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BREAST ANOMALIES, ASYMMETRIES & DIFFICULT CASES
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IMAGINE YOURSELF AT PLASTIC SURGERY ARTS OF NJ BROWSE OUR BEFORE & AFTER BREAST GALLERY
BREAST AUGMENTATION
Patient 1 This 40-year-old woman is typical of those patients who have lost breast volume as a result of pregnancy. This is often referred to as postpartum involution, quite dramatic in this case. Because her nipples were well above the inframammary fold she would not require a breast lift. However, because of her thinness, Dr. Nini suggested a sub-muscular, dual plane implant position. This would allow the upper pole of the breast implant to be covered by muscle which would reduce the risk of visible rippling. The lower portion of the implant is covered by breast skin and glandular tissue which allows for a nice expansion of the lower hemisphere. A moderate plus profile 350 cc silicone gel implant was used. Her breast size increased from a 32A/B to a D cup. Dr. Nini. (KTN)
Procedures performed: Breast Augmentation.
BREAST AUGMENTATION
Patient 2 This is a 51-year-old woman who has the classic symptoms of large breast – back, neck and shoulder pain, groving from the bra straps and overall heaviness of the breasts. Chiropractors and orthopedic evaluation did not help and we were able to work with her insurance company for permission to proceed with breast reduction surgery. Her symptoms have improved, she is much more comfortable and her body proportions are much better. Dr. Wey. (PDW)
Procedures performed: Breast Reduction.
BREAST ASYMMETRY
Patient 3 This is a 31-year-old woman with severe asymmetric constricted breasts. Her preoperative bra size was a 36A cup. Because of the laxity, or strechability of her breast skin, Dr. Nini was able to place a larger implant in the dual plane position without the need for preoperative expansion or and adjustable saline implant. However, because of the narrow nature of her chest wall, we used high profile 450 cc silicone implants. She can now wear a C cup bra and is much happier with the size and shape of her breasts. Photos at 6 months. Dr. Nini. (KTN)
Procedures performed: Breast Augmentation.
BREAST REDUCTION
Patient 4 This is a 29-year-old woman who desires breast augmentation. She presents with fairly dramatic asymmetry and the insides of both “inframammary folds” are tight and asymmetric. Subglandular breast augmentation with 300 gram high profile implants was performed and the lower portion of the breasts are also more even. Preoperative size was 34A; postoperative bra size is now 34C. Dr. Wey. (PDW)
Procedures performed: Breast Enlargement and Breast Implants.
BREAST ASYMMETRY
Patient 5 This 34-year-old woman desired a breast lift. She explained to Dr. Nini that she was pleased with the size of her breasts but simply wanted an improvement in the shape of her breasts and to reduce the sagging. She was 5 feet 2 inches tall and weighed 150 pounds. Her breasts were a full C cup. A Wise pattern mastopexy, or breasts left, was performed as an outpatient. Her results are photographed one year later. As you can see in the photos, her incisions are beginning to heal nicely. Dr. Nini. (KTN)
Procedures performed: Mastopexy.
BREAST ANOMALY AND ASYMMETRY
Patient 6 This is a 45-year-old woman who was referred to Dr. Wey after three prior breast implant procedures and mastopexy (breast lift). When she presented, she had distortion and asymmetry resulting from a ruptured left breast implant, grade 4 (severe) capsular contracture of the right breast implant, volume differences and malposition of the nipple areolar complexes. At surgery she had removal of the scar tissue, implant exchange (400 gram high profile on the right and 375 gram high profile on the left) and revision of the breast lift. Preoperative size unknown, postoperative size about 36D. Dr. Wey. (PDW)
Procedures performed: Capsulectomy, Implant Exchange, Secondary Mastopexy.
CONSTRICTED/TUBEROUS BREAST
Patient 7 This patient is 19 years old, 5 feet 5 inches tall, weighing 154 pounds. She wears a size 36A cup and desired to be a small to medium D cup. Her preoperative photographs demonstrate an asymmetric, moderately severe tuberous breast condition. In this patient, Dr. Nini decided to use an adjustable saline breast implant as a tissue expander. It was placed in the dual plane pocket and utilized a small injection port buried just under the skin and covered by the bra strap. It is just barely visible as a small bump on the breast side view. Into this port, we are able to inject saline solution to fill the implant and gradually expand the breast. The technique of tissue expansion for the correction of tuberous breast is widely accepted. What is unique about this approach, is that we use a saline implant which eliminates the need for a second operation. This patient can simply choose to have the fill port removed and keep the saline implant as her final device. On the other hand, she could have the saline devices removed and exchanged for a silicone breast implant. There is a lot of flexibility with this approach. Dr. Nini. (KTN)
Procedures performed: Breast Augmentation.
CONSTRICTED BREAST
Patient 8 This patient is a 23-year-old woman who desired silicone breast augmentation. She has an asymmetric constricted breast condition. Her right breast is higher and demonstrates less lower pole fullness. Her preoperative bra size was a 36A. To address this condition, Dr. Nini used a dual plane partial sub-muscular augmentation technique. She is now a full C cup following the placement of 350 cc smooth round moderate plus profile silicone breast implants. Her photos are taken one year after surgery. Dr. Nini. (KTN)
Procedures performed: Breast Augmentation.
CAPSULAR CONTRACTURE
Patient 9 This patient is a 38-year-old woman who had undergone a subglandular augmentation with a smooth round silicone breast implant 350 cc in 2009. She had experienced capsular contracture in downward descent of the breasts and was disappointed with the results. She also felt that her breasts were a bit too large for her.A revision was carried out by Dr. Nini, performing capsulectomy and replacing the 350 cc implant with a 275 cc silicone implant. In addition, Strattice, an acelullar dermal matrix, was used as an internal sling to support the breast implants in a new elevated position. There is also some evidence that ADMs will reduce the incidence of capsular contracture. Her postoperative photographs are taken six months later and her breast aesthetics are greatly improved. Dr. Nini. (KTN)
Procedures performed: Capsulectomy and Breast Augmentation.
BREAST ASYMMETRY
Patient 10 This patient is a 20-year-old woman with a developmental breast asymmetry. Her preoperative photographs demonstrate an asymmetric constricted breast deformity. Note the smaller right nipple areolar complex and the shortened distance between the right nipple and chest wall. On the left side, I placed a fixed volume 280 cc saline implant in the subglandular position to better elevate the nipple areolar complex without additional surgical scars. On the right side, I used an adjustable saline implant was in the submuscular dual plane position to help expand the lower hemisphere of the breast. A micro-fill port was placed beneath the skin to allow for post operative filling of the right implant. In order to achieve her goal of a full C cup, small D cup, the final fill volumes were 500 cc on the right and 280 cc on the left. The fill port was removed in the office under local anesthesia. Adjustable saline implants are often a good choice when expansion of the lower hemisphere soft tissue envelope is necessary, such as the case in this patient’s right breast. Dr. Nini. (KTN)
Procedures performed: Breast augmentation.
BREAST ASYMMETRY & FAILURE TO DEVELOP
Patient 11 This 19 year old woman presented with a failure of breast development. Her photographs demonstrate an asymmetric nipple position and virtually no space between the nipple and the fold beneath the breast. As you can imagine, there is very little room for a breast implant. Because of the need for lower hemisphere dimension, Dr. Nini chose a saline breast implant, noting that the weight of the saline implant combined with the hydrostatic forces is more likely to expand the lower soft tissue envelope than a silicone device would. Following intra-operative tissue expansion combined with a dual plane approach, a total fill volume of 350 cc was achieved. Her photographs were taken 6 months after the procedure. Dr. Nini. (KTN)
Procedures performed: Breast Augmentation.
PECTUS EXCAVATUM
Patient 12 This is a 35-year-old woman who requested a breast augmentation. She was a 34A cup and desired a C cup. Her examination was interesting because she presented with a pectus excavatum, a wider left hemi-chest wall, an elevated left shoulder and a left breast, nipple and fold that were slightly higher than the right. In addition, the left breast was approximately 100 g larger than the right.A pectus excavatum is sometimes described as a “sunken breastbone”. In this situation, Dr. Nini prefers a sub-muscular approach which tends to keep the implants from collapsing into the midline. In this patient who is 5 feet 4 inches tall and weighs 112 pounds, we used a 225 cc smooth round silicone classic profile implant on the left side and a 325 cc smooth round high profile implant on the right. Different profiles were used to balance the chest wall asymmetry in an effort to create symmetric projection. Her results can be seen 5 months postoperatively. Dr. Nini. (KTN)
Procedures performed: Correction of Pectus Excavatum Breast Augmentation.
CONSTRICTED BREAST / TUBEROUS BREAST DEFORMITY
Patient 13 This is a 30-year-old woman seeking breast augmentation. She explained that she had nursed one child and after this pregnancy had lost volume in the upper poles of the breast. She wanted to be a small C cup. She was 5 feet 2 inches tall and weighed 117 pounds. However, examination of the breasts revealed high and tight inframammary folds with nipple asymmetry and a very short distance between the nipple and the inframammary fold. This is a characteristic of the constricted breast or tuberous breast deformity. This is a difficult type of augmentation and if not performed correctly the breast implants can end up very high on the chest wall. For this patient a 300 cc smooth round implant was chosen and the dual plain surgical approach was recommended by Dr. Nini. This is a partial sub muscular procedure that promotes lower hemisphere expansion which is what she needed. Although she still has a mild asymmetry, we were very pleased with her outcome. Her photographs are taken 5 months postoperatively and she is a small C cup. Dr. Nini. (KTN)
Procedures performed: Correction of Constricted Breast Breast Augmentation.
BREAST ASYMMETRY & WEIGHT LOSS
Patient 14 This is a 22-year-old woman who had lost 100 pounds by dieting and exercise. As a result, she had experienced tremendous loss of breast volume. As you can see from her preoperative photographs, a considerable asymmetry existed between the left and right sides and the base diameters were too narrow for her chest. Ideally, the outer breast shape should not allow the chest or ribs to show; this helps balance the upper body with the hips. Most surgeons would have insisted on a breast lift, however, she absolutely did not want any visible scars.My plan for her was to choose an implant volume, profile and placement that would correct some of the sagging, asymmetry and chest wall show. A 350 cc moderate plus silicone gel implant was placed in the sub-glandular position with a very nice result. Although it’s not perfect…this patient demonstrates how we are able to meet the patient’s goals by “thinking outside of the box sometimes”. Her photos were taken 10 months after her surgery. Dr. Nini. (KTN)
Procedures performed: Breast Enlargement and Breast Implants.
SKELETAL ASYMMETRY / PECTUS EXCAVATUM
Patient 15 This patient is a 38-year-old woman with small asymmetric breasts, soft tissue and skeletal asymmetry. She presented to Dr. Nini as a 32A cup and desired to be a full B or small C cup. She is an avid athlete and wanted to maintain an athletic natural appearance. A subglandular breast augmentation was carried out with smooth round silicone implants 275 cc on the right and 200 cc on the left. Asymmetric placement of breast implants can oftentimes mask asymmetries. This patient has realized a very nice result without additional scars or heroic surgery because proper technical strategies were employed. A submuscular placement of the breast implants would not have yielded this nice a result. Dr. Nini. (KTN)
Procedures performed: Breast Augmentation.
BREAST ASYMMETRY
Patient 16 This 27-year-old woman presented with asymmetric constricted breasts. She was 5 feet 7 inches tall and weighed 145 pounds. She wore an A cup bra and hoped to be a full B cup or small C cup. Dr. Nini performed a dual plane breast augmentation with saline implants filled to 400 cc. This approach utilizes the pectoral muscles propensity to push implants downward plus the weight of the saline implants to create a better lower hemisphere soft tissue envelope. This is nicely demonstrated on the oblique views. You can see the increased distance between the nipple and the inframammary fold when comparing the pre-and postoperative photos. With constricted breasts, it’s important to have a plan for the lower hemisphere of the breast mound, otherwise the implants will ride up very high on the chest wall and the breasts will have an odd shape. Dr. Nini. (KTN)
Procedures performed: Dual plane breast augmentation.
BREAST ASYMMETRY
Patient 17 This is a 28 year-old female who is interested in achieving breast symmetry. She is 170 lbs and is 5’2, and wears a 38C bra, but does not fill it out evenly. Using a 235cc Mentor smooth round moderate classic silicone memory gel, a mastopexy with subglandular augmentation was performed on the left side and a mastopexy only was performed on the right. Her current size is a 38C. Photos at six months. (KTN)
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