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.
Update: Our patient is seen again, 7 months after surgery. Her scars, which typically get better for 2 years have continued to fade and improve with the topical silicone.
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.
A male student in his late teens who developed female appearing breast tissue in the 3rd-4th grade. He has no history of marijuana or anabolic steroid use, so his case is typically “idiopathic” or of unknown cause. He has tried lifting weights to build up his chest muscles but without improvement. He has not had any significant weight change. He is bothered in fitted shirts and of course with his shirt off. “Shirts vs Skins” in gym class must have been a torment. He is shown just before and again, 5 months after bilateral gynecomastia correction with External Ultrasound assisted/power assisted liposuction combined with direct excision of breast tissue through an incision along the lower areola. 355 cc of lipoaspirate were take from his right side along with the direct excision of 40 gms of breast tissue, and 375 cc of lipoaspirate take from his left side together with 37 gms of breast tissue. A close look will show that the scars are still slightly read but they are not noticeable from a conversational distance and will continue to fade over
the next 18 months. He is thrilled to have a normal chest.
A man in his early 20’s who was troubled by a feminine appearance of his breasts in a bathing suit and in some fitted shirts. He first noted this at the time of puberty but had some additional growth of his breasts and breast tenderness taking over the counter anabolic steroid like supplements. He is shown before and again, 6 weeks after bilateral chest liposuction with a combination of mechanically assisted liposuction combined with a direct excision of a little under an ounce of actual breast tissue from beneath each nipple area. We have just removed his
protective tapes prior to the after photos, and the small incisions at the edge of his areola and in the upper chest are at their reddest and most noticeable at this 6 week mark. They will now continue to fade and improve over the next 18-24 months. He is already thrilled with his improvement and natural appearance after surgery, and is already talking about going to the beach. He will typically also have a little swelling that will diminish and improve over the next 4-6 months.
A professional man in his early 50’s who has been troubled by the feminine appearance of his chest. He has difficulty wearing fitted shirts and sweaters without this being visible and troubling for him. He is shown before and again, 5 weeks after “SAFE” liposuction. After the wetting solution is placed in the operating room, external ultrasound was applied to his chest. Then power assisted separation of the fat with a basket cannula was performed. Then liposuction was performed with cross tunneling from an incision at the areola and an incision in the upper chest. Then fat equalization was performed to smooth the area after aspiration. He is thrilled with his early result. The small
red scars, one on each side of his upper chest, are at their most visible at 6 weeks. They will continue to fade and soften over the next 2 years.