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Patient Details
This is a 31 year old mother of three who is 5’6″ and 127 pounds who presented to me for a breast enhancement. She has small, asymmetrical very laterally displaced and narrow breasts. She has a very wide space between her breasts. Her chest wall is very sloped so that her breasts are sitting off on the side of her ribs pointing laterally. This is not an easy case to say the least.
I am very impressed by her result with an augmentation alone-no lift, just an implant and a fair amount of hard work afterwards to move her implants medially on her chest. She received a breast augmention with 375cc high profile smooth walled silicone implants placed through an incision around the bottom of her areolas.
Her breasts are soft and she actually has a fair amount of cleavage (look at the photo of her wearing the bra). She is extremely happy, likes her size and has no interest in any more breast procedures.
This is a challenging case because the pocket for the implants need to be expanded after surgery. You can’t make this pocket at the time of surgery as you would be cutting the muscle between her breasts and that is a no-no. I made the incision around the bottom of the areola as I thought it would hide well and it keeps my options open to make her areolas smaller if this is what she wants in the future.
I didn’t perform a lift at the time of her augmentation as this could have resulted in a big mismatch between the “lift” part of the procedure and the location of her implants. It is best to get the “foundation” of her breasts established and stable and then adjust the skin of the breast on top of this foundation. If you have the breast foundation moving and the skin and breast tissue moving in different directions they may not end up with the breast on top of the foundation (a bummer to say the very least).
This case epitomizes breast molding-moving the breast implant to expand the surrounding tissues to shape the new breast. Think of it a different way; what would she look like if the surgeon simply put the implant behind her breasts and told her to come back in six months? The answer is weird and unacceptable. She would be unhappy, and the surgeon would be telling her that everything is “normal”.
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