After breast implants are removed, the skin envelope of the breast becomes too large for the quantity of tissue within, causing the breasts to hang and lose their shape, often leading to ugly folds. And when folds form after explantation, they can be very difficult or impossible to correct. In order to minimize the ugly folds and create the best breast shape possible, removal of excess skin is performed in what Plastic Surgeons refer to as a breast lift. While the removal of prostheses and capsulectomy are sometimes covered by the government, breast lifts are never covered.
Not ALL patients require a lift at the time of explantation, particularly younger patients with significant breast tissue and smaller implants. But these patients are a minority. For the majority of patients, Doctor Nicolaidis and leading American explant surgeons perform breast lifts at the time of explantation for the reasons mentioned above. Dr. Nicolaidis performs 2 different kinds of lifts, depending on a number of factors, notably the degree to which the breasts sag and the breast volume. In addition, there are several manoeuvres to consider for patients lacking in breast volume. The choice of lift and these manoeuvres will be discussed at the time of consultation. Many Plastic Surgeons are hesitant to perform lifts at the time of explant for fear of nipple necrosis (death of the nipples). And rightfully so. It took an entire year before Dr. Nicolaidis felt confident enough to do a complete lift without risking nipple necrosis. He now does these surgeries routinely with minimal complications (see below).
It is important that patients have realistic expectations after explantation. The priority is to remove the implant with its entire capsule. The bigger the implant and the thinner the patient’s skin and tissues, the more the skin will tend to fold after explantation. Breast lifts after explantation are designed to minimize the folding and give a reasonable shape to the breasts. Dr. Nicolaidis is NOT a magician. Patients with minimal tissue before breast augmentation will finish with minimal tissue after explantation. Nevertheless, Dr. Nicolaidis regularly hears from his patients that they find their breasts nicer after explantation than they were before augmentation. And rest assured, there are other options that can be offered later on if patients are not satisfied with their breasts, the main option being transfer of fat to the breasts. Dr. Nicolaidis RARELY transfers fat at the time of explant because of the significant risk of complications. Rather, he performs fat transfer as a secondary procedure (usually 4 to 6 months later) in order to retouch irregularities that often develop after explantation. Like all interventions, fat transfer is not without risks. Dr. Nicolaidis will discuss these risks at the time of consultation.
Dr. Nicolaidis was the first Plastic Surgeon to report on the appearance of the breasts following explantation in a prospective study of his first 182 explant cases for Breast Implant Illness (The ASPS Meeting 2020). 52% of patients were very satisfied with the appearance of their breasts, 33% were satisfied and 15% were not satisfied. However, NO patients regretted having the surgery, given their symptom improvement.
* Does not constitute a guarantee of results