Breast Gallery

A mother of 3 in her early 40’s who has breast fed all 3 children and wants her breast to be fuller and less droopy- She still wishes to have a natural appearance and wants to look like her padded c cup bra that she wears now but without the padding. She is shown before and again, 7 months after a vertical mastopexy (“lollipop scar breast lift” ) and 350 cc round, textured, high profile silicone gel implants placed in a dual plane position. Texture was chosen to decrease shifting and dropping of the implants with time, but the implant company with the least aggressive texture (Mentor) was used to decrease the risk of possible problems seen with the more aggressive textures. “Dual plane” means that the implant is under the muscle above but just below the breast down below. This gives the benefits of a subglandular approach with the tendency of the implant to settle more with the breast but still giving the benefits of a subpectoral approach with better coverage of the implant above, lower risk of capsular contracture, easier to perform a mammogram, and better “aging” of the breasts. Her scars will typically continue to fade and improve for 2 years after surgery.

A mother of 3 in her early 50’s who is bothered by grooving and irritation of her shoulders, as well as neck, back and shoulder pain which is related to her 36DD bra size. She also has difficulty exercising despite wearing extra bras, and also gets a rash under her breasts in the summer. She is shown before and again, just 4 1/2 months after bilateral breast reduction with the removal of nearly 1 1/ 2 lbs of breast tissue from each breast. Scars typically will continue to fade and improve for 2 years after breast reduction. At 4 ½ months there is still some redness of her scars but she is already thrilled with her new shape and size. And her symptoms noted above have all resolved.

A woman in her later 50’s who has always been bothered by retracted nipples, also called inverted nipples. The severity of nipple retraction has been graded by Han and Hong as Grade I: the nipple can be pulled out easily and maintains its projection well without traction. Grade II: the nipple can be pulled out but not as easily as grade I and it has difficulty maintaining its position. Grade III: severely inverted and retracted, and is very difficult to pull out. The nipple ducts are shot and severely retracted and are pulling in on the nipple like the lines on a parachute. In this patient’s case she was Grade III on her right, and Grade II on her left.
She is shown before and again, 6 weeks after closed treatment of the inverted nipples through a micro-incision procedure performed under local anesthesia in the office. She is thrilled to have normal looking nipples for the first time in her life. Her nipple sensation remains normal

A mother of 2 in her later 40’s who is a 34-38 D cup and gets a rash on her back with exercise. She would like to be a C cup. She is shown before and again, 6 months after bilateral breast reduction with a superior pedicle technique. She had just under 300 gms removed from her right breast and just over 200 gms from her left breast to reduce her to a mid C cup. Scars will typically fade and improve for the first 2 years- hers have already started to fade nicely with topical silicone.

A woman in her late 30’s with volume loss and drooping of her breasts after 2 pregnancies.  She is also bothered by an area of fat accumulation along her anterior axilla.

She is 5’ 5-1/2” and 130 lbs and is shown before and again, 3 ½ months after bilateral augmentation mastopexy combined with power assisted liposuction of the axilla using the S.A.F.E. technique.  Textured, round, high profile 350 cc silicone gel implants  were placed in a dual plane position.  Her scars will typically continue to fade for the next 2 years.  She already is thrilled with her improvement.  High profile was used to try and restore some upper pole fullness-in a “tight” breast from someone who has never lost weight or been pregnant a high profile can cause too much stretching and atrophy of the breast tissue, but in a woman who has lost upper breast volume it can work well.  The idea is to fill the breast but not overly stretch the breast.  Texture was chosen to decrease the tendency of the implants to fall to the side or drop with time, which is more likely with a “’stretchy” breast after pregnancy. “Dual plane” position has the implant below the muscle in the upper breast and above the muscle in the lower breast- this allows the implant to settle with the breast but still have the benefits of being covered with the muscle in the upper breast- (less capsular contracture, easier to do a mammogram, and the breast ‘ages’ better) A vertical mastopexy was used (“lollipop incision”)

A woman in her late 20’s who had 350 cc high profile smooth round silicone implants placed by another plastic surgeon 7 years before. She felt that the implants were too large for her frame and also had “bottoming out”- placement of the larger implant evidently required releasing her infra mammary fold and it kept dropping to the point that her nipples would peak out of the top of her bathing suit. The breast fold is a ligament that supports the breast and the implant like a shelf. In her case when it was detached, this “shelf “collapsed and the implants dropped down too low. She also wished to have more cleavage.

Her implants were kept in the subglandular space and were exchanged for 255 cc round textured silicone moderate profile implants. Her infra-mammary folds were reconstructed and internal reinforcement was done with Strattice, which is a porcine dermal product that becomes part of the patients tissues and adds strength, and decreases the risk of recurrence. She is shown just before and again, 9 months after surgery. She is thrilled with her correction. The size is appropriate to her frame (5’9”/ 122lbs) and her fold is back and holding her implants in the proper position. This is a cautionary tale for patients that have an implant placed initially that is larger than their tissues can support. Lowering the breast fold should be done with caution, and the tradeoffs of an overly large implant may not be worth the potential problems that can develop.

UPDATE: Our patient is now seen 9 months after surgery. Her breast fold reconstruction has remained stable and her breasts have held their new shape.

A mother of 3 in her mid 40’s who had bilateral subglandular breast augmentation in another part of the country 17 years ago with textured round saline implants. She noted a sudden deflation of her left breast 6 months before seeing me. She was not able to obtain her old records but thought she had textured round implants of the 260-300 cc range. She wished to be slightly fully but still natural in appearance. She has an old breast biopsy scar on her right upper breast. She is not a good scar former and did not want to have the visible scars from a mastopexy (breast lift) The decision was made to replace her implants with a slightly fuller implant placed through her existing infra mammary scars ( at the breast fold).
So the question is what size implant to use? A nice option in a case like this is to drain her other implant in the office under local anesthesia, usually one month before surgery to allow the breast tissues to recover from the pressure of the implant. We can gain some information from the amount of fluid that we remove from the implant, and can then perform our sizing in the office with the Mentor sizing system, a set of silicone shells of different sizes that slip over the breast inside the bra and are excellent at simulating the final size in clothing. Based on this information she selected a 375 cc size, which is a 325-375 cc moderate profile saline implant filled to 375 cc. She is shown before and after deflating her right breast implant and again, 6 weeks after replacement with a smooth round saline implants under general anesthesia at the hospital in the same subglandular plane(above the muscle) through her existing infra mammary incision. A subglandular placement allows the implant to drop with the breast and can decrease the need for a breast lift in some patients who are on the borderline.

An Asian man in his mid 20’s who is bothered by prominent nipple papules both with his shirt off and in clothing. He is shown before an again 6 weeks after bilateral nipple papule reduction under local anesthesia in the office. He wanted the nipples to be as flat as possible and is thrilled with his result. He can wear thin shirts now without the nipple papules showing through his shirt and making him fell self-conscious.

A 21 yo student who wore a 34 DDD bra and who had problems with neck pain, back pain, irritation and grooving of her shoulders as well as difficulty exercising due to the size of her breasts. She is shown before and again, 1 year after bilateral breast reduction with the removal of around 490 gms from each breast. ( one pound = 454 gms) An inverted ‘T” scar was used. She is 5’ 5 ½” and 165 lbs. Scars will typically continue to fade and improve for two years after surgery. She is thrilled with her new, proportional shape, and her symptoms have resolved.

A challenging case in a woman with small breasts and a tight skin envelope, as well as pectus excavatum ( a hollow depression in the chest bone) who wishes to have a natural appearance. When the chest wall is sloped, the implant will tend to migrate “down the slope” towards the middle with time. Therefore we selected textured, cohesive silicone round gel implants. When the tissues are tight the implant needs to be even more precisely matched to the patient. She is 5’5” and 120 lbs and is shown before and again, 22 months after partial subpectoral placement through an inframammary incision. 305 cc Sientra implants were used. Tattoos are blurred for privacy.