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Breast Implant Exchange

Before & After Gallery | Patient 2

Patient 02: Deflated Saline Implant


Patient Details

Case 2 – Bilateral Breast Revision, Exchange of Implants, Bilateral Crescent Lifts

Reason for consulting with OC Breast Surgery specialist
This 53 year old patient from the Los Angeles area came in because her left saline implant had deflated. Her previous surgery was done in 1998 and she was happy with her results.

Saline implants have a silicone shell that holds the contents of the saline (salt water) and when the shell fails, the implant deflates. The saline is redistributed into the body (60% of the body is saline). This is comforting to know, but the result is a flat breast. Though it is not a medical emergency when a saline implant deflates, most patients are quite disturbed by the sudden change in breast appearance.

There are three options when one saline implant fails. Surgery to replace one or both implants is one option. Deflating the other implant is another. This can be done in the office without any anesthetic. The third option is to add gel cutlets to the bra to fill in where the implant is missing. Most patients opt for surgery and most of those choose to replace both implants. This patient was comfortable with her current size implant and despite the distance from her sternal notch to her nipple being greater than 20cm (23/R, 23/L) she did not want a full lift. The surgeon recommended a crescent lift (mastopexy) to raise the nipple areolar complex about 1cm to 1.5cm which does not raise the underlying breast tissue but can make the breasts appear slightly more lifted.

The patients opted to replace her saline implants with silicone implants.

Surgical Plan – Bilateral Breast Revision, Exchange of Implants, Bilateral Crescent Lifts

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Pre-Op Sizing
The patient wanted her breasts to be about the same size after surgery so no pre-op sizing was necessary. Since she elected not to have a lift, she understood that she might need a slightly larger implant than what she had to fill up the skin envelope.

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
Bilateral Breast Revision, Exchange of Implants, Bilateral Crescent Lifts is done under General Anesthesia. Surgical time is 2 hrs and 15 min.

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 right capsule was entered and an intact smooth saline implant found with the markings “McGhan 420 cc” on the back. The saline was carefully removed, and it measured 435 cc saline. A capsulotomy was performed. The left capsule was entered an a deflated “McGhan 420 cc” saline implant was found and removed. Various sizers were tried with the patient in the sitting position, and the surgeon elected to use 445 cc size implants. The sizers were removed and the pockets were irrigated with triple antibiotic solution and instilled with 0.25% Marcaine with epinephrine and Exparel. The 445 cc Natrelle SCM smooth gel implants were placed in each space with use of Keller Funnel.

The bilateral crescent mastopexy was rechecked for appropriate symmetry and the skin removed. The upper skin was undermined and closed with sutures. The wounds were cleaned with saline and alcohol and covered with paper tape, gauze, and a support bra.

Post Op
The next morning at her first post-op appointment, the patient felt great and her implants were moving well. She was instructed to follow the Breast Implant Moving Exercises several times a day for the first two to three weeks until the implants settled into place. She continued to wear her support bra for the next two months. Her post op photos are taken one year after surgery.