Explant with Mastopexy

Not every explant patient needs a lift. The decision depends on your skin quality, nipple position, and how much your tissue has stretched. This article explains how surgeons assess this — and what to expect if you need a combined procedure.

How skin responds to implant removal

When implants are removed:

• Skin envelope is suddenly larger than the underlying tissue
• Some skin recoils — younger patients, shorter implant duration recoil more
• Some skin remains stretched — older patients, larger implants, longer duration
• Breast tissue redistribution determines final shape

The amount of skin recoil is hard to predict precisely. Surgeons assess based on examination, but each patient is individual.

Who typically does NOT need a lift

• Young patients (typically under 40)
• Implants in place less than 5-7 years
• Smaller implants (under 300cc)
• No significant weight changes
• No pregnancies after implant placement
• Skin shows good elasticity on pinch test
• Nipple position remains above the inframammary fold

Who typically benefits from combined explant + lift

• Implants in place 10+ years
• Larger implants (400cc+)
• Pregnancies after implants
• Significant weight loss after implants
• Nipple position at or below the inframammary fold
• Skin pinch test shows poor elasticity
• Patient is over 45
• Patient wants the most refined aesthetic result in one surgery

Ptosis grading

Surgeons grade breast ptosis (drooping) using the Regnault classification:

Grade	Description	Lift typically needed?
Grade 1 (mild)	Nipple at IMF	Sometimes (periareolar)
Grade 2 (moderate)	Nipple below IMF, above lowest tissue	Usually (vertical)
Grade 3 (severe)	Nipple at lowest point of breast	Yes (Wise pattern)
Pseudoptosis	Tissue below IMF, nipple above	Modified approach

Lift incision patterns

Periareolar (around the areola only)

For very mild ptosis. Lifts 1-2 cm at most. Limited reshaping.

Vertical (Lollipop)

Around areola + vertical line down to the fold. Moderate ptosis. Most common modern approach.

Wise pattern (Anchor)

Around areola + vertical + along the inframammary fold. Significant ptosis or skin excess. More scarring but most refined reshaping.

One-stage vs two-stage

One-stage (combined):

• Explant and lift in single surgery
• Single anesthesia
• Single recovery
• Higher technical demand
• Slightly higher revision risk than staged

Two-stage (sequential):

• Explant first, then lift 6-12 months later
• Tissue allowed to settle before lift planning
• Some patients find they don't need lift after seeing healed explant result
• Two anesthesias, two recoveries
• Slightly more predictable lift outcome

Both approaches have merit. We discuss individually.

Recovery if combined

• Slightly longer surgery (3-4 hours total)
• Drains for both procedures
• Similar overall recovery timeline as explant alone, but with added attention to scars
• Lift-related restrictions: no lifting arms above shoulder for 2-3 weeks
• Bra restrictions same as explant

Scar expectations

Mastopexy scars fade over 12-18 months. Initial appearance:

• Months 0-3: Red, raised, very visible
• Months 3-6: Pink, flatter, less visible
• Months 6-12: Pale, often barely visible in good skin types
• Months 12-18: Final maturation; usually well-hidden under clothing

Silicone sheets or scar gel can support scar maturation. Sun protection (SPF 50+) is critical for 12 months.

Frequently Asked Questions

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