A breast reduction in a mother of 2 in her early 40’s who describes herself as a 36 G cup and has problems with back and shoulder pain. At 5’2” and 170 lbs she is over her ideal body weight and does not want her breast to be too small after surgery. In addition, her nipples are pointing to the outside of her breasts and need to be brought back to the midline. She is shown before and again, 1 ½ years after removing more than 2 lbs of breast tissue from each breast to reduce her to a full C cup. Her scars are fading nicely and her symptoms have resolved. She is thrilled to have normal sized breasts.
A woman in her mid 30’s who is bothered by prominence of her nipples. She wanted them to be smaller and less prominent in clothing but still natural in appearance. There is no standard measurement for a hypertrophic nipple but a “normal” nipple is sometimes suggested to be 1 cm wide by 1 cm in projection and in a women I typically aim for a correction to reduce the nipple to 8 mm wide by 8 mm high, as we have done here. Our patient is shown before and again, 6 weeks after a “top hat flap” nipple papule reduction performed under local anesthesia in the office. Her nipple sensation remains intact and she is thrilled with the correction.
A long term follow-up on a woman now in her later 30’s. This helps answer the question of “what will happen to my breast if I get pregnant after breast augmentation” She was initially seen in her late 20’s and described herself as a 32 AA cup and wanted to be a B or C cup if possible, but still natural in appearance. She is petite at 5 feet tall and 101 lbs. She elected for a smooth round silicone gel implant placed in a partial subpectoral position through an inframammary incision. A 250 cc high profile implant was used. This was the largest implant that I felt would still fit her tissues without looking overly round. She is shown just before and again, 10 months after surgery She has since had a child, and is shown again, 7 1/2 years after surgery. Although the breast typically gets larger with pregnancy and then smaller after, she has not developed significant drooping or stretching of her tissues and has maintained an excellent result. This is partly because she does not have as much native breast tissue to change with pregnancy, and partly because she did not have an implant that was too large for her tissues and could therefore lead to more problems with stretch.
A man in his early 30’s who developed gynecomastia at puberty. He does not have a history of significant marijuana use or anabolic steroid use, both of which can cause gynecomastia. Studies report that as many as 30% of young boys will develop some growth of the breasts at puberty. In most cases this goes away on its own by 18 months. If it has not resolved by that time it typically is not going to go away on its own.
He is bothered by the appearance of his chest in fitted shirts and with his shirt off.
He is shown before and again, 6 weeks after Power-Assisted liposuction using a modified S.A.F.E. technique combined with direct excision of breast tissue though an incision around the lower part of the areola. In the S.A.F.E. technique ( the letters stand for S uction A spiration and F at E qualization) the procedure is typically performed under general anesthesia. Wetting solution, sometimes called “tumescent” solution is injected under the skin. This is a dilute solution containing some local anesthetic and epinephrine. Then I perform external ultrasound to soften the fat. Then a cannula with fins called a “Becker” cannula is used without suction to mechanically disrupt the fat. I prefer the Microaire power system that vibrates this cannula rapidly back and forth. This loosens up the fat cells that remain viable however. Then the “aspiration” or liposuction is performed using an incision under the arm as well as the incision around the areola. After excising any remaining breast tissue under the areola, the fat is “equalized” or smoothed by using the finned cannula again to smooth the remaining fat layer around. In this manner the most aggressive liposuction can be performed without as much of a risk of leaving dimples or irregularities. A compression vest is worn for 6 weeks.
Scars are at the pinkest and reddest at 6 weeks and then begin to fade and improve over the next 2 years. The peri-areolar scars are nearly imperceptible even at this time. The lateral access scars are typically the most visible early on, and I try and place these behind the border of the pectoralis muscle so they are not as noticeable. He will now wear topical silicone on the small access scars for the next 3-6 months. He is ready to go to the beach now at 6 weeks. Sunblock is recommended for the first 12 months because any scar that is exposed to the sun while it is still pink can turn brown. He is thrilled to finally have a normal chest.
An athletic man in his early 70’s who had been troubled for years by prominent nipples that showed through his shirts. He did not want an extremely flat nipple papule as is the request of some men, but wanted to have normal prominence of the nipple papule with his shirt off, but correction of the excessive prominence. He is shown before and again, 3 months after nipple papule reduction in the office.
A mother of 2 in her early 40’s who is a 38 G cup and is bothered by back pain, shoulder pain, grooving and irritation of her shoulders from the bra straps, chronic rash under the breasts which has been treated by the dermatologist without success. She is 5’* and 194 lbs and is shown before and again, 10 months after bilateral breast reduction with the removal of 855 gms from her right breast / 889 gms from her left breast to take her down to a C cup. ( There are 454 gms in a pound) Her symptoms have resolved and she is thrilled with her new shape and size.
A mother of 3 in her late 30’s who feels like her breasts are too small to balance her frame, and is also bothered by breast asymmetry in a bathing suit and in T shirts when she is not able to wear a padded bra to camouflage. She has selected the ideal structured saline implants because she didn’t want to worry about silent rupture but wanted an implant that feels more natural than the traditional saline.
She is 5’6” and 138 lbs and is shown before and again, 9 months after bilateral partial sub-pectoral breast augmentation through and inframammary incision with a 300 cc Ideal structured saline implant on her left filled to 320cc which is above the “high” but below the “100%” fill volume, and a 440 cc Ideal structured saline implant on her right filled to the “high” of 440 cc. Tattoos have been blurred for her privacy.
An RN in her later 30’s who wished to have fuller breasts. She comes from another state and found us after seeing one of our patients and being impressed by the natural appearance of her results. She wanted to have a natural but fuller appearance. She found that her breasts looked deflated after losing weight with diet and exercise.
She is 5’6” and 119 lbs. She is shown before and again, 6 weeks after sub-glandular placement of Ideal Structured Saline implants size 370 cc through an inframammary incision.
Discussion: The empty Ideal implant volume is 56 cc. The Back/inner lumen is filled to 214 cc. The front/outer lumen is filled to 100 cc. This gives a total volume of 370 cc. This is listed as “high” fill on the sizing chart. The outer lumen is also designed to be filled to 145 cc which would give a total volume of 415 and is listed as “100%” fill. This greater fill volume is similar to a high profile implant and gives a slightly firmer feel. She did not want to be fuller than the 370 upon sizing in the office and prioritized the softer feel of the implant at 370.
A sub-glandular placement was chosen in her case. With a caliper pinch of 3.2 cm her breast tissues are thick enough to hide the implant ( 2 cm or less is usually considered “thin”). Her nipples are just slightly above the breast fold and she would be prone to a “waterfall effect” with a placement of the implants below the muscle. With a sub-pectoral placement the breast can fall off of the implant. With the sub-glandular placement the implant drops with the breast and avoids the “waterfall”. So when a patient has a nipple just at or above the fold but does not yet require a mastopexy, a sub-glandular placement can be a good tradeoff when the breast tissues are thick enough to hide the implant.
A mother in her early 40’s who would like to have fuller breasts. She is 5’4” and 116 lbs and is shown before and again, 6 weeks after a bilateral partial subpectoral breast augmentation with 275 moderate profile round smooth silicone gel implants placed through an inframammary incision.
A mother of 3 in her late 30’s who wanted fuller breasts. She describes herself as a 34 A cup and wanted to be fuller but still natural in appearance. She petite at 5’3” and 114 lbs and with a measured circumference around her chest of 29 ½ inches, is closer to a 32 Band size bra. ( 3 inches is typically added to this measurement to get the proper band size)
After reviewing the implant options she decided upon the Ideal Structured Saline implant. She was happy to not need to worry about a silent rupture, and even happier to be able to purchase an enhanced warranty from an outside insurance company that she will be able to renew annually for life. The base-width of each breast is 11.85 cm and the nipple to IMF on stretch distance is 8.5 cm. She was sized in the office and liked 325/350 but felt that 375 was simply to full in her clothing. Our decision was for the Ideal 335-375 cc implant that has a base-width of 11.4 cm, filled to a total volume of 350 cc. The implant has an empty volume of 52 cc, and the back/inner chamber is filled to 188 cc. The front/outer chamber was filled to 110 cc to give a total implant volume of 350 cc. Her implants were placed below the pectoralis muscle and through an inframammary incision. She is shown before and again, 4 ½ months after surgery. She is thrilled with her fuller but still natural look.