Before and after bilateral breast revision in a 61-year-old woman. Her 30-year-old breast implants were completely under the muscle, as evidenced by their unnatural flattened shape and high location of the implants on her chest (“superior malposition”), due to the upward pull of the pectoralis major muscle.
Her implants were ruptured – confirmed by MRI – which is not surprising for breast implants inserted in the late 1980’s. Currently available breast implants are less likely to rupture over the long term than former generations of breast implants, which had a very thin shell and less cohesive silicone.
Breast implants available today have a more stable shell than older implants, they are more cohesive (firmer like a fresh gummy bear as opposed to more liquid and sticky like molasses), and the silicone fill is more inert, leading to less inflammation and capsular contracture if the implant shell ever has a fracture in it – known clinically as “rupture”.
This patient had Grade IV capsular contracture – her breasts were hard and painful. She wanted to keep an implant but to have her breasts look more natural and age appropriate now that she was in her 60’s, as opposed to having her implants removed completely.
Her breast revision involved removal of the ruptured implants and replacement of her pectoralis major muscles to the chest wall and reconstruction of her normal chest muscle anatomy. A new pocket was made on top of the muscle, in the subglandular position. Smaller smooth round silicone gel breast implants were inserted in this space.
She was offered a breast lift at the same time (a mastopexy) to raise the height of her nipples, but she did not want additional scars on her breast. She did not mind the fact that her nipples were low on her breast, as this looked most natural to her.
Follow up photos are shown a year and a half after surgery.
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
