A woman in her mid 40’s with a deflation of her left implant. She initially had bilateral sub pectoral breast implants placed by another plastic surgeon in 2004. Her records shown McGhan (now Allergan) style 68 330cc saline implants filled to 360 cc on each side. She describes herself as a 36 C cup and was otherwise been happy with the results. She has a minor “waterfall” effect where the breast drops off of the implant mound with a sub pectoral placement. This could be corrected by changing to a sub-glandular placement of the implants but she likes the other potential benefits of sub-pectoral placement (decreased risk of capsular contracture, easier to perform a mammogram)
She noted a sudden decrease in the size of her left breast in 2019 but then “covid happened” and she was not able to get in for treatment. She decided to switch to the Ideal Structured Saline breast implants, and is shown before and again, 6 months after implant replacement.
Discussion: She has a minor “waterfall” effect where the breast drops off of the implant mound with a sub pectoral placement. This could be corrected by changing to a sub-glandular placement of the implants but she likes the other potential benefits of sub-pectoral placement (decreased risk of capsular contracture, easier to perform a mammogram)
There is no problem waiting for treatment after a saline implant deflation- If the implants can be replaced in the months after and before the tissues tighten around the deflated implant it can be slightly easier but a capsulotomy or release of the implant capsule is typically performed at the time of implant placement. The Ideal structured saline implants may have a lower deflation rate and are closer in feel to the silicone gel implants but filled with saline so they have the same “peace of mind” of avoiding a silent rupture. If they leak it can be detected without obtaining an ultrasound because the breast gets smaller. It is therefore not “silent”
She liked her size so the closest match is the Ideal structured saline implant size 335 cc with the back lumen filled to 188 and the front lumen filled to 135 cc, which, together with the empty implant volume of 52 cc gives a total implant volume of 375 cc.
A woman in her mid 30’s with partial deflation of her left breast ideal structured saline implant after 2 years. She is shown before and again, 6 weeks after replacement of the implant.
Discussion: Although the Ideal structured saline implant has a low failure rate, they do deflate on occasion. When this happens it is typically one of the two chambers and presents as a partial deflation. It has been easier to replace because the still intact second chamber tends to hold the shape of the base and makes it less likely that a full capsulotomy ( release of the contracted capsule) is required.
A woman in her mid 50’s who had breast augmentation done 19 years before when she was in her mid 30’s and when she was a 36 “C” cup, making her a “D” cup after surgery. Since that time she has gained some weight an is now a 38 DD cup. She is having problems with neck pain, and feels that the size of her breasts are a trigger fo migraines and are too big now for her frame. She originally had Saline implants placed through an infra-mammary incision (at the breast fold) and below the muscle. She did not have her old records.
The saline implants were sterily drained in the office and I removed 420 cc of saline from her left breast and 345 cc from her right. This was done a month before her surgery to allow her tissues to recover and allow us to judge how much volume she had to recreate a breast with her own tissue
She is shown again, 4 weeks after draining the implants and then 7 ½ months after removal of the deflated saline implants combined with bilateral breast reduction with a superior pedicle technique. She no longer has symptoms and is thrilled with the new size and more youthful appearance of her breasts.
Breast Augmentation Revision with Ideal Implants – Patient 314
Breast Augmentation Revision with Ideal Implants – Patient 314
A woman in her later 40’s with breast ptosis and deflation of her left breast implant.
She had breast augmentation 20 year before by a different plastic surgeon and noticed a sudden decrease in the size of her left breast 2 weeks before seeing me. She describes herself as a 36 D cup an d wa happy with the size. Since her breast augmentation she has had 2 children, which she breast fed, and her breasts have become “droopier” in appearance. Her implant information was obtained and she had Mentor 300 cc textured implants placed through a transaxillary incision and in a subglandular space. She is active at the gym and likes the lack of animation with a subglandular placement.
She is 5’9” and 167 lbs Sizing was done in the office and she elecdted for a slight increase in size. She is shown 11 months after bilateral implant removal, capsulotomy, and replacement with Mentor Smooth round moderate profile saline 400 cc implants ( 350-400 filled to 400) combined with a periareolar mastopexy using a Round- block Goretex suture. A separate inframammay incision was used to remove her old implants and place the new implants.
Mentor no longer makes a textured saline implant and the smooth surface was used.
Breast Augmentation Revision with Ideal Implants – Patient 313
Breast Augmentation Revision with Ideal Implants – Patient 313
A mother of one in her early 50’s who has a long standing deflation of her left saline implant. She originally had 275 cc smooth round mentor saline implants placed in a partial sub-pectoral position through an infra-mammary incision in 2007. She did well but 3 years ago had a spontaneous deflation of her left breast implant.
She is petite at 5’2” and 118 lbs and elected for a small increase in size. She is now 6 weeks after removal of her ruptured left implant and intact right implant, using the same incisions and replacing with Ideal Structured Saline implants 300 filled to the top recommended total volume of 340.
A mother of 2 in her later 40’s with a left breast implant deflation 2 weeks before seeing mye and breast ptosis ( drooping)
She had had breast augmentation 20 years before by a plastic surgeon who is now retired and described herself as a 36 D cup. She was happy with her size. She has had 2 children and breast fed since her surgery, and her breasts have drooped in appearance. She had her intial implant card showing mentor textured 325 cc saline implants. She had a capsular contracture on her right breast. Her initial surgery was transaxillary ( through the axilla) and her implants were above the muscle. She is active at the gym, and liked the lack of animation deformity ( movement of the implants with activation of her muscles( that is the tradeoff of placement of the implants above the muscles. However, there is a higher incidence of capsular contractrue both with a transaxillary approach and with a subglandular placement. She was sized in the office and liked a slight increase in size. There is a high risk of recurrence of a capsular contracture which can be decreased by changing the position of the implant to underneath the muscle, in a “new pocket”
At the time of surgery she had 350 cc implants filled to the maximum suggested volume of 400 cc and placed in a subpectoral space through an inframammary incision, combined with a periareolar mastopexy. At 5 ½ months after surgery her breasts remain soft, and her mastopexy scars have already faded nicely.
A woman in her late 50’s who had a sudden deflation of her right breast saline implant. She was 9 ½ years after bilateral breast augmentation and right mastopexy with Dr. Hall. She noticed a “funny feeling” on her right breast and the next day noticed that the breast implant had completely deflated. This was at the very start of the Covid 19 quarantine and we were able to first see her virtually online and then as soon as we were able to return to the operating room a few months later, we were able to replace her implants. She is shown now, 5 months after bilateral implant replacement.
Discussion: She has smooth round saline implants with the right side 400 and the left side 375. She is 5’4 and 139 lbs and was pleased with the original size that we had selected so we replaced them with the same size. The implants are under the muscle. The original incision along the inframammary fold was used on each side to replace her implants.
She asks me if she should change her exercise routine to prevent another deflation. The best answer is no. All implants will fail eventually, and a general number is around 8% of implants will fail by 10 years. The advantage of a saline implant is that this failure is not “silent” as it is with a silicone gel filled implant, because the saline is absorbed by the body and the implant gets smaller or generally goes flat. The FDA now recommends with Silicone gel implants that a patient obtain and ultrasound 6 years after surgery and then every 1-2 year thereafter to be able to detect a rupture when it occurs. With a saline implant, ultrasound follow-up is not necessary. Most of the implant companies have a kind of a warranty that is in force for 10 years, one of the companies (Sientra) has 20 years, and Ideal implant company allows you to renew the warranty each year for your lifetime if you desire for a small fee. The warranties typically provide some financial assistance toward the cost of the surgery and a new set of implants. Although the left implant was intact, since is has been 9 1/2 years she made the decision to replace both.
A mother of 2 in her later 40’s who had a breast augmentation 20 years before by another physician who has since retired. Earlier this year when she noticed a sudden deflation of her left breast. Since her augmentation she has had 2 children and breast fed and her breasts have become droopier in appearance. She retrieved her old records and she was noted to have textured Mentor saline 325 cc implants placed in a subglandular space through a transaxillary incision.
She is shown before and again, 6 weeks after removal of her old implants and placement of 400 cc smooth round saline implants through and inframammary incision, combined with a periareolar mastopexy.
Discussion: She likes the lack of animation with the subglandular approach and elected to keep her implants in that space. A transaxillary incision is now known to have a higher risk of capsular contracture and a new inframammary incision was recommended. Although the implants could have been placed through the peri-areolar incision, that would involve splitting the breast tissue and can lead to some unusual puckering and visible retraction of the breast tissue with my preference being for the separate inframammary incision. Permanent Goretex sutures were used around the areola to prevent spreading of the incision.
She was sized in the office and liked a slight increase to 400 cc. The textured saline implant was no longer manufactured by the Mentor company and we changed to a smooth implant.
Texture is controversial: The allergan Texture had a higher risk of Breast implant associated ALCL, a rare kind of lymphoma around the implant. It has a lower incidence with the Mentor and Sientra texture and may decrease the risk of capsular contracture in a subglandular placement and may also decrease the risk of shifting of the implants. In her case, she wished to stay with the saline implants and there was not enough of a benefit to texture in her case to switch to a textured silicone gel implant. Scars are at their peak at 6 weeks and will continue to fade and improve over the next 2 years.
A woman who had a silent rupture of her right breast silicone implant 9 years after her original surgery. She originally had Allergan Natrelle style 15 smooth round 397 cc implants placed in a subpectoral position through an infra mammary incision. She has some mild ptosis of her left breast but not enough to warrant the scars of a mastopexy. She did well until 9 years later when she noticed a change in the feel of her right breast with more folds notices on the side. An MRI was ordered and showed a rupture of the implant.
She has elected to increase slightly in size and was changed to an Allergan 450 cc Inspira Soft Touch smooth round high profile implant on each side.
She is shown before her first surgery in her early 40’s 9 years ago and 6 months after, and then 9 years after surgery and again 4 months after replacing the implants on each side, now in her early 50’s. The higher profile has given her back a little more upper pole fullness.
A mother in her later 50’s who was treated for bilateral ruptured silicone breast implants and bilateral nipple hypertrophy. She had had breast augmentation in the late 80’s by a plastic surgeon who had since retired. Her breasts had been hard since her surgery. She was also bothered by “long nipples” that were overly prominent in clothing and for which she would wear silicone nipple shields to hide them. The nipples were also very sensitive in the shower and in her clo6hing. I recommended an MRI to assess her implants which had been in place for 23 years, and it showed that bilateral subglandular silicones implants with intracapsular ruptured. Her original operative report was obtained and showed that she had 175 cc silicone gel implants. She wished to be a little fuller but still wanted a very natural look. She is petite at 5’2” and 115 lbs and is active at the gym, so did not want to appear unnatural in workout gear.
Sizing was performed in the office and she elected for a very modest increase in size to 250 cc moderate plus smooth round implants. Although there are benefits of placing the implant below the muscle, she did not want to worry about an animation deformity and elected to keep her implants in the subglandular space. She and family members have a history of easy bleeding and bruising and although a hematology workup was non-specific, I recommended against textured implants in her case which, although they may decrease the risk of capsular contracture in a subglandular position can have a potential problem with late bleeding and hematoma which I felt she was at more of a risk for.
She is shown before and again, 3 years after bilateral removal of her ruptured implants and creation of a new pocket below her breast capsule but above the muscle. A “top hat flap” nipple reduction was performed at the same time to reduce the projection and diameter or her nipples. She remains quite pleased with her new size. Her breasts have remained soft. And she no longer has nipple irritation in clothing or the shower, and no longer is embarrassed by excessive nipple projection.