tissue changes over time make it less likely that the skin will recoil (or tighten) back to its original shape when the implant is removed, making it a higher likelihood that some type of skin tightening (i.e. a breast lift) will be needed after implant removal.
TIMING MATTERS
How long a breast implant has been in place is directly related to how long the implant has had to exert its forces on the skin around it. The longer the duration for changes in the surrounding tissue (epidermis, dermis and subcutaneous tissue), the less likely the tissue is to bounce back, recoil, and tighten after the implant has been removed. Smaller implants cause less tissue strain over time, so I expect less drastic changes to the tissue than is the case with larger breast implants. In addition, the longer the implants have been in place, the more likely that significant life events that may alter the breast tissue–pregnancy, breastfeeding or menopause– have also been a part of the implant’s journey.
TISSUE QUALITY
Many women considering breast implant removal have had their implants in place through many life events that have caused changes to the breasts– babies, breast feeding, weight fluctuations, menopause/perimenopause. The degree of changes these events can have on a woman’s breasts can vary widely between women. For example, some women’s breasts decrease in size dramatically with breastfeeding while other women note a substantial and permanent increase in cup size after birth and breastfeeding. Despite this, my general rule of thumb is that the more changes occurring to the breasts over time, the less elastic the skin is likely to be. In turn, the less elastic the skin is, the less likely it is to tighten back to its original shape after an implant is removed and the more likely a patient will need a concurrent skin tightening procedure.
PROCEDURES AFTER BREAST IMPLANT REMOVAL
The two most common procedures I perform after removal of breast implants are a breast lift and fat grafting. A breast lift is a common procedure to help reshape the existing breast tissue, elevate the nipple areolar complex, and tighten the now-loose skin of the breast (post implant removal). The tradeoff for a breast lift is scars, but it is often a powerful plastic surgery procedure to help improve the aesthetic appearance of the breasts after breast implant removal. Breast lifts can be challenging and even risky procedures to perform in patients with chronic tissue strain from long-standing and large breast implants, since the breast has been so stretched out over time that the skin and tissue have a less predictable and reliable blood supply. Blood supply is imperative to good surgical healing, so a less-than-par blood supply can predispose a patient to healing issues postoperatively. In addition, the thin skin and tissue remaining after breast implant removal can also make it hard to recreate meaningful breast projection even with a breast lift.
Fat grafting is also a common procedure I perform in conjunction with breast implant removal. Fat grafting is a procedure that transfers fat cells from one area of the body to another. Many patients tend to think of fat grafting like filler— you can just put a big bolus in certain areas and it will maintain its volume. Unlike filler, however, fat cells are actually alive and must survive the harvest, separation and grafting process in order to stick around in the long run. Moreover, each individual fat cell must develop a robust blood supply from the tissue around it in order to survive. During grafting, fat cells must be strategically interwoven throughout the tissue so they can achieve maximal surface area contact with the host tissue (or in this case breast tissue). What is the net effect of this information for patients? Well, the bottom line is that we simply cannot remove your breast implant and dump a whole bunch of fat in its place. Fat grafting can thicken up the remaining skin and tissue of the breast after implant removal, but it will never be a 1:1 volume replacement for a breast implant, period.
CONCLUSIONS
At the end of the day, there is no crystal ball to predict exactly how a breast will look after implant removal. The considerations spelled out above – implant size, duration of augmentation, tissue quality, amount of current breast tissue– are informational pieces that, as a Plastic Surgeon, I can synthesize in order to devise the most appropriate surgical plan and best set expectations for my patients. If you are thinking of having your breast implants removed, the first step is setting up a consultation to assess your individualized anatomy, implant integrity, tissue quality and aesthetic goals.
Dr. Megan Dreveskracht is a Female Plastic Surgeon in Seattle, Washington who specializes in Aesthetic Surgeries of the Breast, Body & Face. To schedule your consultation, call 206.860.5582 or fill out a contact form here.
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