Breast implant explantation is the surgical removal of breast implants, often chosen for medical reasons, aesthetic preference, or a desire to return to a more natural state. The outcome is never a guaranteed return to the pre-augmentation state because the skin and underlying tissues have been stretched to accommodate the implant volume. The final shape and contour are highly individual, depending on factors unique to each patient’s anatomy and surgical history.
The Immediate Post-Explant State
The appearance of the breasts in the first few weeks after implant removal is temporary and should not be mistaken for the final result. Immediate post-operative changes include swelling (edema), which is the body’s natural response to surgical trauma. Bruising is also expected, resulting from the manipulation of blood vessels during the procedure.
The skin stretched by the implant’s volume will immediately appear loose or redundant, often creating a tight sensation across the chest. This initial deflated look is compounded by the sudden absence of the implant’s bulk. Tissues require several months to begin the process of relaxation and settling.
Factors Shaping the Final Contour
The long-term aesthetic outcome is shaped by several key variables, which explain the wide variation in results among patients. A major determinant is the inherent quality and elasticity of the patient’s skin. Younger patients or those with resilient skin may see a better contraction of the skin envelope after volume removal. Skin with reduced elasticity, often due to aging or sun exposure, will be less likely to tighten effectively.
The characteristics of the implant also play a major role. Larger or heavier implants cause a greater degree of stretching in the skin and supporting breast ligaments compared to smaller ones. The duration of implantation is significant; the longer the implants have been in place, the greater the tissue expansion and the less likely the breast envelope will contract fully. The original implant placement (subglandular or submuscular) and the amount of natural breast tissue before augmentation also influence the final contour.
Appearance After Tissue Settling
Once the initial swelling resolves and the tissues have had time to settle, typically between three to six months, the long-term aesthetic outcome becomes apparent. The most common result is visible deflation and volume loss, particularly in the upper pole of the breast. This often creates a distinct “empty sac” or flattened appearance because the stretched skin envelope now contains only the native breast tissue.
The loss of internal support and volume frequently leads to ptosis, or breast sagging. Ptosis is defined by the nipple and areola complex sitting below the inframammary fold (the crease beneath the breast). The degree of ptosis relates directly to the amount of skin stretching and the patient’s pre-operative breast size.
Loose skin can also present as visible rippling or wrinkling, especially when the original implants were large. Scarring is inherent to the surgical process, with the location depending on the explantation incision, often placed in the inframammary fold or around the areola.
Surgical Options to Enhance Appearance
For patients who are not satisfied with the settled appearance of their breasts, secondary surgical procedures are available to enhance the contour and shape.
Mastopexy (Breast Lift)
The most common procedure performed after explantation is a mastopexy, or breast lift. The goal of a mastopexy is to remove the excess, stretched skin and tighten the remaining breast tissue. This procedure repositions the nipple and areola complex higher on the chest wall, correcting ptosis and creating a firmer, more youthful profile. The choice of incision pattern depends on the degree of correction needed, ranging from a peri-areolar incision to a more extensive inverted-T pattern.
Autologous Fat Grafting
Autologous fat grafting is an option often used to restore minor volume deficiencies and smooth out contour irregularities. This technique involves harvesting fat cells from another area of the body, such as the abdomen or flanks, and injecting the purified fat into the breast. Fat grafting is effective for adding a subtle, natural fullness, particularly to the upper breast pole, but it is not a substitute for the significant volume provided by a large implant. Surgeons often combine a mastopexy with fat grafting to achieve the best possible result, addressing both the excess skin and the volume loss simultaneously.