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Objectives: We present a surgical technique that was specifically developed to recreate the breast mound using the wide laterally displaced breast tissue left after breast implant removal.

Introduction: Patients dissatisfied with their breast implants are commonly presented with 3 options: secondary augmentation, replacement of smaller implants and mastopexy or removal of the implants. Simple removal of breast implants often leads to wide, deflated, and laterally displaced breasts which are notoriously difficult to reconstruct.

Materials / method: Markings and de-epithelization are similar to those of a vertical scar mastopexy.
Periareolar incision and access enable secure closure using multiple layers, control of nipple-areola position, and IMF integrity.
The deep absorbable sutures from the lateral capsule to the IMF just medial to the breast meridian help control the lateral vector of breast ptosis.
Layered closure of the invaginated breast tissue outward to the vertical scar converts breast width to projection, aids final NAC positioning, and reduces tension of the final intradermal skin sutures.

Results: The presented technique is suitable for patients with enough breast tissue to recreate a breast after explantation (Fig. 1). Patient selection is important. The ideal candidate has supple, wide breasts. This technique aims to achieve upper pole fullness and control the position of the nipple-areola complex using horizontal obliteration of dead space formerly occupied by the breast implant

Conclusion: Breast augmentation remains the top plastic surgery procedure performed worldwide. Natural changes in body and breast shape, device failure, malposition, and patient preference bring more patients every year to plastic surgery explantation consultations. The BEP technique is a nonimplant-based surgical option for selected patients seeking removal of their aesthetic breast implants.

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