Margaret Anderson

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 114: Geriatric Breast Revision

This is a 75-year-old hypertensive patient who had breast augmentation in 1984. With the implant ruptured and then flattened breasts, it is important to remove the implants only if the silicone enters the tissue beyond the fibrous capsule. Recommendation was to remove implants and do mastopexy since the breasts were so flattened despite the implants. The only question remains is what type of implant to use and what pocket, subpectoral, subglandular, or completely submuscular.

Case 113: Revision After Subcutaneous Mastectomies

This 62-year-old patient had bilateral mastectomies with silicone implants in 1977. Left ruptured and implants replaced with saline in 1994. In 1999, the right implant deflated. Computerized tomography was recommended to see if there is free silicone in the tissues.

Case 158: Too Much Information

This 32-year-old patient with pectus excavatum and slight ptosis wants to go from a B cup to a D cup. The Group suggestions included anatomical implant in the subpectoral pocket, possible polyurethane-coated implants, mastopexy with augmentation, and breast augmentation only. The patient wishes to avoid circumareolar incision.

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 104: More Ptosis and Asymmetry

This 18-year-old patient had asymmetry with a large right breast compared to left. Suggestions included right Lejour reduction or Wise pattern and left augmentation and do the surgeries in two stages with vertical reduction mastopexy on the right and vertical mastopexy on the left then breast augmentation.

Case 145: Early Problem

The patient had early “bottoming out,” and the question was raised as to what procedure would suffice for long-term result? The discussion included doing nothing to suturing the inframammary fold (IMF) depending on when the fibrous capsule was developed adequately to suture closed.

Case 129: Postmastectomy Implants

The patient had bilateral mastectomies followed by expanders and three sets of implants. She has had complications including rotation, capsule contracture, hematoma, and seroma. The advice was to do a further release of the pectoralis muscle from the sternum and polyurethane-foam covered implants. The problem with Silimed anatomic implants are the lack of larger sizes than 590 mL.

Case 196: Five Surgeries…So Far!

The patient had a complicated implant history with four procedures that followed the initial breast augmentation. Two of the procedures were for capsule contraction (anatomical implants were placed in the second one): one for implant size change and one on the right in an attempt to lift more pectoral muscle to cover the superior pole of the implant. Subsequently, the implant moved laterally and has pain on standing, but not in the supine position. She is dissatisfied with the right side. Comments included possible change to smooth implants, polyurethane implants, superior crescent mastopexy on the left to even out the nipple position, fat transfer to smooth right upper pole, and possible change to submuscular pocket.

Case 103: Tuberous Asymmetry

An 18-year-old patient with breast asymmetry including right tuberous breast and left ptosis.