This is a 29 year old female, 5’4″ and 140 pounds who presented to me after having two previous breast procedures performed elsewhere. She said the first time her implants were too high and the second procedure was done to lower her implants. On examination, she had bottoming out of her implants, pectoral muscle “window shading”, enlarged nipple-areola complexes, saline implant rippling and thinning of the skin on the lower half of the breasts. Her breasts were low lying and heavy and certainly not appropriate for a young woman with no children.
We discussed the issues at hand, the complexity involved in “fixing” the problems and the risks and benefits. This is called informed consent (I tend to be very frank with patients regarding the reality of the situation–although the procedure is “complex,” I felt confident that she will do well).
I performed an extensive breast implant revision. I removed partially submuscular saline implants (390cc smooth), and replaced them with 275cc textured silicone implant and placed them beneath the muscle. In addition, I used ADM (pig dermis) to help with the reconstruction (using the sheet of pig skin to help pull down the pectoral muscle that has moved upwards and to provide for more support to the lower part of the breast). I performed an extensive internal suturing technique of the capsule (scar layer around all implants) so that the implants would remain in an optimal position. I reduced about 50 grams of tissue on both sides, and adjusted the skin of the breast around the new breast implant so that the breast is now “higher, tighter, and perkier”.
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