Breast Gallery

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 petite woman in her mid 20’s who is 32 E-F and is bothered by back and shoulder pain, as well as difficulty exercising due to the size of her breasts.  She is 4’ 9” and 114 lbs.  She is shown before and again, 6 months after bilateral breast reduction with the removal of just over 220 grams of tissue from each breast.  Her symptoms have resolved and she is happy with having a C cup.  Scars typically will get redder and thicker for 6 weeks and then will fade and improve over the next 2 years or longer.  We have had her using topical silicone to help with scar maturation.

A nurse in her mid 30’s who has some breast asymmetry after the removal of 2 benign tumors from her left breast, would also like to have breasts that are fuller and more proportional to her frame.  She is 5’10” and 157 lbs and wears a 34 B cup bra.  She is shown before and again, 6 weeks after the bilateral partial subpectoral placement of Ideal Structured Saline implants filled to 415 ml

Discussion: her nipple to Inframammary fold on the stretch is 8.5 cm and the base width of her breast is 12 cm.  The ideal implant 370-415 when filled to 415 has a base width of 11.7 which is equivalent to a base width of 12 cm.  The ideal implant is curved to fit the chest wall and we add 3 mm to the width and subtract 3 mm from the projection to match the equivalent standard implant. She wanted to have a natural look, and when the Ideal implant  Is wider than the existing breast base it can look overly round or “implant” like in appearance.  A nipple to IMF on a stretch of 8.5 cm would have allowed an implant base of 12.5 cm from the standpoint of keeping the nipple centered on the implant but is wider than her measured base width would suggest. The same size was used on each side because the difference in size was not enough to suggest different-size implants which would have a difference in projection and not appear as symmetric.

She loves her natural look after surgery and finds that her top is now in balance with her hips.  The Ideal structured saline implant also gives the peace of mind of not having to worry about silent ruptures.  She will see a change in size if one of the 2 chambers should fail.    A silicone gel implant rupture on the other hand is typically “silent”, or not noticeable on the outward appearance of the breast.  The FDA recommends that patients with silicone gel implants obtain an ultrasound at 6 years and then every 1-2 years after that.  The six-year recommendation is because the risk of a spontaneous rupture is very low before that point.  Ultrasound has been shown now to be a good screening tool for implant rupture and is significantly less expensive than an MRI.

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 early 30’s with bilateral severely retracted/ inverted nipples.  She had had surgery with dermal flap placement in Spain in 2019 with some improvement on her right but minimal improvement on her left.  She is happy with her breast size. There are many different methods suggested for the treatment of inverted nipples.  I have had success in my hands with a microincision approach, which I did here. In an inverted nipple, The nipple ducts are shortened and pull the nipple down.  Some methods of nipple correction use the placement of a graft or a flap, but I have not found this to be necessary with my technique.  She is shown before and again, 6 weeks after correction.

A medical professional in her early 30s who would like to have fuller breasts, but still have a natural appearance.  She is shown before and again, 6 weeks after bilateral partial subpectoral breast augmentation with Ideal structured saline implants filled to a total of 375.  An inframammary fold incision was used.

Discussion:

The width of her breast is 11.8 cm, and the Inframammary fold  to nipple distance on the stretch is 8.5 cm on her right and 9.5 cm on her left

The Ideal implant 335-375 when filled to 375 has a base width of 11.3.  We add 0.3 m to the base to give the equivalent base of a typical “flat” implant, as the Ideal implant is curved at the base to fit the chest wall. So 11.6 is less than her measured base of 11.8 and will not give her an overly round “implant” look, which she did not want.

We sized her in the office with the mentor sizing system and she did not want to be larger than 375 cc, as fuller implants looked too large to her in clothing.  We used the Ideal Structured saline implant 335-375, with the posterior chamber filled to 188 ml and the front chamber to 135 ml.  Together with the empty implant volume of 52 ml, this gives a total volume of 375

The next larger size of the Ideal implant of 375-415 would have had an equivalent base of 12( 11.7 plus 0.3 cm) and would have exceeded the natural width of her breast and tend to look unnatural and, although fuller in clothing would look like an implant. The Ideal implants are a little stiffer than silicone implants and I can go a little larger with a silicone gel implant and still look natural.  This was a moot point in her case as she did not like a fuller look in clothing, in any event.  If she had wanted to be bigger we would have to discuss the tradeoff of not having a natural look or switching to a silicone gel implant, neither of which she wanted.

A Hispanic male in her later 30’s is bothered by gynecomastia.  He developed female-appearing breasts at the age of 11 or 12.  He is bothered by the appearance of fitted clothes and at the beach. He wears compression garments to camouflage his appearance.  His weight has fluctuated up and down and he is mildly overweight.  As people gain and lose weight their skin has less elasticity.  The skin will shrink a little but the only way to tighten loose skin is to take a piece out and leave visible scarring on the chest which would make it difficult to take a shirt off at the beach.  Many patients prefer to have a correction of the contour and accept some looseness of the skin as he has here, to still be able to look normal with a shirt off.

A man in his early 30’s is bothered by female breast development which happened at the age of 15-16.  He was a regular marijuana smoker at the time and this may have been the cause.  He is bothered by the appearance of his chest with his shirt off and in fitted shirts.  He wears compression shirts under his shirt to camouflage his appearance.  He is shown before and again, just 6 weeks after bilateral gynecomastia excision with power-assisted liposuction using the S.A.F.E. technique combined with direct excision of breast tissue from an incision around the lower areola.  With the S.A.F.E. technique ( Separation Aspiration Fat Equalization) a finned cannula is used initially to breast up the fa.  Unlike energy-based liposuction such as Vaser or laser, this does not damage the fat cells.  Then liposuction is performed, then breast tissue is excised.   Then the remaining fat is smooth or “equalized” with the finned cannula… In my hands, this has given the smoothest result.  Scars are at their reddest and thickest at 6 weeks and will now soften and fade over the next year or more.  Topical silicone is prescribed to improve scar maturation.  Swelling will continue to improve over the next 4 ½ months.  He is already thrilled with his result. He is looking forward to a beach wedding, and finally feeling comfortable with his shirt off.

A woman in her late 50s with bilateral macromastia who describe herself as a 38 DD and had problems with back pain, neck pain, shoulder pain,  grooving and irritation of her shoulders from the bra straps, and a rash under the breasts in the summer time.  She is shown before and again, just 5 weeks after a bilateral breast reduction with the removal of more than 500 grams of tissue from each breast to reduce her to a full C cup. Scars typically will become thicker and redder for 6 weeks and then fade and improve over the next 2 years.  Her symptoms have resolved and she is thrilled with her new shape and size.  We will start her on topical silicone to help with the scar maturation.

A woman in her mid 60’s who was a 36DD cup and has problems with back pain, shoulder pain, grooving, and irritation of her shoulders from the bra straps.  She wanted to be a full C cup after surgery.  She is shown before and again, 8 months after bilateral breast reduction.  She loves her new shape and size, her symptoms have resolved, and her scars have faded nicely with the topical silicone.