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.
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.
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.
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.
Breast Augmentation Revision/Ideal Implants – Patient 291
Breast Augmentation Revision/Ideal Implants – Patient 291
A mother of 3 in her early 30’s who had subglandular breast augmentation with saline implants 9 years before through a trans-axillary incision. She has had her 3 children since that time and would like her breasts to be fuller and more like they were before children. She is also bothered by visible and palpable wrinkles, especially in the cleavage area and upper breast when she leans forward. She is 5’5 and 127 lbs and wears a 32 cup bra.
She is shown before and again, 6 weeks after replacement of her saline implants with Ideal Structured Saline implants 370-415 filled to 415 cc total volume and placed in the original sub-glandular position though an inframammary incision.
Discussion: She already has some stretching of the lower part of her breast which is at 9.5 cm from the infra-mammary fold to the nipple. Her breast tissues are relatively thin with a caliper pinch of 2 cm. She had her implant card which showed Mentor moderate profile 275-300 cc implants filled to 300 cc. The base of this implant is 11.7 cm and it projects 4.3 cm She was sized in the office by adding Mentor sizing shells to her existing volume and she liked the addition of 125 cc but 150 cc started to look too full for her petite frame. In addition, the larger the implant, the more weight related stretching of the breast tissues so we elected for the 415 cc size Ideal structured saline implant, which is similar to a high profile silicone implant. In the case, the empty implant volume is 56 cc and the inner/back lumen is filled to 214 cc and the front/outer lumen is filled to 145 cc to give the total volume of 415 cc. This Ideal implant has a base of 11.7 when filled to 415 and has a projection of 5.3 cm. So is fits the space of her old implant but does not require any modification of the lower breast implant capsule- we can preserve the capsule to help support the new implant and help to protect her tissues from more stretching. She could have changed to a silicone gel implant to have less ripples and wrinkles but did not like the idea of a possible silent rupture- she liked being able to detect a leak with the saline implants on exam. She was changed to the Ideal structured saline implant and loves the new feel. She says that the wrinkles and ripples are nearly gone and do not feel like “a baggy filled with water” like her old implants. The higher profile gives a little more fullness in the upper breast.
A woman in her mid 40’s who has lost 70 lb with diet and exercise and would like her breast to be fuller. She described herself as a 34B cup and wanted to be a C to full C cup. She was fearful of silicone and silent rupture and wanted saline implants. She is 5’6” and 134 lbs. Sizing was performed in the office based on her tissue dimensions and using the Mentor sizing shell system. She liked an implant size around 400 in clothing and felt that 450 was too big.
She is shown before and again, 9 months after bilateral partial subpectoral (below the muscle) placement of Ideal Structured Saline 370-415 cc implant filled to 415 ( the equivalent of a high profile implant) placed through an inframammary incision ( at the breast fold). She is thrilled by the fuller but still natural appearance of her breasts.
Tattoos have been blurred for her privacy. The photos are otherwise untouched.
A woman in her early 20’s who wants fuller breasts but still natural in appearance. She is concerned about silent rupture and has elected for the Ideal structured saline implants.
She is petite at 5’3” and 109 lbs and wore a 32 A to B cup before surgery. She is shown before and again, 4 ½ months after bilateral partial sub-pectoral breast augmentation with the placement of the 300cc Ideal structure Saline implant filled to the 300cc total volume. The empty implant is 37 cc, and the back/inner lumen is filled to 188 cc and the front/outer lumen is filled to 75 cc to give the total volume of 300 cc.
A 20 yo woman with breast asymmetry who wished to be more symmetry in and out of clothing. She is 5’6” ‘and 149 lbs. She has elected for the ideal structured saline implant and is shown before and again, 11 months after bilateral partial subpectoral placement of the Ideal implants through an inframammary incision. She has a 370 cc implant filled to the “high” volume of 370 on her right, which is actually similar to a moderate profile implant in profile and a 210 cc implant filled to 235 cc on her left which is closer to the “100%” and more similar to a high profile implant in profile. The right breast, which is the smaller of the two breasts will tend to have more superior pole convexity, or fullness of the upper breast because it is relatively tighter. So to balance the upper pole fullness between the two breasts, a higher profile is used on the left, but, of course, a smaller implant to better balance the size.