This is a 44 year-old female who presented to my medical practice. She had undergone breast surgery on two prior occasions by other surgeons, and she was very unhappy with the appearance of her breasts. Specifically, she felt that her breasts were asymmetric and unnatural in appearance, and she also felt the implants were too visible and rippled in appearance.
After reviewing her medical records, I determined that she had undergone an initial augmentation over the chest muscle many years ago by one surgeon, with a more recent replacement of her implants with a simultaneous lift by another surgeon. On examination, the patient had extremely thinned-out appearing skin with implants that were visible, wrinkled, and unnatural in appearance.
As with any corrective breast surgery, I informed this patient that repairing her breasts would be significantly more complex than performing a primary breast augmentation. This is due to the fact that she already had preexisting scars, internal scar tissue, disruption of her tissue planes, and thinned out skin from large implants she had in the past.
To correct this patient's appearance, I recommended a number of maneuvers. First, I wanted to change her implant position from over the pectoralis (chest) muscle to under the muscle in order to camoflage the implants. Secondly, I needed to tighten the breast pockets so the implants would stay in a central position rather than falling to the sides of her chest. Thirdly, I recommended changing from saline to silicone implants to reduce wrinkling of the implant. Finally, I needed to perform differential tightening of her breast skin to remove the excess and "custom tailor" more natural appearing breasts.
After this relatively complex surgery, I was able to achieve the goals we had set preoperatively. The patient was thrilled with the improvements, and no longer felt embarrassed about the appearance of her breasts. The final implants were Mentor smooth, round, moderate profile plus cohesive gel implants in the mid-300cc range.