The decision to remove breast implants, known as explantation, often leads to questions about the appearance of the breasts. The breast tissue and skin have been significantly altered over time. The outcome is highly variable and depends on surgical factors and individual biological responses. Setting realistic expectations is important, as the final look will be unique to each person and generally will not be an exact replica of the pre-augmentation appearance.
Defining Post-Explant Appearance
It is unrealistic to expect the breasts to revert to their pre-implant appearance following explantation. The presence of an implant, particularly a large one, stretches the skin and soft tissue envelope to accommodate the increased volume. Once the implant is removed, this stretched envelope and displaced tissue may not fully retract to the new, smaller volume. Initially, the breasts may appear deflated, flattened, or even somewhat “pancake-like” due to the implant volume loss.
The body’s natural healing process involves a period of settling, often referred to by surgeons as “fluffing,” where the remaining breast tissue softens and redistributes within the skin envelope. This settling can take six to nine months, as the tissues adjust to being implant-free. However, the skin’s ability to contract and conform to the new contour is limited by its inherent elasticity, which is a primary determinant of the ultimate shape.
Factors Determining Final Contour
The final breast contour after explantation is influenced by several variables. Primary among these is the size of the removed implant; larger implants cause more stretching of the skin and underlying tissues, leading to a greater likelihood of excess skin. The duration the implants were in place also matters, as a longer presence allows for more sustained stretching and displacement of the natural tissue.
Skin quality and elasticity play a significant role in how well the breast tissue reshapes. Genetic factors, age, smoking history, and weight fluctuations all impact the skin’s resilience and its capacity to contract after the volume is gone. Patients with excellent skin elasticity, often younger individuals, may experience better retraction. The amount of natural breast tissue present before the augmentation procedure also affects the final result, as more remaining tissue provides a better foundation for volume and shape post-explantation.
Specific Post-Removal Changes: Ptosis and Volume Loss
The two primary aesthetic changes observed after explantation are ptosis and volume loss. Ptosis occurs when the nipple-areola complex and the breast tissue fall below the inframammary fold. This happens because the skin envelope has been over-stretched by the implant and cannot support the remaining tissue mass adequately.
Volume loss is a consequence of the implant displacing the natural breast tissue over time, causing tissue atrophy or thinning. When the implant is removed, the remaining tissue volume may be insufficient to fill the now-redundant skin, resulting in an empty upper pole or a deflated appearance. In cases with significant skin laxity and minimal remaining volume, the resulting shape can be described as a “rock in a sock,” where the tissue falls to the bottom of the stretched skin envelope.
Options for Restoring Breast Shape
When the post-explant appearance is unsatisfactory due to sagging or volume issues, surgical options are available to restore contour. The most common procedure to address skin redundancy and ptosis is a mastopexy, or breast lift. Mastopexy involves removing excess skin, tightening the skin envelope, and repositioning the nipple-areola complex to a higher, more youthful location.
Fat grafting is another option used to address localized volume loss, particularly in the upper portion of the breast. This technique harvests fat from another area of the body using liposuction and injects it into the breast. Fat grafting helps to smooth contours, fill in depressions, and provide a subtle increase in volume. These corrective procedures can be performed either simultaneously with the explantation or as a staged procedure later, depending on the patient’s anatomy and aesthetic goals.