Q: Dr. Eppley, I am interested in a breast reduction but my situation is a bit unusual. I currently have breast implants but gained weight after surgery with my third child. That was over ten years ago. I would like a breast reduction with my implants removed. I do not want to be bigger than B cup… I am currently a D/DD cup.
A: With breast implant removal and some significant breast tissue on top of them, a full breast lift may be likely needed. Due to concerns about blood supply to the nipples, the amount of breast reduction/lift that can be done may be more limited than going all the way down to a B cup may permit. Conversely, based on the size of your existing indwelling implants and their location (submuscular vs. subglandular), such a breast size reduction may be very possible. Larger breast implants that are in a submuscular position will safely permit more of a breast reduction/lift. I would need to see pictures of your breasts to help make that determination.
Removal of breast implants by itself causes an obvious breast reduction effect. But the now excess and potentially sagging overlying breast tissue must be managed to create a smaller and tighter breast mound.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in breast implant removal. If I have complete removal do you take out the capsule? Do you check for fungal or bacterial infection? With breast lift create risks of deformities? How many removals have you done? If the implants are not removed is there a concern of future surgery at my age. My primary care Dr will contact you for a consultation. Thank you.
A: In answer to your questions:
1) There is no compelling medical reason to remove the capsules. They will shrink away on their own with time. It can be done if the patient wants.
2) Without evidence of an active or chronic infection, there is no reason to do bacterial or fungal cultures.
3) Concurrent breast lifts will create their own aesthetic deformities known as scars. How extensive they would be depends on the type of breast lift needed.
4) While breast implant removals without replacement are fairly rare, I have done dozens of them over the years. About half the time a breast lift is needed with their removal.
5) If you replace the implant with silicone devices that would be the most assured approach to keeping implants and have the lowest risk of of any future implant-related problems.
It is not necessary to have your primary care doctor arrange for a consultation. These are not procedures that would be covered by insurance unless there original placement was for breast reconstruction due to cancer. Otherwise this is a cosmetic procedure.
Dr. Barry Eppley
Q: Dr. Eppley, I am 70 years old and got saline breast implants forty years ago. Recently my left saline implant ruptured. Need surgeon with your skills. I am confused about options with my saline breast implant deflation. I saw you on Real Self. Can you help me please? Thank you.
A: Having saline breast implants that have lasted for forty years is way beyond what one would expect them to last without suffering a deflation. The duration most saline implants are typically expected to last is in the ten to twenty-five year range. I have never heard of a saline breast implant lasting four decades!
With a recent saline breast implant deflation, the simplest and most economically efficient option would be to simply replace the ruptured implant with a new saline implant. Breast implants replacements are easy because there is an established implant pocket already. You could, of course, switch to silicone implants in both breasts if you still want implants and want to eliminate any future risks of an implant deflation. (since silicone implants do to deflate) As an alternative option, you can simply remove both implants if you no longer desire to have them and wish to most assuredly eliminate any future breast implant concerns.
Dr. Barry Eppley
Q: Dr. Eppley, I have breast implants and I want them removed. I do not want another implant and instead want fat transferred to my breasts.
A: . Fat grafting to the breast can be done when implants are removed. But the advisability and success of the procedure is predicated on several important issues. First, do you have enough fat to harvest to make the procedure worthwhile? Since only concentrated fat is injected, it takes a greater fat harvest than most patients think to have enough injectate to produce any significant breast volume. Secondly, it is important to know how much actual breast tissue you have between the breast skin and implant capsule as this is the layer that is injected. Fat can not be injected directly into an empty implant capsule. There must be enough tissue between the skin and the capsule to serve as a recipient site. Lastly, what are your size expectations and can fat serve as an adequate substitute in volume for your existing implants. Unlike implants which have stable volume, injected fat has a variable take which will always be less than what was initially injected. Therefore patient expectations should be tempered with what fat can actually achieve in terms of final volume retained.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in removing my breast implants and doing fat grafting as a replacement. I’ve had two children and after their births, I lost a lot of volume and my areolas stretched quite a bit. Currently, I have 350 cc saline implants making me a full C-cup. I was hoping to get a donut lift with areola reduction and fat grafting. I don’t expect to be a full C-cup again but what type of volume replacement could I expect?
A: While breast implants can be ‘replaced’ with fat grafting, it is important to appreciate several concepts about breast fat grafting. The success of any fat grafting procedure is dependent on the amount of fat one has to harvest and how much of the injected fat survives. Each part of the fat grafting process has a depreciating value. This means for example if 1000cc of fat aspirate can be harvested, when it is reduced (concentrated for each injection) the amount of fat available for grafting will be 1/3 to 1/2 of the harvest. (1000cc = 500cc) When the fat is injected only a percent of it will survive. While that percent can be quite variable for each patient (0 to 100%), let us assume the average take is 50% of the injected fat. (250cc) When you do this math for each breast, the final volume replacement of a 350cc implant will be 125cc of fat volume. (and this assumes that you would have 1000cc of fat to harvest) So you are correct in assuming that you would not be a full C cup with fat replacement but more likely a small to medium B cup. Thus it is easy to see that replacing implants with fat grafting is not close to a 1:1 exchange and the trade-off for a natural replacement will be loss of 50% to 75% of what the implant volume provided. Of course it is also possible that you may have greater than a 1000cc fat aspirate obtainable and then the volume replacement will be somewhat better.
Dr. Barry Eppley
Q: I had a breast augmentation about 10 years ago. I felt that they were too big right after surgery but my doctor somehow convinced me to keep them at the time. I would them either downsized or completed removed with some type of lift done at the same time. My question is what are the chances of my insurance covering a breast reduction or at least part of it? Have you ever dealt with a situation like this?
A: The simple answer is that this is not a procedure that would be covered by one’s health insurance. While the breasts are being downsized, this does not constitute a medically necessary breast reduction as implants are being removed, not breast tissue. The premise of a true breast reduction is that there is too much breast tissue present and a certain amount must be taken out. A medically necessary procedure has at its origin a health or medical cause. Prior breast augmentation is a cosmetic cause not a medical one. Breast implant removal and any lift that may be associated with it to reshape the loose and sagging breast skin is a cosmetic procedure.
Dr. Barry Eppley