Breast Lift
Dr. Nicolaidis was the first plastic surgeon to report on breast appearance after explantation in a prospective study of his first 182 explant cases for breast implant disease (The ASPS Meeting 2020). 52% of patients were very satisfied with the appearance of their breasts, 33% were satisfied, and 15% were dissatisfied. However, NO patients reported regretting having surgery, given the improvement in symptoms.
What is simultaneous breast lift and capsulectomy?
After breast implant removal, the breast’s skin envelope becomes too large for the amount of tissue inside, causing the breasts to sag and lose their shape, often resulting in unsightly folds. When folds form after explantation, they can be very difficult, if not impossible, to correct. To minimize unsightly folds and create the best possible breast shape, excess skin is removed in what Plastic Surgeons call a breast lift. While implant removal and capsulectomy are sometimes covered by the government, a breast lift is never covered.
Not ALL patients require a lift at the time of explantation, especially younger patients with significant breast tissue and smaller implants. But these patients remain a minority. For the majority of patients, Dr. Nicolaidis and leading US explant surgeons perform breast lifts at the time of explantation for the reasons mentioned above. Dr. Nicolaidis performs 2 different types of lifts, depending on several factors, including the degree of breast sagging and breast volume. In addition, several maneuvers are considered for patients lacking breast volume. The choice of lift type and maneuvers are discussed at the time of consultation. Many Plastic Surgeons are hesitant to perform lifts at the time of explantation for fear of nipple necrosis (death of the nipples). And rightly so. It took a full year before Dr. Nicolaidis felt confident enough to perform a full breast lift without risking nipple necrosis. He now performs these surgeries routinely with minimal complications (see below).
It is important for patients to have realistic expectations after explantation. The priority is to remove the implant with its entire capsule. The larger the implant and the thinner the patient’s skin and tissue, the more the skin will tend to fold after explantation. A breast lift after explantation is designed to minimize wrinkling and achieve a reasonable shape for the breasts. Dr. Nicolaidis is a plastic surgeon, not a magician. Patients with minimal tissue before breast augmentation will end up with minimal tissue after explantation. That said, many patients who have gained weight and had pregnancies since their implants end up with more breast tissue than before their augmentation.
What are the possible complications specific to capsulectomy with simultaneous breast lift?
Dr. Nicolaidis is the first Plastic Surgeon world-wide to report prospectively on the complications of capsulectomy with simultaneous breast lift, presented at the American Society of Plastic Surgeons Meeting in October 2022. Here, Dr. Nicolaidis was pleased to win the “outstanding paper presentation” award. The following are the complications in his first 500 explant cases; it is important to keep in mind that these complication rates are in experienced hands and are likely higher in the hands of someone who does not do these surgeries regularly:
Nipple necrosis: Nipple necrosis involves death of the nipple tissue when the blood supply to the nipple is severely compromised and requires removal of the dead nipple tissue. Fear of nipple necrosis is the reason that Dr. Nicolaidis waited a full year before doing his first complete breast lift at the time of explantation. In 500 cases, he had one case of partial nipple necrosis, in a patient whose nipples had to be raised 7 centimeters and who had a delay in draining a hematoma after she returned home. Two other cases posed a concern for nipple loss but this was avoided with 1-2 days of hyperbaric oxygen treatment. So, 1 partial nipple loss out of 1000 nipples for a rate of 0.2%.
Infection: Minor infections may occur following small wounds in the closure sites. One patient required oral antibiotics for concerning infection around the nipple following a large lift and did fine. So, a rate of 0.2%.
Reaction to Anesthesia: While some patients may develop a sore throat following anesthesia, no patients had a major reaction to anesthesia, requiring transfer to the hospital or anything of that nature. So, a rate of 0%.
Total complication rate: 4.8%. For comparative purposes, the estimated revision rate for breast augmentations is 10%.
Revision Surgeries Following Explantations: Revision surgeries are typically done 4 to 6 months following explantation, in an effort to improve the final appearance of the breasts. But before we get to that stage, consideration is always given to massage and cupping of the skin to improve indentation, etc. Even Dr. Nicolaidis is sometimes amazed at how much breast appearance can improve with such treatments. Should that fail, minor scar revisions and releases can be done under local anesthesia. But clearly the most powerful revision tool is fat transfer to the breast.
The worst results Dr. Nicolaidis has seen are in patients who did not undergo breast lift at the time of explantation. He has a number of patients who regret not touching the nipples at the time of explant. However, he has no patients who regretted having a lift at the time of explantation.
Before/After
Dr. Nicolaidis regularly hears from his patients that they find their breasts look better after explantation than they did before augmentation. And rest assured, there are other options that can be offered later if patients are not satisfied with their breasts, the primary option being fat transfer to the breasts. Dr. Nicolaidis RARELY transfers fat at the time of explantation due to the significant risk of complications. Instead, he performs fat transfer as a secondary procedure (usually 4-6 months later) to touch up irregularities that often develop after explantation. Like all procedures, fat transfer is not without risks. Dr. Nicolaidis will discuss these risks at the time of consultation.
360 ml explantation with round re-draping
Explantation 275 ml with complete re-draping
Explantation 300 ml with complete re-draping
Post-surgery advice
After your surgery, if you experience shortness of breath, acute chest pain, or severe leg pain, contact us immediately and go to the emergency room, preferably at the Centre hospitalier de l’Université de Montréal (CHUM), located at 1051 Sanguinet Street, Montreal, Quebec, H2X 3E4 (corner of Sanguinet, one street west of St-Denis and René-Lévesque Boulevard). Otherwise, go to the nearest emergency room if you are too uncomfortable.
The first week
• Keep your dressing clean and dry;
• Keep your arms close to your body, use only your forearms without forcing;
• Wash with a damp towel unless otherwise advised by Dr. Nicolaidis;
• Sleep ONLY on your back;
• Walk at least 5 minutes every hour during the day (don’t stay in bed all the time).
Your first post-operative appointment with Dr. Nicolaidis is very important, even if you feel great. If no appointment has been scheduled, please call us as soon as possible (this first visit is normally scheduled before surgery).
After the first week
• Keep your arms close to your body for an additional week (2 weeks in total after surgery);
• Keep the dressing clean and dry;
• You can take a shower with your back to the shower;
• Protect your scars from the sun for a total period of 6 months;
• Avoid lifting heavy objects until authorized by Dr. Nicolaidis;
• Avoid bathing until authorized by Dr. Nicolaidis;
• To prevent complications from blood clots, keep moving (walk regularly during the day).
• For patients who have had a round or horizontal facelift (and not a full facelift), the compression bra must be worn 24 hours a day.
• For patients who have had a full facelift, a sports bra is sufficient.
• After any explantation, do not use an underwire bra for at least 2 to 3 months to avoid friction on the scar.
