Breast Revision

Before And After Photos

This is a 40 year old female, 5’3″ and 115 pounds who had a previous breast augmentation many years ago above the muscle with saline implants and she developed a bilateral breast contracture. Her breasts were rock hard, did not move, and they were painful to her. It’s interesting that if you look at her pre surgery photos, they don’t look bad. The problem is that they are stuck on and rock hard and painful to touch.

We discussed options at length. She wanted larger implants and she wanted saline implants because they were less expensive than the silicone variety. At her surgery, I removed her contracted saline implants that were above the muscle. I removed the capsule around the implants at the same time. I put in 420cc saline implants beneath the muscle and used acellular dermal matrix to help support the muscle with the larger implants. She is seen here about 1.5 years after surgery. Her breasts are soft and certainly larger. You can see how she can move them to the midline. I can feel rippling around the perimeters of her implants as she has a very thin layer of skin on top of her implants. She is pleased. She wanted me to put in larger implants but I told her that I wouldn’t.

Lessons to learn:

  1. Implant contracture is the most common problem associated with breast implants. It tends to happen (if it does) within five years of surgery, but it can occur at any time.
  2. The use of ADM (acellular dermal matrix) is used in her case to help support her implants internally as she has very thin tissues and the implant would overwhelm the thin tissue with these larger implants in no time.
  3. She wanted larger implants. I would have preferred smaller ones from an engineering perspective and from a potential complication perspective.
  4. The rippling of her implants can’t be seen in her pictures—I can feel the ripples when I examine her breasts. This would no likely occur if she had silicone implants. She would do better with silicone implants but she didn’t want to pay the increased cost of the implants. I told her that anytime in the future if she wanted to exchange out the saline for silicone that this would be relatively easy.
  5. It has been my experience that the submuscular location of an implant is better than when it is above the muscle.
  6. Because of her thin tissues and larger implants, the use of a support bra is very important. I want the weight of her implants to be supported by the bra, and not her tissues.