Breast Augmentation – Patient 291

A woman in her later 30’s who wishes to have fuller breasts. She has not had children or significant weight loss but does work out 2 hours a day at the gym and finds that her breasts have deflated in appearance. She is 5’6” and 133 lbs and describes herself as a 34 A to small B cup. Based on her tissue dimensions she was sized in the office and felt that a 400 cc implant was too large but liked the 350-375 cc size in clothing, using the Mentor sizing system.
After discussions she elected for a Mentor 375 cc high profile micro-textured implant placed through an inframammary incision in a partial sub-pectoral position. She is shown before and again, 5 months after surgery. She is thrilled with the fuller but still natural appearance of her breasts after surgery.
Discussion: A high profile was chosen to try and add some fullness to the deflated upper breast. Breast implants tend to shift to the side and to drop with time. This is more of a problem in “looser” breasts after weight loss or pregnancy. Texture can decrease the risk of this shifting. But texture can also increase the risk of Breast-implant associated ALCL, a kind of lymphoma that can start in a late fluid collection (seroma) around an implant and is felt to be related to Biofilm around an implant. Although rare, it has only been reported after the use of textured implants. It is more common in aggressively textured implants. When we chose to use texture I prefer the micro-textured implants such as the Mentor, which gives us the benefits without as many risks. In our patient’s case, after discussing the tradeoffs, she felt that the greater stability of the implant was worth the small increased risk of BIA-ALCL that is seen with texture.

Update: Our patient is now seen close to 2 years after breast augmentation. The micro-textured implants have remained stable and have not shifted as we might expect to have seen with smooth implants.