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.
A woman in her early 50’s who is bothered by drooping and the size of her breasts. She described herself as a 34 DD-G cup before surgery and had probems with grooving and irritation of the shoulders, back pain, a rash under the breasts in the warmer months, and difficulty exercising due to the size of her breasts. She is a runner and wished to be closer to a middle C cup. She also felt that her breasts were out of proportion to her frame and was a size 6 in pants and a size 10-14 in tops She is shown before and again, 7 ½ months after bilateral breast reduction including liposuction of mild lipodystrophy in her anterior axilla that would show in an off the shoulder dress. She is 5’ 7 ½ “ and 157 lbs and had a superior pedicle/ Short T scar techinique with the removal of 421 gms of tissue from her left breast and 381 gms of tissue from her right breast, along with Power assisted liposuction of the anterior axilla using the S. A.F.E. technique. Her symptoms have resolved and she is thrilled to be able to run without her breasts getting in the way. Scars will typically continue to fade and improve for 2 years or more after surgery.
A woman in her late 40’s who has been interested in breast reduction for many years and finally got her courage up to come in and discuss it. SH had been going to a chiropractor for 10 years for neck pain, back pain and shoulder pain but had not had relief. She was a 38 G cup. She is over her ideal body weight at 5 1 ½ and 200 lbs but was not able to lose weight easily because of difficulty exercising due to the size of her breasts. She is shown before and again, 7 months after a bilateral breast reduction with the removal of more 500 gms of tissue from each breast. She is now a full C cup, more proportional to her frame. She is thrilled that all of her symptoms have resolved and she has not needed to go back to the chiropractor. She also tells me that she loves being able to do her yoga and not worry about her breasts falling out. Scars will typically continue to fade and improve for the first 2 years after surgery.
An RN in her mid 60’s who wears a 36D-DD bra and has problems with back pain, grooving and irritation of her shoulders from her bra straps, a rash under the breasts in the summertime (“intertrigo”) as well as difficulty exercising due to the size of her breasts. She takes Plaquenil for rheumatoid arthritis. She is shown before and again, just 5 months after a bilateral breast reduction. Her healing was uneventful and her symptoms have resolved.
Update: Our patient is now seen 14 months after surgery. Her scars have continued to fade and improve. She did not have any healing issues due to her Plaquenil.
A woman in her early 20’s who described herself as a 34 A cup and wanted to be a full C but still natural in appearance. She is 5’4” and 135 lbs. She is shown before and again, 5 months after bilateral partial subpectoral placement of 325 cc Sientra smooth round 5th generation cohesive silicone gel implants with a moderate plus profile, placed through an inframammary incision. I have recommended that she remove and not replace her nipple piercings to decrease her risk of capsular contracture. Nipple ducts have bacteria, and a piercing in this area may allow bacteria to enter the bloodstream and travel to the implant. I also recommend against oral or vaginal piercings after surgery for the same reason.
Update: Our patient is now seen 6 months after surgery. The breasts have settled and appear even more natural in appearance.
An 18 yo woman of color with severe macromastia and breast asymmetry. She describes herself as a 38G cup and has problems with grooving and irritation of the shoulders, back pain, shoulder pain, difficulty exercising and intertrigo. She is shown before and again, 5 months after bilateral breast reduction with an inferior pedicle Inverted T scar technique with the removal of 1538 gms from her right breast and 961 gms from her left breast to reduce her to a full Cup. Scars will typically fade and improve over the next two years. She is thrilled with her result. She no longer has symptoms due to the size of her breast and is able to exercise now. She is confident now, and showed me photos of her being able to wear beautiful dresses now from a recent trip to a bridal shop that she could never have been comfortable in before.
A 17 year old woman with severe breast asymmetry. She is larger than a DD on her right and a full C cup on her left. She has had problems with right shoulder and back pain due to the size of her breasts. She had first developed breasts at the age of 13 and has not had any changes in size over the past year.
She is shown before and again, 7 ½ month after a J breast lift on her left side and a short T scar technique on her right. Gortex Round block sutures were used to prevent spreading of the areola. 40 gms of tissue were removed from her left and 252 gms from her right. Her symptoms have resolved and she is thrilled to have breast which match. Scars typically get thicker and redder for 6 weeks and then fade and improve over the next 2 years or longer. She is using topical silicone to help with the scar maturation.