A mother of 3 in her late 30’s who feels like her breasts are too small to balance her frame, and is also bothered by breast asymmetry in a bathing suit and in T shirts when she is not able to wear a padded bra to camouflage. She has selected the ideal structured saline implants because she didn’t want to worry about silent rupture but wanted an implant that feels more natural than the traditional saline.
She is 5’6” and 138 lbs and is shown before and again, 9 months after bilateral partial sub-pectoral breast augmentation through and inframammary incision with a 300 cc Ideal structured saline implant on her left filled to 320cc which is above the “high” but below the “100%” fill volume, and a 440 cc Ideal structured saline implant on her right filled to the “high” of 440 cc. Tattoos have been blurred for her privacy.
An RN in her later 30’s who wished to have fuller breasts. She comes from another state and found us after seeing one of our patients and being impressed by the natural appearance of her results. She wanted to have a natural but fuller appearance. She found that her breasts looked deflated after losing weight with diet and exercise.
She is 5’6” and 119 lbs. She is shown before and again, 6 weeks after sub-glandular placement of Ideal Structured Saline implants size 370 cc through an inframammary incision.
Discussion: The empty Ideal implant volume is 56 cc. The Back/inner lumen is filled to 214 cc. The front/outer lumen is filled to 100 cc. This gives a total volume of 370 cc. This is listed as “high” fill on the sizing chart. The outer lumen is also designed to be filled to 145 cc which would give a total volume of 415 and is listed as “100%” fill. This greater fill volume is similar to a high profile implant and gives a slightly firmer feel. She did not want to be fuller than the 370 upon sizing in the office and prioritized the softer feel of the implant at 370.
A sub-glandular placement was chosen in her case. With a caliper pinch of 3.2 cm her breast tissues are thick enough to hide the implant ( 2 cm or less is usually considered “thin”). Her nipples are just slightly above the breast fold and she would be prone to a “waterfall effect” with a placement of the implants below the muscle. With a sub-pectoral placement the breast can fall off of the implant. With the sub-glandular placement the implant drops with the breast and avoids the “waterfall”. So when a patient has a nipple just at or above the fold but does not yet require a mastopexy, a sub-glandular placement can be a good tradeoff when the breast tissues are thick enough to hide the implant.
A mother in her early 40’s who would like to have fuller breasts. She is 5’4” and 116 lbs and is shown before and again, 6 weeks after a bilateral partial subpectoral breast augmentation with 275 moderate profile round smooth silicone gel implants placed through an inframammary incision.
A mother of 3 in her late 30’s who wanted fuller breasts. She describes herself as a 34 A cup and wanted to be fuller but still natural in appearance. She petite at 5’3” and 114 lbs and with a measured circumference around her chest of 29 ½ inches, is closer to a 32 Band size bra. ( 3 inches is typically added to this measurement to get the proper band size)
After reviewing the implant options she decided upon the Ideal Structured Saline implant. She was happy to not need to worry about a silent rupture, and even happier to be able to purchase an enhanced warranty from an outside insurance company that she will be able to renew annually for life. The base-width of each breast is 11.85 cm and the nipple to IMF on stretch distance is 8.5 cm. She was sized in the office and liked 325/350 but felt that 375 was simply to full in her clothing. Our decision was for the Ideal 335-375 cc implant that has a base-width of 11.4 cm, filled to a total volume of 350 cc. The implant has an empty volume of 52 cc, and the back/inner chamber is filled to 188 cc. The front/outer chamber was filled to 110 cc to give a total implant volume of 350 cc. Her implants were placed below the pectoralis muscle and through an inframammary incision. She is shown before and again, 4 ½ months after surgery. She is thrilled with her fuller but still natural look.
A woman in her early 30’s who is bothered by prominent nipples and hides them with a padded bra. She notes that her nipples are sore when she ovulates but does not have irritation of the nipples in the shower or with sports. She is shown before and again, immediately after a Top Hat flap nipple papule reduction and then 6 weeks after.
A mother of 2 in her later 30’s who is a 32 double H bra and has problems with back and neck pain, irritation of her shoulders from the bra strap and a rash under the breasts in the warmer months. She is 5’5” and 152 lbs and is shown before and again, 4 months after an inferior pedicle short T scar breast reduction with the removal of more than 1150 gms of tissue from each breast. The nipples were pointing to the inside before and were brought back to the median of the breast. She has significant drooping and internal plication of her tissues were used to add more support. Scars will continue to fade and improve over the next 18 months or more. Her symptoms have all resolved and she is thrilled with her new shape and size.
Update: Our patient is now shown 8 months after her breast reduction. The scars continue to fade and soften. The breasts have maintained a good shape with the internal plication sutures.
A woman in her early 30’s who wants fuller but still natural appearing breasts. She is 5’6” and 120 lbs . She describes herself as a 34 small A and wants to fit into bras and clothing but still have a relatively natural appearance. She did not mind the idea of a slight implant look out of clothing if needed to obtain her goals in clothing,
She was carefully sized in the office based on her tissue dimensions and characteristics and we were able to use a 350 cc high profile round smooth cohesive silicone gel implant placed in a partial sub-pectoral position through an infra=mammary incision.
She is shown before and again, 4 ½ months after surgery. Tattoos are blurred for her privacy.
Discussion: She is thrilled to have a natural but fuller appearance. Casual acquaintances’ and coworkers know that she looks better but are not sure why. She loves the fact that her clothes and tops fit her now. Her pre-op breast width is 11.9 cm and the nipple to IMF distance is 6.5 cm, but 8 cm on stretch. The chosen implant is 11.7 cm at the base and 4.8 cm in projection. Because the implant width is not wider than her breast base she does not have an “implant look”. When the nipple to infra-mammary fold distance is 8 cm on stretch then it is best to use an implant that is 12 cm in diameter or less to avoid excessive superior pole convexity. Again, the implant chosen fits her dimensions well.
A woman in her mid 50’s with large breasts who is bothered by neck pain, back and shoulder pain due to the size of her breasts as well as grooving and irritation of her shoulders from her bra straps and a rash under her breasts in the warmer months. She is 5 feet tall and 124 lbs and is a 34 DD cup bra. She is shown before and again, 9 months after bilateral breast reduction with the removal of 420 gms of tissue from each breast. Scars will typically fade and improve for the first 2 years. She is thrilled to be a C cup after surgery and her symptoms have all resolved. A short Inverted T scar technique was used with an inferior pedicle.
An 8 year follow-up on a woman who had correction of a retracted nipple on her left side. She was bothered by having retraction of the nipple for more than 25 years. She was able to manipulate this and bring it out to breast feed her children, but was bothered by the appearance. She would be considered a Han and Hong grade II- With a grade I the nipple can be pulled out easily and maintains its position without traction. A grade II can be pulled out manually, but not quite as easily as a grade I and has difficulty maintaining its position. A grade III is severely inverted and cannot be pulled out manually.
She had micro-incision procedure for release of the retracted nipple in the office with a stent placed for one week and protective pads worn for 6 weeks after her procedure. She was seen for another reason in the office today and is still thrilled to have a normal nipple prominence.
Breast Augmentation Revision/Ideal Implants – Patient 292
Breast Augmentation Revision/Ideal Implants – Patient 292
A woman in her mid 20’s with a tuberous breast deformity. She is bothered by the shape and also the size of her breasts. She wanted to be fuller but still natural in appearance. With a Tuberous breast, the base of the breast is relatively constricted and narrow and needs to be expanded. The breast is overly “pointy” and needs to have the shape flattened a little. A periareolar round block gortex suture flattens a tuberous breast and improves the shape. She is 5’5’ and 132 lbs but the base width of her breast is just 10.7 cm on her right and 10.5 cm on her left. The inferior areola to the breast fold distance is just 5 cm. So an implant needs to be carefully chosen that will widen the base of the breast but not be too large for the new nipple to breast fold distance which with reduction of the areolar with a gortex suture would be 7 to 7.2 cm. This would suggest based on the geometry that an implant with a base width of 11-11.2 cm is the widest that can be used without needing to lower her breast fold. Lowering the fold increases the risk of “bottoming out” and also of a “double bubble”.
She elected for the Ideal structured saline implant and so the 300 cc implant was selected. This has a base width of 11.1 cm so it is just a little wider than the base of her existing breast which helps to widen the base of the breast, but is not too large for her new nipple to fold distance after her periareolar round block suture is placed. The implant was placed in a subglandular plane.
The 300 cc implant has an empty implant volume of 37 cc due to the internal baffles, and the back/inner lumen is designed to be filled to 188 cc. The front lumen can be filled to 75 cc to give a moderate profile and total volume of 300 or to 115 cc to give a high profile and a total volume of 340 cc.. In her case a moderate profile has a better effect and the implant was filled to 300 cc total volume. She is shown before and again, just 3 months after surgery.
The scars around the areola will typically continue to fade and improve over the first 2 years after surgery. She is already thrilled with her new shape and size. It would have been difficult to use a larger implant in her case and still maintain a natural appearance because of the tissue dimensions of her breast.