Dr. Robert Whitfield explains that breast explant patients do not universally require a lift; decisions are individualized based on anatomy, implant history, and patient goals. He describes an illustrative case of a small-framed, low-BMI patient whose implants were placed via an axillary (armpit) incision, explains why explant via the axilla is limited, and outlines scar-minimizing options: periareolar (donut) lift, lollipop lift, or explant without a lift. He states he avoids anchor and crescent lifts and prefers submammary incisions for control when necessary. Emphasis: minimize scarring, offer fat transfer later, and respect patient choice.
Chapters
Do breast explant surgery patients also need a lift? All right. So I get asked all the time, is the lift mandatory? And of course, it's not basically what I try to do. For each and every patient, we'll say, for instance, I had a patient come from New York recently. Very small framed patient. Implants were kind of, as most of my patients who are low bmi, desire was to give them a more feminine appearance. Initially, when they got a breast augmentation, they were never discussed other options like a fat transfer and. Or a smaller device. So they have a device typically between 3 and 400 cc's. And so in this particular patient, it was through an axillary approach. So the traditional types of incisions were through the armpit, under the breast, around the areola, and through the belly button. So I predominantly focused on under the breast because it was the safest, provided the most control, had the least amount of complications. So in this particular patient of mine, the placement was through the armpit, so there's no scar. And I can't take the patient's implants out through the armpit because I cannot go through the armpit and get all the capsular material out, all the scar out. And so I either have to go under the breast or in this instance, I discussed with the patient tightening up her skin so that reduced the amount of excess skin at one time. And then using that peri areolar scar or a scar around the circle, a donut lift to go through that to help get the device out and leave no scar on the. The bottom third of the breast or under the breast. So less visible scarring for her, and she wants a fat transfer later. So basically, the long story short is nobody actually needs a lift. Everybody can have an explant without a lift. That's their prerogative. I totally understand waiting, evaluating your skin, seeing if it will tighten over time. And I did several hundred that way before I started doing e lift procedures back when I started doing this in 2016. So we can do it in whatever manner the patient wants in order to help them get where they want to be at the end. I always will try to come up with ways to limit scarring. But, you know, that being said, there's the circular or the donut lift, there is basically a lollipop lift. And those are predominantly how we will help patients with skin tightening. That is surgical. I don't do an anchor, and I don't do a crescent. An anchor, to me, is something that's going to box out the bottom of the breast. So I don't prefer it, especially if you're going to go back and fat transfer up against that. I think it's much harder. I have lots of little adjustments that can be made afterwards if there's no lift or circular lift or a lollipop lift, that would not work when there was an anchor. So I focus on those to help our clients get the best possible, you know, outcomes and in the littlest amount of time or surgical steps as possible. So, in summary, not every breast explant surgery patient needs a lift. They have to come with, you know, their questions, and I try to give them the best possible information that they ultimately want to have a lift or don't want to have a lift. It's their choice.
