Breast augmentation or augmentation mammoplasty as we call it in medical terms, represents a surgical procedure used to improve the shape and size of a woman’s breasts. The surgery is performed for many reasons: to improve the body contour of the patient who considers that her breasts are too small, to correct a breast reduction procedure performed after pregnancy, to correct breasts asymmetries or as a method for mammary reconstruction after breast surgical interventions. When making an appointment for a breast augmentation with silicone implants, your plastic surgeon should make you aware of the fact that a revision surgery might be needed to correct aesthetic imperfections and you might also encounter complications that will require implant removal in the future. When thinking about explantation of breast implants, probably one of the most common issues that come to mind is whether the breasts will sag or not. The decision to explant We had patients coming in after 8 or more years of having had breast implants saying they want to explant. The reasons behind their request are multiple: sagginess of the breasts resulting from a big volume implant, and occurrence of rippling or capsular contracture where they don’t want to bother with having the implants replaced and again putting themselves at risk for different complications. Most of them want to know if their breasts will sag if we remove the implant. No other answer but yes, breasts will sag after an explant. If you had implants for many years, if your breasts already started to sag with the implants inside, it will certainly sag more and look more unpleasant visually once you decide to explant. Some tend to mistakenly believe that instead of changing the breast implants after ten years or more, they can just remove them completely and get back to the shape and the size of the breasts they had before the initial breast augmentation procedure. Unfortunately, this is not at all possible, unless the implant removal is associated with other breast enhancement procedures. Please note that through the years, your body has fully accepted the implants and gotten used to them. The tissues have stretched to accommodate them perfectly, the skin on your breasts expanded to cover the increased size of the breasts and the ligaments that keeps the breasts up, become lax through time. This happens as part of the natural aging process. The skin loses its youthful elasticity, and this condition is exacerbated, when you have big breast implants. If your decision to explant is based on the fact that you don’t want to have other breast surgeries, do reconsider. In most cases, the breast implant removal needs to be performed in association with or followed by a mastopexy (breast lifting intervention). If the reason behind your desire to explant is because of a medical condition, such as rupture of the implants or capsular contracture that is painful or has modified the shape of your breasts, it is important to know that in most cases, a revision surgery to correct these issues might be less costly and your breasts will still look the same after the implants are replaced with new ones. Complications after implant explant The removal of the implants is a surgical procedure and it should be performed only when all else failed. Any surgery comes with associated risks and complications such as bleeding, infection, swelling and bruising, skin necrosis and so on. When you decide to explant, know that the risk of breast sagging increases with the length of time you had them on, the size of the implants, and the quality of your skin, among other things. In order to have nice looking breasts after explanting, an additional surgical intervention like breast lifting might be needed. It is important to know that the mastopexy intervention can leave behind visible scars, depending on the quantity of skin and mammary gland tissue that needs to be removed. If you want to explant out of a sudden whim or caprice, be aware that you will either be left with sagging breasts or with visible scars. About the breast implant removal procedure The implants removal is the surgical procedure that is the exact opposite of the breast augmentation with implants. The plastic surgeon will perform incisions, usually in the same places as the initial intervention and explant. Cleaning of the pocket where the breast implant was placed might be required too, especially if capsular contracture occurred. After the implant is removed, the surgeon will close and suture the wounds. When the implants removal procedure is coupled with breast lifting, the implant is first removed, after which the plastic surgeon will excise the excess skin, fat and mammary gland tissue in order the reshape the breasts to achieve firmness and identical and smooth consistency. Keep in mind that once you had a breast augmentation procedure with implants performed, your breasts will never be the same, not even after the implants are removed. You just might be one of the few lucky patients who will not need breast lifting if the implants were introduced for less than a year, if the implants are not huge, and if you have good skin elasticity as the skin can naturally retract and the breasts won’t sag as a result. Remember that there are no guarantees for how your breasts will look after the explant and if a plastic surgeon promises you that your breasts will be identical to the ones you had before the breast augmentation, then I strongly suggest you go find another specialist for your intervention. Conclusion Put simply, your breasts are indeed going to sag after you explant, especially if you had the implants for a long period of time and they are big sized implants. Your skin quality is another important factor that can determine sagginess after the explantation. In most cases, it will normally be recommended that you combine your breast implant removal with a breast lifting procedure in order to maintain aesthetically pleasing breasts.