John Flynn

Case 73: Double Bubble After Capsular Contracture Treatment

This patient had subglandular breast augmentation. Postoperatively, the implants did not seem to be positioned well and there was capsule contracture. She then had submuscular implants and developed double bubble with more fullness of the left medial breast. The discussion included the type and size of implant to use, the pocket position above or below the pectoralis, and recreation of the inframammary fold.

Case 155: Painful Flipping Implants

This patient had lost weight and had small breasts with slight ptosis. She had breast augmentation with high profile textured implants. A month after augmentation, she had a mobile left implant. This implant was replaced with a coarsely textured implant. Both implants became mobile with pain. The group discussed multiple options for correcting the problem including exchange of implants for polyurethane implants, possible capsulectomy, and trying a firm bra. Seroma was to be ruled out. Ultimately revision was done and seromas found and possible gel bleed. Polyurethane implants were used after cleaning out the fluids and scoring the capsules.

Case 121: Tips or Traps

This patient had gained weight to 80 kg and then reduced her weight to 53 kg. There were empty pendulous breasts as a result. A vertical mastopexy was performed and she developed a hematoma postoperatively that had to be evacuated. She ultimately “bottomed out” and requested implants. It was decided to perhaps do an augmentation but the surgeon wanted to know of any tips or traps in this type of case. Ultimately an augmentation was performed but the implants remained too high. Another procedure was performed to lower the implants.

Case 97: Upper Pole Problem

This patient had breast augmentation with subglandular textured silicone gel implants through an inframammary incision. The upper poles appear blunted and palpably irregular but not hardened. Discussion centered around the size of implant, possible change in subglandular pocket, type of implant, and possible mastopexy.

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 133: Hypomastia and Obesity

This overweight female with hypomastia and right breast larger than the left desires larger and more even, natural shaped breasts. There was a comment that the patient had tuberous breasts as well. There were a variety of suggestions as the type of procedure that would benefit the patient.

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 49: Unexplained Possible Implant Rupture

This concerns a case of a patient who had breast augmentation, and 6 years later, a routine mammogram/ultrasound examination showed a very small amount of fluid, ‘presumably silicone’, to be present in each pocket. There was no history of trauma.

Case 71: Ruptured Implants

This case is about a patient who had breast augmentation 10 years previously using textured gel implants in the submuscular position. She presented with a lump in the axilla and ultrasound showed an extracapsular leak. Aspiration of the axillary mass disclosed silicone. The contributors discussed the removal of the implants with methods of removing the leaked silicone, whether capsulectomy or capsulotomy is advisable, and questions that should be asked of the patient.

Case 34: Late Revision

This 49-year-old patient had bilateral submuscular mammary augmentation with saline implants. Six months postoperatively, she had deflation of the right implant that was replaced. She now wants larger implants and better cleavage. There was discussion as to the type of implant for replacement, how to improve cleavage, whether to do capsulotomy, possible conversion to subglandular pocket, and how to handle mild double bubble. Ultimately capsulotomies with sharp dissection of the inframammary folds and larger implants were performed.