Can a mastopexy (breast lift) be performed immediately after explantation (implant removal) of breast implants?

Mastopexy After Breast Implant Explantation

Mastopexy (breast lift) can be safely performed immediately after breast implant explantation in most patients, with excellent aesthetic outcomes and acceptable complication rates. This combined approach avoids the need for multiple surgeries and addresses breast ptosis that often becomes apparent after implant removal.

Patient Selection and Preoperative Considerations

• Appropriate candidates include:

  • Patients with adequate native breast tissue
  • Non-smokers or those who have quit smoking at least 4 weeks before surgery
  • Non-diabetic patients or those with well-controlled diabetes
  • Patients without previous radiation to the breast area

• Contraindications:

  • History of breast radiation (relative contraindication for implant-based reconstruction) 1
  • Active smokers (higher risk of wound healing complications) 1
  • Inflammatory breast cancer 1
  • Severe obesity (increased risk of complications) 1

Surgical Approach

Immediate Mastopexy Technique

1. Implant removal first:

   • Complete removal of the implant and capsule as appropriate
   • Careful hemostasis to minimize bleeding and hematoma formation

2. Breast reshaping:

   • "Tailor-Tack" technique can be used to determine optimal skin resection 2
   • De-epithelialized dermoglandular flaps can maximize volume conservation 3
   • Medial pedicle technique has shown good perfusion outcomes 4

3. Skin envelope adjustment:

   • Wise pattern (inverted-T) or vertical scar patterns based on degree of ptosis
   • Careful preservation of nipple-areolar complex vascularity

Volume Restoration Options

For patients concerned about volume loss after implant removal:

• Auto-augmentation using local tissue flaps 5
• Lipofilling (fat grafting) can be performed concurrently 6, 5
  • Average injection volumes of 250-300cc have been reported
  • May require a second session for optimal results

Expected Outcomes

• Reduction in breast cup size (typically one cup size) 6
• High patient satisfaction scores with combined approach 6
• Improved breast shape and position without foreign material

Potential Complications

• Early complications (within 30 days):

  • Hematoma, infection, skin necrosis (rare with proper technique)
  • No reported cases of nipple loss in recent studies 2

• Late complications:

  • Hypertrophic scarring (8.9%) 2
  • Poor nipple-areolar complex shape (7.1%) 2
  • Recurrent ptosis (3.6%) 2
  • Surgical revision rate approximately 12.5% 2

Special Considerations

• Previous radiation therapy: Autologous tissue reconstruction is preferred over implant-based approaches if the patient has previously received radiation therapy 1

• Perfusion assessment: Intraoperative laser fluorescence imaging can be used to evaluate nipple-areolar complex perfusion in complex cases 4

• Secondary procedures: Additional fat grafting may be required to achieve optimal volume in some patients 6

The combination of mastopexy with implant removal provides excellent aesthetic outcomes while addressing patient concerns about implant-related issues. This approach is supported by recent research showing acceptable complication rates comparable to those of either procedure performed independently 2, 6, 5.