BREAST ASYMMETRY – SEVERE

The below case is a patient who is 20 years old, presenting with severe tubular breast deformity on the left with severe breast asymmetry and right breast ptosis.  To reconstruct this young lady’s breasts in order to create a normal appearance, requires both different volume implants as well as a formal mastopexy on the right as well as release of the tubular breast deformity on the left.  This patient underwent augmentation mammoplasty procedure with 160 cc high profile saline implant placement on the right and 280 cc high profile saline implant placed on the left.  An inframammary release of the pectoralis major fascia was performed on the left in order to reduce the tubular breast appearance.  She also underwent formal mastopexy using the inferior pedicle Wise-pattern technique on the right to recreate a symmetric nipple areolar position and reduce the grade 3 ptosis.

The patient is now at three weeks postop, sutures have been removed today, the nipple areolar complex positions are even and the size is quite good.  The inframammary folds are even and the swelling is reduced greatly.

Only Board Certified Plastic and Reconstructive Surgeons should be performing these very difficult operations of tubular breast deformity with conical shaped breasts as well as breast asymmetry and ptosis.

CASE 2

The above patient presents with silicone gel implants placed 34 years ago.  These are ruptured silicone gel implants that had been placed over one-third of a century ago.  The patient left the implants in and has now noticed increasing pain.  An MRI shows intra and extracapsular ruptured silicone implant and implant material.  She has undergone open periprosthetic capsulectomy, removal of calcified granulomas, silicone calcifications, ruptured silicone gel implant material and subsequently reconstruction with new high profile style 20 Allergan silicone gel implants.  Notice the calcification and hardness of this tissue.  Over years the silicone will calcify with the collagen and create a thickened, hard scar ball, almost the consistency of chalk.  The patient has also developed calcified granulomas with small circumscribed areas of silicone which have become loculated in the tissue.

Notice the hardness of the breasts preoperatively, associated with this thickened calcified scar ball.  The implant shell has pretty much deteriorated as can be seen on this photograph of the ruptured loose gel material being pulled out of the breast.

Patients who have Dow Corning implants should have them removed as soon as possible.  The tendency for them to rupture within originally 10 years was very high and it is unlikely that any of these implants are intact in any women throughout the world.

 The example here shows a patient with complete loss of upper pole fullness, severe ptosis, grade 3, the nipple is well greater than 3 cm below the fold and an implant has been placed under the muscle with a formal lift, removing skin both vertically and along the inframammary fold.  Her postoperative photographs show a nice elevation of the nipple areolar complex. 

This is a four-week photo.  Notice there is still some pink around the areolas and the vertical scars.  This, however, will soften with time.  The position of the areolas shows nice lifting and the nipples are at a direct straight out position.  It is safe to perform both implants and lifts at the same time as long as you find a qualified Board Certified Plastic and Reconstructive Surgeon who specializes in augmentation mammoplasty and mastopexy, understanding the anatomy and blood supply to the nipple to prevent any type of avascular episodes.

Note on example 1, the nipple areolas are actually quite stretched out.  She had a Benelli lift, around block technique, which simply caused stretching of the areolas with widespread subtle-like scarring.  She is very dissatisfied that the nipple areolas actually did not elevate whatsoever.  Rather, she ended up with widespread areolas and the nipples still in the low position.  The implant is high on the left with scar tissue contracture and is a flat moderate profile showing a very displeasing result.  Her after photo notably shows high profile 600 cc saline implants over-filled to 650 cc, open capsulotomy lowering the left implant and complete revision of the breast lift showing a nicer pattern to the nipple areolar complex, reducing the tension around the areola, allowing for a more rounded shape and less of a sunray appearance.  The vertical scar has actually healed quite nicely as well.

Example 2 indicates a patient who underwent augmentation mammoplasty procedure twice and a breast lift by a different surgeon with severe encapsulation and right double-bubble breast deformity.  Flattening of bilateral breast was extremely unpleasant to the patient.  She also underwent open capsulectomy, replacement with 700 cc high profile saline implants through the periareolar approach and then open capsulotomies high profile implants were used and then the nipple areolar complexes were reduced with a complete formal mastopexy.  The after photo shows a nice rounding shape to the breast, no longer flattening along the inframammary fold.  The nipple areolar complexes are now in the proper position.  The right one has been lowered and there is no further bottoming out.

Breast augmentation mastopexies require tremendous experience in judgment by Board Certified Plastic Surgeons.  Make sure your doctors are specialists in breast augmentation as well as reconstruction and revision when considering this difficult operation.

Dr Linder,

Thank You!  At 60 yrs with 3 surgeries behind me, I was scared to death to try to fix my problem again. From the first phone call with Nellie, ( I luv you Nellie!) she put me at ease and that gave me hope of walking in another office.  Meeting you, sealed the deal. You were so kind and understanding. Very professional to tell me you would ‘help me’ make the decision regarding size according to my body, skin, previous surgeries, etc..I was very, very afraid until I met you and your staff. You ARE a master at revision surgery!!  My boobs are wonderful, Awesome, in fact!!  The whole procedure was something to learn from. Choose the best and you won’t regret it!  Adrianna, I appreciate you!  All your help and kind hug made me cry! Surgery staff, you’re the best!! I will tell everyone, EVERYONE…if you want the best, see Dr Linder!!!!  Again, thank you soooooo much for my 20yr old looking boobies!!!

A.C

California

Other consultations that day also included mommy makeover, including breast implant lift, tummy tuck and liposculpture of the hips.  These patients present to Beverly Hills from Las Vegas for surgery, including breast augmentation, breast revision, breast lift, breast reduction, liposculpture, and abdominoplasty.

The below example is a patient showing with very narrow inframammary fold, minimal cleavage and bilateral breast hypoplasia.  Great candidate for saline implants placed under the muscle using high profile saline Allergan implants.  Due to the thickness of the muscle, the 500 cc, style 68 high profile Natrelle implants were placed through the periareolar approach and the subpectoral dual plane technique.  Preoperatively, she is hypoplastic, there is minimal upper pole fullness and the cleavage is approximately 4 cm along the intersternal distance.  Postoperatively, you can see at six weeks the implant position is excellent, there is good upper pole fullness and there is approximately 1.5 fingerbreadths of cleavage and the inframammary folds are even.  Because of the narrowness of this woman’s chest diameter, 12.5 cm inframammary fold distance, the high profile tapered implants are an excellent choice, allowing for upper pole fullness, good cleavage and reduction of lateral fullness or matronly appearance.  At six weeks she has softened appropriately and nicely.  She is now able to wear underwire brassieres and can continue workout and tissue expansion exercises. 

High profile saline implants are an excellent choice for younger patients under 25 years of age, who have thick muscle and bilateral breast hypoplasia as well as those who have narrow chest diameters.

Patients are presenting for cosmetic dentistry with Dr. Kevin Sands, a world recognized leader in cosmetic dentistry, including all forms of dental bonding, veneer and perfect smile dental work.  He has a multitude of celebrity clientele who have undergone his masterful artistry in perfect dental reconstruction and cosmetic perfection.  Patients are also presenting for facial rejuvenation surgery, including eyelids, rhinoplasty and dermal fillers. 

Dr. Robert Kotler is a facial cosmetic surgery specialist who performs absolute remarkable beautification and rejuvenation, creating a youthful appearance to the face through his eyelid surgery, brow lift and facelift procedures.  He is a world recognized leader in rhinoplasty and nasal surgery, creating the absolute perfection of proportionality of the nose to the specific woman’s facial structure.  Robert Kotler is considered a truly greater facial plastic surgeon with well over 35 years of experience and celebrity clientele from every major Hollywood studio. 

In a similar fashion, patients present for body sculpting, including breast enhancement, breast revision, breast reduction, breast lifting, tummy tucks and total body lipo-contouring, to us, Dr. Linder, Beverly Hills Body Sculptor.  The name Linder with the Dr. Linder Bra has become a “figure in the community,” consistency with body sculpting from patients of every walk of lift, from celebrities and patients of international travelers worldwide. 

The Beverly Hills Extreme Makeover includes complete body and facial transformations from worldwide leaders and experts, including cosmetic dentistry, Dr. Kevin Sands; facial plastic surgery and rejuvenation with Dr. Robert Kotler and total body mommy makeovers and extreme body sculpting, lipo-contouring with Dr. Stuart Linder.