Dr. Robert Whitfield (podcast/YouTube, June 29, 2023) explains how different incision approaches for breast explant surgery affect scarring and breast shape. He describes three primary access options — periareolar (around the areola), vertical/T ("lollipop") for narrowing/lifting, and inframammary fold (under-breast) — when each is appropriate, typical incision length for IMF removal (about 6–7 cm), and technical points about preserving nipple sensation and where fat grafting should be placed (in the fatty layer between skin and breast, not in the implant pocket). He also notes that revising prior lift scars frequently involves tangential periareolar skin excision rather than removing the nipple complex.
Chapters
Doctor Robert Whitfield, and welcome to my breast Implant illness podcast. Today we're going to discuss the question, will I have scars after breast explant surgery? So explant surgery for me is done through either the fold, through a vertical or through a periareolar approach. And so let me delve into what that means relative to the breast size and shape. So allow me to, you know, be a little liberal with how I I think about this and try to explain my thoughts. If you have a wide breast that extends into your armpits, you're going to want that narrowed. Otherwise when you remove the device itself, it may be more flattened and boxy at the bottom. So in those instances where we want to narrow and lift the breast, we're going to use a vertical T technique, often referred to when you look at the scar pattern as a lollipop. So that allows us to take tissue from below the nipple complex and advance and lift the tissue as we close it. That's how you get an increased or elevated nipple position. You do not take the nipple off. Many times people have had lifts. I'm just revising that incision by carefully tangentially excising skin around the areola to make it fit a smaller breast. So tangential means like think of the outside of an onion just peeling in a way. You're not removing the nipple complex. I'm removing the tissue below the nipple complex in a way that allows me to close and lift at the end. So when that vertical excision is done, you have a wide open appearance to the actual tissues. And then you could go through the tissues and expose the implants scar capsule and then take it out circumferentially in a intact manner entirely. And I like to tell you, picture, you know, not breaking the the shell of an Easter egg. Don't want to see the candy inside. If there's not going to be a lift, then it's purely about how was it put in. Was it put in periareolar or through the fold? Because I can't take an implant and it's scar capsule out through the armpit. So that's off the table. So if we're underneath the breast, we need a slightly bigger incision typically to get all out because the tissue around it makes it hard to get out. It's not smooth anymore. Can't just advance it through a small incision. So typically about 6 to 7 centimeters. Once again, 6 to 7 centimeter incision to get that out, all hidden in the fold. If the tissues will drape over that fold incision. And then of course I can take things out through a periareolar incision. Obviously Danica Patrick talked about this when she explained her explant journey and how it was done. The then ramifications of doing these different types of procedures, we'll take them one by one. So if you just do a periareola, I'm typically going to do a periareolar lift with it so that I can diminish the stretched out areola if that's the case. Because typically you want to downsize it to match a smaller breast so that can be done at the same time. So that leaves you just with one scar pattern around the outside of the areola. Then we discussed the vertical which gonna leave you with a lollipop type scar, but allows you to take out excess skin and tissue, not breast tissue, but you know, a little excess fatty tissue and mostly skin. So that you wanna preserve breast tissue in that instance IMF or the fold incision, once again straightforward. It's, it's not going to take any excess skin out really. It's just really to get the implant material capsule all out together. When we're talking about any of these, you know, we want to preserve sensation always. That's why when I talk about that little tangential excision of breast skin around the areola that's meant to not affect sensation. We want to minimize scarring whenever we can. So to have a lollipop you have to have a wide breast and need the nipple position elevated. If it's done through a periareolar as the initial incision, you can do periareolar lift. If you feel like the periareolar lift is going to help you because there's excess skin but the nipple's in good position, you can do that. Then of course there's the below the breast incision and that's, you know, the infirmary fold incision. So these are all the types of things that we discuss and evaluate to see what will work best. And then with any of those I can always add a fat transfer to help revolumize the breast. But always remember, fat goes between the skin and above the breast because that's the fatty layer. That's where the fat belongs. It doesn't belong in the breast and I don't put it in the pocket where I took the breast implant and its capsule out of because it's not going to survive there. So if you're going to have this, make sure your provider understands these, these points. I discussed the different types of incisions, the ramifications of those incisions. If a lift is necessary, what type of lift is necessary? What does it really mean? How is it going to help? And if you need to revolumize, then that's with the fat transfer. Make sure that you understand that where to place it, and that will optimize your results. Obviously, anybody can take advantage of our recovery program, harp. If their provider doesn't have that, then, you know, we're always looking to help, support any way we can.
