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, the pictures of the implant showing complete loss of integrity, probably well over 15 years ago had been ruptured.  Notice the thick, hard calcified shell of the entire exenterated capsule that has been removed, that this is silicone that has bled into the tissue through the capsule and has now caused calcification, hardening and actually loose calcified silicone material within the pocket.�
All Dow Corning implants should be removed.  The integrity of all these shells probably last less than 10 years.  These should be removed as soon as possible, the pockets should be cleaned and all scar tissue and capsule should be exenterated.  Reconstruction with saline or silicone implants can be performed.

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.

Below is a case example of a severe double-bubble breast deformity in which the patient presented status post augmentation mammoplasty procedure 26 years ago through a transaxillary approach which she thought were saline implants.  Intraoperatively, the patient was found to have Becker double lumen silicone gel, internal lumen and saline external lumen implants.  Note, on the photograph the outer layer of saline has actually ruptured and has leaked out through the shell; however, the silicone remains within the intra capsule.  In any case, there is greater underfill of this implant which required reconstruction using style 45, 550 cc extra high profile Natrelle silicone gel implants, open capsulectomy and a secondary formal mastopexy.  Her postoperative photos will be presented on a blog in approximately eight to 12 weeks.

Becker implants have been used for both cosmetic and reconstructive purposes in the past.  I personally do not use these implants.  We either use straight saline or silicone cohesive implants.  The double lumen shall Beck implants have a relatively thin external shell and I have seen a significant number of ruptured Becker implants over the last 15 years.  Patients often do not know what type of implant and what the viscosity of the implants are internally, silicone versus saline, and it is extraordinarily rare that they can remember having these double lumen Becker implants with saline exterior and silicone interior lumens.

Breast augmentation costs

When considering breast augmentation, it is most important to see a specialist in breast augmentation, breast revision surgery, who is Board Certified with the American Board of Plastic Surgery.  There are absolutely no substitutes whatsoever.  The centers should be licensed and only Board Certified Anesthesiologists should be used.  The only two FDA-approved implants are Mentor and Allergan Pharmaceuticals.  We use currently Allergan Pharmaceutical implants, Natrelle implants which have a lifetime warranty on the implants, both saline and silicone.  Remember, the final cost should not be the ultimate determinate of your surgery, but rather, to achieve the best surgical outcome with the most experienced qualified Board Certified Plastic Surgeon.