The Surgeon Minute

Breast Surgery Without Implants

Breast Surgery Without Implants

With the rise in media attention surrounding breast implant illness and the very rare, but very real, BIA-ALCL (breast implant-associaed anaplastic large cell lymphoma), a lot of women are coming into their plastic surgeon’s office to talk about having their implants removed. While this is a personal decision between patient and surgeon, it is important to keep in mind that breast surgery today does not have to involve implants.

Board certified plastic surgeon and breast surgery expert Dr. Brad Calobrace of Louisville, KY discusses the many other options for making your breasts look fantastic, including fat grafting to the breast. 

Breast Surgery without Breast Implants

“I think for women, it’s an important message to let them know that breast surgery doesn’t always include implants,” shares Dr. Calobrace. We are living in a time of increased breast fear. All women are brought up knowing about breast cancer statistics. Today, however, patients are also worried about breast implant illness and BIA-ALCL a rare form of non-Hodgkins lymphoma that has been found in patients with textured breast implants.

 Breast Implant Illness Sad Woman

Some women are so full of anxiety about the fact that their implants may make them ill that they just want them out. Even so, there is no longer a need for a patient to have her implants removed and suffer the consequences. “[Patients today] have options to make their breasts look fantastic!” explains Dr. Calobrace. 

No Implant Procedures

Let’s say you’ve decided to have your implants removed. Chances are, you have had those implants for at least a decade. During that time, it is probable that you have gained and lost some weight and/or had children, all of which can stretch out the skin and tissues of the breast. With those factors, when you remove the implant, something needs to be done to address the lost volume and loose, sagging skin.

Thankfully, there are a number of breast surgery procedures that can deliver lovely results without a breast implant, such as:

  • breast lift (mastopexy)
  • auto-augmentation
  • fat grafting to the breast

Before and After Breast Implant Removal

A breast lift will tighten up the breast envelope by removing any excess skin and “repackaging” the tissue. The end result is a lifted, youthful-looking breast. Depending on whether or not you’ve gained weight with age, you may wind up with close to the same amount of breast volume that you had with your initial augmentation! In an auto-augmentation, Dr. Calobrace will take part of your breast tissue and create something that resembles an implant in  order to restore some fullness and projection to the breast

Fat Grafting to the Breast

Fat grafting to the breast is a relatively new procedure that has become incredibly popular. “I do fat grafting on breasts every day,” explains Dr. Calobrace. It’s highly successful for improving overall breast volume, shape, and cleavage. The results from fat grafting to the breast are permanent. However, not all of the fat that is placed will survive. Typically, only about 50% of the grafted fat cells will remain.

There are other limitations to fat grafting to the breast. “Fat grafting does not do a great job of providing core projection,” explains Dr. Calobrace. Replacing lost volume in the middle of the breast where the implant was sitting is hard to do with just fat. “Fat does a much better job of filling out the sides, and filling out the cleavage,” continues Calobrace. Furthermore, patients are only going to get about a 50% increase in the size of the breast, so it may take multiple sessions to achieve end results.

Having said that, Dr. Calobrace rarely finds the need for more than one fat grafting to the breast session. 

Remove the Capsule or Not?

Aside from reconstruction options, the other big decision for any patient who is wanting to remove her breast implants is whether or not to also remove the capsule. A capsulectomy is a more involved surgery that requires the use of drains. For this reason, Dr. Calobrace is always weighing the pros and cons with each patient about removing the capsule. If a woman just has a general concern that her breasts are now too large and she would like her implants out, or she doesn’t want to deal with them anymore, or she has a capsular contracture, it is quite possible that the capsule can remain in place.

If a patient is worried about breast implant illness or BIA-ALCL, Calobrace will perform a capsulectomy. It’s the only way that he knows for certain that he’s eliminated the implant as a source of her illness. “What I don’t want to do is take breast implants out of somebody who is not going to get better and then they’re going to be left with breasts that are not attractive and that make them feel self-conscious,” says Dr. Calobrace. The goal is to either do a better job of diagnosing whether or not taking out the implants is going to improve the patient’s health or continuing to improve the options for providing a beautiful breast without an implant. 

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