The breast is there, use it: Making sense of breast implant removal and breast reshaping
Objectives: Upon completion, participants will be able to:
1. Identify optimal candidates for the Borenstein Explantation Pexy technique
2. Execute the key surgical steps including the signature Borenstein maneuver
3. Manage patient expectations regarding scarring and outcomes
4. Apply critical technical tips to maximize aesthetic results in breast explantation cases
Introduction: With 3+ million breast implants placed since 2005 and rising BIA-ALCL awareness, explantation requests are surging. Traditional removal leaves patients with deflated, aesthetically poor results - creating an unmet need for aesthetic explantation without replacement. The Borenstein Explantation Pexy technique addresses this challenge by converting breast width to projection, recreating natural breast mounds immediately after implant removal using the patient's own tissue.
Materials / method: Retrospective analysis of patients undergoing BEP technique. Inclusion criteria: adequate breast tissue, supple envelope, realistic expectations. Surgical approach: superior pedicle mastopexy markings, periareolar access, capsule-to-pectoralis suturing for lateral control. Core technique: Borenstein maneuver using thin dermal flaps with horizontal figure-8 sutures converting width to projection. Assessment: patient satisfaction, complications, revision rates.
Results: BEP technique successfully achieved upper pole fullness and natural breast projection in selected patients. Lateral capsule-to-pectoralis suturing effectively controlled ptosis vectors. The Borenstein maneuver consistently converted breast width to projection. NAC positioning remained stable with 3D verification approach. Complication rates were minimal with proper patient selection. Patient satisfaction was high regarding aesthetic outcomes and avoidance of implant replacement.
Conclusion: This Explantation Pexy technique provides an effective non-implant option for aesthetic breast implant removal in properly selected patients. Key success factors include adequate breast tissue, supple envelope, and meticulous surgical technique. The procedure addresses the growing demand for aesthetic explantation while maintaining natural breast appearance. Proper patient counseling regarding scarring is essential for optimal outcomes.
