Breast Revision

Before And After Photos


This is a 37 year old woman, who is 5’8″ and 130 pounds who was interested in a breast revision. She told me that she didn’t like the feel of her breasts nor the shape. By history, she has submuscular saline implants that are textured and 325cc in volume.

On first visual inspection, her breasts looked fine but a bit separated or far apart on her chest wall. On physical examination, her implants were firm and non mobile, and you can easily feel her saline bag and associated implant rippling. She had a VERY significant “pigeon chest” type of condition. Her central ribs were quite high and prominent and I can feel the edge of her ribs adjacent to the medial part of her implants. It was impossible to move her implants towards the center of her chest because I couldn’t get them over this “hump”. I can easily feel her saline “bag” along the bottom of her breasts as her skin and tissue was so thin in this area.

Although her breasts don’t look “bad”, and certainly these photos don’t do justice to the success of this case, we decided on a plan as follows:

  • I will remove her existing saline implants and replace them with larger silicone implants in the same pocket (submuscular).
  • I will adjust the pockets internally to move her implants medially.
  • I will use ADM or Acellular Dermal Matrix to assist in the revision/reconstruction as needed.
  • She will be responsible for post-operative molding, which in this case is a HUGE endeavor as she has to expand the implant pocket and pectoralis muscle towards the midline and this will require a lot of outright physical effort. She will need help. She can’t do it alone (I don’t care how strong you think you are).

So here she is with 350cc smooth walled high profile silicone implants used in the same pocket, I closed off the pocket laterally on both sides to move the implants medially, I used ADM to keep her implants medially and up. Her breasts are quite soft and natural, the shape is improved for sure, and she is able to get her implants two finger breaths close from the center of her chest. I found at surgery that she had big time pigeon chest with a depression in her ribs from the saline implants sitting on them with a contracture. Her pectoral muscle had retracted up towards her clavicles and was providing very little coverage, and even less support, to her breast implants.

Take a look at her post-operative photos (they don’t do the result justice). Check out the “rig” that she found that works for her. She told me she couldn’t find a bra that fits in the store but she was at “BIG LOT” and found what works. She needed to keep her implants medially on her chest. You can see the picture of her in her full top with her breasts towards the center. You can see her wearing two bras—the first black one below the supportive outer bra. The black bra was for comfort the outer support bra was to hold her implants medially. It works. It’s her “rig”. She and her significant other worked quite hard to expand the pockets medially and I know they were successful because they moved towards the midline (over her rib “humps”).

Lessons to learn:

  1. This case is a challenge for sure. Success depends on a good surgeon and a cooperative patient. ADM was mandatory in her case or we would not have been able to achieve this success.
  2. Patients often underestimate the impact of their chest wall anatomy on the results of breast surgery. Most patients don’t just show up with the ideal rib shape. In her case, breast implants will often sit off on the side of her ribs and the possibility of achieving cleavage is just about zero. However, if you are fortunate to have sought the expertise of an experienced surgeon, he or she can help you to obtain the best result.
  3. Saline to silicone is a no brainer in her case. Textured to smooth implants are also the way to go. Textured implants are designed NOT TO MOVE. You can’t use the textured implant to expand an implant pocket. You can put in a larger implant and how that it expands the pocket and the tissues but in her case it would be impossible.
  4. Contracted implants don’t move. Soft implants will move. The benefit of a contracted implant is that you won’t have to worry about the need for a “rig” to keep you implants in the best position. The downside is that they don’t move and are often firm, odd shaped and uncomfortable. Like anything in life, your choice has trade-offs.
  5. There are real differences on her photos if you examine them carefully. I only wish you can “feel” the result and hear from this patient how happy she is with her result. There is no argument that her happiness is the bottom line. A happy patient is a happy patient.
  6. ADM is not inexpensive, and adds considerably to the cost and risk of any procedure in which it is used. I am fortunate/lucky that I have had wonderful success using the product.