Colin C. M. Moore

Case 127: Sad Breasts

This patient had breast augmentation with subglandular insertion of saline-filled implants. She developed upper rippling and she had a revision with left capsulectomy and excision of scar on the right side. Three months later, she had thinning and discoloration of the left upper breast. This was treated with bilateral capsulectomies and changing the implants to a subpectoral position. This resulted in ptosis, and revision was performed by capsulectomies and replacement of implants in new subglandular pockets. Now, 12 years later, she has bilateral capsular contracture and ptosis as well as a 3 cm mass in the lower part of the left breast that was benign on needle aspiration.

Case 143: Bad Rippling

This is a case of a patient who had breast augmentation 6 years previously that was revised 6 months later because of rippling, and then 1 year later, the implants were replaced because of capsule contracture. At the present time, there is rippling and there is nipple asymmetry. The contributors discuss the possibility of synmastia and the type of surgery necessary to treat the patient’s problems. Also described are the types of implants available and the use of fat transfer to the breast.

Case 138: Bottoming Out

This concerns a patient with “bottoming out” following breast augmentation. The Group discussed various methods for treating the problem and described their own experience. The main concern was how to treat the inframammary fold (IMF).

Case 182: Much Too High

This 31-year-old patient had subglandular breast augmentation. A few years later, she had Baker 3 bilateral contractures after her two children were breast-fed. Breast revision was performed with change of implants to the subpectoral pocket. However, postoperatively, the implants remained too high. There were suggestions for the procedure to correct the high implants, the type of implant to use, and which pocket to use. The surgery for correction of the problem was performed and the results were good.

Case 173: Falling Implant

This 22-year-old patient has pectus excavatum, significant lumbar scoliosis, and asymmetry of the breasts. She had breast augmentation with smooth, round, full profile silicone gel implants placed in the subglandular pockets. When she returned a few years later, she complained that the left implant fell laterally more than the right when she was lying supine and she felt uncomfortable when lying prone. The discussion revolved around whether or not to make any changes surgically. There was a suggestion that repair of the excavatum might help.

Case 140: Congenital Synmastia

This 21-year-old patient with congenital synmastia wanted better cleavage. The discussion included liposuction over the sternum, use of compression garments, implant augmentation and transcutaneous suture technique to fix the subdermal tissues to the sternum. Reconstruction consisted of liposuction, breast augmentation and compression over the sternum. The synmastia recurred but not as severe as preoperatively.

Case 148: Eager Beaver

The patient requested a breast augmentation at 3 months postpartum (before her wedding). The minimum waiting period is at least 3 months post-lactation. There was a comment that on the photo she appeared to have tuberous breasts and surgery could help that.

Case 187: One High Implant

The patient had a breast augmentation in August 2013. Round, textured, high profile silicone implants were used. The left breast now is higher and firmer than the right breast. The patient wants larger implants. There was discussion about the need for the preoperative photos to assess prior asymmetry, whether or not to do any further surgery, capsulotomy, or capsulectomy, possible change pocket position, and possible circumareolar mastopexy.

Case 139: Rupture During Pregnancy

A pregnant patient is presented with ruptured implant 2 ½ years after augmentation. The discussion centered on surgery during pregnancy to remove the implant and gel, MRI to diagnose rupture, and literature on the subject of complications of breast augmentation with various implants.

Case 146: Red Breast

A 42-year-old patient had breast augmentation in 1992 with textured silicone gel implants in a subpectoral position. She had 1 week of swelling and pain in the left breast in 2007 and again in 2009. Patient seen in 2012 complaining of pain and burning in both breasts for years and “bruising” of breasts inferiorly. She wants replacement of the implants and excision of a small tumor of the breast (possible silicone granuloma). Suggestions included removal of implants, rule out anaplastic large cell lymphoma, biopsy the red area, possible gel bleed, and taking a biopsy of the pocket wall and replace with polyurethane implants after 3–6 months.