Case-25846 Gallery

Before and after bilateral breast implant revision in a 20 year old woman.  She was born with tubular breasts and congenital breast asymmetry that was previously treated with saline implants under the muscle.  

She had obvious breast asymmetry, with bottoming out:  her implants sat lower than her natural breast fold, and her tubular breast shape and high fold was accentuated with a “double bubble” from the high fold of the tubular breast sitting abnormally on top of the tight muscle draped over her implant.  She had thought about removing her implants altogether, but was relieved to hear that she had options that involved keeping an implant but making things better!  

Her breast revision surgery involved removing her saline breast implants, separating her pectoralis major muscle from the undersurface of her breast tissue, and reconstructing her chest wall muscular anatomy.  Her inframammary folds (the folds underneath the breasts) were reconstructed, and smooth round silicone gel breast implants were placed on top of the muscle, in the subglandular plane.  

For tubular breasts and many congenital breast asymmetries, subglandular breast implant placement is often/usually recommended to avoid the deformities listed above – double bubble, animation, and persistent stigmata of a tubular breast shape.  In this case, simply moving the implants from under the muscle to on top of the muscle corrected most of her problems – this is usually the case in breast implant revisions, even if the breast is not tubular.  

Liposuction of her bra roll and armpit area, known as the axillary roll, improved the aesthetics of the sides of her breasts.  After surgery, she took a full month off from lifting more than 5 pounds and did no exercise that raised her blood pressure and heart rate.  Follow up photos are shown 9 months after surgery.  Her breasts have significantly improved symmetry and she “looks normal” now (her ultimate goal).  

Her nipples are still somewhat low, but she is planning on having children in the next ten years and she does not want to do anything that could potentially interfere with the ability to nurse her babies.  We educate patients that in any breast procedure, we do our best to preserve the two functions of the breast – breast feeding ability and erogenous sensation to the nipples.  

Lifting the nipples involves only removing skin around the nipples and “tucking the skin” under the areola, just like a dart in a dress.  All structures from the breast to the nipples remain intact, so breast feeding and sensation should recover after surgery.  However, she is very comfortable in her decision to leave her nipples low, and avoid additional scars on her breast that would be required with a breast lift.  

She has finally moved on with her life after several years of strive, and will come to see us every year for a few years, then eventually every ten years, until she decides she wants a change or does not want her implants any longer.  Surgery is not necessary every 10 years after breast implant surgery – which is a relief for most of our patient to learn!