Breast Reconstruction with Ideal Implants – Patient 312
A woman in her early 20’s who is a 32A cup and wished to be a full b or small c if possible. She is very thin at 5’7” and 101 lbs and a BMI of 16.06. Her case is also complicated by a pectus excavatum, which is a depressed hollow of the sternal area. In very thin patients I like to have them supplement their nutrition with an additional 80 gms of protein a day for a months before and after surgery. She had a nipple piercing when she first came in and I have recommended that she not replace this after surgery to decrease the risk of capsular contracture. There is bacteria in the nipple ducts, and any trauma can allow this bacteria to get into the blood stream and potentially travel to the implant, with the resultant biofilm potentially leading to a capsular contracture. The base width of her breast is 9.8 cm. The nipple to fold is 5 cm and increases on stretch to 6.5 cm. She is shown before and again, 4 months after bilateral subpectoral placement of Ideal Structured saline implants 210-235 cc filled to 235 cc. The empty implant volume is 30 cc. The back/inner lumen is filled to 120 cc and the front/outer lumen is filled to 85 cc to give the total of 235 cc. The breast fold was reinforced by anchoring it temporarily to the rib periosteum with long lasting but dissolving sutures to prevent “bottoming out” of the breast.
The dimensions of this implant are 9.7 cm but we add 0.3 cm because it is measured on a curved surface to give a base equivalent of 10 cm. The projection is 4.4 cm. The equivalent diameter is 0.2 cm larger than her native breast and can therefore give a slight implant look which she was ok with. She wanted the Ideal implant which is filled with saline and this is the smallest size that the company makes, but just fit. If she had wanted to be any fuller I would have recommended that she switch instead to a silicone gel implant which can allow a slightly fuller implant to be used.
She is thrilled with her fuller, but still natural appearance. Tattoos have been blurred for her privacy.
Update: She is now seen 9 months after surgery. The breasts have settled in appearance and appear even more natural.
Breast Reconstruction with Ideal Implants – Patient 311
Breast Reconstruction with Ideal Implants – Patient 311
A mother of 3 in her mid 30’s who is bothered by a deflated appearance of her breasts after pregnancies and breast feeding. She describes herself as an A cup and would like to be a C cup. She did like the appearance of her breasts after they were enlarged for breast feeding. She wished to have a natural appearance after surgery and liked the idea of the Ideal structured saline implant so she would have the peace of mind of not needing to worry about a silent rupture. She is shown before and again, 7 weeks after surgery with an Ideal implant filled to 340 cc on her right (maximum fill) and 300 on her left (minimum fill) to balance her asymmetry.
On a sizing visit, she liked the 300/325 size. She felt the 325 was “a little full but she could live with it”. The base width of her breasts are 11.6 cm on her right and 11.4 cm on her left. Her nipple to fold distance on stretch is 8 cm on her right and 8.2 cm on her left.
The Ideal Structured Saline implant 300-340 was chosen and was placed through an inframammary incision and underneath the pectoralis muscle. The base of the Ideal implant is 10.9 cm but because it is curved we add 0.3 cm to give an 11.2 cm equivalent. So we can be confident that it will “fit” the base of her existing breast and not give an overly round “implant” look that she did not desire.
Breast Reconstruction with Ideal Implants – Patient 310
Breast Reconstruction with Ideal Implants – Patient 310
A mother of 1 in her early 40’s with a history of breast cancer. She had lumpectomy and radiation of her right breast 9 years before. She has a significant contour deformity of her right breast as well as breast asymmetry and both breasts which are smaller than ideal for her frame. I first reconstructed the contour deformity from her lumpectomy and radiation with 2 sessions of fat grafting. In the first session, 120 ml of fat were grafting to her right breast along with scar release. 4 months later she had additional fat grafting and scar release of the right breast. She then had bilateral breast reconstruction with placement of Ideal Structured saline implants in a partial subpectoral position through an inframammary incision. A left nipple reduction was performed at the same time to better match her opposite breast. She is shown 6 weeks after this final procedure. The Ideal structured saline implants were the 370 cc implants. The empty shell volume is 56 cc. The posterior/inner lumen is filled to 214 cc. The front/outer lumen is filled to 105 cc to give a total implant volume of 375 cc.
A mother of 2 in her mid 30’s who is bothered by a deflated appearance of her breasts after pregnancy. She described herself as a 34 A cup and wanted to be a B or C cup if possible, but still natural in appearance. She is 5’ 3 ½ inches in height and 119 lbs. She is shown before and again, 6 weeks after bilateral partial subpectoral placement of 270 cc Ideal Structured Saline implant filled to 270 cc and placed through an inframammary incision.
Discussion: She liked the idea of not having to worry about a silent rupture and chose the ideal structured saline implants. Her chest diameter at the IM fold is 29 inches which would place her in a 32 inch bra. (3 inches is added to this distance to get the bra band size). Her nipple to inframammary fold distance on stretch is 7.2 cm on her right and 8 cm on her lift. Her breast diameter is 11.3 cm. The dimensions of the Ideal 270-305 implant at 270 is 10.7 cm with a projection of 4.3 cm. Because the implant is shaped to fit on a curved surface such as the chest wall I would typically add 3 mm to the width to be equivalent with a “standard” implant. So 11 cm base equivalent is smaller than her existing base width so her breast does not have an overly round “implant” look and the nipple to fold distance of 11.2 accommodates an implant base of 11-11.1 without giving too much superior pole convexity or unnatural fullness of the upper breast. Tattoos have been blurred for her privacy.
A mother of one in her early 30’s who is bothered by a deflated appearance of her breasts after breast feeding. She describes herself as a 36 B but wanted to be a full C. She is 5’4” and 158 lbs and is shown before and again, 4 ½ months after bilateral subglandular breast augmentation with Ideal Structured Saline implants filled to 410 cc.
Discussion: She has pseudoptosis with her nipples being located just at to above her breast fold. Caliper pinch of her breasts shows a thickness of 4.5 cm. A subglandular placement was chosen because she has enough breast tissue thickness to hide the implant and a subpectoral placement puts her more at risk for a “waterfall effect” with her somewhat loose breast falling off of the breast mound. With a subglandular placement, the implant drops with the breast, avoiding the potential for a waterfall effect. She has the Ideal 370-410 cc implant. The empty implant volume is 56 cc and the inner lumen is filled to 214 cc. The outer lumen is filled to 145 cc to give a total implant volume of 410 cc. This higher fill volume is similar in profile to a high profile silicone implant and gives a little more fill to the upper breast. She is pleased with the soft feel of the Ideal Implants which are nearly as soft to the touch as silicone implants. She is also happy to not have to worry about silent rupture.
A mother of 1 in her early 30’s who is bothered by a deflated appearance of her breasts after pregnancy and breast feeding. She describes herself as a 36 B and would like to be a full C. She is 5’4” and 158 lbs and is shown before and again, 6 weeks after bilateral subglandular placement of Ideal Structured Saline implants 370 filled to “100%” fill of 410 cc.
Discussion: Our patient wanted a natural but fuller appearance and wanted to restore some volume to her upper breasts. Her breast width is 13.97 on her right and 14.3 on her her left. Her nipple to breast fold distance on stretch is 9 cm. The diameter of the Ideal Implant she selected and filled to 410 is 11.7 I usually add 3 mm to the base width of the Ideal because is it designed to sit on a curved surface. So 12 cm is less than her breast width, so it will not “look like an implant”. Her nipple to breast fold on stretch is 9cm. Any more and she may be a candidate for a lift. If her implants were placed below the muscle the implant would move separately from the breast and the breast which is slightly lax would have a tendency to drop off of the implant- this is sometimes called the “waterfall effect”. In a case like hers where the breast is lax, a subglandular placement allows the implant to move with the breast and settle with the breast, giving a more natural look. The tradeoff for a subglandular placement is a slightly higher risk of capsular contracture.
The 370 implant has an empty implant volume of 56 cc. The inner lumen is always filled to 214 cc. The outer lumen is filled to 145 cc, giving her a total implant volume of 410 cc. This gives a higher profile, which helps to add some volume back to her deflated upper breast.
Update: Our patient is now seen nearly 1 year after surgery. Her breasts have settled and appear even more natural in appearance. She remains thrilled with the improvement in shape and size.
A 39 year old woman who described herself as a 34B but wished to be a full C to D but still relatively natural in appearance. She was concerned about capsular contracture because of a friend who has breast augmentation elsewhere and wished to do everything to avoid this. She wanted to have some superior pole fullness as long as it would look relatively natural. After discussing the different implant choices she elected for an Ideal Structured Saline implant because she did not want to have to worry about a silent rupture. She is 5’5” and 137 lbs and elected for a 455 cc implant placed through an inframammary fold incision and below the pectoralis muscle.
She is shown before and again, 10 months after her surgery.
Details: We used the 405 cc Ideal Structured saline implant with the empty implant volume of 60 c. The inner lumen was filled to 235 cc and the outer lumen was filled to the maximum recommended volume of 160 cc to give a total volume of 455cc. ( “100% fill “) Because of the relatively large size of the implant that she selected, I reinforced her inframammary folds by anchoring her inframammary fold ligament to the rib periosteum at the time of surgery with a strong dissolvable suture to decrease the risk of “bottoming out”. This can be an issue with a larger implant when additional force is placed on the fold, causing it to “give way” and allow the implant to drop excessively. She is thrilled with her very full but still natural appearance, and her inframammary folds have been stable.
A mother of 2 in her late 30’s who has 2 children and breast fed. She describes herself as a 34 B cup but would like to be a C cup. She is 5’2” and 127 lbs and is shown before and again, 6 weeks after bilateral partial subpectoral placement of Ideal Structured saline implants.
She had the 270 cc implant with the inner lumen filled to 165 cc, the outer lumen filled to 70 cc to give, along with the empty implant volume of 35 cc a total volume of 270 cc. This is considered the “ High” volume. The outer volume could also have been filled to a total of 200 cc to give the “100%” fill of 305 cc for this particular implant. She is thrilled with her fuller but still natural appearance.
Update: Our patient is now seen 11 months after surgery. The breasts have softened in appearance and appear even more natural.
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 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.