A man in his late 30’s with gynecomastia since puberty. He was heavier as a child and had a maximum weight of 250 lb. He took some anabolic prohormones in his early 20’s and developed some tenderness and increasing fullness of his breasts. He has reduced his weight to 190 lbs but continues to have female appearing breasts which are prominent in fitted shirts and also bother him with his shirt off. He wears extra shirts to try and camouflage the appearance.
He is shown before and again, 6 months after surgery with power assisted liposuction using the S.A.F.E. technique combined with direct excision of breast tissue through a periareolar incision.
Although he continues to have mild skin laxity from decreased skin elasticity following his weight loss, his appearance is greatly improved. The only reliable way to tighten loose skin would be to place a visible scar on his chest which would not be worth the tradeoff.
A woman in her early 50’s who is 40 DD bra and has problems with shoulder and back pain, grooving and irritation of her shoulders from her bra strap as well as difficulty exercising and moisture and rashes under her breasts in the warmer weather. She is shown before and again, 6 months after breast reduction with the removal of more than 550 grams of tissue from each breast. (454 grams is = one pound)
Her symptoms have resolved and she is thrilled with being able to fit in clothes better and her new shape and size.
A teacher in her early 20’s with back pain, shoulder pain, and difficulty with her postured. She cannot wear traditional bras due to the size of her breasts and needs to wear several sports bras, which is still not enough to allow her to exercise.
She wears a 38 DDD bra. She is 5’ 3 ½ “ and 176 lbs and is shown before and again, 8 months after breast reduction with the removal of 744 grams from her left and 823 grams from her right to reduce her to a full C cup. ( 454 grams = one pound)
He symptoms have resolved and she is thrilled to fit into her clothes and bathing suit.
A woman in her later 50’s who wears a 40 G cup and has had problems with back pain, shoulder pain, grooving and irritation of her shoulder from the bra straps and a persistent rash under the breats. She is shown before and again, 6 months after bilateral breast reduction with a free nipple graft technique. 1498 grams of tissue were removed from her right and 1544 grams of tissue from her left ( 454 grams is a pound(.
A free nipple graft technique was chosen because of the extreme drooping of the breast and large amount to be removed. In this technique nipples are completely removed and replaced as a free graft with some of the tissue preserved from below to add volume to the breast. It is more straightforward for healing for those patients where we anticipate a large reduction and a long length to the “pedicle” or blood supply to the nipple. It is also helpful in patients who smoke, which was not the case here. She healed uneventfully and all of her symptoms have resolved.
A woman in her mid 40’s with a deflation of her left implant. She initially had bilateral sub pectoral breast implants placed by another plastic surgeon in 2004. Her records shown McGhan (now Allergan) style 68 330cc saline implants filled to 360 cc on each side. She describes herself as a 36 C cup and was otherwise been happy with the results. She has a minor “waterfall” effect where the breast drops off of the implant mound with a sub pectoral placement. This could be corrected by changing to a sub-glandular placement of the implants but she likes the other potential benefits of sub-pectoral placement (decreased risk of capsular contracture, easier to perform a mammogram)
She noted a sudden decrease in the size of her left breast in 2019 but then “covid happened” and she was not able to get in for treatment. She decided to switch to the Ideal Structured Saline breast implants, and is shown before and again, 6 months after implant replacement.
Discussion: She has a minor “waterfall” effect where the breast drops off of the implant mound with a sub pectoral placement. This could be corrected by changing to a sub-glandular placement of the implants but she likes the other potential benefits of sub-pectoral placement (decreased risk of capsular contracture, easier to perform a mammogram)
There is no problem waiting for treatment after a saline implant deflation- If the implants can be replaced in the months after and before the tissues tighten around the deflated implant it can be slightly easier but a capsulotomy or release of the implant capsule is typically performed at the time of implant placement. The Ideal structured saline implants may have a lower deflation rate and are closer in feel to the silicone gel implants but filled with saline so they have the same “peace of mind” of avoiding a silent rupture. If they leak it can be detected without obtaining an ultrasound because the breast gets smaller. It is therefore not “silent”
She liked her size so the closest match is the Ideal structured saline implant size 335 cc with the back lumen filled to 188 and the front lumen filled to 135 cc, which, together with the empty implant volume of 52 cc gives a total implant volume of 375 cc.
An early ( 6 week) followup on a woman in her mid 20’s who describes herself as a 34 DD cup and has problems with back pain, shoulder pain, a rash under her breast in the warmer months and difficulty exercising. She has irritation of her shoulders from her bra straps. She is also self-conscious about the size of her breasts and feels that they are too large for her frame.
She is 5’4” and 128 and is shown just 6 weeks after a bilateral breast reduction. Scars are typically at their reddest and thickest at 6 weeks and then will fade and improve over the next 2 years. She is already thrilled with her result, and all of her symptoms are gone
Breast Augmentation with a Mastopexy – Patient 333
Breast Augmentation with a Mastopexy – Patient 333
A mother of 1 in her late 30’s who is bothered by a deflated and drooping appearance of her breasts after weight loss and pregnancy. She wanted to be fuller and less droopy in appearance. She is shown before and again, 7 months after augmentation mastopexy ( a breast at the time of breast implant placement.)
Discussion: She is 5 1 ½ and 120 lbs. She had Sientra High strength round smooth cohesive gel 350 cc high profile implants placed in a partial subpectoral position at the time of an inverted T mastopexy. She did not want a larger implant that might draw to much attention in her workplace and likes the natural but fuller look.
A mother of 3 in her later 40’s who is bothered by being “ tint in the breast area” and described herself as a 32A cup. Her breasts became smaller after pregnancy and she now wanted to improve this. She still wanted to have a natural appearance after surgery. She is shown before and again, 1 yeaar after partial subpectoral placement of Sientra, High Strength cohesive silicone gel round smooth implants placed through an inframammary incision.
Discussion: She is 5’6” and 148 lbs Her nipple to infra-mammary fold distance on stretch is 7.2 cm on the right but just 7 cm on the left. She elected for a sientra HP 280 cc implant which is 11.1cm at the base. Typically an 11 cm base fits well with the nipple centered when the distance on stretch is 7 cm. I reinforced her existing inframammary fold at the time of surgery by anchoring it to the rib periosteum with long lasting dissolvable sutures to prevent it from “giving way” and leading to “bottoming out”. The Sientra silicone gel implants have the lowest reported rupture rate at 10 years of any of the silicone gel implants on the market. She is thrilled with her fuller but still natural appearance.
A woman in her mid 30’s with partial deflation of her left breast ideal structured saline implant after 2 years. She is shown before and again, 6 weeks after replacement of the implant.
Discussion: Although the Ideal structured saline implant has a low failure rate, they do deflate on occasion. When this happens it is typically one of the two chambers and presents as a partial deflation. It has been easier to replace because the still intact second chamber tends to hold the shape of the base and makes it less likely that a full capsulotomy ( release of the contracted capsule) is required.
A man in his later 50’s who has been bothered for years by prominence of his nipples which is visible through his clothing.
He is shown before and again, 6 weeks after bilateral nipple papule reduction with an amputation technique leaving a 3-4 mm base. He is thrilled with his improvement and tells me he wishes he had done this years ago.