Will My Breasts Sag After Implant Removal? Explant With or Without a Lift

The short answer: some breasts sag after implant removal and some do not, and the difference is predictable before surgery. Women with a reasonable amount of natural breast tissue, modest implants and a nipple still sitting above the breast fold usually look natural after removal alone; women with large or long-standing implants, stretched skin or a low nipple almost always need a lift at the same time to avoid a deflated appearance. Dr. Paulo Michels, a Brazilian board-certified plastic surgeon with over 18 years in breast surgery and the Gold Medal for Best Body Contouring at the World Plastic Surgery Olympiads 2025, performs breast implant removal at Elyzee Hospital in Abu Dhabi for patients from Dubai and across the UAE.

What actually happens to the breast when an implant comes out?

An implant does two things to the breast around it: it fills a space, and it stretches the envelope that holds that space. Over years the skin, the ligaments inside the breast and — under a large implant — the gland itself adapt to a volume that was never yours. When the implant is removed, what remains is your own tissue inside a skin envelope that was tailored to something bigger.

That is not the same as the breast collapsing. Skin retracts, and it goes on retracting for months. Tissue that has been pressed flat against the chest wall rounds out again as the pressure comes off. The breast you see in the mirror two weeks after explant is not the breast you will have at six months — worth remembering when you look at photographs online, which are very often taken far too early.

So the variable that decides the outcome is not the implant. It is what you had underneath it, and how much the envelope stretched while it was in place.

Which three things predict whether my breasts will sag?

Almost the whole answer sits in three measurements taken at the consultation.

• How much natural breast tissue you have. A woman who started with a small A cup and chose a 400 cc implant is left with very little once it is gone. A woman who started with a full B and chose 250 cc is left with most of a breast. The same operation produces two completely different results.
• How far the skin has stretched. Implant size and the number of years it has been in place matter most, then pregnancy and breastfeeding, weight change, age and simple genetic skin quality. A stretched envelope that has lost its elasticity cannot shrink back around a smaller volume.
• Where the nipple sits relative to the breast fold. This is the measurement that decides between one operation and another. If the nipple is still above the crease under the breast, the problem is volume alone. If it sits at or below the crease, the problem is position — and removing volume makes a position problem more obvious, not less.

Two further findings modify the plan. A long-standing large implant can thin the tissue lying over it through simple pressure, so the cover is less generous than the original anatomy suggests. And a capsular contracture may be holding the breast in an artificially high, firm shape that will not survive removal, which is one reason a contracted breast can look deceptively good before surgery.

Which of the three explant groups am I in?

In practice, patients divide into three groups, and the honest conversation is about telling you which one you are in before you commit to anything.

Group	Typical findings	Usual plan
Removal alone is enough	Good skin elasticity, modest implant, decent native tissue, nipple above the fold	Implants out through the existing scar, capsule assessed on its condition
Borderline	Nipple at the fold, moderate skin laxity, upper breast likely to look empty	Removal with fat transfer, or removal with a limited lift, decided at consultation
A lift is needed	Large or long-standing implants, stretched envelope, nipple at or below the fold	Explant with mastopexy in one operation, sometimes with fat transfer

Dr. Michels uses direct examination, measurements and 3D simulation at the consultation to show you what removal alone would look like on your body compared with an explant-lift. Patients who see both versions rarely make the wrong choice.

What does an explant with a lift actually involve?

Explant with mastopexy is a single operation. The implants come out and, if the capsule needs to be removed, that is done at the same time. The remaining breast tissue is then reshaped, the nipple is raised to its correct height and the excess skin is removed. The incision pattern follows the degree of sagging, exactly as in a standard breast lift: around the areola for mild sagging, a vertical lollipop for moderate, an anchor for severe.

Two details matter more here than in an ordinary lift, because there is no longer an implant providing structure. The first is internal support: rather than synthetic mesh, Dr. Michels builds an Internal Bra from your own fascia and muscle, a living sling that holds the reshaped breast in position instead of leaving that job to the skin. The second is auto-augmentation — where the lower breast tissue is generous, it is repositioned higher on the chest wall rather than discarded, restoring upper-pole fullness from your own tissue.

Operating time is roughly one hour for removal alone and two to three hours when a capsulectomy, a lift or fat transfer are combined.

Can fat transfer replace the volume instead of a lift?

Partly, and only for the right problem. Fat grafting harvests your own fat by gentle liposuction from the abdomen, flanks or thighs, purifies it and injects it in fine layers into the upper breast and cleavage. It softens the step at the top of the breast and adds a modest natural volume that moves like breast tissue because it is your own.

What it will not do is lift anything. Fat restores fullness; it does not move a nipple. Typically 60 to 80 per cent of the transferred fat survives long term once swelling resolves, the amount that can be grafted in one session is limited by the tissue receiving it, and some patients choose a second session months later. For a borderline patient who wants softness in the upper pole, it is an excellent addition. For a patient whose nipple has dropped below the fold, it is not an alternative to a mastopexy.

Should I remove the implants now and decide about a lift later?

This is a reasonable option and it is offered to some patients. Removing the implants first, waiting three to six months while the skin retracts, then reassessing has one clear advantage: the decision about a lift is made on the breast you actually have rather than on a prediction. It suits women who are unsure, who want the implants out quickly for their own reasons, or whose skin quality is genuinely hard to call.

The trade-off is that staging means two operations, two anaesthetics and two recoveries, and the interim months are spent with a breast that looks emptier than the final result. For patients with clear-cut findings — a nipple well below the fold, a heavily stretched envelope — staging usually delays the inevitable. Both routes are discussed openly, and neither is pushed.

What is explant regret, really?

The regret stories that circulate online are rarely about the implants coming out. Read carefully, most of them describe one of three things: a lift that was indicated and declined, often to avoid scars; a result judged at two or three weeks, when the breast is still swollen and the skin has not yet retracted; or an expectation that the breast would return to how it looked before the first augmentation, which was often ten or twenty years and a pregnancy ago.

All three are avoidable, and all three are avoided in the same way — by being told plainly, before surgery, what removal alone will look like on your anatomy, and by being shown the alternative rather than being sold one.

How do the breasts change over the first six months?

The shape you end with arrives slowly, in a predictable sequence.

• Weeks 1 to 2. Swelling and bruising dominate. The breast can look flatter and wider than it will be. A compression bra is worn day and night, and most patients are back at desk work within five to seven days after removal alone.
• Weeks 3 to 6. Swelling settles, bruising fades and the skin begins visibly to retract. Light cardio restarts at three to four weeks, the compression bra is usually stopped somewhere between four and six weeks, and unrestricted exercise resumes at around six weeks.
• Months 2 to 6. The real change. Skin continues to tighten, tissue redistributes, and if a lift was performed the breasts drop out of their initial high, firm position into a natural shape. Three to six months is the earliest honest point to judge the result.
• Months 6 to 18. Scars mature, fading from pink to pale. Sun protection and the scar-care routine given at follow-up make a genuine difference to the final line.

When should I contact the surgeon after explant surgery?

Most recoveries are uneventful, but a few findings should always be examined rather than watched:

• one breast becoming noticeably larger, tighter or more swollen than the other, particularly after the first week
• redness or warmth spreading over the skin rather than fading
• fluid or blood leaking from an incision, or wound edges separating
• pain that was settling and then clearly increases
• any new lump, or a swelling that appears months or years after surgery

None of these are common. All of them are easier to deal with early, and no one at this practice minds being contacted about something that turns out to be nothing.

How are explant consultations arranged for patients from Dubai?

All consultations and surgery take place at Elyzee Hospital in Abu Dhabi, about an hour’s drive from Dubai, and Dr. Michels does not operate anywhere else. The consultation covers your reason for removal, examination and measurement of nipple position and skin quality, review of your implant records where you have them, and imaging — ultrasound routinely, MRI where a rupture is suspected or the implants are old. 3D simulation is used to compare removal alone with an explant-lift on your own body.

For patients travelling from Dubai or elsewhere in the UAE, visits are grouped wherever possible, so that consultation, pre-operative tests, surgery and follow-up reviews take as few journeys as they can. Patients based in Dubai can also read how breast lift consultations are arranged for them before booking.