A 14 boy with gynecomastia (feminine breast development) of idiopathic (unknown) cause is shown before and 4 months after surgery with a combination of liposuction and direct excision. The small scars in the upper chest and at the lower edge of the areola are barely visible at 4 months, but will continue to diminish over the next 18 months. He already feels comfortable going without his shirt in gym class.
A mother of 3 in her mid 40’w who was 21 years after saline breast augmentation when she developed a sudden deflation of her right breast implant. She did not have her records,so we had to make an educated guess and have a range of implants available in the operating room. Her left implant was weighed upon removal and was determined to be filled to 392cc. She did not have a history of capsular contracture (firmness of the breast due to tightening of the scar tissue around the implant, often felt to be from “biofilm”) so I felt comfortable with immediately replacing her implants. She elected for silicone gel implants, and was replaced with 375 cc cohesive round silicone gel high profile implants, which are similar in dimensions to her current implants. She is shown before and again, 8 months after surgery. She is especially pleased with the more natural feel of the implants, compared to her prior saline implants. I was able to use her original infra mammary incision. She had an abdominoplasty at the same time. Of course the breasts are “sisters and not twins” with her right nipple being higher than her left before and after surgery.
An Asian professional in her early 40’s. Mother of one. Now shown 14 months after bilateral partial sub pectoral breast augmentation with 375 cc round smooth silicone gel moderate profile plus implants placed through an inframammary (breast fold) incision in a partial sub pectoral (below the muscle) location. She is 5’4″ and 118 lbs.
An Asian professional in her early 40’s. Mother of one. Initially shown 14 months after bilateral partial sub pectoral breast augmentation with 375 cc round smooth silicone gel moderate profile plus implants placed through an inframammary (breast fold) incision in a partial sub pectoral (below the muscle) location. She is 5’4″ and 118 lbs. It is said that 90+% of women after breast augmentation wish that they had “gone larger” but that is not always the case. Some women wish to downsize. This woman initially selected the 375 cc implant after discussions and sizing in the office. She was ok with the look in clothing, but always felt a little self-concious in a bathing suit. Then her liftestyle changed and she began to spend more time at the gym. The tight gym clothes accentuated her breasts to the point that she felt that they were too full. She decided after 2 1/2 years to return to the operating room and down-size to a 275 cc moderate profile plus round smooth silicone gel implant. Her original incision at the breast fold was used, and I tightened her lower pocket by performing an excision of the breast capsule in the lower portion and anchoring it to the periosteum (covering) of her rib (this is called a capsulorrhaphy). The “pocket” that the implant was in would be too large for the new implant otherwise. She is now seen 7 1/2 months since this second procedure. Her breasts are fuller than before her initial surgery but now seem absolutely natural to her in her workout clothes and in a bathing suit. It is a cautionary tale, that even with careful discussion of the tradeoffs and sizing in the office, not everyone “wishes that they had gone larger”
A woman in her mid 30’s who describes herself as a 32 DDD. She had breast implants and a breast lift in Texas in 2011 with 375 cc silicone implants. She feels that she is too large, and does not like the superior fullness in her upper breasts from the implants. Her nipples are properly positioned at 21 1/2 cm from the sternal notch, but she has an increased distance from the nipple to the breast fold. There is always a worry about the blood supply to the nipple when a patient has had previous surgery in this area, so not having to move the nipples is a relief. She had an inverted T mastopexy using her previous scars,, along with removal of her implants. She is shown again, 2 months after surgery. She had enough breast volume remaining to be pleased with her “C”cup breast after surgery. Her scars have also been improved slightly, and will continue to fade over the next 2 years. The imprints on her skin are from the silicone pads that we are having her wear after the surgery to improve her scars.
Our patient is seen again, now 5 months after surgery. Her scars continue to fade with the silicone pads, and the breasts are “settling in” to their new shape.
A mother of 3 in her mid 40’s who developed a sudden implant deflation on her right side, 21 years after having saline implants. She did not have her original records. Her left intact implant was weighed at the time of removal, 392 gms. They were both replaced with 375 cc smooth round high profile cohesive silicone gel implants. She had an extended abdominoplasty along with repair of an umbilical hernia. Seri Surgical scaffold was used to reinforce the umbilical hernia repair at the time of surgery. EXPAREL was used at the end of surgery to decrease postoperative pain. She is shown before and again, 4 months after surgery. There is typically still some swelling in the lower abdomen for the first 6 months, so she may decrease a little more in the lower abdomen. She reports that she is down from a 10 to a 6 dress size. The oblique view demonstrates the periumibilical hollow and champagne groove sculpted in the fat at the time of surgery.
A mother of 2 in her early 50’s who had bilateral implant rupture diagnosed on MRI. She is 5’5″ and 136 lbs. She initially had surgery in Boston 19 years before, but was unable to obtain her records. She remembers significant bruising after her original surgery and rapid development of firmness of her right breast, which softened a little over the following years. On examination, she was shown to have capsular contracture on both sides. Her incisions were initially placed through an incision around the areolar. Treating a capsular contracture can be challenging. Many capsular contractures may be the result of Biofilm (bacteria that attaches to the implant and walls itself off so the body cannot fight it properly) and may best be treated by leaving the implants out for a few months while the body clears the bacteria, before replacing the implants. Some recent longitudinal (long term) studies have suggested a higher risk of capsular contracture when the implant is placed through an incision around the nipple or in the axilla. Another option may be to use Acellular dermal matrices such as Strattice but these involve using an animal product and additional expense. Her history of severe bruising followed by a contracture which softened a little with time seems more consistent with a hematoma as the cause. She elected for bilateral implant removal with creation of NeoSubpectoral pockets bilaterally and placement of 350 cc round textured cohesive silicone gel implants through an infra mammary (at the breast fold) incision. A “neosubpectoral” pocket involves carefully making a new space between the capsule around the implant and the pectorals muscle. Her implants were “riding high” and the new pocket was made slightly lower. She is shown just before and again, 6 weeks after surgery. Her breasts remain soft. She is not “out of the woods yet” in terms of the risk of developing another contracture, but we are hopeful that we have solved her problem.
At 4 1/2 months after surgery the breasts remain soft and without recurrence of her capsular contracture.
A breast cancer survivor in her mid 50’s. She is 8 years s/p lumpectomy and radiation, and is thankfully free of disease. But she is troubled by the difference in size of her breasts after her cancer removal and radiation, as well as the “dent” in her breast that shows in her cleavage area with clothing. She is 2 years after needle scar release( sometimes called ” Riggotomies ” after the Italian plastic surgeon who first described this.) combined with micro fat grafting with 93 ml of concentrated fat along with placement of a 300 cc round smooth saline implant to better balance her breasts. She then had a second session of needle scar release (Riggotomies) combined with micro fat grafting of 35 cc of concentrated fat 11 months ago, along with an abdominoplasty. (The fat was harvested from the portion of the abdomen that was eventually removed with the abdominoplasty,) Nipple position remains higher on the cancer side because of the removal of tissue with the lumpectomy and the radiation changes that have contracted and pulled it higher. To lower this would require additional, typically visible scarring from a flap to replace the missing skin and is often more noticeable than the nipple malposition. She is pleased that the volume of her breasts matches in clothing now. In addition to the correction of the “dent”, the scar has improved in appearance and she can now wear clothing styles that show her Decolletage (note to ran put this in italics with the accent over the e) area.