Breast Reconstruction with Ideal Implants – Patient 311
A mother of 3 in her mid 30’s who is bothered by a deflated appearance of her breasts after pregnancies and breast feeding. She describes herself as an A cup and would like to be a C cup. She did like the appearance of her breasts after they were enlarged for breast feeding. She wished to have a natural appearance after surgery and liked the idea of the Ideal structured saline implant so she would have the peace of mind of not needing to worry about a silent rupture. She is shown before and again, 7 weeks after surgery with an Ideal implant filled to 340 cc on her right (maximum fill) and 300 on her left (minimum fill) to balance her asymmetry.
On a sizing visit, she liked the 300/325 size. She felt the 325 was “a little full but she could live with it”. The base width of her breasts are 11.6 cm on her right and 11.4 cm on her left. Her nipple to fold distance on stretch is 8 cm on her right and 8.2 cm on her left.
The Ideal Structured Saline implant 300-340 was chosen and was placed through an inframammary incision and underneath the pectoralis muscle. The base of the Ideal implant is 10.9 cm but because it is curved we add 0.3 cm to give an 11.2 cm equivalent. So we can be confident that it will “fit” the base of her existing breast and not give an overly round “implant” look that she did not desire.
An registered nurse and mother of 2 in her later 30’s who described herself as a 36DD and had symptoms of back pain, shoulder pain, difficulty exercising, as well as postural difficulties. She has had cortisone shots in the past to the back for her pain. She is shown before and again, 8 months after bilateral breast reduction with a short T scar, inferior pedicle technique. She had 444 grams of tissue removed from her right breast and 544 grams from her left breast. ( 454 grams = l pound) Her symptoms have all resolved, and she is thriller with her new shape and size. Scars will typically continue to fade and improve over the first 2 years after surgery.
A woman in her late 20’s who had been thinking about breast augmentation since she was 18. She feels that she is tall at 5’8” and 147 lbs. and has full hips and wanted to have fuller breasts that were more proportional to her frame, but still natural in appearance. She is a 34 B cup bra before surgery and a full C after. She is shown before and again, 8 weeks after bilateral partial subpectoral breast augmentation with the placement of Sientra, 5 th generation silicone cohesive gel round smooth high profile implants placed in a partial subpectoral position through an inframammary incision. Her Inframammary fold was reinforced at the time of surgery by anchoring it to the rib periosteum with long lasting absorbable sutures.
Discussion: After careful sizing and measurements in the office she has a base width of 12.2cm on her left and 12.4cm on her right. Her nipple to Inframammary fold distance on stretch (to simulation the weight of the implant) is 8 cm on her right and 8.5 cm on her left. She liked a volume of 385 cc in her Bra. The Sientra 385 HSC implant has a base width of 12.3 cm and a projection of 4.9 cm. So the base width is just under the diameter on her left and just over on her right. In my experience it is possible to go just slightly wider than the base of the breast as shown here without giving an overly round “implant” look. The ideal IMF-Nipple distance for a 12 cm base implant is typically suggested as 8 cm so the base width of the implant is perhaps 2 mm wider than ideal given this distance on her right. To decrease the risk of the fold “’giving way” and “bottoming out” it was reinforced at the time of surgery.
At 8 weeks she already has a natural appearance which should appear even more natural over the next few months as the breasts gently stretch to accommodate the new implants. In the side views we will notice that early on she has mild fullness of the right breast upper pole which is expected now that we know the IMF to fold distance on stretch before surgery of 8 cm, and no upper pole fullness on the left which had the IMF to fold distance on stretch of 8.5 cm.
Woman in her early 20’s with severe macromastia who describes herself as a 36H cup bra. She has problems finding bras to fit, as well as difficulty with exercising, rashes under the breasts, posture, back pain and shoulder pain and irritation from the bra straps. She is shown before and again, 9 ½ months after inferior pedicle breast reduction with more than 1250 gms of tissue removed from each side. (more than 5 ½ lbs in total weight)
She is thrilled to have complete relief of her symptoms as well as beautiful, proportional breasts.
Breast Reconstruction with Ideal Implants – Patient 310
Breast Reconstruction with Ideal Implants – Patient 310
A mother of 1 in her early 40’s with a history of breast cancer. She had lumpectomy and radiation of her right breast 9 years before. She has a significant contour deformity of her right breast as well as breast asymmetry and both breasts which are smaller than ideal for her frame. I first reconstructed the contour deformity from her lumpectomy and radiation with 2 sessions of fat grafting. In the first session, 120 ml of fat were grafting to her right breast along with scar release. 4 months later she had additional fat grafting and scar release of the right breast. She then had bilateral breast reconstruction with placement of Ideal Structured saline implants in a partial subpectoral position through an inframammary incision. A left nipple reduction was performed at the same time to better match her opposite breast. She is shown 6 weeks after this final procedure. The Ideal structured saline implants were the 370 cc implants. The empty shell volume is 56 cc. The posterior/inner lumen is filled to 214 cc. The front/outer lumen is filled to 105 cc to give a total implant volume of 375 cc.
A woman in her early 50’s who wears a 42 G cup bra and has been bothered by the size and weight of her breasts, which has given her problems with back pain, shoulder pain and neck pain, as well as a rash under the breasts in the warmer months. She is also bothered by the prominence of her nipples in clothing and excess fat in the anterior axilla.
She is 5’ 4” and 191 lbs and is shown before and again, 4 ½ months after bilateral breast reduction along with nipple reduction and liposuction of the anterior axilla. 1063 grams of tissue were removed from her left breast and 857 grams from her right breast to reduce her to a full C cup to better match her frame. Her symptoms have resolved. Scars typically become thicker and redder for 6 weeks and then fade and improve over the next 2 years or more.
A mother of 4 in her early 50’s who is bothered by a deflated appearance of her breasts after pregnancy. She is 5’ ½” and 112 lbs and is shown before and again, 6 weeks after subglandular placement of Sientra Opus smooth round high profile 280 cc cohesive silicone gel implants placed through an inframammary incision.
Discussion: She has early breast ptosis but because of her petite size the implants were enough to fill up the breasts and correct the drooping appearance. She is on the borderline of requiring a breast lift and the implants were placed in a subglandular space so that they will drop with the breasts and avoid a “waterfall” appearance that would be likely to happen in her case with a subpectoral placement which would have the breasts “falling off” of the breast implant. 6 weeks is still early and we can expect the breasts to drop and settle more over the next few months.
A woman in her early 30’s who is petite at 5’5 and 112 lbs. She has a very narrow breast width at 10.6 cm and a nipple to inframammary fold distance on stretch of 7.2 cm. She wanted to be fuller but still natural in appearance. She also has a mild pectus excavatum (depression of the chest bone) and an accessory nipple on her right. She is shown before and again, just 6 weeks after bilateral partial subpectoral placement of smooth round high profile Sientra Opus implant through inframammary incisions. The base width of this implant is 10.5 cm. A slightly larger implant was tried at the time of surgery and appeared unnatural. The breasts will typically continue to settle and appear even more natural over the next 3-4 months.
A mother of 2 in her mid 30’s who is bothered by a deflated appearance of her breasts after pregnancy. She described herself as a 34 A cup and wanted to be a B or C cup if possible, but still natural in appearance. She is 5’ 3 ½ inches in height and 119 lbs. She is shown before and again, 6 weeks after bilateral partial subpectoral placement of 270 cc Ideal Structured Saline implant filled to 270 cc and placed through an inframammary incision.
Discussion: She liked the idea of not having to worry about a silent rupture and chose the ideal structured saline implants. Her chest diameter at the IM fold is 29 inches which would place her in a 32 inch bra. (3 inches is added to this distance to get the bra band size). Her nipple to inframammary fold distance on stretch is 7.2 cm on her right and 8 cm on her lift. Her breast diameter is 11.3 cm. The dimensions of the Ideal 270-305 implant at 270 is 10.7 cm with a projection of 4.3 cm. Because the implant is shaped to fit on a curved surface such as the chest wall I would typically add 3 mm to the width to be equivalent with a “standard” implant. So 11 cm base equivalent is smaller than her existing base width so her breast does not have an overly round “implant” look and the nipple to fold distance of 11.2 accommodates an implant base of 11-11.1 without giving too much superior pole convexity or unnatural fullness of the upper breast. Tattoos have been blurred for her privacy.
A mother of 2 in her early 40’s who is bothered by a deflated appearance of her breasts after pregnancy. She described herself as a 34 A cup before surgery and wished to be a full B-C cup but still natural in appearance. She has breast ptosis, with her nipples being lower than her breast fold. She is shown before and again, 18 months after an augmentation mastopexy. She had Mentor high profile 325 cc silicone gel micro-textured implants placed in a dual plane position through an inframammary incision and combined with a periareolar round block mastopexy using a Gortex suture to prevent spreading of the areola.
Discussion: when the breasts are “loose” after pregnancy, a smooth implant is more likely to shift to the side. Although aggressive textures such as the Allergan texture have a higher association with Breast Implant associated anaplastic large cell lymphoma (BIA-ALCL) it is much less common in the less aggressively textured implants such as the Mentor and Sientra devices, and many surgeons feel that texture still has a place in decreasing the risk of implant shifting in carefully selected cases such as this. At 18 months, her implants have remained soft and stable and have not shifted laterally or inferiorly. She has maintained volume in her upper breasts.