An medical professional and mother of 1 who describes herself a s a 32 A cub. She was a C cup with her pregnancy and wanted to be a C cup again if possible. She did mind a slight implant look if needed to achieve her goals as long as she did not look overly unnatural. She has a mild pectus excavatum ( a depression of the sternum) She is shown before and again, 6 weeks after bilateral partial subpectoral breast augmentation with the placement of 350 cc high profile textured silicone gel implants using the milder texture.
Surgical planning: The width of her breast were 12.1cm on the right and 12.6 cm on her left. The nipple to inframammary fold distance on stretch is 8cm on her right and 7cm on her left. There is a mild laxity of her tissues from her previous pregnancy. The 350 cc high profile implant has a base width of 11.7 cm and this was the largest implant that would “fit” without requiring us to lower her inframammary fold and risk a double bubble or collapse of the fold and bottoming out. Texture was chosen to prevent medial migration of her implants over time into her pectus excavatum. Texture can be controversial because of it’s association with the rare condition of BIA-ALCL but seems to be less of a problem with the milder textures. It also is felt to be related to biofilm formation and we used the typical measures during surgery to avoid this: nipple shields/insertion sleeves ( “Keller funnel” ) as well as antibiotic irrigation. I also recommend that my breast implant patients take oral antibiotics just before dental cleaning or procedures to decrease the risk of bacteria from the mouth going through the blood stream and settling on the implant after surgery. In her case, after discussion she felt that the possible tradeoffs of texture were worth the benefits of better stability of the implants over time.
A woman in her early 30’s who wished to have fuller breasts. She described herself as wearing a padded B cup bra and wished to be a C cup without the padding. She had initially seen us two years previously and was not comfortable with the implant choices available at the time. She chose the Ideal breast implant once it was available, because it has a more natural feel than the traditional saline implant but without the risk of a “silent” rupture. It appealed to her to be able to follow her implants after surgery by simple observation rather than with ultrasound or MRI which is needed to detect the failure of a silicone gel implant.
She is 5’5” and 131 lbs and selected a 270 cc implant in the office. She is shown before and again, 6 weeks after partial subpectoral placement of 270 cc Ideal structured saline implants through an inframammary ( at the breast fold) incision. She is thrilled with her fuller but still natural appearance. The Ideal implants have two lumens and can be filled to give either a moderate or a full profile look. In this case the 270 is similar to a moderate profile standard saline implant in projection. It could also be filled to 305cc to give the equivalent of a high profile.
A woman in her mid 40’s who has lost 80 lbs and is bothered by a deflated appearance of her breasts. She has always wanted breast implants but was concerned about the possibility of a silent rupture with a silicone implant, but did not like the potential problems with rippling and wrinkling that can be seen with traditional saline implants. She wanted to be fuller but still natural in appearance, and wanted some volume back in the upper portion of her breasts. She was excited that the Ideal structured saline implants are now available and after careful sizing in the office based on her nipple to fold distance on stretch and the base width of her breasts we selected a 415 cc total volume Ideal breast implant. When it is filled to the full capacity it has the profile of a “high profile” silicone implant which is good for restoring some fullness to the upper breast. She is 5’5” and 134 lbs and is shown before and again, 6 weeks after bilateral “dual plane” placement of the Ideal breast implants through an inframammary incision
A mother of 3 who is bothered by a deflated appearance of her breasts and would like to have fuller breasts. She is 5’ 5” and 128 lbs. She is shown before and again, nearly 4 years after bilateral partial sub-pectoral placement of smooth round 350 cc moderate profile plus silicone gel implants through an infra mammary incision.
A mother of 3 who is now in early 50’s. She was bothered by a deflated look of her breasts after pregnancy and wished to be fuller but still natural in appearance. She is 5’6” and 167 lbs and is now 11 years after bilateral partial sub-pectoral breast augmentation with smooth round moderate profile 375 cc saline implants, She stopped by the office for a quick check and to see if she needed to “do anything” now that her implants are 11 years old. This is a question that comes up frequently. Breast implants in general have about an 8 % rupture rate in 10 years- that means that in 10 years, 8 patients out of 100 will have developed a leak. If she had silicone gel implants it would be reasonable to send her for an ultrasound or an MRI to see if the implants are intact- a “silent” rupture can occur with silicone implants and it may not be possible to tell if the implant is intact without one of these tests. With saline implants its much easier. If the implants are still there when you look in the mirror, then they are intact! So this is the big advantage of saline implants. If the implant leaks, the saline gets absorbed by the body and the implant shell goes flat. The breast “deflates” and it’s obvious. Not a panic situation but time to consider a replacement. But she is doing great, her breasts remain soft, and she can wait until she has a deflation. This could be 20 or more years. I have personally seen patients who are 30 years out from saline implants (before I started my practice) who still have intact implants. I generally recommend that my patients with Silicone gel implants get an ultrasound at 9 years after their surgery-a silent rupture doesn’t cause any immediate problems- there may be some slow thickening of the capsule of scar tissue around the implant over the years, but if it is failed it is better to know before the warranty has expired at 10 years.
This case also illustrates the importance of choosing the proper sized implant. An overly large implant is heavier and may cause more stretching of the tissues with time.
A woman in her early 20’s who would like to have breasts that are fuller and more proportional to her frame, but still natural in appearance. She is 5’4” and 154 lbs and is shown before and again, 6 weeks after bilateral partial sub-pectoral breast augmentation with 425 cc high profile smooth round implants placed through an infra-mammary ( at the breast fold) incision. She also had a retracted nipple on the left and requested treatment at the same time. A micro-incision technique was used. Her left breast is smaller than the right and it was necessary to lower her left breast fold slightly to accommodate this sized implant. I am cautious when lower a breast fold because sometimes it can “give way” and the implant can drop-this is called “bottoming out”. In order to decrease the chance of this happening her left breast fold was anchored with internal sutures to the rib periosteum on the left. She is thrilled with her fuller but still natural appearance.
A challenging case in a woman with small breasts and a tight skin envelope, as well as pectus excavatum ( a hollow depression in the chest bone) who wishes to have a natural appearance. When the chest wall is sloped, the implant will tend to migrate “down the slope” towards the middle with time. Therefore we selected textured, cohesive silicone round gel implants. When the tissues are tight the implant needs to be even more precisely matched to the patient. She is 5’5” and 120 lbs and is shown before and again, 22 months after partial subpectoral placement through an inframammary incision. 305 cc Sientra implants were used. Tattoos are blurred for privacy.
A woman in her early 30’s who describes herself as an A-B cup and would like to be closer to the padded C cup bra that she currently wears, but still natural in appearance. She is 5’ 2 1/2” and 112 lbs and after careful sizing in the office based on her tissue measurements and characteristics a 325 cc moderate profile plus smooth round silicone gel implant was selected. She is shown before and again, 6 weeks after partial subpectoral ( below the muscle) placement of the implants through an infra mammary ( at the breast fold) incision. She is thrilled with her fuller but still natural appearance.
A mother of 1 who has gained and lost 90 lbs with her pregnancy. She does not feel feminine because of her flat chest “ like a 14 year old boy” and wants to have a fuller but natural look. She describes herself as a 32 iA but was a 36 C cup before pregnancy. She is 5’6” and 135 lbs. She is shown before and again, 18 months after Sientra, round, 385 cc High Profile silicone gel textured implants. They were placed in a dual plane position through an inframammary ( at the breast fold) incision. The High profile implant was selected to help add some fullness to the upper part of the deflated breast. The goal is to fill but not overly stretch the breast, and her breast was deflated after pregnancy and weight loss. Texture is chosen to decrease the tendency of a smooth implant to drop and/or slip to the side with time. A ”dual plane” allows the implant to be under the muscle in the upper breast and under the breast in the lower breast. This helps when the breast is starting to droop to allow the implant to settle more with the breast and decrease the tendency to a “waterfall” effect where the breast drops off the implant. At 18 months she has maintained a stable and natural looking result.