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Patient Details
This mother of two who is 5’6″ and 123 pounds had a previous breast augmentation and “breast lift” performed elsewhere. The surgeon had moved the nipple up into a better position and placed submuscular 350cc saline implants and then transected (cut) the pectoralis muscle along the bottom of the breast. Skin was removed to tighten the breast but there was no removal of breast tissue.
Clearly on her pre operative photographs she has “bottomed out”, her breasts are larger than her frame and there is no place for her implants to go but down and off to the side. She complained that her breasts were too large, too low and too lateral. She wants her breasts to be smaller, higher, tighter, and perkier looking (not a small order request!). Since the surgeon had released the pectoral muscle at the bottom of the breast this has removed a significant support structure of the new breast. Cutting of the muscle has also allowed the muscle to retract upwards so that it covers only a small portion of the breast implant.
She is seen here after a breast revision. I removed her saline implants and replaced them with smaller silicone 300cc in the same submuscular pocket. I could not move the muscle down to its normal position. I adjusted the pocket to move her breasts upwards and to the midline and I reduced low lying breast tissue (62 and 112 grams) asymmetrically to compensate for the larger natural breast. She is seen here three years out from her procedure. Look at the arrows which help to illustrate the elevation of her breasts on her chest . Her breasts are still somewhat larger in size but they are located in a much more youthful position and the shape is vastly improved. The photo of the patient wearing the bra is to see how well she is being supported and molded.
Several points are worth noting in this case. Anytime an implant is used as well as another procedure on the breast this will add significant complexity to your case. There are greater risks for complications and the revision rate is significantly higher than, say, a breast augmentation alone. Breasts can be molded long term. Wearing a bra that shapes your breast can change the shape of your breast short and long term!Aggressively cutting the pectoralis muscle is like removing a support structure that helps to resist the forces of gravity that want to move your breast lower and laterally. Although it may be necessary to reduce some of the muscle to achieve a desired outcome, I would not recommend wholesale reduction of this important support structure. Recently, the use of ADM or Acellular Dermal Matrix can benefit secondary cosmetic breast procedures. This is typically human or pig dermis (skin component) that can be used to help support the breast and possibly improve outcomes such as improved stability, shape, feel and possibly reduce the breast contracture frequency. Only allow a very well qualified plastic surgeon work on complex breast cases.
In the patients own words: “Thank you for everything Dr. Caridi! You did a great job on giving me exactly what I asked for. It really has changed the way I feel inside and out.”
