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This patient is a 40 year old mother of 3 who flew from the St. Louis, MO area to visit my practice. This patient had undergone a previous saline breast augmentation in 2006, and was unhappy with the unnatural appearance of her breasts. In particular, when this patient raised her arms or flexed her chest muscles, the implants shifted apart, causing a large space where her cleavage should have been.

Additionally, this patient noted excess skin and weakness of the lower abdomen due to her multiple pregnancies. She was in excellent physical shape, but the excess skin and abdominal laxity did not improve with diet and exercise.

For this patients breasts, I felt that the unnatural appearance was due to a few issues. First of all, her prior implants were 325cc saline implants overfilled to 410cc. This excessive overfilling caused the implants to look more narrow, and to feel abnormally firm. Additionally, she had developed some tightening of the pockets around the implants, causing some lateral displacement of the implants on her chest.

To correct these problems, I recommended removing the overfilled saline implants and exchanging them for a broader, more natural appearing silicone cohesive gel implants. I also felt that the breast pockets would need to be revised internally to allow the implants to sit more centrally on the chest.

With regards to the abdomen, since the patient's problem involved the lower abdomen only (the area from the bellybutton down) I recommended a mini-abdominoplasty which would tighten the lower abdominal wall internally, and would remove the excess skin which bothered her. She also requested liposuction of the "love-handle" area, and I felt that conservative liposuction of the flanks would improve her overall contour.

I performed an exchange of implants with tightening of the lateral breast pockets and released of the central breast pockets. I exchanged her overfilled saline implants with 500cc moderate-plus profile Mentor cohesive silicone gel implants (because she was 5'8", a larger implant looked natural on this patient). Finally, I performed a mini-abdominoplasty with tightening of the lower abdominal wall and excess skin removal. I also performed a modest amount of liposuction of the "love-handle" area to contour her abdomen.

This patient recovered without any significant issues, and within a few days she was feeling great. She was extremely pleased with the natural, proportionate appearance of her breasts, and the flat, aesthetic appearance of her waist and lower abdomen. She flew home approximately one week after surgery.

Provider: Dr. Cohen

Age: 40
Gender: Female