All Explants Are Not the Same
It is quite common for women to decide upon breast implant removal. Motivation for this varies but includes concerns about breast implant illness, implant related pain, implant malposition, capsular contracture as well as feeling the breast implants are now too big for their body. This often occurs later in life when women have gained some weight.
Performance of a breast lift during implant removal is not straightforward. Mastopexy involves reshaping the breast through incisions and retaining the nipple areola complex upon a base of tissue that affords blood supply. This is called a pedicle. Patients who have had prior sub glandular implants also known as "on top of the muscle " in many cases have had some of the predictable blood supply interrupted during the first operation for their initial breast augmentation. Pedicle design is less predictable with an increased chance of potential loss of the nipple's blood supply, .It is common as women age, to develop more fatty breasts which generally have less blood supply. Submuscular positioning of implants usually preserves more blood supply and generally breast implant and lift is somewhat safer in this situation. Patients undergoing Breast lifting after sub glandular implant removal are at somewhat higher risk of nipple ischemia or loss which could lead to complete loss of the nipple or partial loss. When this occurs the nipple changes to a dark purple color eventually turns black and becomes a scab. This is a very serious situation requiring salvage techniques when it is noticed but can results in complete loss of nipple. Patients are advised to work with Board certified plastic surgeon with extensive experience in these types of cases.
This patient had long-standing breast implants which were sub glandular and desired removal and lift. She did develop temporary signs of ischemia although both nipples survived and the procedure was successful.