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Monthly Archives: September 2014

BREAST AUGMENTATION, SEVERE BREAST ASYMMETRY

SILICONE GEL MODERATE PLUS RECONSTRUCTION

 

The patient preoperatively, as you can see, has significant asymmetry. The right breast is wider and slightly larger than the left breast which is narrower by approximately 1.5 cm. She also has a pectus carinatum of the upper sternal area. She is an excellent candidate for style 15 Allergan silicone gel implants in the dual plane, two-thirds under the muscle, one-third over. A 371 cc style 15 implant was placed on the right with a 397 on the left. Her symmetry is quite good. Cleavage is excellent. Upper pole fullness is reasonable and the inframammary folds are at precise levels.

This is an excellent example of use of moderate plus, style 15 Natrelle Allergan implants using silicone gel to reconstruct a patient with severe asymmetry and pectus carinatum.

DOUBLE BUBBLE DEFORMITY, SEVERE BREAST DEFORMITY

This is an excellent case example of a patient with severe encapsulated superior retropositioned implants with a double-bubble deformity with an overhanging of the nipple areolar complex.  She desired reconstruction; however, declined any significant scarring, including inverted  T. I decided upon a bilateral periareolar lift with complete release of the parasternal muscle attachments and an inferior displacement of the implants through a total open capsulectomy.  Her postoperative results of three weeks show excellent healing and bilateral repositioning of the nipple. She continues to wear an upper pole compression band. Sutures have been removed at three weeks and she will continue with the Dr. Linda Bra for six week. Notice the reshaping of the breast without a lift of an inverted T, but simple due to the superior periareolar lift and repositioning of the implant to its proper position, the nipples now show some white underneath the areolar which indicates good placement of the nipple areolar complex.

Patients with severe double-bubble breast deformity  can have periareolar lifts without  inframammary scars if they  are the  correct candidate as in this case example, severe double-bubble breast deformity with superior retroposition of the nipple with a periareolar lift.

Ruptured Silicone Implant

This is a case example of a patient who presents with a ruptured silicone implant who had a breast augmentation only four years ago. She presents with severe Baker IV capsular contracture with a very hardened right breast with severe scar tissue hardening. Interestingly, she denies any incidents of trauma to her breast whatsoever nor heavy workout or exertion. In the operating room, immediately upon opening the incision and entering into the breast pocket through the capsule, loose silicone was identifiable. The posterior portion of the implant was largely torn with loose silicone throughout the pocket.

Patients who undergo silicone implants should simply have MRIs every three years. Often asymptomatic, patients may still have a tear within the shell of the implant that is not obviously identifiable clinically. This patient did have severe scar tissue with a Baker IV capsule which indicated that there may have been some trauma that she however was unaware of, which could have been associated with the posterior rupture of the silicone gel implant. MRIs are very sensitive for ruptured silicone gel implants and should be performed at least every three years per guidelines of the FDA.

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