A woman in her late teens who is bothered by inverted nipples . She has the most severe category of nipple retraction and would be considered Han and Hong grade III: “ The nipple is severely inverted and retracted. It is very difficult to pull the nipple out manually”
Many different methods have been described for correction. What has worked well in my hands is a micro-incision technique . The severely retracted nipple has ducts which are short and retracted, with a lack of soft tissue. The tethered nipple ducts are released with a microinciision using a special instrument and then held out to length with a special stent. In this way we can avoid buried sutures and dermal, connective tissue or skin flaps. She is shown before and again, 6 weeks after correction under local anesthesia in the office.
An Asian woman in her mid 30’s with bilateral nipple hypertrophy is shown before and again, 2 ½ years after top hat flap reduction of the right and 6 weeks after a second top hat flap reduction on the left. Her initial correction was good but her left nipple papule had increased in size some following her initial procedure and the second reduction was performed.
A mother of 2 in her later 30’s who is bother by a deflated appearance of her breasts after pregnancy. She was a full B cup before pregnancy, became a D cup with pregnancy and now describes herself as a 34-36 A cup . She would like to be fuller but no excessively large and wants to still be natural in appearance. She is shown before and again, 6 weeks after bilateral partial subpectoral breast augmentation with Sientra smooth round high profile high strength cohesive gel 350 cc implants..
Discussion: She has IMF to N on stretch distance of 9 cm and base width of 12.5 cm. This implant is 12 cm at the base. She could have used a implant with a 12.5 cm base width without looking overly round “like an implant” but felt that these larger implants were much too large for her in clothing and she preferred to look like her padded bra but without the padding. She is very pleased with the natural appearance of her breasts after surgery.
A woman in her mid 60’s who is a 40 D cup and has problems with chronic back pain. She is shown before and again 7 months after a bilateral breast reduction with the removal of 533 grams of tissue from her right breast and 478 grams from her left breast to reduce her to a “C” cup. Her back pain is dramatically better and she is thrilled with her new shape and size.
A man in his later 40’s with bilateral gynecomastia since he was a body builder in his early 20’s. He is bothered by the appearance in fitted shirts and with his shirt off. He wears compression shirts to camouflage the appearance of his chest.
He is shown before and again, 6 weeks after Power-assisted liposuction using the S.A.F.E. technique (Separation/Aspiration/ Fat equalization) combined with the direct excision of breast tissue through an inferior per-areolar incision.
At 6 weeks he is thrilled with his correction. The skin of patients in their 40’s does not contract as well as patients in their 20’s but is usually better in appearance than placing a visible scar on the chest to tighten the skin further and allows him to feel comfortable removing his shirt at the beach. He has a prominent rib cartilage on the left side which is more visible with the hands on the head view.
Breast Augmentation Revision with Ideal Implants – Patient 313
Breast Augmentation Revision with Ideal Implants – Patient 313
A mother of one in her early 50’s who has a long standing deflation of her left saline implant. She originally had 275 cc smooth round mentor saline implants placed in a partial sub-pectoral position through an infra-mammary incision in 2007. She did well but 3 years ago had a spontaneous deflation of her left breast implant.
She is petite at 5’2” and 118 lbs and elected for a small increase in size. She is now 6 weeks after removal of her ruptured left implant and intact right implant, using the same incisions and replacing with Ideal Structured Saline implants 300 filled to the top recommended total volume of 340.
An early ( 6 week) follow-up on a woman in her early 20’s with macromastia.
She is 5’ 2 ½ “ and 126 lbs and is shown before and again, just 6 weeks after bilateral breast reduction with the removal of 378 gms from her right breast and 423 gms from her left breast to reduce her from a 34 DDD to a 34 Cup. Scars are typically at the reddest and thickest at 6 weeks and will now begin to soften and fade over the next 2 years. She is already thrilled with her new shape and size and her symptoms of back and shoulder pain have completely resolved.
A mother of 3 in her later 30’s who is bothered by a deflated appearance of her breasts after breast feeding. She describes herself as a 34 ato b cup and would like to be a c cup. She is 5’3” and 115 lbs and is shown before and again, 6 weeks after bilateral partial sub-pectoral placement of Sientra 385 cc textured round high profile silicone gel implants placed through an inframammary incision
She has chest wall asymmetry and breasts which are higher risk for shifting of the implants, which is more common with a smooth implant. The Sientra microtexture decreases the risk of this shifting with the trade- off of a slightly increased risk of BIA-AlCl. Her breast base width is 11.8 cm and the nipple to inframammary fold on stretch is 9.5 cm. She was sized in the office and liked 350 and 375 but felt that 400 was a little out of proportion. The chosen implant has a base of 12.3 cm and a height of 4.9 cm. This is slightly wider than her existing base and will therefore give her a mild “implant” look for a few months but should then settle in and appear even more natural as the breast stretches slightly.
A mother of 2 in her later 20’s is bothered by a deflated appearance of her breasts after pregnancy, and also would like to be fuller. She describes herself as an A cup and would like to be a full C cup. She is shown before and again, 6 weeks after partial subpectoral breast augmentation with Sientra 440 cc smooth round cohesive high strength silicone gel implants placed through an inframammary incision.
Discussion: She is 5’4” and 150 lbs. She does not mind a mild implant appearance but wishes to be relatively natural in appearance. She has pseudoptosis, and could be at risk for a mild waterfall effect from a subpectoral placement but prefers this and a lower risk of capsular contracture to a subglandular placement where the implant drops with the breast
Her base width is 12.7 cm and the Inframammary fold to nipple distance on stretch is 8.5 cm. She has elected for a Sientra 10621-440 High profile smooth round implant which is 12.8 cm at the base and has 5.1 m in projection. This is just slightly larger in diameter than her base width and early on can give a mild implant appearance but will settle and look even more natural in a few months. A base of 12.5 cm would be perfect of and 8.5 cm nipple to IMF on stretch. Her IMF was reinforced with long lasting but dissolvable sutures at the time of surgery to prevent “bottoming out” and a potential double bubble formation- this give mild superior pole fullness early on but should settle with time as the breast stretches to accommodate the implant.
A young man is his later teens who has had female breast development when he was 11 or 12. He is bothered by the appearance of his chest in fitted shirts and with his shirt off. He is shown before and again, 6 weeks after bilateral chest liposuction using the S.A.F.E. technique (Suction Aspiration Fat Equalization) combined with a direct excision of breast tissue through and incision around the areola. Scars are at their reddest at 6 weeks and then begin to fade and improve over the next 2 years. He is thrilled with his new contour.
Update: Our patient is now seen 3 months after his surgery. Scars typically become thicker and redder for 6 weeks and then fade and improve over the next 2 years. He is thrilled with his new chest and his scars are fading as expected with topical silicone to help.