A young lady presented with severe tubular breast deformity with grade 2 ptosis of the left breast and severe breast asymmetry. The patient declined to have any scarring with breast lifts performed. In any case, the patient underwent augmentation mammoplasty with saline high profile smooth implants, 330 cc filled to 400 on the right, 330 cc filled to 380 cc on the left using the dual plane technique, periareolar approach and radial striation of the lower pole of the right breast. Her “before and after” photographs are shown for reference.
Interestingly, the left breast pocket was made very conservative, especially lateral to the areolar border, which allowed the implant to sufficiently tighten up the left breast skin without the necessity of a breast lift. Her cleavage is actually quite good as well. The most important part of this operation was releasing the right breast lower pole inferiorly in order to reduce the tubular shape of the breast (this can be seen nicely on the oblique view), also limiting the pocket dissection on the side of the breast and using high profile saline implants in the dual plane technique, two-thirds under, one-third over. This is an interesting case. Once again, the successful surgery on a patient presenting with tubular breast deformity, sagginess or grade 2 ptosis of the left breast and asymmetry without the use of breast lift scarring.
The female patient presented to the left was requesting to have a breast revision surgery due to her breast being asymmetry . During the examination, the breast had asymmetry due to the right breast having scar tissue (capsular contracture) and the left breast experiencing a rippling effect. Capsular contracture is scar tissue that forms around the breast implant which causes the breast to harden and the rippling was due to the amount of soft tissue covering the implant. After listening to her goals, and agreeing on the expectation, we scheduled a surgery date.
During the surgery we used 445 cc SRX extra full profile silicone (gel) implants. This implant has a smooth shell surface and provides the patient with the fullest, roundest look. Using the silicone gel will also help reduce most of the visible rippling.
The post-op photo to the right is at 7-weeks and as you can see her breast are symmetric and she is very pleased with her shape and fullness.
To schedule your consultation with Dr. Linder and learn more about breast revision surgery, call our office at (310) 275-4513 in Beverly Hills or fill out our online contact form today.
Breast asymmetry can be associated with normally congenital, developmental or even traumatic or associated with breast cancer which may require breast reconstructive surgery causing breast asymmetry. Breast asymmetry is associated with one breast looking larger or smaller than the other. It can also be associated with one breast being saggier or having more ptosis than the other side. Correcting breast asymmetry can be very difficult, if not impossible. The correction of breast asymmetry may require creative thought, which may include different surgical procedures on one or both breasts in order to create similarities.
Technique #1: Using implants of different sizes to create symmetric breasts. This is most often associated with breast when the nipple areolar complex is above the fold and there is no degree of sagginess (ptosis).
Technique #2: Performing a breast reduction on a larger breast and simply a breast lift on the contralateral breast if both show sagginess, but one breast is significantly larger than the other.
Technique #3: Placing an implant on one breast and/or an implant and a lift on the other breast if the contralateral breast has a degree of sagginess or ptosis.
Technique #4: A breast reduction or lift on one breast alone to even it out with the left breast if the left breast shows no degree of sagginess and similar sizes in volumes can be created with a lift and implant on contralateral side.
Technique #5: A culmination of these multople procedures including breast lifts on both sides with different size implants if there is asymmetry of volume and/or both breasts show a significant degree of sagginess with a nipple areolar complex which may be below the inframammary fold grade III ptoris.
The preoperative photos indicate the patient has undergone two previous breast augmentations. The patient has severe Pectus Carinatum deformity of her right breast, greater than the left. She has severe pectus carinatum of the entire right lateral chest cavity, sloping laterally and posteriorly. This causes lateral displacement of the implant. There is visibility of the implant as well as a pin cushioning along the right medial breast bone or sternum. Notice the implant edge which was causing severe irritation of the sub-dermis. This patient will require Pectus Carinatum surgery via breast reconstruction. She used 600 cc style 45 extra high profile Natrelle Allergan silicone implants with a right medial open capsulotomy, meticulously releasing the capsule along the inferior parasternal ridge as well as releasing the right medial muscle. Her postoperative photograph shows six weeks postoperative status post medial open capsulotomy, inferior capsulectomy of the right breast, superior bilateral open capsulotomy and removal of the low profile 450 cc implant with replacement with 600 cc style 45 silicone gel implants as well as a right areolar reduction in order to regain symmetry with the left side.
The patient has done extraordinarily well. The patient has used compression Dr. Linder Bra for six weeks postoperative in order to maintain the medial breast pocket shape. This is extraordinarily difficult surgery. Only breast revision specialists who perform augmentation mammoplasties and breast reconstructions who are Board Certified with the American Board of Plastic Surgery should be performing difficult surgery and revision breast surgeries such as the above example. The extra high profile gel reduced visibility and rippling due to its round shape and increased AP projection with decreased lateral width.
The patient to the left presented with a slight tubular breast deformity. Tuberous breast deformity is a congenital breast anomaly that becomes manifest at the time of puberty and breast development. Her preoperative photo shows a conical appearance to the breast and a poorly defined inframammary fold along the bottom of the breast. During her consultation, she desired a more rounded breasts with fullness. After setting her expectations, we agreed to perform an augmentation mammoplasty procedure using 350cc high-profile saline breast implants.
The 24-year-old patient is now six weeks post op. As you can see by the photo, she has nice fullness and a rounded appearance.
If you would like more information regarding tubular breast deformity or want to set up a consultation today, call us at 310-275-4517 or fill out our online contact form
Every week at my Beverly Hills practice, I see patients who have some variation of breast asymmetry. Breast asymmetry is defined as a difference of form, position, or volume of the breasts, and it affects more than half of all women. Slight differences in a woman’s breasts are generally of no concern; however, if the differences are greater than one bra cup size, they may cause some psychological distress, particularly during adolescence, when a young woman’s body and psyche are already changing so rapidly.
In the typical breast asymmetry patient, one breast will be larger with sagging, and the smaller breast will be tubular, conical in shape, and tighter. Most often, the smaller breast should have a saline implant placed with the dual plane technique and release of the parasternal attachments of the pectoralis major muscle and release of the inframammary fold as well as rounding out of the lower pole of the breast. Once this implant has been placed, the contralateral smaller implant can be placed in the dual plane location, and then a formal mastopexy can be performed to tighten sagging tissues and lift the breast. The patient will then be placed in a sitting position, and if further tailoring by breast reduction of the medial and lateral flap is necessary, this can be done meticulously and carefully in order to regain symmetry with the contralateral breast.
Below are the before and after photos of two patients who had their breast asymmetry corrected, and you can see the symmetrical results after surgery. I recommend that women be over the age of 18 years for this surgery. For more information or to set up a consultation, call us at 1-310-275-4513 or contact us via email.
Preoperatively, the patient had significant asymmetry. Breast asymmetry is defined as a difference of form, position, or volume of the breast and affects more than half of all women with some natural asymmetries.
During the consultation, the 26-year-old patient explained her goals, and we agreed to address the right breast by elevating the fold and nipple with a breast lift
(mammoplasty) and a breast augmentation using 330 cc high-profile saline breast implants, filling each to 375 cc to achieve a nice symmetrical balance.
The postop photo is only one day out, but she is excited to already see a nice natural look and balance.
I was presented with a 41-year-old female who was looking to have a breast augmentation as well as correct her asymmetry of her breast. During the consultation she explained her goals and we agreed to address the right breast by elevating the fold and nipple along with using 350 cc high profile saline breast implants. I filled the right breast to 380 cc and the left to 370 cc to achieve a nice symmetrical balance.
As you can see from the 6 week post op photo the augmentation achieved a natural look and a nice balance.
Six Week Post Op
I was presented a 26 year old patient with severe congenital pectus excavatum condition along with asymmetry of the breast. As you can see the patient appearance of the chest is sunken in or caved in. During the consultation we discussed her goals and outlined the approach to achieve her breast enhancement.
For the right breast we selected 350cc high profile saline implant and built out to 450cc. The left breast we selected 300cc moderate plus saline implant built out to 350cc. As you can see from the 6 week post op photo the augmentation achieved a nice symmetrical balance.
This patient presents with congenital asymmetry of the breast. Severe breast asymmetry such as the following is most easily correctable with high profile saline implants. The patient had sutures removed in 10 days and then continue with dry dressing changes twice a day for 10 days.
Severe congenital breast asymmetry comes in many forms. The before and after photo is an excellent example of this correction.