This 36-year-old female is a great example of going to a slightly larger implant the second time around. She had saline implants placed 10 years prior 350 mL on the left and 325 mL on the right. Now 10 years later she decided to go to highly cohesive Allergan gummy bear silicone implants 520 mL bilaterally through the underarm. It really gave her nice fullness and avoided having to do a lift!
Breast Implant Revision / Replacement
SERVING SCOTTSDALE, PHOENIX, GILBERT, MESA, CHANDLER AND TEMPE, ARIZONA
This 52-year-old female presented with above the muscle 330cc textured saline deflation which had been placed in 1999. She wanted to switch to gummy bear implants and wondered if we could somehow improve her cleavage. Because with the deflation the capsule begins to close up, I did not anticipate needing to move the capsule inward, but I did so on the left. We placed 345cc Allergan SCM on the left and 360cc SCM on the right. She now has better cleavage and better upper pole fullness.
There is so much talk about “Tear drop” shaped implants to get the most natural outcome that I think this is a great example of how the shape of the implant isn’t the most important factor, in many patients. This patient had saline implants placed at age 19, then removed at age 32. She then came to me for a re-augmentation and wanted tear drop cohesive gel implants 395cc, which we did. 18 months later she reported not liking the feel of the new implants, and we then changed them out for Saline round implants 425cc on the right and 400cc on the left. The patient likes the slightly larger size and feel, with not much noticeable difference in the two!
More upper pole fullness can be achieved with capsulorrhaphy (sewing the pocket) or with just adding a larger implant, and in this case, we did both! Moving an implant uphill is always a challenge, especially when the patient wants to go larger in size! She had 385cc originally and had slipped too low on the right side. She desired to have this fixed and to go larger! Another surgeon had told her to do capsulorrhapy on both breasts, but my feeling was she just needed it on her right side with a larger implant and just a larger implant on the left. We put 560cc Allergan SRM on the right and 600cc on the left....
This patient had saline implants placed 13 years prior with 375cc filled to 460cc on the right and 475cc on the left. She wanted to be larger but also felt uneven. Her “before “picture shows a cleavage gap, the left breast higher than the right, and a short inframammary fold on the right. One challenge is if the implant is lowered too much on the left, it will push the nipple even higher, so I tend to “split the difference “accepting some asymmetry. We placed an Allergen 650cc SCF, High Profile “gummy bear “implant. She was very happy!
This 45-year-old woman had her first breast implants placed 17 years prior, 380- Saline. She felt now, like she had lost upper pole fullness and wanted improved cleavage. She also wanted to be much bigger and liked the look and roundness of saline implants. She felt with a slightly broader shoulder she could handle a much bigger implant, and she did. We placed an Allergan style 68HP saline implant, 600cc and filled it to 700cc, which sounds really big but she loved the results and carries it well.
This 42-year-old is a classic example of a breast implant revision going from an above muscle breast augmentation years ago to an under the muscle implant exchange with a lift. Her original implants were 350 mL textured silicone implants above the muscle and over the years her skin and stretched quite a bit. She was now complaining of a hanging sensation as well as loss of volume in the upper pole. She really didn’t want to be much smaller, just more support and better cleavage. In surgery, I removed her old implants and opened the space under her muscle. I used part of her old capsule to support the implants which were 375cc Allergan SCM gummy bear implants. I then did a Brazilian superior pedicle lift on top of it all. Her photos are now 13 months postop with still very good support to her implants and breast tissue!
This shows the difference between a smaller saline implant and a larger silicone in the same patient. In 2005 350cc saline implants were placed and 12 years later, (and one baby) she desired to be bigger and see if she could get better cleavage as well. We placed 560cc Allergan SCM “Gummy bear” implants through the underarm using a Keller funnel, with a rounder fuller result.
This 37 year old woman had breast implants placed 13 years prior, through the underarm, but ABOVE the muscle. They were 300cc and 320cc Saline and over the last few years, she noticed more rippling. She then went and did and implant exchange and became encapsulated on both sides, even with silcone implants.
I then took her to surgery, removed her old implants and put in silicone 397 cc on the right and 421cc on the left...all through the underarm AND moved them to below the muscle. She really like the more natural new look.
This 31 year old who had a previous mastopexy/augmentation with saline implants under the muscle done in 2007 done elsewhere. She presented to me wanting her breast lifted off her tummy, much more fullness in the upper part and to be larger and to change to silicone. She also still had the dark portions of her areola that were left from the last operation along the bottom of her breast. I explained to her the difficulty of keeping a larger gel implant uphill in thin tissue that has already been stretched from prior surgery. I feel this is a case where extra support may be needed. We decided to use Strattice at the bottom portion of the breast, change her implants to 457cc Allergan, and redo her mastopexy and really is an example of "Cosmetic-Reconstruction". Her pictures 18 months later still show good upper fullness and her breast still up off her tummy!