Breast Augmentation with Ideal Implants – Patient 329
A mother of 2 in her mid 30’s who would like to have fuller breasts but still natural in appearance. She is currently a 32 A to B cup and wanted to be a small C. She liked the idea of the Ideal Structured Saline Implant because she would not need to worry about a silent rupture. She is shown before and again, 6 weeks after bilateral partial sub-pectoral placement of Ideal structured-Saline 270 implants filled to 275 cc, placed through an inframammary incision.
Discussion: She is thin at 5’ 5 ½” and 127 lbs. Based on her distance around her chest at the inframammary fold of 29” she is a 32 band bra ( actual measurement plus 3 inches). Her breast base width is 11.7 cm and her inframammary fold to nipple distance on stretch is 7.4 cm on her right and 7.3 on her left. Based on her breast dimensions she could have used an Ideal structures saline implant as large as 300-340 ( this implant has a base width of 10.8 when fully filled and when this dimension is adjusted by adding 3 mm to account for the curved base would be the equivalent of 11.1 cm, which would be less than her existing base width and therefore would not give an overly round or implant look. Also, it would fit the nipple to IMF fold on stretch distance of 11.3 cm and would not have given excess fullness of the upper breast ( “superior pole convexity”) When
She was sized in the office with the Mentor sizing system she felt that 300 was simply too big for the look that she wanted. She liked 250 and felt that 275 was “slightly full, but she could live with it”.
More often than not, a patient will get used to a chosen size and then wish that they had gone with a larger size. But after careful discussion and consideration she felt that she would be most happy with this size. And I could assure her that it would still have a natural appearance because of the base dimensions of her existing breast.
She is very pleased with her conservative increase in size.
Update: Our patient is now seen 4 months after surgery. The breasts have “softened” in appearance in look even more natural.
Breast Augmentation with Ideal Implants – Patient 328
A mother of 2 in her later 30’s who is bothered by a a deflated appearance of her breasts after pregnancy. She wears a 36 B and was a 38 C when breast feeding, She liked this size. She is 5’ 6” and 152 lbs and is shown before and again, 6 weeks after bilateral partial sub-pectoral
( below the muscle) placement of Ideal Structured Saline Implants 405-455 filled to 425
Discussion: she wanted a full but still natural appearing result. Her breast base width is 13.27 on her right and 13.21 on her left. Her nipple to fold on stretch is 9 cm. So a 13 cm base implant would not give her excessive superior pole convexity ( bulging of the upper breast) and as long as the base width of the implant is less than the width of her breast it should not look overly like an implant. The base width of the Ideal implant is 12-11.9 from minimum to maximum recommended fill and we add 3 mm to that to get the comparable implant width because of the curved base of the Ideal implant. I like to undersize the Ideal implants slightly to give a more natural appearance. I find that I can go a little larger with the silicone gel for patients that want the maximum volume but still a natural appearance. So the Ideal implant has an empty implant volume of 60 cc, the back chamber is filled to 235 cc and together with the front chamber fill of 130 cc we get the final volume of 425 cc.
Her photos are at just 6 weeks. I find that it takes 4-5 months for the Ideal implants to settle completely to the final result. The breasts are “sisters and not twins” and her right breast is slightly larger before and after surgery-because the left breast is slightly smaller we see a little more fullness of the upper breast on her left at 6 weeks- this will typically settle over the next vew months as the breasts stretch slighty to accommodate the implants.
Breast Augmentation with Ideal Implants – Patient 327
A 20 year old Asian woman who wanted fuller breasts. She has had a benign tumor called a fibroadenoma excised from her right breast at the age of 11 and has some breast asymmetry as well. She wanted to have a natural appearance and liked the idea of the Ideal Structured saline implants so that she did not have to worry about silent rupture. She is shown before and again, 6 weeks after bilateral partial sub-pectoral breast augmentation with Ideal Implants 270-305 filled to 305
Discussion: Her nipple to fold distance on stretch on her right breast ( the smaller of her two breasts) is 7 cm which would suggest an implant that is 11 cm at the base or less. The Ideal implant 270-305 when filled to 305 has a base width of 10.6 cm to which we add 0.3 cm = 10.9 cm corrected because it is curved to fit on the chest wall. The measured base width of her breasts are 11.4 cm on her right breast and 11.9 cm on the left. So an implant that is 11 cm or less will fit the nipple to fold distance without having too much superior pole convexity or bulging and she won’t have an overly round “implant” look as long as the base width of the implant is less than the base width of her breasts. We decided to use the same size on each side, using the largest implant that we could use on her smaller breast-if we put a larger implant on that side to balance the slight difference in breast volume then the smaller breast because it has a tighter skin envelope would appear unnatural. Her breasts look good at 6 weeks and will continue to soften in appearance over the next 4-5 months as the breasts stretch to accommodate the implants.
Breast Augmentation Revision with Ideal Implants – Patient 313
A mother of one in her early 50’s who has a long standing deflation of her left saline implant. She originally had 275 cc smooth round mentor saline implants placed in a partial sub-pectoral position through an infra-mammary incision in 2007. She did well but 3 years ago had a spontaneous deflation of her left breast implant.
She is petite at 5’2” and 118 lbs and elected for a small increase in size. She is now 6 weeks after removal of her ruptured left implant and intact right implant, using the same incisions and replacing with Ideal Structured Saline implants 300 filled to the top recommended total volume of 340.
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
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
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.
Breast Augmentation/Ideal Implants – Patient 307
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.
Breast Augmentation/Ideal Implants – Patient 304
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.
Breast Augmentation/Ideal Implants – Patient 301
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.