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Posted On: November 01, 2018 Author: The Office of Dr. Stuart Linder Posted In: Breast Asymmetry

breast_asymmetry17a Patients present with breast asymmetry prior to undergoing their implant surgery. That’s why in reality it’s difficult, if not impossible, to completely correct asymmetries. However, asymmetries must be identified in the early stage prior to surgery in order to allow for volume changes.

When a patient has already undergone breast augmentation with saline or silicone and will undergo breast revision surgery to correct this problem that wasn’t corrected initially, several approaches can be taken. Breast revision surgery for secondary breast asymmetry problems include:

  1. Saline implants refilling or reducing volume of one implant
  2. Replacing the saline implant altogether presenting a larger saline implant
  3. Silicone implant replacing with a larger or smaller silicone implant to the asymmetric side

Patients who present to Dr. Linder in both Beverly Hills as well as in his Las Vegas practice, present with breast asymmetry preoperatively. These patients’ folds are marked. The distance of the inframammary folds must be identified and the distance between the inferior areolar to the inframammary fold distance shall also be reviewed. Patients should be asked and clinically examined for obvious asymmetry in a brassiere. When it is identifiable significant and saline implants are to be used before original surgery has occurred, then a different size implant of different volume will usually be used. If the asymmetry is only slight, then the same implant volume, however, titrated differently.  For example, a 400 cc filled to 400 cc and a 400 cc filled to 430 cc can be placed in order to regain symmetry. With silicone patients this is more difficult in that silicone implants will require obviously a standard pre-filled implant which cannot be changed in the operating room in terms of titrated volume.  The smaller volume of silicone implants has shorter ranges. For example, 25 cc differences which can allow for increased symmetry. As you get into the 500’s and larger, the volumes up by 50 cc make it more difficult to titrate the symmetry volumes.

When a patient presents with asymmetry after original breast augmentation and has saline implants, we like to obtain the previous operative report and implant catalog lot number and serial number with implant volumes identifiable. Frequently, patients do not have access to the records and therefore Dr. Linder in the operating room has to make his own judgement through his experience of thousands of breast surgeries and revisions to determine the proper size and most appropriate volume. Most importantly, remember that breast asymmetry, both before the original breast augmentation as well as after the primary augmentation is the norma and regaining absolute perfect symmetry is difficult, if not completely impossible.

Case Study:

Breast augmentation, severe breast asymmetry silicone gel moderate plus reconstruction.

Breast Augmentation Before and After

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 how to use the moderate plus, style 15 Natrelle® Allergan implants with silicone gel to reconstruct a patient who has severe asymmetry and pectus carinatum.