Age: 52 Breast Revision
This is a 52 year old mother of two, 5’10″ and 142 pounds, who had silicone implants placed above the muscle about twenty five years ago and now they are quite firm. In fact, her daughter told her that some of her friends noticed how firm they were when they hugged her.
You can see from her pre-operative photos that her breasts look somewhat distorted. The implants are sitting up high and the breast is falling off the implant with low-lying nipple-areola complexes. The breasts appear quite round and “ball-like” because of the contracture process. Her breasts were also tender and even painful at times.
We discussed all of her options at length. We elected to remove her ruptured implants and place new high profile implants in the submuscular position. We used 375 cc silicone implants. I preferred high profile because I wanted to narrow her wide appearing breasts (more youthful and projecting). We didn’t know the size of her existing implants so I used my best guess on size based on her anatomy and personal preference in terms of the way she wanted to appear.
It was a difficult procedure because it required a lot of dissection to completely remove her old capsule. The capsule is the scar tissue that develops around ALL implants. When it is this old it is usually calcified and needs removal so that it doesn’t distort the breast or interfere with future mammograms. I did not use ADM (Acellular Dermal Matrix) in her particular case but it certainly could have been used to help provide for internal support (it is common to use this material in breast revision procedures). I used drains in her case because I wanted to pull out the fluid that would certainly accumulate in the “old” subglandular pocket as she heals.
She is soft and natural now. You can see the difference clearly in the post-operative photos–a more natural “take off” of the upper breast, a better position of the breast implant that lifts the lower part of the breast, and most importantly, a very soft, natural feel. Best of all, she is a different woman now who invests in herself to a much higher degree than before surgery, because she has assets and not liabilities and because she looks as good as she feels. She passes the “hug test” with flying colors!
Age: 39 Breast Revision
This female patient wanted “larger and fuller” breasts. She had a moderate “tubular breast” shape. They were widely separated on her chest wall. She had enlarged nipple-areola and narrow breasts. In addition, she had clumps of dense breast tissue immediately beneath the areola. The breasts were also shaped differently and were different sizes. She was reconstructed by inserting 350cc silicone implants in the submuscular position. The implants were placed through an incision around the areola–in order to make the areola smaller. Her breast tissue was also manipulated so that it would be less “bunched or clumpy”. She was seen frequently early post operative to massage her breasts–to allow the implant to reshape her breast and expand the chest wall tissues to mold fuller, more symmetrical breasts.
Age: 44 Breast Revision
This female patient already had a previous augmentation with 230cc textured saline, anatomic (tear drop shaped) implants. She wanted more cleavage, larger implants and a more natural appearance. We revised her breasts by placing 325cc smooth, silicone implants with pocket adjustment and prescribed a post operative exercise regimen.
Age: 37 Breast Revision
This is a 37 year old mom, 5’3” and 135 pounds who had a previous breast augmentation performed elsewhere. She told me that she didn’t think her breasts were big enough. Her implants were silicone 225cc bilaterally and placed above the muscle (subglandular). On examination of her breasts, they were relatively soft and symmetrical. Nothing, per se, was abnormal. However, on further analysis her breast implants appeared somewhat “stuck on” in appearance (she described them as looking like Christmas ornaments). Her breasts also appeared quite round as her implants were above the muscle and they were not big enough to fill out her chest and appear natural.
I removed her implants and replaced them with moderate profile silicone variety, 350cc in volume, and put them below the muscle. You can clearly see that they “fit” her better. Submuscular placement of the implant resulted in a more natural slope of the upper breast and a better feeling breast. In her case, larger is better as they are more proportional and look more natural, less “stuck on.” A larger implant is also more appropriate in her chest wall contour as much of the volume of the implant is used just to fill in the “low” areas of her chest. As much as I encourage moderation of implant size, this is a rare case of “should have gone larger.”
Choosing the right style implant and correct implant size is a very critical component of a successful outcome, yet plastic surgeons use very different techniques. Some surgeons use measurements to determine breast size. This method is good if you don’t have the experience to simply “eyeball” the best fit. Various alternatives include computer imaging, sizing in the operating room, asking what size a patient prefers, bringing in photos that you would like to be, using what a girlfriend who’s already had a breast enhancement selected, and trying on sizers before surgery to see what works best.
In my opinion, the best alternative is the last. Seeing for yourself what your breasts would look like in the mirror, accompanied with feedback from your surgeon, is about as foolproof as it gets.
Age: 44 Breast Revision
This female patient had 400cc textured saline implants done 10 years ago and came to my office because she had a deflation of the left implant. In addition, she had a moderate contracture on the right side with excess superior fullness. She desired a natural shape, softer breasts, and greater symmetry. Therefore, we performed a removal of her implants, adjustments of both her pockets and replaced with 400cc smooth, round silicone implants.
Age: 35 Breast Revision/Reconstruction
This female patient had a previous breast augmentation and came to my office with a deflation of the right breast and a left breast that was contracted, displaced laterally and with rippling about the entire implant. She also has excessive superior breast fullness. She didn’t like the way her breasts feel, the way they behave, and their unnaturalness. She wanted softer, rounder implants with less lateral and superior fullness and more natural movement and appearance. Therefore, we placed smooth, round 300cc saline implants and adjusted both breast pockets.
