Breast Augmentation Revision/Ideal Implants – Patient 292
A woman in her mid 20’s with a tuberous breast deformity. She is bothered by the shape and also the size of her breasts. She wanted to be fuller but still natural in appearance. With a Tuberous breast, the base of the breast is relatively constricted and narrow and needs to be expanded. The breast is overly “pointy” and needs to have the shape flattened a little. A periareolar round block gortex suture flattens a tuberous breast and improves the shape. She is 5’5’ and 132 lbs but the base width of her breast is just 10.7 cm on her right and 10.5 cm on her left. The inferior areola to the breast fold distance is just 5 cm. So an implant needs to be carefully chosen that will widen the base of the breast but not be too large for the new nipple to breast fold distance which with reduction of the areolar with a gortex suture would be 7 to 7.2 cm. This would suggest based on the geometry that an implant with a base width of 11-11.2 cm is the widest that can be used without needing to lower her breast fold. Lowering the fold increases the risk of “bottoming out” and also of a “double bubble”.
She elected for the Ideal structured saline implant and so the 300 cc implant was selected. This has a base width of 11.1 cm so it is just a little wider than the base of her existing breast which helps to widen the base of the breast, but is not too large for her new nipple to fold distance after her periareolar round block suture is placed. The implant was placed in a subglandular plane.
The 300 cc implant has an empty implant volume of 37 cc due to the internal baffles, and the back/inner lumen is designed to be filled to 188 cc. The front lumen can be filled to 75 cc to give a moderate profile and total volume of 300 or to 115 cc to give a high profile and a total volume of 340 cc.. In her case a moderate profile has a better effect and the implant was filled to 300 cc total volume. She is shown before and again, just 3 months after surgery.
The scars around the areola will typically continue to fade and improve over the first 2 years after surgery. She is already thrilled with her new shape and size. It would have been difficult to use a larger implant in her case and still maintain a natural appearance because of the tissue dimensions of her breast.
A mother of 2 in her late 40’s who is bothered by a deflated appearance of her breasts after pregnancy. She describes herself as a 34 B cup and would like to be a C to CC cup. She is 5’2” and 132 lbs and is shown before and again 2 ½ years after bilateral partial sub-pectoral placement of 350 cc smooth round moderate profile plus cohesive silicone gel implant, placed in a dual plane position through an inframammary incision.
Discussion. She has a drooping appearance of the breasts but her nipple is still located above the breast fold. When part of the breast falls below the fold in this way it is called “pseudo-ptosis”. Pseudo means “false” and ptosis is a word for drooping so “false drooping” because the breasts look droopy but the nipple is still located above the breast fold. A dual plane approach releases the lower edge of the pectoralis muscle to allow it to ride up, so that the implant sits under the breast in the lower breast but under the muscle in the upper breast. This gives some of the benefits of being below the muscle (easier to do a mammogram, less capsular contracture, more padding over the implant) but also allows the implant to settle more with the breast which is an advantage of the sub-glandular approach (above the muscle). There is then less of a “waterfall” effect with the breast dropping off of the implant.
A woman in her later 30’s who wishes to have fuller breasts. She has not had children or significant weight loss but does work out 2 hours a day at the gym and finds that her breasts have deflated in appearance. She is 5’6” and 133 lbs and describes herself as a 34 A to small B cup. Based on her tissue dimensions she was sized in the office and felt that a 400 cc implant was too large but liked the 350-375 cc size in clothing, using the Mentor sizing system.
After discussions she elected for a Mentor 375 cc high profile micro-textured implant placed through an inframammary incision in a partial sub-pectoral position. She is shown before and again, 5 months after surgery. She is thrilled with the fuller but still natural appearance of her breasts after surgery.
Discussion: A high profile was chosen to try and add some fullness to the deflated upper breast. Breast implants tend to shift to the side and to drop with time. This is more of a problem in “looser” breasts after weight loss or pregnancy. Texture can decrease the risk of this shifting. But texture can also increase the risk of Breast-implant associated ALCL, a kind of lymphoma that can start in a late fluid collection (seroma) around an implant and is felt to be related to Biofilm around an implant. Although rare, it has only been reported after the use of textured implants. It is more common in aggressively textured implants. When we chose to use texture I prefer the micro-textured implants such as the Mentor, which gives us the benefits without as many risks. In our patient’s case, after discussing the tradeoffs, she felt that the greater stability of the implant was worth the small increased risk of BIA-ALCL that is seen with texture.
A woman in her mid 40’s who has lost 70 lb with diet and exercise and would like her breast to be fuller. She described herself as a 34B cup and wanted to be a C to full C cup. She was fearful of silicone and silent rupture and wanted saline implants. She is 5’6” and 134 lbs. Sizing was performed in the office based on her tissue dimensions and using the Mentor sizing shell system. She liked an implant size around 400 in clothing and felt that 450 was too big.
She is shown before and again, 9 months after bilateral partial subpectoral (below the muscle) placement of Ideal Structured Saline 370-415 cc implant filled to 415 ( the equivalent of a high profile implant) placed through an inframammary incision ( at the breast fold). She is thrilled by the fuller but still natural appearance of her breasts.
Tattoos have been blurred for her privacy. The photos are otherwise untouched.
A woman in her early 20’s who wants fuller breasts but still natural in appearance. She is concerned about silent rupture and has elected for the Ideal structured saline implants.
She is petite at 5’3” and 109 lbs and wore a 32 A to B cup before surgery. She is shown before and again, 4 ½ months after bilateral partial sub-pectoral breast augmentation with the placement of the 300cc Ideal structure Saline implant filled to the 300cc total volume. The empty implant is 37 cc, and the back/inner lumen is filled to 188 cc and the front/outer lumen is filled to 75 cc to give the total volume of 300 cc.
A woman in her early 20’s who describes herself as a 32 a-b cup and would like to be fuller but still relatively natural in appearance. She wanted the Ideal structured saline implant because she did not want to worry about silent rupture but wanted a more natural look and feel than the traditional saline implants. She is shown before and again, 3 months after bilateral partial sub=pectoral placement of the 300 cc Ideal implant filled to 300c, placed through an inframammary incision.
Discussion: She is very petite. When sized for a bra we are taught to measure around the chest just under the breast and add 3 inches- she measures 28” so a 31” bra would be her actual band size if they were made. The base width of her left breast is 11.2 cm. With the Ideal implant the edges are a little firmer and it is best to use an implant base width that is less than the actual breast base width. In a silicone gel implant it is possible to go slightly wider.
In addition, she has a mild pectus excavatum, a hollow in the sternal area that limits the medial placement of the implant. The base width of the 300cc ideal implant is 10.9, so it just fits within the base of her breast. The next larger size is 5 mm wider and would tend to stretch the breast more and appear unnatural. So, as is our usual practice, we want to use the largest implant that we can use that still looks relatively natural and won’t cause problems by overly stretching the breast.
A woman in her early 20’s who is bothered by breast asymmetry and would also like to have fuller breasts. She describes herself as a 34 B and is 5’3” and 150 lbs. She is shown before and again, 5 ½ months after bilateral partial subpectoral breast augmentation through an inframammary incision with a 300 cc smooth round moderate profile plus silicone gel implant on her right and a 200 cc smooth round moderate profile plus silicone gel implant on her left.
Discussion: The difference in her nipple position is not enough to justify the typical scar of a mastopexy (breast lift). Her right breast is the smaller and tighter of the two breasts and limits the size of the implant that can be used. So we choose the largest implant that will fit in her right breast based on her breast dimensions and that she also finds acceptable in clothing, and then work backwards with a smaller implant on her left breast to match as closely as possible. A larger implant on her right breast would have more fullness in the upper breast because it would be even more implant to breast proportionally and therefore not match the shape of her left breast as closely. She is thrilled with her result.
A mother of 3 in her mid 30’s who is bothered by a deflated appearance of her breasts after pregnancy. She describes herself as a 34 A, and would like to be a C cup but still natural in appearance. She is 5’7” and 130 lbs and is shown before and again, 5 ½ months after breast augmentation. She elected for a 350 cc high profile round silicone gels with microtexture which were placed through an inframammary incision is a partial subpectoral position.
Discussion: she is quite thin and the caliper pinch of her breasts is only 1.4 cm which places her at a higher risk of palpable and visible ripples. She has some asymmetry of the nipple position, but not enough after discussion to warrant the scars of a mastopexy (breast lift). The high profile helps to add some volume back to the deflated upper breast. The texture may decrease the risk of the implants shifting with time to the side. The micro texture may have less risks of late seroma formation, pseudocapsule and BIA-ALCL than is seen with the more aggressively textured implants.
A 20 yo woman with breast asymmetry who wished to be more symmetry in and out of clothing. She is 5’6” ‘and 149 lbs. She has elected for the ideal structured saline implant and is shown before and again, 7 weeks after bilateral partial subpectoral placement of the Ideal implants through an inframammary incision. She has a 370 cc implant filled to the “high” volume of 370 on her right, which is actually similar to a moderate profile implant in profile and a 210 cc implant filled to 235 cc on her left which is closer to the “100%” and more similar to a high profile implant in profile. The right breast, which is the smaller of the two breasts will tend to have more superior pole convexity, or fullness of the upper breast because it is relatively tighter. So to balance the upper pole fullness between the two breasts, a higher profile is used on the left, but, of course, a smaller implant to better balance the size.
Update: Our patent is now seen 5 months after her surgery. The breasts have softened in appearance as the breast tissues stretched to accommodate the implants.
A mother of 3 in her late 30’s who feels like her breasts are too small to balance her frame, and is also bothered by breast asymmetry in a bathing suit and in T shirts when she is not able to wear a padded bra to camouflage. She has selected the ideal structured saline implants because she didn’t want to worry about silent rupture but wanted an implant that feels more natural than the traditional saline.
She is 5’6” and 138 lbs and is shown before and again, 6 weeks after bilateral partial sub-pectoral breast augmentation through and inframammary incision with a 300 cc Ideal structured saline implant on her left filled to 320cc which is above the “high” but below the “100%” fill volume, and a 440 cc Ideal structured saline implant on her right filled to the “high” of 440 cc. Tattoos have been blurred for her privacy.
Update: At 5 months the breasts have softened in appearance