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Breast Implant Exchange

Before & After Gallery | Patient 1

Patient 01: Bilateral Capsular Contracture


Patient Details

Case 1 – Breast Revision with Exchange of Implants to the Submuscular position and a Super Breast Lift

Reason for consulting with OC Breast Surgery specialist
This 71 year old from Orange County, California had Grade 4 capsular contracture in both breasts from her 40 year old saline implants. Capsular contracture occurs when the scar capsule that forms around the entire breast implant contracts more than desired, then it tries to shrink smaller than the implant and this makes it feel hard, sometimes very hard to the touch. This patient’s implants were placed in the subglandular position (on top of the muscle) which tends to further increase the risk of capsular contracture. In addition to capsular contracture, this patient also had breast ptosis (sagging). The distance from her sternal notch to her nipple areolar complex measured 31.5 cm on the right side and 30 cm on the left, making her an excellent candidate for a lift.

Surgical Plan – Breast Revision with Exchange of Implants to the Submuscular position and a Super Breast Lift

Pre-Op Sizing
The patient wanted smaller breasts so there was no need for implant sizing before surgery. She submitted several photos of naked breasts in a neutral position to depict her ideal breast size and others she felt were too small or too large.

Pre-Op Labs
Blood Test
All breast surgery patients are required to have a Mammogram or Ultrasound within 1 year of the surgery date. All patients must have a CBC and Basic Metabolic blood test to be cleared for surgery. Patients over the age of 50 must have had an EKG within 1 year of the surgery date.

Day of Surgery
Breast Revision with Exchange of Implants to the Submuscular position and a Super Breast Lift is done under General Anesthesia. Surgical time is 5 hrs.

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Skin marks were placed with the patient in the sitting position prior to surgery. In surgery, the breasts were prepped and draped in the sterile fashion. The areolae marked out approximately 4.4 cm in diameter on each side, and the new inferior areola-to-inframammary fold distance was marked out at 9 cm. All tissue inferior to that marking was eventually removed. This weighed 85 g on the right and 80 g on the left. Inframammary fold had been incised and dissection carried down to the capsule with cautery. There was a completely encapsulated calcified hard capsule which was removed en bloc, and this calcified capsule which was in the subglandular space was opened on the back table, and a smooth double-lumen implant was removed. The outer shell had failed, and the back read “McGhan 325 cc.” The exact same thing was carried on the opposite side without deviation, and a similar implant was found. The various sizers were tried with the patient in the sitting position and elected to use 210 cc implants. The Super Breast Lift triple dermal tightening technique was applied in the nipple areolar dermis, lower breast curve dermis, and lower breast fold dermis. The sizers were removed, and the pockets irrigated with Triple Antibiotic solution and the 210 cc Natrelle SRM implants were then placed in each space. Dilute lidocaine/epinephrine/saline solution had been infused in the lateral chest, medial and lateral breasts, and the midline of the superior sternal fatty bump, and after 20 minutes, the areas were reduced with liposuction. A 150 cc was removed from each side. A total of 295 cc on the right and 290 cc on the left which involved approximately 85 g of tissue, 150 cc of liposuction, and 115 cc reduction in the implant size. The wounds were cleaned with saline and alcohol and covered with skin tape, gauze, and a support bra.

Post Op
The next morning at her first post-op appointment, the patient was instructed to follow the Breast Implant Moving exercises several times a day for the first two weeks as the implants settled into place. At two months the implants were moving well and her breasts were soft. She was extremely happy with her results.