This patient is 5’6″ tall and weighs 120 pounds. She presented to me complaining about the shape of her breasts. She had an augmentation done elsewhere with THREE revisional procedures. Her first surgery was with saline implants placed through the transaxillary (underarm) approach which left her implants too high. The second operation was to lower her implants but they went too low. The third operation was done with an incision around her areola and was designed to lift her breast but this was unsuccessful as well.
After much education about the issues involved, and much confusion on the patients behalf, I told her that I felt that I can manage her problem (but gave her no guarantees). As you can see from her pre operative pictures, the right breast has bottomed out and the nipple has moved upward and the implant has moved downward. Her breasts implants are too large for her anatomy. I told her that when I fixed her breasts that I recommend smaller implants as well as switching out her saline variety for silicone (I believe silicone implants have less of a tendency to stretch the tissue because of the “hammer effect” of a water bag as opposed to a silicone variety). I discussed tacking up her breast folds and adjusting the pocket as needed and the requirement for the use of an excellent supportive bra to help maintain her result.
She is seen here at five months after the breast revision procedure. I replaced her 300cc saline implants that were under her muscle with 225cc silicone implants in the same pocket after I adjusted the pocket with sutures. You can see that her breasts are more symmetrical now and that they actually fit her better (less implant falling off to the side). I was able to move her pockets to the center which gives her more cleavage and moved her implants up higher which makes her breasts appear more youthful.
There are several lessons revealed in her case. First, I am not a big fan of the transaxillary approach because of the potential difficulty in making the breast perfectly symmetrical. Also, if a revision has to be done (and ALL breast enhancements will have one or more in the future), it is difficult if not IMPOSSIBLE to make corrections/adjustments through this incision. A periareolar incision in an Asian patient can result in unfavorable scarring as you can see on her right side. Can you see the incision that I made in the inframammary crease? The photo of her bra helps illustrate that the bra is not working to elevate and move her breast to the midline. It may look nice but it’s not doing its job. It may take some time to find the right bra but it is critical in her case so that is why we referred her to a professional.
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