If you had breast implants before losing a great deal of weight, the breast around them has changed even though the implants have not. The tissue that covered them has thinned, the skin envelope has stretched and emptied, and the implant often sits high while the breast hangs below it.
That is a specific problem, and it is not solved by replacing the implant alone.
What weight loss does to an augmented breast
| Change | What you notice |
|---|---|
| Loss of breast tissue around the implant | The implant becomes more obvious; edges and rippling show |
| Thinner soft tissue cover | You can feel the implant more, particularly at the upper pole |
| Skin stretched and emptied | The breast hangs; the implant stays where the pocket holds it |
| Nipple descends | It sits low on the breast, sometimes below the fold |
| The implant now looks too big | Proportions have changed with the rest of you |
The options
- Lift around the existing implant. Where the implant is sound and still the right size, a mastopexy repositions the breast and nipple over it. Implant removal with a lift covers the related decision.
- Exchange the implant and lift. Often the implant is now too large for a smaller frame, or too old, and a smaller device with a lift gives a better proportion.
- Remove the implant and lift. Many patients after major weight loss want the device out. Explant surgery.
- Remove, lift and add your own tissue. Auto-augmentation or fat grafting restores upper fullness without a device. Auto-augmentation and removal with fat grafting.
Dr Kumar will recommend one rather than present the list, based on what tissue you have left, your skin quality and what you want the result to do.
Why thin cover changes the calculation
An implant needs soft tissue over it to look and feel natural. After major weight loss that cover is often much thinner than when the implant was placed, which makes rippling, visible edges and palpability more likely — whatever device is used.
That is the honest argument for considering removal rather than exchange in this group, and it is worth having openly. Implant placement and tissue cover.
Timing
Weight stable for at least six months, as with all body contouring. If you are still losing, the breast will change again. There is background on judging stability at My Weight Loss Journey.
It is also worth planning this alongside the rest of your surgery rather than separately — breast work often combines with an upper body lift or arm surgery. What can be combined.
Medicare
Two separate questions. For the implant: item 45548 covers removal as an independent procedure ; item 45551 covers removal with excision of at least half the capsule, not with insertion of any prosthesis, and is intended for capsular contracture, a mass within the capsule, or evidence of BIA-ALCL.
For the lift: item 45558 requires at least two-thirds of the breast tissue including the nipple to lie below the inframammary fold, with marked photographic evidence, and is claimable once per lifetime.
Common questions
Can I just have smaller implants? Sometimes, but if the skin has stretched a lift is usually needed too.
Will my breasts be very small without implants? Usually smaller than before you had them, because the tissue has both been stretched and lost volume.
Do old implants need replacing? Not on a schedule. When implants need replacing.
Should this be done before or after my other surgery? Usually planned within the overall sequence. How many operations.
Next step
Bring a GP referral — it is required to see Dr Kumar — and your implant cards if you have them. He consults at Westmead, Penrith and Orange, and you can send photos first. Call 1300 267 726. More about implant removal and revision.
The initial consultation with Dr Kumar is $400, with a Medicare rebate of approximately $88 where you have a GP referral. Surgical fees are quoted individually after your consultation, in a written itemised quote.
All surgery carries risks, and individual results will vary. Read more about the risks of surgery here. A GP referral is required to see Dr Kumar.
Dr Rohit Kumar (MED0001630444) Registered medical practitioner, specialist plastic surgeon (specialist registration in surgery – plastic surgery).
