This patient presents from Missouri, having had three operations for her breast enhancement. She has consistently had problems, including right breast double-bubble breast deformity with superior retropositioning of the implant and skin laxity of the lower pole. Also, there is severe bottoming out of the left breast where the implant is placed too low. She underwent a vertical mastopexy; however, the skin inframammary fold was never addressed and the skin laxity remains. She now presents for her first surgery with us in order to have this reconstructed.
In her preoperative photograph, it is evident that the upper pole of the right breast is quite full. There is also skin laxity on the right nipple and is significantly lower than the left side. On the left breast the implant is positioned quite low and there is increased skin laxity along the inframammary fold. The operation included both scar tissue removed, an open capsulectomy of the right breast, as well as an inferior open capsulotomy, releasing the implant bringing it down, as well as repositioning of the nipple areolar complex by doing a complete lift, that is, a formal mastopexy using the inverted-T or the Wise-pattern technique.
Specimen of the capsule removed is shown. The formal mastopexy was performed on the right and on the left a vertical T mastopexy with the specimens now showing skin removed (specimen #2) with 6 cm of skin removed from the inframammary fold reducing her bottoming out from 13 cm down to 7 cm. The implants were also replaced to regain symmetry with slightly different implants. High profile saline implants, 320 cc filled to 330 cc on the right, and 350 cc filled to 380 cc on the left, allowed volume symmetry.
Her postoperative Day 1 photographs are shown. With the bra open, note the upper pole fullness is even. The nipple positions are also the same level and that there is no longer bottoming out of the left breast. With the Linder Bra in place notice the cleavage is enhanced, there is great upper pole fullness with symmetry and the breasts are even. This is the case of a very difficult breast reconstruction where the patient actually presented with two problems, a double-bubble deformity (implant too high) and bottoming out (implant too low). By performing the correct surgery, i.e., a formal mastopexy rather than a vertical lift, it was quite easy to regain symmetry, narrow the breast with high profile saline implants and have upper pole fullness with symmetry as well.
I evaluated a 29-year-old female who, after a previous breast augmentation in Mexico, was looking to improve the appearance of her breasts. During her consultation and examination, she expressed that she was hoping to correct the asymmetry of her breasts and the size of her nipples as well as downsize their overall shape. After listening to her desires and agreeing on the expectation, we scheduled her for breast revision surgery.
During her surgery, I removed the breast implants from the previous surgery and discovered that they were CUI silicone implants, which are not available in the United States. After I removed the CUI implants, I performed a breast reduction (mammoplasty), nipple reduction (areola reduction), and breast augmentation using 350 cc high-profile saline implants.
As you can see from the four-week post-op photo, the revision surgery has achieved a nice symmetrical balance , well-defined cleavage, smaller nipples, and a slightly smaller overall size.
To schedule your consultation with Dr. Linder and learn more about breast revision or breast reduction surgery, call our office at (310) 275-4513 in Beverly Hills or fill out our online contact form today.
Patients who undergo both formal mastopexies as well as breast reduction procedures usually will have a reduction in the areolar size. In general, areolas are made between 3.8 and 4.4 cm in size. I prefer to make them approximately 4.2 cm or 42 mm.
We have what are referred to as cookie cutter patterns in the three sizes, 38, 42, 44 to 46 mm. I use 4.2 cm cookie cutter patterns on both my breast lifts and breast reduction procedures in the majority of cases. The areolar reduction is considered a part of a breast reduction or breast lift procedure if the areolar is enlarged. Areola enlargement can be seen as large as 8 to 10 cm on large women’s breasts who undergo large reduction mammoplasties or women who have had significant stretching of the breast tissue after breast feeding or postpartum. As a result, the areolar reduction can be made with skin removed in a circumferential fashion around the areola.
Areolar Reduction Techniques
Different techniques can be performed, including the round block or Benelli technique, which is simply an areolar reduction with skin removed circumferentially as in a donut mastopexy. This, however, has significant problems with stretching of the scars, widespread scars and pin cushioning which can look very, very poor. Scarring, in other words, can be very poor with the Benelli lift. As a result, I prefer not to use this approach whenever possible. A vertical mastopexy can be performed where skin is removed along the vertical plane and around the areola which will reduce the tension around the nipple areolar complex, bringing it below the 6 o’clock position of the areolar down along the vertical or midline plane of the breast. This helps to dissipate tension from the areolar scar and the results I have found to be much better in general.
Finally, a formal mastopexy using the inferior pedicle Wise-pattern technique can be performed in an anchor scar-like fashion, where the skin is removed again around the areola vertically and along the inframammary fold. This greatly reduces scarring, stretching and tension along the nipple areolar complex and has led to beautiful scarring around the nipple areolar complex.
In our practice we use Kelo-cote once the sutures are removed, usually on day 14 to 17. The Kelo-cote silicone gel spray or cream can be used twice a day for three to six months which greatly reduces scarring, spreading, hyperpigmentation and telangiectasias and blood vessels within the scar.
The female patient presented was looking to improve her overall breast appearance as well as reduce her areolas. During her consultation, she expressed that she wanted to increase the volume of her breasts as well as give them a slight lift. She also was concerned about the size of her areolas and wanted to see if they could be reduced a little. After discussing her expectation, we agreed to an augmentation, mastopexy, and slight reduction to the areolas.
During her surgery, I performed a round or “donut” mastopexy, which requires two incisions around the areola. The first incision is much like it is for a normal breast augmentation, and the other incision is made a little wider around the first. The skin between the two circles is then removed and the resized areola is stitched into a higher position on the breast. The larger circle is gathered into the areola in a”purse-string.” During the procedure, I placed 435cc high-profile saline breast implants and filled the right breast implant to 450cc and filled the left breast implant to 470cc.
As you can see from the six-week post-op photo, she has achieved nice volume, symmetrical balance, and a reduced areola.
To schedule your consultation with Dr. Linder and learn more about breast augmentation, breast lift, or areolar reduction, call our office at (310) 275-4513 in Beverly Hills or fill out our online contact form today.