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Mastopexy After Taking Out or Substituting Breast Implants


When all breast procedures are accounted for, they form a major piece of the pie of all aesthetic plastic procedures performed worldwide. Why? Because breasts are what differentiate males from females.

Throughout art history, we see how important it is for artists to represent the female breast and because plastic surgery is unique among other specialties, regarding the artistic view, this is why for the practice of a plastic surgeon, breast surgery is so important. Although we plastic surgeons are artists of the human body, we surely have important differences from a true artist. An artist is free to make their piece of art; the limit is their imagination. For us plastic surgeons, we definitely have more limitations. We work on human bodies and our starting point is not ideal; this is the magic, we need to make something that is aesthetically consonant, aesthetically balanced. Today, enhancing a person’s natural beauty is a must in plastic surgery. The times when plastic surgery was here to show that a procedure was done is in the past, because good plastic surgery today is that which is considered so natural that nobody notices it.

This is why it is becoming more popular to replace large breast implants or even take them out without replacing them, and this is frequently requested in the plastic surgeon’s practice today.

As a woman I am more prone to listen to my patients and understand them when they tell me: “Doctor, I wished I had never had the procedure” when referring to their breast augmentation procedure. Cleavage is important not only to reassure our femininity, but also because clothes look better when we have breasts, and here I am not talking about big breasts with deep cleavages.

Once I listen to the patient and understand that she does not wants her implants any more but is afraid of having them removed, I take my time to allow her to understand that doing a mastopexy and not replacing the implants is a good option. However, I tell them I cannot assure a beautiful outcome in the end, as it is not until the implant is out that we as surgeons will see what is truly left of the breast tissue and how much excess skin is present, and can determine how much we can lift the breast and how we can better re-create the upper middle pole, which is what gives the breast cleavage that we like.

By setting the right expectations for the patient, we can proceed in planning to take away the implants without replacing them and to accompany the surgery with a mastopexy.

Why It Is Important as Doctors to Offer These Types of Treatments?

As plastic surgeons, we need to listen and understand what our patients want and design a surgery plan that serves them better.

When taking into consideration taking out or replacing breast implants, many times as surgeons, we believe the patient will end up happier if we leave implants because we will have a better contour, plus the procedure will be easier to perform. However, with years and years of performing these procedures, many times, it can be even easier to take the implants and reconstruct the breast than to reduce the implant or correct malposition of previous breast implants.

Approaches to the area

Whether to remove or replace the breast implants will depend on how and what the patient wants and feels. If the patient tells me, “I am tired of my breast implants,” or, “I enjoyed my breast implants, but now they are no longer my priority,” I will propose to perform a mastopexy, remove the implants, and not replace them.

If the patient says, “For me, it is very important to keep my cleavage. I will not feel good if I lose it,” or, “I do not want to lose breast volume; I like my breast size,” I will propose to replace the implants and do a mastopexy.

Mastopexy Technique When Taking Away Breast Implants and Not Replacing Them

Here I want to share with you my preferred mastopexy technique when taking away breast implants and not replacing them.

  • 1.

    During the appointment, show Pitanguy’s point A to the patient to have an idea of how high the nipple areola complex can move upwards and by doing so, have more realistic patient expectations after the procedure. I always tell the patient, “Please do not forget when you look at yourself in the mirror after the procedure and you think ‘I wish they would be higher.’” Remember, as plastic surgeons. We have limitations, and this point A measurement gives us a good idea of how far up the nipple/areola complex can move.

    • Point A is estimated by placing your index finger vertically on the submammary fold and projecting it forward and anteriorly on the upper skin of the patient’s original nipple areolar complex.

      Fig. 3.1, Pitanguy’s point A.

  • 2.

    The day of the surgery, mark the patient standing up starting with Pitanguy’s point A, and also mark the submammary fold.

  • 3.

    Start the surgery by marking on the operation table a periareolar incision with its upper limit being the previously marked point A. Medial limit of the periareolar incision is no less than 10 cm from the midline and the lateral limit is the lateral aspect of the areola. The lower limit of the periareolar incision is marked under the lower aspect of the areola and can go until 1 cm below, depending on each individual case.

    Fig. 3.2, Peri-areolar marking.

  • 4.

    Afterwards, we make a pinching maneuver on the lower aspect of the periareolar incision and mark where the skin borders touch.

    Fig. 3.3, Pinching maneuver to determine the width of skin to be resected.

  • 5.

    Then, two downward vertical lines are drawn, one on each skin mark made with the pinching maneuver. These two vertical lines will be the limits of the skin resection. This skin resection can be widened once the implants are taken out.

    Fig. 3.4, Drawing the vertical limits of the skin resection.

  • 6.

    The vertical lines are measured. They should be between 5 and 7 cm, nearer 5 cm if there is little breast tissue. Basal compensating triangles are marked to match the submammary fold, as seen in Figure 3.5 .

    Fig. 3.5, Basal compensating triangles.

  • 7.

    Marked skin is de-epithelized.

    Fig. 3.6, (A) Marked skin is de-epithelized. (B) Incision at the submammary fold for extracting the implant.

  • 8.

    We proceed by making a horizontal incision at the submammary fold for extracting the implant. The incision goes through skin, subcutaneous tissue, muscle, and capsule. The implant is taken out through this incision.

  • 9.

    Dissect the borders of the de-epithelized skin leaving a superior base flap. When needed, resect the implant capsule.

    Fig. 3.7, Dissection of the borders of the superior flap.

  • 10.

    The flap is folded upwards and 2-0 Prolene sutures are used to fix it on the upper medial breast quadrant to the muscle on the superior limit of the previous breast pocket.

    Fig. 3.8, Folding flap upward and fixing it on the medial superior breast quadrant.

  • 11.

    Approximation and suturing in layers of the breast tissue and skin is done. If more skin is needed to resect, resection is done before closing the skin. No periareolar purse sutures are done.

    Fig. 3.9, Approximating and suturing tissue and skin borders.

  • 12.

    Preferably, no drains are left; drains increase risk of future skin depression.

    • Now let us hear our expert and his recommendations on what to do for a mastopexy when a patient wants to have her breast implants taken out or replaced.

Expert Approach: Mastopexy After Taking Out or Substituting Breast Implants

  • Gianluca Campiglio

  • Plastic Surgeon

  • Milan, Italy

Why did you decide to do this technique?

I decided to do my technique many years ago when I realized that the traditional approach for mastopexy after implant removal or substitution was not appropriate for all cases, and in some circumstances even led to poor results in terms of shape of the breast and reduction of the scar length.

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