CONCAVE CHEST DEFORMITY AKA PECTUS EXCAVATUM
We see patients with a multitude of different congenital deformities of the chest. Women present for breast augmentation reconstruction in order to create a normal appearance to their chest wall. Patients with concave chests do appear in my office. This is referred to as pectus excavatum in which the sternum is depressed, the costochondral ribs are also depressed medially and then come out laterally. This leads to a depression along the central aspect of the chest wall. In terms of final surgical results, it is difficult to establish cleavage in a significant number of these patients. However, I have found that implants will help to disguise the concavity to some extent, reducing the appearance of the pectus excavatum or concavity of the chest wall. These are congenital deformities. Severe pectus excavatum may require a thoracic surgical release of the ribs in order to expand volume space for the lungs. Some patients do present with decrease in total lung capacity, forced expiration and thereby require chest wall reconstruction. Patients that we see, however, have more mild forms of pectus excavatum that will simply require an augmentation mammoplasty procedure. I am able to do the dual plane technique with saline or silicone implants in these patients.
Once again, we are able to disguise a significant portion of the concavity that appears from these chest wall deformities.
For patients with severe grade 3 ptosis, the Wise-pattern technique is my favorite approach. This approach is basically referred to as the “keyhole pattern” in which skin is taken circumferentially around the nipple areolar complex vertically and along the inframammary fold. By removing skin both vertically and along the fold, we able to tighten up the breast as well as to reshape the breast to give it a normal, round shape. The nipple areolar complex is elevated to its new normal position. Usually measurements from the bottom of the nipple areolar complex to the inframammary fold are approximately 5.0 to 5.5 cm. The nipple areolar complex is premarked at 4.2 cm with a cookie cutter pattern and the skin is then de-epithelialized along the inframammary fold to the extent necessary to prevent dog-ears either along the medial or lateral breast.
Many of my breast revision patients are patients who have undergone breast lifts that were not satisfactory to correct the skin laxity vertically as well as along the inframammary fold. When patients present with grade 3 ptosis aka the nipple areolar complex is below 3 cm under the inframammary fold, normally a lollipop lift or a periareolar lift will not be sufficient and skin must be removed along the inframammary fold. It is worth the tradeoff of an extra scar along the inframammary fold in order to have a perfect shaped breast.
Mastopexy and breast reduction surgeries are similar with respect to the Wise-pattern or anchor scar when patients present with severe grade 3 ptosis. Remember, if you do the improper surgical operation such as a round block or a lollipop with severe grade 3 ptosis, you are sure to have a disfigured deform-shaped breast and will probably be knocking at our door for breast revision surgery.
The patient below presents for breast augmentation surgery from the Midwest!!
We are always excited to take great care of out of state patients. She underwent a simple saline breast implant surgery and did great .
Made my trip from Oklahoma worth the effort and expense. I wanted the best and got the best for my breast augmentation procedure. I had very little pain and am thrilled with my results. Dr. Linder is a perfectionist (which is what I expected) and his staff is the most friendliest and reassuring group of women I have ever met.
Industrial Crime Adversely Affects Global Aesthetic Industry Growth
March / April 2012 issue
The Aesthetic Guide Magazine, March / April 2012 issue discusses the Poly Implant Prothese (P.I.P.) breast implant. I was asked by Aesthetic Guide to contribute to this article and had the opportunity to discuss topics that included symptoms of a ruptured implant, european regulators, and public safety.
For more information regarding this topic and the Aesthetic Guide magazine go to www.miinews.com .
GIGANTOMASTIA SURGERY: BREAST AMPUTATION
WITH FREE NIPPLE GRAFTING
The patient below is a 48-year-old female presenting with massive gigantomastic breasts/breast hypertrophy, 40KK breasts, with symptoms of severe back pain, neck strain, grooving around the shoulder blades and coracoid aspects of the shoulders, including ulnar neuropathy, rashes and ulcerations of the breasts due to poor circulation associated with the massive skin laxity and grade 3 ptosis. This patient is a perfect candidate for bilateral breast reduction using the breast amputation technique with a free nipple graft. The pedicle will probably be approximately 30 cm long, if not longer, and therefore will require most likely a free nipple graft in the operating room in order to prevent avascular necrosis of the nipple areolar complex due to the length of the pedicle and inadequate blood supply through osmotic diffusion.
The frontal and oblique views of this patient will be shown. This patient is an extraordinary case due to the massive size of her breasts as well as the severe degree of skin laxity and ptosis. These surgeries require skillful Board Certified Plastic Surgeons who specialize in breast reduction to reduce the risk of fat necrosis, bleeding, infection and nipple areolar necrosis.
The above patient presents with severe scar tissue contracture, Baker IV capsular contracture leading to a ruptured saline implant. The patient had severe bottoming out of the right implant with implants placed by a different surgeon at a different part of the country. In any case, she is noted as having severe bottoming out with encapsulation of the upper pole of the right breast causing the implant to become inferiorly displaced. The right implant through a severe Baker IV capsular contracture over eight years led to hardening around the bag and severe encapsulation leading to a ruptured saline implant with a valvular leak.
The preoperative photo shows a significant deflation of the right breast with complete loss of upper pole fullness and flattening of the entire chest. Clinical diagnosis of saline implant shows the ruptured implant. No diagnostic testing is necessary for this saline rupture. The implant is then removed under general anesthesia and after prepping and draping the patient. Notice the yellow color of the fluid in the bag which is consistent with a chronic rupture. This patient will undergo bilateral open periprosthetic capsulectomy, removal of bilateral implants, circumferential capsulotomies and reconstruction with high profile saline implants in order to regain upper pole fullness as well as an inframammary tightening procedure in order to remove skin along the left inframammary fold to reduce the distance from the 6 o’clock position of the nipple areolar complex to the inframammary fold to match bilaterally with 8 cm even.
Ruptured silicone implants appear in my office on a weekly basis from patients throughout the United States. These should be removed and replaced as soon as possible in order to reduce the encapsulation and scar tissue impingement of the pocket.
STATUS POST AUGMENTATION MAMMOPLASTY
The patient presents with a massive seroma, right breast, and painful Baker IV capsular contracture associated with increasing pain over the last two weeks. The right breast shows massive scar tissue with fluid collection and superior retroposition of the implant. The patient has pain in the right breast and notes that she had trauma to her breast approximately two weeks ago.
The patient was brought to the operating room, placed in the supine position. She was prepped out with Betadine solution, given a gram of Ancef intravenously. Notice the before picture, the right breast is enormous, showing superior swelling and lateral fluid collection. The postoperative photo shows the implant removed and an open capsulectomy with 600 cc seroma evacuated. Scar tissue is also released and she now has complete decompression. Notice the canister showing the 600 cc of clear straw-colored fluid which is serous fluid, usually associated with a tear in the capsule with no evidence of infection.