Breast Augmentation/Ideal Implants – Patient 296
A mother of 2 in her late 30’s who has 2 children and breast fed. She describes herself as a 34 B cup but would like to be a C cup. She is 5’2” and 127 lbs and is shown before and again, 6 weeks after bilateral partial subpectoral placement of Ideal Structured saline implants.
She had the 270 cc implant with the inner lumen filled to 165 cc, the outer lumen filled to 70 cc to give, along with the empty implant volume of 35 cc a total volume of 270 cc. This is considered the “ High” volume. The outer volume could also have been filled to a total of 200 cc to give the “100%” fill of 305 cc for this particular implant. She is thrilled with her fuller but still natural appearance.
Update: Our patient is now seen 11 months after surgery. The breasts have softened in appearance and appear even more natural.
Breast Augmentation – Patient 297
A long term follow-up on a woman now in her later 30’s. This helps answer the question of “what will happen to my breast if I get pregnant after breast augmentation” She was initially seen in her late 20’s and described herself as a 32 AA cup and wanted to be a B or C cup if possible, but still natural in appearance. She is petite at 5 feet tall and 101 lbs. She elected for a smooth round silicone gel implant placed in a partial subpectoral position through an inframammary incision. A 250 cc high profile implant was used. This was the largest implant that I felt would still fit her tissues without looking overly round. She is shown just before and again, 10 months after surgery She has since had a child, and is shown again, 7 1/2 years after surgery. Although the breast typically gets larger with pregnancy and then smaller after, she has not developed significant drooping or stretching of her tissues and has maintained an excellent result. This is partly because she does not have as much native breast tissue to change with pregnancy, and partly because she did not have an implant that was too large for her tissues and could therefore lead to more problems with stretch.
Breast Augmentation/Ideal Implants – Patient 296
An RN in her later 30’s who wished to have fuller breasts. She comes from another state and found us after seeing one of our patients and being impressed by the natural appearance of her results. She wanted to have a natural but fuller appearance. She found that her breasts looked deflated after losing weight with diet and exercise.
She is 5’6” and 119 lbs. She is shown before and again, 6 weeks after sub-glandular placement of Ideal Structured Saline implants size 370 cc through an inframammary incision.
Discussion: The empty Ideal implant volume is 56 cc. The Back/inner lumen is filled to 214 cc. The front/outer lumen is filled to 100 cc. This gives a total volume of 370 cc. This is listed as “high” fill on the sizing chart. The outer lumen is also designed to be filled to 145 cc which would give a total volume of 415 and is listed as “100%” fill. This greater fill volume is similar to a high profile implant and gives a slightly firmer feel. She did not want to be fuller than the 370 upon sizing in the office and prioritized the softer feel of the implant at 370.
A sub-glandular placement was chosen in her case. With a caliper pinch of 3.2 cm her breast tissues are thick enough to hide the implant ( 2 cm or less is usually considered “thin”). Her nipples are just slightly above the breast fold and she would be prone to a “waterfall effect” with a placement of the implants below the muscle. With a sub-pectoral placement the breast can fall off of the implant. With the sub-glandular placement the implant drops with the breast and avoids the “waterfall”. So when a patient has a nipple just at or above the fold but does not yet require a mastopexy, a sub-glandular placement can be a good tradeoff when the breast tissues are thick enough to hide the implant.
Breast Augmentation – Patient 295
A mother in her early 40’s who would like to have fuller breasts. She is 5’4” and 116 lbs and is shown before and again, 6 weeks after a bilateral partial subpectoral breast augmentation with 275 moderate profile round smooth silicone gel implants placed through an inframammary incision.
Breast Augmentation/Ideal Implants – Patient 294
A mother of 3 in her late 30’s who wanted fuller breasts. She describes herself as a 34 A cup and wanted to be fuller but still natural in appearance. She petite at 5’3” and 114 lbs and with a measured circumference around her chest of 29 ½ inches, is closer to a 32 Band size bra. ( 3 inches is typically added to this measurement to get the proper band size)
After reviewing the implant options she decided upon the Ideal Structured Saline implant. She was happy to not need to worry about a silent rupture, and even happier to be able to purchase an enhanced warranty from an outside insurance company that she will be able to renew annually for life. The base-width of each breast is 11.85 cm and the nipple to IMF on stretch distance is 8.5 cm. She was sized in the office and liked 325/350 but felt that 375 was simply to full in her clothing. Our decision was for the Ideal 335-375 cc implant that has a base-width of 11.4 cm, filled to a total volume of 350 cc. The implant has an empty volume of 52 cc, and the back/inner chamber is filled to 188 cc. The front/outer chamber was filled to 110 cc to give a total implant volume of 350 cc. Her implants were placed below the pectoralis muscle and through an inframammary incision. She is shown before and again, 4 ½ months after surgery. She is thrilled with her fuller but still natural look.
Breast Augmentation – Patient 293
A woman in her early 30’s who wants fuller but still natural appearing breasts. She is 5’6” and 120 lbs . She describes herself as a 34 small A and wants to fit into bras and clothing but still have a relatively natural appearance. She did not mind the idea of a slight implant look out of clothing if needed to obtain her goals in clothing,
She was carefully sized in the office based on her tissue dimensions and characteristics and we were able to use a 350 cc high profile round smooth cohesive silicone gel implant placed in a partial sub-pectoral position through an infra=mammary incision.
She is shown before and again, 4 ½ months after surgery. Tattoos are blurred for her privacy.
Discussion: She is thrilled to have a natural but fuller appearance. Casual acquaintances’ and coworkers know that she looks better but are not sure why. She loves the fact that her clothes and tops fit her now. Her pre-op breast width is 11.9 cm and the nipple to IMF distance is 6.5 cm, but 8 cm on stretch. The chosen implant is 11.7 cm at the base and 4.8 cm in projection. Because the implant width is not wider than her breast base she does not have an “implant look”. When the nipple to infra-mammary fold distance is 8 cm on stretch then it is best to use an implant that is 12 cm in diameter or less to avoid excessive superior pole convexity. Again, the implant chosen fits her dimensions well.
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.
Breast Augmentation – Patient 292
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.
Breast Augmentation – Patient 291
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.
Update: Our patient is now seen close to 2 years after breast augmentation. The micro-textured implants have remained stable and have not shifted as we might expect to have seen with smooth implants.