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Patient Details
This is a 39 year old mother of two who is 5’2″ tall and 131 pounds. She was interested in a breast enhancement. She knew that she didn’t want a “breast lift” because she didn’t want the scars. Her pre-operative evaluation revealed significant breast and chest wall asymmetries. The left breast was larger and had a palpable central area of dense breast tissue that was quite different from the opposite breast. The left breast nipple-areola complex was also pointing much lower than the right side. Given the fact that she wouldn’t consider a breast lift my surgical options changed significantly.
She is seen here at five months post operative from a bilateral breast augmentation with saline implants (375cc on the right and 310cc on the left) as well as a breast tissue reduction of about 25 grams on the larger left breast. It was a difficult and challenging surgery because of her anatomy. She was seen in the office after surgery frequently in order to instruct her on the proper massage techniques on her breasts to mold them into good shape. There is a vast improvement on what she had before she saw me and she is very pleased with her result, but she isn’t perfect. Her right breast is firmer than her left side. You can see that the top of the right breast is more rounded than that on the left. There has been a tremendous “lift” associated with the breast implant alone on the left side. She enjoys the improved symmetry and superior breast fullness.
This case illustrates what can be achieved when my options are limited. She developed a contracture on the right side probably because this implant is subglandular (her muscle was very small and I was not able to put the implant below this small muscle). Subglandular implants contract more than submuscular. I also had to manipulate her fibrotic breast tissue in order to allow it open up around her implants. I believe this tissue manipulation increases the potential for contracture especially with subglandular implants. The bottom line in her case is that I was able to make the patient happy even though the results are imperfect. I am also pleased with how I was able to change the shape of her breasts with implants, tissue manipulation/reduction and post operative breast molding. Interestingly, she understands the “value” of a mild breast contracture because this actually helps stabilize the position of her implants. I told her that she can always come back in the future and I can perform and open capsulotomy (cutting into the scar around the breast to make the breast softer through her original incision). There is no guarantee this will work but in my experience it has often been very rewarding. We also discussed before any surgery that she can always elect for a breast lift afterwards if she feels this is needed to meet her goals.
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