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.
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.