Breast Augmentation Revision Gallery

A mother of 3 in her mid 40’s who had bilateral subglandular breast augmentation in another part of the country 17 years ago with textured round saline implants. She noted a sudden deflation of her left breast 6 months before seeing me. She was not able to obtain her old records but thought she had textured round implants of the 260-300 cc range. She wished to be slightly fully but still natural in appearance. She has an old breast biopsy scar on her right upper breast. She is not a good scar former and did not want to have the visible scars from a mastopexy (breast lift) The decision was made to replace her implants with a slightly fuller implant placed through her existing infra mammary scars ( at the breast fold).
So the question is what size implant to use? A nice option in a case like this is to drain her other implant in the office under local anesthesia, usually one month before surgery to allow the breast tissues to recover from the pressure of the implant. We can gain some information from the amount of fluid that we remove from the implant, and can then perform our sizing in the office with the Mentor sizing system, a set of silicone shells of different sizes that slip over the breast inside the bra and are excellent at simulating the final size in clothing. Based on this information she selected a 375 cc size, which is a 325-375 cc moderate profile saline implant filled to 375 cc. She is shown before and after deflating her right breast implant and again, 6 weeks after replacement with a smooth round saline implants under general anesthesia at the hospital in the same subglandular plane(above the muscle) through her existing infra mammary incision. A subglandular placement allows the implant to drop with the breast and can decrease the need for a breast lift in some patients who are on the borderline.

A 13 year followup on a patient with saline breast implants. Her case was made more complicated by having a history of Von Willebrand’s disease, which can increase the risk of bleeding. Clearance was obtained from her cardiologist she was given DDAVP ( STIMATE) just before and after her surgery. She had 325 cc smooth round saline implants placed through an inframmary incision and above the muscle (sub-glandular). She did not have any problems with bleeding after her surgery and is still doing well 13 years later. She was back for a routine check, One advantage of saline implants is that it is easy to tell if they have leaked ( the saline is absorbed and they go flat) so they are easy to evaluate without obtaining an MRI or ultrasound.