Age: 50 Breast Revision
This patient, 5’8″ and 130 pounds, presented to me after having two previous breast procedures. First she had silicone breast implants but had them removed after the “scare” in the eighties when the FDA removed them from the market for suspected problems related to connective tissue disorders. They were replaced with saline implants. Her complaint was that the right breast implant deflated and her left breast implant felt firmer and was displaced superolaterally as well. Her implants were subglandular.
We elected to remove both implants and perform a complete capsulectomy on both sides (removal of the scar capsule that forms around all implants). I removed implants that were 425cc and replaced them with 400cc smooth silicone beneath the muscle. I adjusted the pockets to station the implants in the ideal position.
Note the improved shape and symmetry. They are soft and natural to touch. It is often recommended that when you have had your implants for 10 plus years that you remove as much as the implant capsule as possible particularly if it appears calcified because this can interfere with mammography. I moved the implants into the submuscular position for better implant soft tissue coverage, more long lasting results, a more natural shape and feel and probable less likelihood of breast contracture recurrence.
Age: 49 Breast Revision
This mother of two who is 5’6″ and 123 pounds had a previous breast augmentation and “breast lift” performed elsewhere. The surgeon had moved the nipple up into a better position and placed submuscular 350cc saline implants and then transected (cut) the pectoralis muscle along the bottom of the breast. Skin was removed to tighten the breast but there was no removal of breast tissue.
Clearly on her pre operative photographs she has “bottomed out,” her breasts are larger than her frame and there is no place for her implants to go but down and off to the side. She complained that her breasts were too large, too low and too lateral. She wants her breasts to be smaller, higher, tighter, and perkier looking (not a small order request!). Since the surgeon had released the pectoral muscle at the bottom of the breast this has removed a significant support structure of the new breast. Cutting of the muscle has also allowed the muscle to retract upwards so that it covers only a small portion of the breast implant.
She is seen here after I removed her saline implants and replaced them with smaller silicone 300cc in the same submuscular pocket. I could not move the muscle down to its normal position. I adjusted the pocket to move her breasts upwards and to the midline and I reduced low lying breast tissue (62 and 112 grams) asymmetrically to compensate for the larger natural breast. She is seen here three years out from her procedure. Look at the arrows which help to illustrate the elevation of her breasts on her chest . Her breasts are still somewhat larger in size but they are located in a much more youthful position and the shape is vastly improved. The photo of the patient wearing the bra is to see how well she is being supported and molded.
Several points are worth noting in this case. Anytime an implant is used as well as another procedure on the breast this will add significant complexity to your case. There are greater risks for complications and the revision rate is significantly higher than, say, a breast augmentation alone. Breasts can be molded long term. Wearing a bra that shapes your breast can change the shape of your breast short and long term!Aggressively cutting the pectoralis muscle is like removing a support structure that helps to resist the forces of gravity that want to move your breast lower and laterally. Although it may be necessary to reduce some of the muscle to achieve a desired outcome, I would not recommend wholesale reduction of this important support structure. Recently, the use of ADM or Acellular Dermal Matrix can benefit secondary cosmetic breast procedures. This is typically human or pig dermis (skin component) that can be used to help support the breast and possibly improve outcomes such as improved stability, shape, feel and possibly reduce the breast contracture frequency. Only allow a very well qualified plastic surgeon work on complex breast cases.
In the patients own words: “Thank you for everything Dr. Caridi! You did a great job on giving me exactly what I asked for. It really has changed the way I feel inside and out.”
Age: 36 Breast Revision
This female patient desired implant removal. Note the appearance of her breasts after removal of normal implants.
Age: 49 Breast Revision
This is a 49 year old patient who had a breast enhancement done 25 years ago elsewhere and she says she “was never quite happy” with her results. She had a bilateral breast contracture with asymmetrical, firm breasts, and visible distortion. Her implants are in the subglandular position.
I removed her ruptured silicone implants and the implant capsules (scar tissue around the implants) placed new larger silicone implants in the submuscular position and narrowed the diameter of her areolas. She is seen here at five months with a world of a difference – her breasts look natural and symmetrical and they are very soft. Her left areola spread more than her right side for a small asymmetry. Her goal of “normal looking breasts that are softer and maybe a bit larger” has been successfully achieved.
Age: 39 Breast Revision
This woman had several children. Her large breasts “fell” after her pregnancies. She had a breast lift and breast implants placed by another surgeon. She had a contracted right breast with loose skin on both breasts.
She came to Westlake Plastic Surgery because she wanted her breasts to be tighter, elevated, softer and more natural and symmetrical in appearance.
We performed a reconstruction by removing her implants, reducing breast tissue on both breasts, and placing 300cc silicone implants beneath the muscle and revising her breast lift (Mastopexy) to tighten the breast and remove excess skin. After her procedure, she had some skin excess below the right breast and her implant was displaced a bit laterally (see second photo).
A second procedure was performed to remove excess skin below the right breast and move the implant toward the midline of her chest. Her reconstruction is complete in the third photo.
Complex reconstructions often require more than one surgical procedure to obtain the best result. It is interesting how much this patient’s life was changed by making her happy with her breasts. She hadn’t realized how unhappy she was because of her displeasure with her breasts. She also learned the value of wearing a proper supportive bra which helped to mold her breasts as well as provide long term support to preserve her wonderful new breast shape.
Age: 25 Breast Revision
This woman had a previous breast enhancement. She was not quite pleased with her results and wanted to know if there is anything I could do to improve them. She had 425cc saline implants that were easily palpable with mild rippling bilaterally. She had “bottomed out” both her implants (the implants had moved down and laterally over time because of the large size).
We corrected her problem by using smaller, 325cc silicone implants and adjusted the pocket extensively so the implant is located more superiorly and medially providing her with the perkier, more attractive breasts. It’s important that all post breast enhancement patients wear a “push-up” type bra (to reduce the load on their skin and minimize implant malposition).
