Explantation with Mastopexy and Fat Transfer, Raleigh, NC*

Explantation of breast implants with simultaneous mastopexy and fat grafting can be a challenging procedure. This patient had subglandular saline breast implants placed over 20 years ago. She developed capsular contracture and another plastic surgeon removed the capsules but replaced her implants in the same location which resulted in a recurrent capsular contracture. The patient did not want to have implants anymore but realized that she would be quite deflated appearing after removal. She underwent removal of her 400 cc saline breast implants with capsulectomy with simultaneous mastopexy and fat grafting. Because the capsules were removed, fat grafting was more limited. Conservative grafting was performed with only 100 cc placed per side. In cases where capsulectomy is performed, there is much more limitation to the amount of fat that can be grafted. Special care has to be taken to avoid overgrafting directly into the breast parenchyma to avoid lumps and cysts. Mastopexy with subglandular implants is also more challenging as blood flow to the nipple has been interrupted to a greater degree than submuscular placement. Potential loss of nipple is a possibility. Preservation of nearly all of the breast tissue is necessary and must be reshaped with skin removal most commonly as a inverted T or Wise pattern. The patient was pleased with the smaller lifted appearance of the breasts and was happy to have her implants removed