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Patient Details
This is a 25 year old woman who is 5’7″ and 120 pounds. She presented to me stating that she was no happy with the results of a previous breast augmentation she had elsewhere. She said that she felt that she was too large and the shape is not what she prefers.
It turns out that she had a bilateral breast augmentation with 520 cc saline implants placed beneath the muscle from an incision at the crease at the bottom of her breast. I can clearly recall seeing her as she entered the office and saying to myself that this young woman has breasts that are far too large for her small, thin frame. She essentially looked like “all boobs”. This was the first and last thing anyone saw.
She complained of back pain since she had her augmentation. You can see from the photographs that her breasts are clearly too large. They don’t fit her frame and they are not in proportion. They look like large balloons that are attached to her chest. She has bottomed out on both sides (right more than left) with the nipples riding up high. She has rippling of the implants that you can easily feel because the implant thinned her tissue so much there is little tissue covering the implant.
This is a challenging case that is that way because the implants that were chosen were simply too large. It’s like trying to cross the Atlantic Ocean in a canoe — no way, no how. The weight of the implants stretched and thinned her skin and the implants displaced down and to the sides because of gravity. A large saline balloon is quite heavy. It’s like carrying a bunch of tomato soup cans in a HEB plastic bag it will only last until you get to your car and then it will fall out the bottom. Rippling is seen in saline implants more so than silicone and the thinner the skin covering the implant the more extensive the rippling will be. Traction rippling refers to wrinkles in the skin over the breast when you change position (most noted when you lean over with your breasts hanging).
What I did in her case is perform a breast revision. I removed her large implants and replaced with smooth saline implants 330cc on the right and 346cc on the left. Hopefully you can see on the intraoperative photo that she has a depression of the ribs under her implants (what we call a spoon deformity). This is not uncommonly seen when a patient has implants that are too large or if an implant contracture exits. The underlying ribs react to the pressure of the implant by changing shape. This can make it appear like your breasts have become smaller and you are suspecting a leak of the fluid but in actuality the volume is unchanged it’s simply that the implant doesn’t project as much as it used to.
I would have preferred to use silicone implants in her case for a variety of reasons but she wanted no part of the silicone implants because she feared them. I tried to convince her otherwise but it didn’t work. I felt her tissue would contract well based on my exam and her age. I also did extensive work on the implant pockets to make them smaller and move the breast crease to a better/higher location.
Her results are not perfect. She still has lateral positioning of her nipple complex on the right side but this is what she had before. I told her that she can work that towards the middle with massage and optimal positioning of her breast in a very supportive bra which she must wear 24/7. Her back pain is gone. Her proportions are improved. She is pleased with the improvement.
As a general rule, choosing a large implant for your size is a set up for future problems. What is a large implant anyway? Good question. It all depends on the anatomy of the patient and her overall size and skin/tissue quality. It takes a reputable surgeon to obtain that answer even if it’s not necessarily what you want to hear. The current fad is for shapely, natural looking, proportional breasts that require as little upkeep as necessary!
