A woman in her early to mid-30s who describes herself as a B cup and wishes to be a full C cup. She is 5’5” and 134 lbs and is shown before and again, 18 months after bilateral partial sub pectoral ( below the muscle) placement of Sientra high strength gel, smooth round high profile silicone gel implants 330 size. They were placed through an incision at the inframammary fold.
Discussion: The base width of her right breast is 12.3 cm and her left breast is 12 cm. The nipple to inframammary fold distance on the stretch is 9 cm on the right and 8.5 cm on the left.
The 330 HP implant is 11.7 cm at the base. When two breasts are different in size, which is common, we usually limit our size based on the smaller of the two breasts if we wish to maintain a natural appearance. When the implant is bigger than the base width it can start to give an “implant “ look. Also, the nipple-to-breast fold distance on stretch guides us in choosing an implant that is centered under the nipple. Typically, 7 cm on the stretch will accommodate an 11 cm base implant, 8 cm, a 12 cm base, and 9 cm a 13 cm base implant without looking overly “bulgy” (superior pole convexity) in the upper half of the breast. In this case, the implant gives her the volume that she liked during sizing in the office, but still gives her a natural appearance.
A woman in her later 30s with a deflated appearance of her breasts after weight loss. She is 5’ 4 14” and 112 lbs and is shown before and again, 4 ½ after the bilateral partial subpectoral placement of Sientra round smooth moderate profile cohesive silicone gel 355 breast implants. They were placed through an inframammary incision.
The base width of her existing breast are 11.9 cm on her right, and 11.8cm on her left. Her IMF-N ( infra-mammary fold to the nipple) distance on the stretch is 9 cm. This represents the approximate expected distance with the weight of an implant in the breast.
She was sized in the office and liked a volume of 350 but felt that 375 and 400 looked out of proportion to her petite frame. A Sientra 355 moderate plus projection cohesive round smooth high strength silicone gel implant is 12.1 cm at the base. Although this is 3 mm wider than her existing breast base it is s silicone gel implant and we can go slightly larger than the base without appearing unnaturally round once the breasts have had a few months to settle. More importantly, with an IMF-N on the stretch of 9 cm, a 12 cm base implant allows the breast implant to be centered under the nipple so that the upper ½ of the breast is optimally filled but not overfilled and bulging.
A 4 ½ months her breasts are full but not overly so and maintain a natural appearance.
Tattoos have been blurred for the patient’s privacy. The photos are otherwise untouched.
Details: A woman in her early 30s who has been thinking about breast augmentation for years, and describes herself as an “A” cup. She is thin at 5’8” and 131 lbs and has some mild breast asymmetry. She is shown before and again, 6 weeks after bilateral partial subpectoral breast augmentation with Sientra smooth round High profile High strength silicone gel implants placed through an inframammary incision. Her Inframammary fold was reinforced at the time of her surgery with long-lasting absorbable sutures.
Discussion: Her IMF distance on the stretch is 7.5 cm which suggests that the largest implant that we can use that will still look natural and not put excessive stress on her Infra mammary fold is the Sientra HP 300 ml implant with a base of 11.4 cm. Her existing breast base is 12.45 cm so this fits within that measurement and will therefore not give her an “implant” look, which she doesn’t want. She is thrilled with her full but still natural appearance after surgery.
A mother of 2 in her later 40s is bothered by the deflated appearance of her breast after children. She describes herself as a 34 B cup and would like to be fuller. She is shown before and again, 4 months after bilateral sub glandular Sientra smooth round 350 ml High profile cohesive silicone gel implant placed through an inframammary incision.
Discussion: Although a partial sub-pectoral placement of the implant is more common in my practice when a patient has some drooping and an increased stretch of the lower pole of the breast, a sub-glandular placement allows the implant to settle with the breast and gives a more natural appearance in this instance. If the implant is placed under the muscle and the breast “drops off” the mound we call that a waterfall effect and it does not look as natural.
A woman in her later 30s with a deflated appearance of her breasts after weight loss. She is 5’ 4 14” and 112 lbs and is shown before and again, 6 weeks after the bilateral partial subpectoral placement of Sientra round smooth moderate profile cohesive silicone gel 355 breast implants. They were placed through an inframammary incision.
An Asian mother of 2 in her later 40’s who described herself as a 32 A cup and wanted to have a fuller but still natural look. She has some asymmetry with her right breast being higher and slightly more lateral on her chest wall She does not want an “implant” look. She is shown before and again, 4 ½ months after bilateral partial sub-pectoral placement of round smooth highly cohesive silicone gel Sientra 255 High profile implants through an inframammary incision.
Discussion: The Sientra 255 HP implant is 10.8 cm at the base. The measured base width of her breasts was each 10.6 cm and the IMF to nipple distance on the stretch was 7.5 cm. A larger implant would have been significantly wider than her breast and would have been more likely to give her an overly round “implant” look, which she wanted to avoid. She is thrilled with her fuller but still natural appearance.
A mother of 3 in her early 60’s who is bothered by a deflated appearance of her breasts after children. She is 5’ 4” and 116 lbs and is shown before and again, 6 weeks after subglandular placement of Sientra 415 cc high profile smooth round high strength cohesive silicone gel implants.
Discussion: Although I would more typically recommend a subpectoral placement of the implants ( below the muscle) which may have a lower risk of capsular contracture, She has some early ptosis or drooping of the breasts. A subpectoral placement in her case would place her at a higher risk of a “waterfall deformity” with the breasts falling off of the implant mound. With a subglandular placement, the implants settle with the breasts and gives a more natural appearance.
An Asian mother of 2 in her later 40’s who is bothered by a deflated appearance of her breasts after pregnancy. She wanted to be fuller but still natural in appearance. She is shown before and again, 6 weeks after bilateral partial subpectoral placement of Sientra round smooth cohesive silicone gel implants.
Discussion: She has truncal asymmetry and her right breast is positioned higher on her chest, before and after surgery. This is a “foundation” problem and is not changed with implants. She is 5’ 3 ½” and 109 pounds and selected Sientra 255 High Profile implants. This helps to fill the deflation of the upper breast but because it is not wider than the base of her existing breast it does not give an “implant” look.
Breast Augmentation with a Mastopexy – Patient 333
Breast Augmentation with a Mastopexy – Patient 333
A mother of 1 in her late 30’s who is bothered by a deflated and drooping appearance of her breasts after weight loss and pregnancy. She wanted to be fuller and less droopy in appearance. She is shown before and again, 7 months after augmentation mastopexy ( a breast at the time of breast implant placement.)
Discussion: She is 5 1 ½ and 120 lbs. She had Sientra High strength round smooth cohesive gel 350 cc high profile implants placed in a partial subpectoral position at the time of an inverted T mastopexy. She did not want a larger implant that might draw to much attention in her workplace and likes the natural but fuller look.
A mother of 3 in her later 40’s who is bothered by being “ tint in the breast area” and described herself as a 32A cup. Her breasts became smaller after pregnancy and she now wanted to improve this. She still wanted to have a natural appearance after surgery. She is shown before and again, 1 yeaar after partial subpectoral placement of Sientra, High Strength cohesive silicone gel round smooth implants placed through an inframammary incision.
Discussion: She is 5’6” and 148 lbs Her nipple to infra-mammary fold distance on stretch is 7.2 cm on the right but just 7 cm on the left. She elected for a sientra HP 280 cc implant which is 11.1cm at the base. Typically an 11 cm base fits well with the nipple centered when the distance on stretch is 7 cm. I reinforced her existing inframammary fold at the time of surgery by anchoring it to the rib periosteum with long lasting dissolvable sutures to prevent it from “giving way” and leading to “bottoming out”. The Sientra silicone gel implants have the lowest reported rupture rate at 10 years of any of the silicone gel implants on the market. She is thrilled with her fuller but still natural appearance.