A man in his early 30’s with gynecomastia. He first noted breast development at the age of 15-16. This bothers him with his shirt off and in fitted shirts. He wears additional shirts to camouflage the appearance of his chest. He does not have a history of marijuana or anabolic steroid usage. He has had endocrinology screening which is normal.
He is shown before and again, just 6 weeks after a modified S.A.F.E. technique using power assisted liposuction and external ultrasound assist, combined with a direct excision of breast tissue through an incision around his areola. The S.A.F.E. technique (Suction Aspiration Fat Equalization) uses a cannula with fins to mechanically loosen up the fat followed by power assisted liposuction to remove fat and then the finned cannula again to smooth or “Equalize” the remaining fat. In my hands this allows the most aggressive removal of fat with less chance of dimples and irregularities. I modify this technique by starting with external ultrasound to soften the fat. After the liposuction is performed I check the chest and if there is a distinct mass of breast tissue (as in his case) I excise this through an incision around the lower aspect of the areola. A gynecomastia vest is worn continuously for 6 weeks along with micro-pore tape. We have just removed his tape in the office. Although scars are typically the reddest and thickest at 6 weeks, he already has an excellent contour. He is thrilled to have a normal appearance of his chest again.
A 71 yo woman who describes herself as a 32 DD cup. She did not like the drooping of her breasts, and also felt that they were out of proportion to her frame and embarrassing in some clothing. She had shoulder and neck pain. She has had problems since she first developed breasts but has finally decided to do something about it. She is shown before and again, 7 months after bilateral breast reduction with an inferior pedicle/ short T scar technique. She is 5’2’ and 120 lbs and had just over 300 gms of breast tissue removed from each side to reduce her to a C cup.
A mother of 1 in her early 30’s who is bothered by a deflated appearance of her breasts after pregnancy and breast feeding. She describes herself as a 36 B and would like to be a full C. She is 5’4” and 158 lbs and is shown before and again, 6 weeks after bilateral subglandular placement of Ideal Structured Saline implants 370 filled to “100%” fill of 410 cc.
Discussion: Our patient wanted a natural but fuller appearance and wanted to restore some volume to her upper breasts. Her breast width is 13.97 on her right and 14.3 on her her left. Her nipple to breast fold distance on stretch is 9 cm. The diameter of the Ideal Implant she selected and filled to 410 is 11.7 I usually add 3 mm to the base width of the Ideal because is it designed to sit on a curved surface. So 12 cm is less than her breast width, so it will not “look like an implant”. Her nipple to breast fold on stretch is 9cm. Any more and she may be a candidate for a lift. If her implants were placed below the muscle the implant would move separately from the breast and the breast which is slightly lax would have a tendency to drop off of the implant- this is sometimes called the “waterfall effect”. In a case like hers where the breast is lax, a subglandular placement allows the implant to move with the breast and settle with the breast, giving a more natural look. The tradeoff for a subglandular placement is a slightly higher risk of capsular contracture.
The 370 implant has an empty implant volume of 56 cc. The inner lumen is always filled to 214 cc. The outer lumen is filled to 145 cc, giving her a total implant volume of 410 cc. This gives a higher profile, which helps to add some volume back to her deflated upper breast.
A woman in her late 40’s who wore a 42 GG cup bra and was bothered by back pain, grooving and irritation of her shoulders from the bra strap as well as a rash under the breast in the warmer months and difficulty exercising due to the size of her breasts. She is significantly over her ideal body weight at 5’3” amd 239 lbs but was not able to lose weight before surgery. She is shown before and again, just 4 months after surgery with the removal of more than 2 lbs of breast tissue from each breast. And inferior pedicle short T scar technique was used. Scars will typically continue to fade and improve over the next 2 years. She is already pleased with her new shape and size, and her symptoms have gone away.
A 39 year old woman who described herself as a 34B but wished to be a full C to D but still relatively natural in appearance. She was concerned about capsular contracture because of a friend who has breast augmentation elsewhere and wished to do everything to avoid this. She wanted to have some superior pole fullness as long as it would look relatively natural. After discussing the different implant choices she elected for an Ideal Structured Saline implant because she did not want to have to worry about a silent rupture. She is 5’5” and 137 lbs and elected for a 455 cc implant placed through an inframammary fold incision and below the pectoralis muscle.
She is shown before and again, 10 months after her surgery.
Details: We used the 405 cc Ideal Structured saline implant with the empty implant volume of 60 c. The inner lumen was filled to 235 cc and the outer lumen was filled to the maximum recommended volume of 160 cc to give a total volume of 455cc. ( “100% fill “) Because of the relatively large size of the implant that she selected, I reinforced her inframammary folds by anchoring her inframammary fold ligament to the rib periosteum at the time of surgery with a strong dissolvable suture to decrease the risk of “bottoming out”. This can be an issue with a larger implant when additional force is placed on the fold, causing it to “give way” and allow the implant to drop excessively. She is thrilled with her very full but still natural appearance, and her inframammary folds have been stable.
A more than 17 year follow-up on a woman who is now in her 40’s but had a breast augmentation with us at the age of 24 with saline implants. She had per-areolar incisions with partial sub-pectoral placement of 300-325 filled to 305 on her left and 325 on her right. She continues to do well and just stopped in for an implant check in our office. Her case illustrates 3 important concepts of breast augmentation.
First, pick the right size but don’t use an overly large implant. She is 5’2” and 117 lbs and has not had issues with too much stretching of her tissues because we did use too large of an implant for her tissues. 17 years later she still looks good.
Second: Don’t keep the nipple piercing in after surgery ( or a tongue or vaginal piercing) because they may increase the risk of capsular contracture by allowing bacteria that lives in the nipple ducts/ mouth or vagina to get into the blood stream and travel to the implant, leading to biofilm and a capsular contracture. Her breasts remain soft after 17 years.
Third: One huge benefit of saline implants is not having to worry about a silent rupture- the implant will go flat when it eventually leaks. So it is nice to be able to tell her that her implants are fine without getting an MRI or an ultrasound as would be need at this point to check on the integrity of a silicone gel implant.
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.
A 17 yo high school student who was 16 at the time of her surgery. She had consults with and interviewed multiple plastic surgeons before deciding who she wanted to perform her breast reduction. I am, of course, delighted that she chose our office. She was a 30 G cup and had problems with back pain, shoulder pain, irritation of her shoulders from her bra as well as difficulty exercising. She was active in gymnastics until she had her breast development at the age of 13, but was not able to do gymnastics since because of the size of her breasts. As an aside, 30 is a difficult band size to find and she was able to obtain these at Lula Bell in Hanover, Massachusetts. She wished to be a full C after her reduction. She is petite at 5’2” and 127 lbs and is shown just before her surgery at the age of 16 and again, now 10 months after her surgery. She had a short T scar, superior pedicle breast reduction with the removal of 596 gms of tissue from each breast. (454 gms make a pound). She is thrilled with her new shape and size. Her symptoms are gone. She was proud to show me the difference between her size 6 prom dress, which she called a “granny dress” before her surgery, and this year’s prom dress which is a size 2, and looks like it she belongs on the red carpet in a Hollywood premiere.
A 17 yo woman with 36DD-DDD breasts that have large since she was 13. She has not had any further breast development since she was 15. She has back pain, and also feels that her breasts are out of proportion to her body and draw undue attention. In addition she does not like the drooping appearance of her breasts. She is petite at 5’2” and 136 lbs .
She is shown before and again, 8 months after a superior pedicle breast reduction with a short T scar pattern and the removal of 250 gms of tissue from each side. Scars continue to fade and improve for 2 years or longer. She was meticulous in wearing a postoperative support bra and using the topical silicone that we recommended, as well as “resting her breasts” as instructed for 6 weeks after surgery. She loves her new shape and size, but is even happier to no longer have back pain. And the exciting news is that recent studies confirm that breast reduction via the inferior, medial or superior pedicle does not decrease the ability to breast feed later. And her clothes fit better now. She happily reports that she was able to go from a size 8 dress before her surgery to a size 4 for the most recent school dance! She is thrilled to be able to start her college without back pain or drooping breasts.
A 22 yo woman with breast asymmetry and macromastia who wears a 34 DDD cup bra and has problems with back pain, neck pain, grooving and irritation of the shoulders from her bra strap, difficulty with her posture especially in her job as hair stylist and also difficulty exercising due to the size of her breasts. She needs to wear extra sports bras to exercise. She is petite at 5 ‘ 3 ½ and 125 lbs. She is shown before and again, just 4 months after an inferior pedicle short T scar breast reduction with internal plication sutures to support her breast. 477 gms of tissue were removed form her right and 289 gms from her left ( 454 gms = 1 pound) to bring her down to a C cup. Although scars will continue to fade and improve over the next 2 years, she is already thrilled with her new shape and size. Her symptoms are gone, and she loves being able to exercise without extra bras.