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Breast Augmentation Revision: Patient 21

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This 26 year old lady went to a plastic surgeon in North Jersey and was very upset with her results.  The biggest concerns after her surgery were that the implants were too low on her chest.  This creates high appearing nipples that fall out of bras and bathing suits and are a major problem.  Furthermore she had a flexion deformity with muscle contraction that bothers her.  Finally she wishes to be larger.  I discussed with her several points.  We can go a little bigger, but not much larger as she has already bottomed out on both sides.  This common term for inferior displacement of the implants results for several reasons.  Sometimes when the soft tissue at the base of the breast is not strong enough to support the implants the implants will descend.  Sometimes this area of tissue will stretch and allow the implants to drop.  Sometimes the pocket is created too low during surgery.  Correction requires elevating the pocket.  Sometimes this can be done with natural tissue.  Sometimes stretched tissue needs to be removed.  Sometimes a supporting mesh can be inserted for extra support.  The animation deformity of concern is very common with implants under the muscle.  Sometimes this can be improved but often it is very normal movement of the implant that bothers the patient.  One solution is moving the implants above the muscle.  Pros and cons of being above the muscle versus below the muscle need to be considered.  Finally the thickness of the implant gel should be considered and here since going above the muscle a thicker gel, Allergan Cohesive SCF 485 on the left and SCF 450 on the right was used.  Her original surgeon refused to address her implant position issues and simply wanted to do fat grafting to cover the animation muscle deformity.  I do not think this would have done much to change her result.   She is delighted with the improved result of galaflex mesh support, pocket exchange, and slightly larger implants.