A woman in her early 30’s who is bothered by prominent nipples and hides them with a padded bra. She notes that her nipples are sore when she ovulates but does not have irritation of the nipples in the shower or with sports. She is shown before and again, immediately after a Top Hat flap nipple papule reduction and then 6 weeks after.
A mother of 2 in her later 30’s who is a 32 double H bra and has problems with back and neck pain, irritation of her shoulders from the bra strap and a rash under the breasts in the warmer months. She is 5’5” and 152 lbs and is shown before and again, 4 months after an inferior pedicle short T scar breast reduction with the removal of more than 1150 gms of tissue from each breast. The nipples were pointing to the inside before and were brought back to the median of the breast. She has significant drooping and internal plication of her tissues were used to add more support. Scars will continue to fade and improve over the next 18 months or more. Her symptoms have all resolved and she is thrilled with her new shape and size.
Update: Our patient is now seen 10 months after surgery. Scars continue to fade and improve and her breasts have maintained their shape.
A woman in her early 30’s who wants fuller but still natural appearing breasts. She is 5’6” and 120 lbs . She describes herself as a 34 small A and wants to fit into bras and clothing but still have a relatively natural appearance. She did not mind the idea of a slight implant look out of clothing if needed to obtain her goals in clothing,
She was carefully sized in the office based on her tissue dimensions and characteristics and we were able to use a 350 cc high profile round smooth cohesive silicone gel implant placed in a partial sub-pectoral position through an infra=mammary incision.
She is shown before and again, 4 ½ months after surgery. Tattoos are blurred for her privacy.
Discussion: She is thrilled to have a natural but fuller appearance. Casual acquaintances’ and coworkers know that she looks better but are not sure why. She loves the fact that her clothes and tops fit her now. Her pre-op breast width is 11.9 cm and the nipple to IMF distance is 6.5 cm, but 8 cm on stretch. The chosen implant is 11.7 cm at the base and 4.8 cm in projection. Because the implant width is not wider than her breast base she does not have an “implant look”. When the nipple to infra-mammary fold distance is 8 cm on stretch then it is best to use an implant that is 12 cm in diameter or less to avoid excessive superior pole convexity. Again, the implant chosen fits her dimensions well.
A woman in her mid 50’s with large breasts who is bothered by neck pain, back and shoulder pain due to the size of her breasts as well as grooving and irritation of her shoulders from her bra straps and a rash under her breasts in the warmer months. She is 5 feet tall and 124 lbs and is a 34 DD cup bra. She is shown before and again, 9 months after bilateral breast reduction with the removal of 420 gms of tissue from each breast. Scars will typically fade and improve for the first 2 years. She is thrilled to be a C cup after surgery and her symptoms have all resolved. A short Inverted T scar technique was used with an inferior pedicle.
An 8 year follow-up on a woman who had correction of a retracted nipple on her left side. She was bothered by having retraction of the nipple for more than 25 years. She was able to manipulate this and bring it out to breast feed her children, but was bothered by the appearance. She would be considered a Han and Hong grade II- With a grade I the nipple can be pulled out easily and maintains its position without traction. A grade II can be pulled out manually, but not quite as easily as a grade I and has difficulty maintaining its position. A grade III is severely inverted and cannot be pulled out manually.
She had micro-incision procedure for release of the retracted nipple in the office with a stent placed for one week and protective pads worn for 6 weeks after her procedure. She was seen for another reason in the office today and is still thrilled to have a normal nipple prominence.
Breast Augmentation Revision/Ideal Implants – Patient 292
Breast Augmentation Revision/Ideal Implants – Patient 292
A woman in her mid 20’s with a tuberous breast deformity. She is bothered by the shape and also the size of her breasts. She wanted to be fuller but still natural in appearance. With a Tuberous breast, the base of the breast is relatively constricted and narrow and needs to be expanded. The breast is overly “pointy” and needs to have the shape flattened a little. A periareolar round block gortex suture flattens a tuberous breast and improves the shape. She is 5’5’ and 132 lbs but the base width of her breast is just 10.7 cm on her right and 10.5 cm on her left. The inferior areola to the breast fold distance is just 5 cm. So an implant needs to be carefully chosen that will widen the base of the breast but not be too large for the new nipple to breast fold distance which with reduction of the areolar with a gortex suture would be 7 to 7.2 cm. This would suggest based on the geometry that an implant with a base width of 11-11.2 cm is the widest that can be used without needing to lower her breast fold. Lowering the fold increases the risk of “bottoming out” and also of a “double bubble”.
She elected for the Ideal structured saline implant and so the 300 cc implant was selected. This has a base width of 11.1 cm so it is just a little wider than the base of her existing breast which helps to widen the base of the breast, but is not too large for her new nipple to fold distance after her periareolar round block suture is placed. The implant was placed in a subglandular plane.
The 300 cc implant has an empty implant volume of 37 cc due to the internal baffles, and the back/inner lumen is designed to be filled to 188 cc. The front lumen can be filled to 75 cc to give a moderate profile and total volume of 300 or to 115 cc to give a high profile and a total volume of 340 cc.. In her case a moderate profile has a better effect and the implant was filled to 300 cc total volume. She is shown before and again, just 3 months after surgery.
The scars around the areola will typically continue to fade and improve over the first 2 years after surgery. She is already thrilled with her new shape and size. It would have been difficult to use a larger implant in her case and still maintain a natural appearance because of the tissue dimensions of her breast.
A woman in her early 20’s who is a 38 DD cup and is bothered by back pain, shoulder pain, difficulty exercising even with 2 bras on, as well as problems with her posture when she is trying to sit up straight at her desk. She is 5’5” and 148 lbs and is shown before an again, 3 ½ months after a bilateral breast reduction with the removal of more than 500 gms of tissue from each breast. It is still early after her surgery as scars will typically get redder and thicker for the first 6 weeks and then will soften and improve over the next 2 years. She is thrilled with her new shape and size, and using topical silicone as recommended to help with the scarring. Her back and shoulder pain has resolved.
A woman in her 70’s who described herself as a 32 DD who is bothered by shoulder and neck pain from the weight of her breasts, as well as by the drooping appearance. She is shown before and again, 4 ½ months after an inferior pedicle short T scar reduction mastopexy with internal plication sutures. Scars will typically continue to fade and improve over the first two years or longer. She is already thrilled with her new shape and size ( small C cup) and her symptoms have resolved.
A mother of 4 in her later 40’s who wears a 32 G cup bra and has trouble with her posture, grooving and irritation of her shoulders from her bra straps, back pain and neck pain as well as difficulty exercising and a rash under her breasts in the warmer months. She is shown before and again, just 2 ½ months after bilateral short T scar breast reduction with more tissue being removed from her left than her right breast to balance the difference in size.
Although scars will typically improve over the next 2 years she is already settling well with the topical silicone and is thrilled that her pain is gone. The short T scar approach utilizes an inverted T scar but gathers the skin at the inner and outer aspect to that it does not show along the sides of the breasts with revealing clothing styles.
A mother in her later 50’s who was treated for bilateral ruptured silicone breast implants and bilateral nipple hypertrophy. She had had breast augmentation in the late 80’s by a plastic surgeon who had since retired. Her breasts had been hard since her surgery. She was also bothered by “long nipples” that were overly prominent in clothing and for which she would wear silicone nipple shields to hide them. The nipples were also very sensitive in the shower and in her clo6hing. I recommended an MRI to assess her implants which had been in place for 23 years, and it showed that bilateral subglandular silicones implants with intracapsular ruptured. Her original operative report was obtained and showed that she had 175 cc silicone gel implants. She wished to be a little fuller but still wanted a very natural look. She is petite at 5’2” and 115 lbs and is active at the gym, so did not want to appear unnatural in workout gear.
Sizing was performed in the office and she elected for a very modest increase in size to 250 cc moderate plus smooth round implants. Although there are benefits of placing the implant below the muscle, she did not want to worry about an animation deformity and elected to keep her implants in the subglandular space. She and family members have a history of easy bleeding and bruising and although a hematology workup was non-specific, I recommended against textured implants in her case which, although they may decrease the risk of capsular contracture in a subglandular position can have a potential problem with late bleeding and hematoma which I felt she was at more of a risk for.
She is shown before and again, 3 years after bilateral removal of her ruptured implants and creation of a new pocket below her breast capsule but above the muscle. A “top hat flap” nipple reduction was performed at the same time to reduce the projection and diameter or her nipples. She remains quite pleased with her new size. Her breasts have remained soft. And she no longer has nipple irritation in clothing or the shower, and no longer is embarrassed by excessive nipple projection.