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Breast Augmentation: Patient 239

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This is a 27 year old lady with breast implants that were originally placed via the axillary armpit incision in a under the muscular position but ended up with significant bottoming out (inferior and lateral displacement) of the left breast.  Her original plastic surgeon in Philadelphia tried to revise this in the office under local anesthesia by making a new crease incision and trying to elevate the implant.  This left her with the result that she hated when she came to see me.  We discussed her concerns which included the asymmetry of the breasts, the left breast being too low, and lack of cleavage and fullness superiorly.  We chose to revise the breasts and convert them to subfascial in order to get a new pocket, get better fullness and shape superiorly and medially and to increase size.  As increasing size always increases the risks of problems recurring I also placed galaflex mesh to give extra support as an internal bra.  While galaflex mesh is off label for breast surgery it is often used in cases such as this to provide extra needed support.  Consultations with your physician about the pros and cons of using a mesh like this need to discuss all of the options in detail.  This is a 650cc high profile Sientra style 107 gummy bear cohesive gel breast implant.   Interestingly the left implant was found to be a leaking Mentor high profile 475cc silicone breast implant.  It is hard to detect leaking silicone implants and this reinforces the need for MRI or ultrasound starting at 5 years then every 2 to 3 years as this implant was only 6 years old.  I have learned and believe that placing silicone implants via the armpit incision is necessarily the greatest idea due to possible microfractures that can occur during the placement through this remote incision.   She is shown here after her surgery with significantly better symmetry and a beautiful result that she loves.