Breast Gallery

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.