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Breast Revision Gallery Plastic Surgery in Austin | Patient 44

Patient Details

This is a 29 year old mother of one, who is 5’2″ and 119 pounds who had three previous breast surgeries and eventually presented to me because her breast implants have “bottomed out“. She said she developed a hematoma on the right breast after surgery then had two additional procedures to position the breast implants and they didn’t work.

She has 400cc high profile silicone implants in the submuscular position. You can clearly see that her breasts have bottomed out to some degree, right side much more than the left. It has resulted in her right nipple areola complex moving upwards and the scar on the right breast lifting off the crease on to the front aspect of the breast. Her right breast implant is a lot lower than the left side. The bottom of the breast feels very unsupported on examination (the skin is holding up her implant only).

I revised her breast implants by keeping the same implants in the submuscular position and using ADM (acellular dermal matrix or pig skin) to help stabilize her chest muscle that was displaced and to help shore up the bottom of the breast. I adjusted the breast implant pockets so her implants don’t move off to the side like they did before surgery.

She is seen here about one year out from her procedure. Her breasts are soft and symmetrical. There is no longer bottoming out and her breasts are “front and center”. She wears a great supportive bra to keep them there day and night. Her right nipple areola complex has been lowered into a normal position and the scar on the right breast is now in her inframammary fold area where it belongs. Her scars are still red and will continue to lighten in color over the next year.

Lessons to learn:

  1. Repeated attempts to raise a breast means failure of the technique to raise the breast implants and provide stability. In this case, the use of acellular dermal matrix is important to stabilize the chest muscle and support a new “floor” for the breast implant so it stays where I put it.
  2. It is critical to wear a great bra to keep her breast in the best position. Gravity will still work on my repair to move the implants down and under her arms if not supported.
  3. As of this writing (2012), acellular dermal matrix has been proven to be very effective and reliable in breast revision procedures with very few complications with its use next to a breast implant.
  4. Unfortunately, the photos in her case don’t do her results justice. Her breast look more symmetrical and better positioned for sure, but they feel so much better, more stable than they did before her revision.
  5. The use of acellular dermal matrix adds considerable cost to any breast procedure because it is not inexpensive—but it is very effective.

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