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Breast Restoration after Implant Removal

Autologous fat transfer would not cause body reactions that occur after the insertion of foreign objects. Thus, if patients need to remove implants or undergo revision surgery due to capsular contracture, breast hardening, or deformation as a result of failed breast augmentation, then they may also consider autologous fat transfer instead of repeated implant placement. There are two surgeries to restore the breasts after implant removal. The first is immediate reconstruction, which injects autologous fat in the breasts that could possibly sag immediately after implant removal. The second method is delayed reconstruction, which allows the breasts to recover for 6 months after implant removal before performing fat transfer. Based on Dr. Chuang’s experience, immediate reconstruction is more likely to be affected by capsules from previous augmentation with a limited amount of injection and thus have less satisfactory results. Over-injection can cause complications such as fat necrosis or lumps or even displacement resulting from tightened skin. In addition, the simultaneous completion of implant removal and fat transfer may increase the risk of fat absorption. More fat transfer may be needed in the future to achieve similar results as implants. Thus, Dr. Chuang does not recommend immediate reconstruction but rather suggests waiting for breast skin to restore its elasticity before undergoing fat transfer. Delayed reconstruction allows a larger amount of fat cells to be injected, increases the survival and safety of the transferred fat because of reconstructed skin circulation, prevents possible fat necrosis and lumping, and obtains more stable and evident results.

Surgical conditions

Duration

0hr
  • Type of anesthesia: General anesthesia
  • Type of incision: Transaxillary incision (for implant removal)
    Surgical incision: 0.3-cm pinhole incision in the medial or lateral lower breast
  • 1-cm liposuction incision (belly button or groin)
  • Recovery: 3–5 days
  • Removal of stitches: 7–10 days

General instructions

No food and water on the day of surgery

0hr
  • Stimulation with cold compress or excessive heat should be avoided for 2 weeks postoperatively.
  • Compression or aggressive massage of breasts should be avoided for 1 month postoperatively.
  • Smoking and alcohol consumption should be avoided for 3 months postoperatively.
  • Dieting should be avoided for 6 months postoperatively.
  • Periodic follow-ups and check-ups are necessary if breast lumps are observed even after 6 months.

Ideal candidates

  • Those who decide to remove implants after failed augmentation mammoplasty.
  • Those who have failed multiple breast augmentations with implants due to refractory capsular contracture.
  • Those who cannot get used to implants and would like to remove them and have fat transfer augmentation instead.
  • Those who have obvious breast ptosis or concavity after the removal of implants.

Possible complications

  • Breast calcification
  • Unknown lumps
  • Fat displacement
  • Inflammation
  • Autologous absorption
  • Limited choice of breast shape
  • Unsatisfactory results

Surgical advantages

  1. Eliminates risks associated with implants such as capsular contracture and breast deformation.

  2. No postoperative massage required.

  3. The breasts feel similar to real breasts.

  4. Can correct concavity or deformation caused by implant removal.

Surgical drawbacks

  1. Slower recovery than fat transfer in primary breast augmentation.

  2. Breast size could be limited by the severity of capsular contracture; usually only approximately half a cup size can be increased at a time.

  3. Higher absorption rate of autologous fat.

  4. More likely to have problems such as breast calcification, lumping, or inflammation.

  5. Immediate reconstruction is more likely to cause problems such as infection or fat displacement.

Possible procedures in conjunction