A mother of 2 in her later 40’s with a left breast implant deflation 2 weeks before seeing mye and breast ptosis ( drooping)
She had had breast augmentation 20 years before by a plastic surgeon who is now retired and described herself as a 36 D cup. She was happy with her size. She has had 2 children and breast fed since her surgery, and her breasts have drooped in appearance. She had her intial implant card showing mentor textured 325 cc saline implants. She had a capsular contracture on her right breast. Her initial surgery was transaxillary ( through the axilla) and her implants were above the muscle. She is active at the gym, and liked the lack of animation deformity ( movement of the implants with activation of her muscles( that is the tradeoff of placement of the implants above the muscles. However, there is a higher incidence of capsular contractrue both with a transaxillary approach and with a subglandular placement. She was sized in the office and liked a slight increase in size. There is a high risk of recurrence of a capsular contracture which can be decreased by changing the position of the implant to underneath the muscle, in a “new pocket”
At the time of surgery she had 350 cc implants filled to the maximum suggested volume of 400 cc and placed in a subpectoral space through an inframammary incision, combined with a periareolar mastopexy. At 5 ½ months after surgery her breasts remain soft, and her mastopexy scars have already faded nicely.
A nursing student in her late teens who had breast development at the age of 11 and described herself as a 32 H cup bra. She had problems with back pain, shoulder pain, irrigation of the shoulders from her bra strap, intertrigo in the warmer months (a rash under the breasts) as well as difficulty exercising due to the size of her breasts. She is shown before and again, 6 months after bilateral breast reduction, reducing her to a C cup. She is 5 feet ½ inches and had 360 grams of tissue removed from her right breasts and 490 grams of tissue from her left breast. (454 grams= 1 lb.)
She is thrilled with her new size, her symptoms have resolved and she is able to exercise comfortably again. Scars will typically continue to fade and improve for 2 years or longer.
A mother of 2 in her early 30’s who is bothred by a deflated appearance of her breasts following pregnancy. She is 5’ 3 ½” and 132 lbs and is shown before and again, just one 6 days after bilateral partial subpectoral breast augmentation through an inframammary incision with 385 cc Sientra High profile round smooth cohesive silicone gel implants.
Discussion: The implant is 12.3 cm at the base. Her left breast base is 12.3 cm and her right breast is 12.5 cm. Her inframammary fold to nipple distance on stretch is 9 cm. The 12.3 cm base fills her breast but does not overly stretch her breast and even at just 6 days after surgery has a natural look because it is the proper size for her and is not significantly wider than her excisting breast. With an nipple to breast fold of 9 cm, an implant of 12 cm is needed to adequately fill the breasts. So this implant restores her lost fullness from pregnancy, but because is is not wider than her breast does not give her an “implant look” She is a medical professional and wanted to have a natural appearance after her surgery.
A woman in her early 60’s who describes herself as a 38 DDD and has had problems with back pain, shoulder pain, grooving and irritation of the shoulders from her bra strap, and a rash under the breasts in the warmer months. She has had physical therapy in the past for her back pain, without success. She is shown before and again, 4 ½ months after bilateral reduction-mastopexy, with the removal of 360 grams from her left breast and 430 grams from her right breast to reduce her to a “C” cup. Internal plication/reinforcement was used to help with the breast lifting component.
Scars will typically continue to fade and improve for the next 1 ½ to 2 years. She is using topical silicone twice a day to help these to continue to fade. She is absolutely thrilled with her new shape and size, and her symptoms have completely resolved!
An early follow-up of a woman in her late 40’s with bilateral breast hypertrophy. She wore a 34 F bra and was bothered by the typical problems with back and shoulder pain, grooving and irritation of her shoulders from the bra straps and difficulty exercising due to the size of her breasts. She is shown before and again, 4 ½ months after bilateral breast reduction with the removal of more than 500 gms from her right and more than 600 gms from her left to reduce her to a C cup to better match her frame. Scars will typically fade and improve over the next 2 years. She is already thrilled with her new shape and size, and her symptoms have all resolved.
A medical professional in her early 30’s who is bothered by the small size of her breasts. She describes herself as a 34 A cup and would like to be fuller but still natural in appearance. She is 5’9” and 157 lbs and is shown before and again, 6 weeks after bilateral partial subpectoral breast augmentation with 350 cc Sientra Opus 600 series round smooth cohesive high strength silicone gel implants placed through an inframammary incision.
Discussion: She likes fullness in the upper breast and does not mind a slight implant look if needed. Her nipple to Inframammary fold distance is just 8 cm on her left ( the smaller of her two breasts) with a base width of 12.2 cm. The Sientra 350 High Profile implant is 12 cm at the base, which will just be accommodated by the n-IMF on stretch of 8 cm and bhte base width at 12 cm is must slightly less than the existing base of her breast so it should not have an “implant look” that can happen with the implant is wider than the breast. A larger implant would be difficult to do without worrying about her Inframmamary fold giving way and causing “bottoming out” or a “double bubble”. To decrease this risk I have reinforced her fold at the time of surgery with Long lasting but dissolvable sutures.
A woman in her late 50’s who had a sudden deflation of her right breast saline implant. She was 9 ½ years after bilateral breast augmentation and right mastopexy with Dr. Hall. She noticed a “funny feeling” on her right breast and the next day noticed that the breast implant had completely deflated. This was at the very start of the Covid 19 quarantine and we were able to first see her virtually online and then as soon as we were able to return to the operating room a few months later, we were able to replace her implants. She is shown now, 5 months after bilateral implant replacement.
Discussion: She has smooth round saline implants with the right side 400 and the left side 375. She is 5’4 and 139 lbs and was pleased with the original size that we had selected so we replaced them with the same size. The implants are under the muscle. The original incision along the inframammary fold was used on each side to replace her implants.
She asks me if she should change her exercise routine to prevent another deflation. The best answer is no. All implants will fail eventually, and a general number is around 8% of implants will fail by 10 years. The advantage of a saline implant is that this failure is not “silent” as it is with a silicone gel filled implant, because the saline is absorbed by the body and the implant gets smaller or generally goes flat. The FDA now recommends with Silicone gel implants that a patient obtain and ultrasound 6 years after surgery and then every 1-2 year thereafter to be able to detect a rupture when it occurs. With a saline implant, ultrasound follow-up is not necessary. Most of the implant companies have a kind of a warranty that is in force for 10 years, one of the companies (Sientra) has 20 years, and Ideal implant company allows you to renew the warranty each year for your lifetime if you desire for a small fee. The warranties typically provide some financial assistance toward the cost of the surgery and a new set of implants. Although the left implant was intact, since is has been 9 1/2 years she made the decision to replace both.
A mother of 3 in her early 50’s who is bothered by a deflated appearance of her breasts after pregnancy. She was a 34 B cup before pregnancy and wanted to be a full C with some fullness of the upper breast if possible but still natural in appearance. She is 5’ 6/12” and 132 lbs. She is shown before and again, nearly 8 months after bilateral partial subpectoral ( below the muscle) placement of Sientra 440 cc textured round High profile cohesive implants placed through an inframammary incision.
Discussion: The base width of her breast is 12.6 cm and the inframammary fold to nipple distance is 7.5 but increases to 10 cm on stretch. More than 9 cm on stretch is sometimes an indication for a breast lift, but her sternal notch to nipple distance is 18.5 cm on the right and 19.5 cm on her left ( “normal” is 21cm) So she is a risk for increased stretching of the lower pole skin of the breast which would allow the implant to drop and give the appearance of “bottoming out”.
A microtextured implant is less likely to drop and shift and “bottom out” balancing the potential slight increased risk of BIA-ALCL with textured implants which is much lower with the Mentor and Sientra “microtextured” implants vs the higher risk of bottoming out in a patient who is prone to this.
This Sientra implant is 12.8 cm at the base- This matches the current width of her breast which is 12.6 cm . I we went much wider than her breast width it could begin to give an overly round or “implant look” which she did not want.
An early ( 6 week ) follow-up on a woman in her later 50’s who is bothered by the weight of her 38 D cup breasts as well as looseness of the skin in her back. She had grooving and irritation of her shoulders from her bra straps, back pain and difficulty with her posture. She did not have enough breast tissue to be removed to be covered by her insurance company but decided to proceed on a cosmetic basis. She is shown just 6 weeks after bilateral breast reduction combined with a bra-line back lift. She had 219 gms of tissue removed from her right breast and 313 gms from her left breast to bring her down to a c cup. Her shoulder and back pain have resolved, and she loves her new shape and size. A bra-line back lift places the scar directly under the bra strap area. Scars are at their reddest and thickest at 6 weeks and will now start to fade and improve over the next 2 years or longer. I have recommended topical silicone to help the scars fade.
An 18 yo student of color with gynecomastia since the age of 10. He is bothered in fitted shirts and with his shirt off. He is shown before and again, 6 weeks after Gynecomastia treatment with external ultrasound assisted, power assisted liposuction using the S.A.F.E. technique ( Suction aspiration fat equalization) with the removal of 325 cc of lipoaapirate and 18 gms of tissue directly excised from the left, and 300 cc of lipoaspirate and 20 gms of tissue excised from his right. He attended school in a distant state and was not able to return for further follow-up visits.