Breast Gallery

J.S. is a 36 yo who is shown before and 6  months after bilateral partial subpectoral placement of smooth 360cc silicone gel moderate profile implants placed through an infra-mammary crease incision.

R.R. is a 44 yo shown before and 5 months after bilateral partial- subpectoral placement of smooth round saline implants filled to 325cc.  The incision approach was at the infra-mammary crease.

A challenging case of a woman in her early 30’s with a right implant deflation, and bilateral fold malposition. She had breast augmentation down south when she was 21. She was small C at the time and wished to be a full C. Her records were obtained and show that 500 cc high profile saline implants were placed below the muscle through a periareolar incision. She was a 34D-DD after her surgery and was having issues with back and shoulder pain due to the new size of her breasts. She came in to see us after her right implant had deflated. She did not like her breasts falling off to the side and the loss of fullness in her upper breast. She wished to be smaller but still a full C. Our plan was to deflate her left saline implant in the office and let her breast recover for at least 4 weeks before surgery. In the mean time she made the happy discover that she was again pregnant so we went ahead and deflated her saline implant in the office so that her breast would not stretch even more with her pregnancy and then waited until 6 months after her pregnancy to let her breast resume its normal volume and perform her surgery. We sized her again in the office and she liked a 375-400 cc volume the best. She is 5’7” and 145 lbs. Typically the volume of an implant will drop into the lower breast after it has been stretched with pregnancy or prior implants and not give lasting fullness in the upper breast. In order to help maintain some fullness in her upper breast, she elected for a round, high profile silicone gel implant. Texture was chosen to help stabilize the implants and decrease stretching of the lower breast and lateral shift. The Sientra gel is “form stable” in their round implants and is the most cohesive of the choices so this was selected for her. A 415 high profile textured round implant was placed after performing a capsulorrhaphy ( a suturing internally to tighten the prior implant space which had been overly stretched) and a bilateral mastopexy. We had Seri Scaffold available in the OR to reinforce the internal capsulorraphy repair but is was not needed.

Our patient is now seen 7 months after her surgery. Her scars continue to fade and the shape has “settled”. The lateral capsulorraphy (repair of the lateral pocket) and textured form stable implant has prevented lateral shift ( the implants dropping to the side) which is demonstrated in a photo with her lying down flat. Her breasts remain soft, and she continues to like the “feel” of the silicone gel implants better than the saline implants. She continues with the topical silicone application- her scars are doing well for 7 months, but will typically continue to fade and improve over the next 18 months.

A mother of one in her later 50’s who wears a 40DD bra and is bothered by chronic neck, back and shoulder pain, difficulty with exercising, and problems with moisture and rashes beneath her breasts. She is 5’1” and 170 lbs. She is also bothered by fat deposits in her upper chest area that are visible when she wears certain clothing styles.

She is shown before and again, 5 months after bilateral breast reduction (Inferior pedicle/Inverted T) with the removal of more than 700 gms of breast tissue from each side. Liposuction of the axillary area was performed at the same time. Although her scars will continue to improve for the next 18 months, she is already thrilled with her new size and shape. She is enjoying her new bathing suits for the summer, and can wear tops that show the axilla now. Her symptoms have resolved.

21 year-old woman with DDD breasts who is bothered by back and shoulder pain. She is over her ideal body weight at 5’1” and 174 lbs but finds it difficult to exercise due to the size of her breasts. She is shown before and again, 9 months after bilateral breast reduction with the removal of more than 800 gms of tissue from each breast. She is now a “C” cup and no longer has problems with back and shoulder pain. Scars will typically continue to fade and improve for 2 years after surgery.

A mother of 3 who is bothered by a delated appearance of her breasts after breast feeding. She was a D cup when breast feeding. She feels that her breasts are “flat” and not as full as before children. She wants to have a natural appearance after surgery. She is 5’ and 130 lbs and is shown before and again, 6 weeks after bilateral subglandular placement of 375 cc smooth round moderate profile saline implants through an inframammary incision.
Discussion: Her case is more complicated because she has early drooping of the breast with her nipples being located at to just below her breast fold. If the implant is placed below the muscle, the breast may fall off of the mound ( a “waterfall” effect) and look like a rock in a sock.) A breast lift could be performed but would add a visible scar around the areola. She has elected for a subglandular placement. With the implants above the muscle, the implants will drop with the breast and avoid the potential waterfall effect. This is one benefit of the subglandular approach. She is willing to accept the tradeoffs of a potentially higher rate of capsular contracture and the possibility of more visible ripples with time- her tissues are thick enough with a caliper test of 3.5 cm that this may not be a problem in her case.
She has also elected to have saline implants. Although they have a higher chance of having ripples it is easier to tell if they have leaked down the road without an ultrasound or an MRI.