Before and after bilateral breast implant revision in a 57 year old woman. She had her implants in place for several years and felt like they were too big for her body. She didn’t want to have a drastic change in her body image, but instead to “be less booby” and to better match her athletic, slender frame.
She was so happy to learn that she did not need a general anesthetic to have an implant exchange. An in-office procedure was planned to remove and replace her implants and keep the same pocket, using her existing scar in the fold under her breast. She had minimal animation deformity, although it was accentuated when she flexed her chest muscles due to the proportionally large size of her implants.
An awake office procedure performed under local anesthesia was planned using an oral anti-anxiety medication and inhaled mixture of laughing gas (nitrous oxide) and oxygen to take the edge off the numbing injection sting. The decision was made to keep her implants in their existing pocket under the muscle, given that she wanted to minimize recovery time that would be expected after changing the implants from under the muscle (submuscular plane) to on top of the muscle (the subglandular plane).
Our patient participated in the sizing process. After numbing her scar in the inframammary fold, the old intact implants were removed and a temporary sizer was inserted. It was inflated to a variety of volumes smaller than her previous implants, and she chose a new implant size that was around 75 cc (2.5 ounces) smaller. Although it was intimidating at first, seeing different implant sizes in her body as she sat up and looked in a mirror was an empowering experience.
Once we had confirmed the best implant size for each breast, her pockets were washed out with antibiotic solution, and the new implant was inserted through her existing incision. No drains were needed and she was allowed to shower in 48 hours.
She returned to full exercise in 3 weeks and was delighted that she could help choose her new implants and “try on different sizes” in her own body during our office procedure. It is possible to plan an awake procedure under local anesthesia if a patient already has an implant pocket that does not need major modification. Primary breast augmentations (patients who do not already have an implant pocket) need to go to sleep under general anesthetic since a new pocket needs to be dissection – you cannot be awake for this.
Follow up photos are shown 2 months after surgery. She feels more comfortable in her skin and found the experience immensely positive and rewarding.
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
