Breast Revision

Before And After Photos

This is a 29 year old female, 5’4″ and 140 pounds who presented to me after having two previous breast procedures performed elsewhere. She said the first time her implants were too high and the second procedure was done to lower her implants. On examination, she had bottoming out of her implants, pectoral muscle “window shading”, enlarged nipple-areola complexes, saline implant rippling and thinning of the skin on the lower half of the breasts. Her breasts were low lying and heavy and certainly not appropriate for a young woman with no children.

We discussed the issues at hand, the complexity involved in “fixing” the problems and the risks and benefits. This is called informed consent (I tend to be very frank with patients regarding the reality of the situation–although the procedure is “complex,” I felt confident that she will do well).

I performed an extensive breast implant revision. I removed partially submuscular saline implants (390cc smooth), and replaced them with 275cc textured silicone implant and placed them beneath the muscle. In addition, I used ADM (pig dermis) to help with the reconstruction (using the sheet of pig skin to help pull down the pectoral muscle that has moved upwards and to provide for more support to the lower part of the breast). I performed an extensive internal suturing technique of the capsule (scar layer around all implants) so that the implants would remain in an optimal position. I reduced about 50 grams of tissue on both sides, and adjusted the skin of the breast around the new breast implant so that the breast is now “higher, tighter, and perkier”.

Results to note/Lessons to learn:

  1. Low heavy matronly breasts have been lifted, narrowed, and made perkier and lighter.
  2. Her upper chest is shorter and her abdomen looks a lot longer. Use her freckles to note how much lift has occurred.
  3. Strattice (also called Acellular Dermal Matrix or ADM) has been used in her case to support the result. It has been used for five or so years and has been found to be very beneficial with minimal complications to date. Its use in secondary breast surgery is becoming more frequent.
  4. Larger saline implants that ripple to smaller silicone implants that ripple less was the reason for the implant change. In addition, silicone implants feel better, more natural and more comfortable than saline variety.
  5. Thinning tissue at the bottom of her breasts was from the weight of the implants being supported by the breast skin. Retraction of the chest muscle can occur after your surgeon removes the muscle origin along the breast crease. The muscle “rolls up” like a window shade would move up. When this occurs, there is less support at the bottom of the breast and the implants can/will move down resulting in “bottoming out.” Less tissue coverage over the implant from muscle retraction means less coverage of the breast implant and greater implant palpability.
  6. As I have said many times before, this is challenging surgery best left to experts who have extensive experience with these cases.
  7. This could have all been avoided by better decision making on the part of the patient and surgeon the first time she decided to get implants.