John Walker

Case 40: Problem Submuscular Implants

This patient had subfascial saline implants by way of an axillary approach. Three months later she had an anchor scar mastopexy because of drooping. The sagging recurred, and 3 months later she had capsulectomy and submuscular placement of the implants. Now, when she flexes her left pectoralis muscle, the muscle is visible. The discussion included the idea that the original implants were too large and made the ptosis worse. Move the left implant to the subglandular position, to do capsulotomy and revise the mastopexy and use a smaller implant, and perform dual-plane placement of the implants through an areolar approach.

Case 135: Augmentation After Massive Weight Loss

This patient had extreme weight loss from 100 to 59 kg. There was mild ptosis. Mastopexy and mastopexy with breast augmentation were discussed. The patient decided on breast augmentation alone. Postoperatively there was some ptosis and Snoopy deformity. Patient was dissatisfied with the implant size. There was discussion about the types of procedures that could be used. It was elected to insert polyurethane-covered prostheses.

Case 161: Immediate Problem

This patient had breast augmentation, and after the swelling subsided noted the right breast was higher than the left, uncomfortable, and of unusual shape. Suggestions were made by the Group that included anterior capsulectomy on the right with change of the implant, lowering the implant and closing the upper pole of the pocket as well as capsulorrhaphy and the use of polyurethane-covered implant.

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 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 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 42: To Not Operate

This 47-year-old patient had breast augmentation with four revisions. She presents now with the appearance of “two oranges in a top, nipples too wide, and not centered” and requesting a wider implant base. Her tissues are very thin and the implants easily palpable. The Group advice was not to operate again since the appearance was good.

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.