REVISION BREAST SURGERY
This patient is an excellent case study of a ruptured left saline implant status post motor vehicle accident, leading to complete collapse of the upper pole of her left breast with severe scar tissue contracture. Notice the elevation of a left nipple areolar complex with the scar tissue contracture associated with elevation of the ruptured implant. Postoperatively, note the symmetry of the nipple areolar complex. Also, the sternum area is rounder, softer and notably the cleavage is more well-defined and narrowed. The upper pole shows equal fullness and the inframammary folds are even. Notably, the preoperative left ruptured implant shows approximately .5 cm elevation of the inframammary fold with approximately 1 cm elevation of the nipple areolar complex.
Her close-up view shows excellent symmetry saline implants without visible rippling, equal fullness nipple position, inframammary fold height and cleavage.
This patient presents with severe disfigurement, left superior retroposition of her implant, with scar tissue contracture with painful breast deformity left breast. Patient has had multiple surgeries by multiple surgeons without relief of her problem. Note, the left implant is elevated superiorly. There is complete loss of the lower portion of her breast. She has inadequate release of the parasternal attachments of the pectoralis major muscle as well as release of the fascia from her previous two surgeries. In order to reconstruct and repair this, she had a total capsulectomy, lateral capsulotomy and resection of the parasternal attachments of the pectoralis major muscle with inferior radial release of the lower pole of her breast pocket with replacement of her 100 cc Mentor moderate plus silicone gel implant and a superior areolar lift.
On Postop Day 1, note that the implant is now in the correct position. She will wear a Dr. Linder Bra, extra small, for the next weeks and an upper pole compression band in order to maintain the inferior positioning of her breast implant.
1 Week Out
Los Angeles is the melting pot of people from throughout the entire globe. The Asian population of patients, including Chinese, Korean and Thai, play a significant role in our patient base that undergo breast enhancement procedures every year. In general, many of our Asian patients desire the most natural look possible. For these patients, we often use a moderate plus silicone or saline implants, a little less upper pole fullness, a little more width and a more natural slope.
This patient example shows a Chinese female with hypoplastic breast with minimal breast tissue. She is a 32AA and desires to be a full B. She is an excellent candidate for moderate plus saline implants placed in the dual plane through a periareolar approach. The three-month postoperative results show excellent symmetry of the inframammary fold cleavage and upper pole fullness. The nipple positions are even. Periareolar scars have healed well. In general, for the smaller framed oriental Asian patients, the moderate plus implants from Allergan seem to do the job. The implants are not too wide and they are not too narrow. They are just perfect, in between. They are also not too round, the AP projection is natural and they have an upper pole natural slope even in very thin chested women. Natural-appearing breast implants depend upon the anatomy of the patient. These factors will include the inframammary fold diameter, the amount of glandular and breast tissue to cover the implant, and the thickness of the pectoralis major muscle. Positioning is often associated with the diameter of the chest wall which should be measured both preoperatively as well as in the operating room.
The patient presents with an excellent case example of severe deformity and distortion of the right breast with ruptured silicone calcified breast implants. Preoperative evaluation shows hardening with severe encapsulation with silicone calcified granulomas in the right breast.
Notice the disfigurement of the breast and the flattening of the inframammary fold down to the bottom of the right breast. Postoperatively, she has a complete open capsulectomy, softening of the breast pockets with style 68 high profile over-filled saline implants to reduce the visible rippling because her tissue is so thin. Symmetry is excellent. Cleavage is great. The folds are even and the upper poles are soft and at the same level. The patient is now three months postoperative and is extraordinarily happy with the results. She will maintain vitamin E orally to reduce recurrent scar tissue with tissue expansion exercises. This is an excellent example of asymmetry with severe disfigurement associated with ruptured calcified implants.
This is an excellent example of a patient presenting with congenital breast asymmetry. Notably, she is a 21-year-old Latin female. Her right breast shows grade 3 ptosis. The left breast shows a tubular breast deformity. The right breast is approximately 1.25 cup size larger than the left. We decided upon the use of high profile smooth saline Natrelle Allergan implants in the dual plane, 350 right, 400 cc left, and a right formal complete mastopexy using the inferior pedicle Wise-pattern technique or anchor scar. The patient is now six weeks postop.
Notice that there is excellent symmetry and volume. The right nipple is still slightly higher than the left, but this will settle over the next three months. The fullness is even in her bra and the tubular shape of the left breast has been alleviated by radial striated releases along the lower pole of the breast. The volume is excellent. Inframammary folds are similar and her cleavage pattern is closer and more proportionate for her body.
The patient will continue with Bio Corneum silicone gel liquid twice a day for the next six months and a Dr. Linder Bra for support. Patients presenting with the typical congenital breast asymmetry as in this example, do well with a combination of augmentation mammoplasties often using saline implants that can be filled to different volumes to create a more predictable accuracy as well as breast lifting as necessary.