Breast Revision/Reconstruction

Age: 36 Breast Revision/Reconstruction

This patient is 5'6" tall and weighs 120 pounds. She presented to me complaining about the shape of her breasts. She had an augmentation done elsewhere with THREE revisional procedures. Her first surgery was with saline implants placed through the transaxillary (underarm) approach which left her implants too high. The second operation was to lower her implants but they went too low. The third operation was done with an incision around her areola and was designed to lift her breast but this was unsuccessful as well.

After much education about the issues involved, and much confusion on the patients behalf, I told her that I felt that I can manage her problem (but gave her no guarantees). As you can see from her pre operative pictures, the right breast has bottomed out and the nipple has moved upward and the implant has moved downward. Her breasts implants are too large for her anatomy. I told her that when I fixed her breasts that I recommend smaller implants as well as switching out her saline variety for silicone (I believe silicone implants have less of a tendency to stretch the tissue because of the "hammer effect" of a water bag as opposed to a silicone variety). I discussed tacking up her breast folds and adjusting the pocket as needed and the requirement for the use of an excellent supportive bra to help maintain her result.

She is seen here at five months after the procedure. I replaced her 300cc saline implants that were under her muscle with 225cc silicone implants in the same pocket after I adjusted the pocket with sutures. You can see that her breasts are more symmetrical now and that they actually fit her better (less implant falling off to the side). I was able to move her pockets to the center which gives her more cleavage and moved her implants up higher which makes her breasts appear more youthful.

There are several lessons revealed in her case. First, I am not a big fan of the transaxillary approach because of the potential difficulty in making the breast perfectly symmetrical. Also, if a revision has to be done (and ALL breast enhancements will have one or more in the future), it is difficult if not IMPOSSIBLE to make corrections/adjustments through this incision. A periareolar incision in an Asian patient can result in unfavorable scarring as you can see on her right side. Can you see the incision that I made in the inframammary crease? The photo of her bra helps illustrate that the bra is not working to elevate and move her breast to the midline. It may look nice but it's not doing its job. It may take some time to find the right bra but it is critical in her case so that is why we referred her to a professional.

Age: 36 Breast Revision/Reconstruction

This patient is 5 feet tall and weighs 92 pounds. She had a previous mastopexy technique because of sagging breasts. She came to me a few years later because she wanted "perkier breasts". By all means her breasts are attractive, but she does lack superior fullness and her breasts are not particularly firm and they are situated lower on her chest than she would prefer. She wants to go braless at times and not feel like she needs a lot of support and that her breasts are not hanging low.

We elected to revise her mastopexy (breast lift) and use a small 175cc silicone implant placed beneath her muscle. You can see her here at about five months after the procedure. Her breasts are certainly higher on her chest, they are indeed "perkier" and they are firmer and more youthful. There is an abundance of superior fullness.

What is the moral of this story? First, a mastopexy or breast lift only accomplishes so much. Remember that your breast has fallen in part because of your genetics, and in part because of other factors such as pregnancy and age and gravity. Lifting will improve the result for sure, but often it's not enough for those who want a more ideal result. Secondly, in this patients case you can see that she has a LOT of superior fullness and she enjoys this very much. You can make an argument that her implants have not completely settled quite yet and that is why they are sitting a bit high. This fact also shows how powerful the lift is and that the use of a perfectly fitting bra helps to support the result.

Age: 38 Breast Revision/Reconstruction

This mother of two is 5'2" and 118 pounds. She had four previous breast surgeries. All her procedures involved removing excess skin and tightening of the breast tissue (Mastopexy) as well as two sets of breast implants, the first being 350cc and the final set being 700cc.

She complained of "being too big, breasts have bottomed out, my implants are under my arms, loss of superior fullness, loss of sensation, implants make me look fat, I can't play golf and my breasts are in the way in general and they don't fit my body".

I performed a augmentation-reduction-mastopexy procedure with removal of her old implants, replacement with 400cc silicone implants, a vertical Mastopexy with the removal of about 45 grams of tissue each breast.

She is seen here at about five months after her procedure. Her breasts are not higher, tighter, smaller and perkier. It's important never to choose an implant size that is too large that your skin can't even hold them up. A Mastopexy procedure is a challenging operation that requires experience and judgment.

Age: 40 Breast Revision/Reconstruction

This female patient is 5'8" and 143 pounds and had a previous breast augmentation performed elsewhere and was not satisfied with the result. Her breasts are laterally displaced on her chest wall ("under my arms") and her breast skin is loose and saggy. It's easy to palpate rippling of her saline implants because she has very little breast tissue covering her implants.

We discussed a breast augmentation/reduction/Mastopexy procedure with the use of silicone implants, adjustment of the implant pocket medially and a lift and tightening of the breast tissue. She was very concerned about the scars from the breast lift.

These are her post operative photos taken at four months. She couldn't be happier with her result. Her scars have done beautifully and she has no problem with them whatsoever BECAUSE not only are they finer than she thought they would be, but the drawback of her scars pales in comparison to the outstanding appearance of her breasts! As a general rule, fear of scars on the breast are overblown.

Age: 33 Breast Revision/Reconstruction

This is a 5'5" 117 pound woman interested in a breast enhancement. She had a previous breast lift done elsewhere without an implant because she wanted to be "natural". She has an anchor shaped scar from her lift. On exam, she has an overall pleasing breast shape but without any fullness, particularly superiorly. We augmented her with 275cc silicone implants beneath the muscle using her previous scars to place the implant.

Note the improvement in superior fullness and the enhanced appearance. This case illustrates the difference between a breast lift and a breast augmentation. A lift will improve the shape somewhat but cannot provide for the fullness, particularly superiorly, that most women are seeking.

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