Patient 57 Gallery

Before and after breast revision surgery that involved bilateral explantation (breast implant removal) and a breast lift /areola reduction in a 33 year old woman. She had previously placed submuscular silicone gel breast implants that she felt were too big for her body and sat too far out to the sides.

Submuscular implants often have a wide-set appearance, due to the pectoralis major muscle vector that pulls up and out. This is one of the reasons why we are not fans of submuscular implants – in addition to the animation deformity with muscle flexion.

This patient also had a previous attempt at a breast lift by the periareolar method (also called donut mastopexy or Benelli mastopexy) performed elsewhere. This technique does not usually work and in fact usually causes stretching of the areola so that it is larger than before surgery. Her goals were smaller, natural breasts, lifted nipples and smaller areolas.

While we can often perform explantation and a minor lift of the nipples in the office under local anesthesia, this patient’s surgical plan was more extensive and required an outpatient trip to the operating room. Her large submuscular implants were removed, the pectoralis major muscles were returned to the chest wall, and a breast tissue rearrangement (mastopexy) was performed in addition to liposuction of her axillary rolls (armpit fat).

The final image in the series of before and afters shows an intraoperative view after one side has been completed for comparison (warning – graphic). The puckers and pleats in the fold under the breast will slowly fade and flatten over 6-12 weeks. This type of closure is called a pursestring technique and is used to shorten the inframammary fold incision – rather than leaving a long “anchor scar”. This is standard for breast reductions and breast lifts in our practice.

Follow up images are shown 7 months after surgery. She has a youthful breast shape and her scars are maturing. Over the next 6-12 months they will continue to flatten and fade. Her areolas are smaller and lifted to a more aesthetic position on her breasts. She is looking forward to starting a family and is relieved to learn that she will most likely be able to breast feed!