Michael Szalay

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 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 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 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 117: Multiple Revisions

This 31-year-old patient had subglandular breast augmentation in 2000. Six to 12 months postoperative, she developed capsule contracture and had bilateral capsulectomy and reinsertion of the implants into the same pocket. She developed bilateral capsule contracture again and had bilateral capsulectomy with insertion of polyurethane foam-covered prostheses placed into subpectoral pockets. The right implant was too high and this was repositioned 1 week postoperatively. She now has double bubbled and flattened breasts. The Group had suggestions that included periareolar mastopexy and placement of polyurethane implants subglandular, only perform a “wedge resection” of the part of the capsule between the old inframammary fold (IMF) and the new IMF correcting the double bubble, possible dual plane placement of the implants, and possible removal of the implants.

Case 58: More Tuberous Breasts

This 29-year-old patient with tuberous breasts requested larger breasts. Subglandular augmentation through a periareolar incision and PIP round, high-profile, smooth implants was suggested. The Group discussed inframammary incision, dividing the fibrous bands of the tuberous breasts, low-profile anatomical implants, excising part of the gland, and periareolar incision. Breast augmentation was performed using lower intra-areolar incisions and using 290 mL smooth, round, high-profile, titanium-coated, silicone gel implants in subglandular pockets. A small amount of breast tissue is excised from behind each areola, with diathermy and the breast tissue scored radially in four quadrants by direct vision.

Case 107: African Skin

This 29-year-old African female seeks breast augmentation. She does not want polyurethane (PU)-covered implants or saline implants, nor does she want breast lift except for areolar lift. Suggestions included periareolar approach for an African female, implant size varying from 300 to 425 mL, high-profile implants, possible inframammary or transaxillary approach, and subpectoral pocket.

Case 105: Early Recurrent Capsular Contracture and Thin Tissue

This 25-year-old patient had subglandular breast augmentation in 2008. She developed grade 2 capsule contracture and was treated medically with some improvement. Fourteen months after surgery, the capsule contracture was grade 3 that did not respond to medical treatment. Capsulectomy was performed with implants changed to subpectoral pockets. Capsule contracture grade 3 developed on the right side postoperatively. There was a discussion on polyurethane implants and Alloderm. A second revision was performed and she returned in 2015 with flipping of the implants and indentations.

Case 162: Upper Pole Ridge

The patient had subglandular polyurethane implants and 3 weeks later noted a ridge on the left upper pole of the breast. The Group suggested that the leading upper edge of the implant has possibly tilted anteriorly on insertion, possible buckling of the implant, may need implants changed to subpectoral or total submuscular, might need ultrasound, CT, or MRI, might do capsulotomies and enlarge the pocket, and possibly wait for 6 months for the redo.

Case 160: Double Folds and Polyurethane Foam-Covered Implants

The 21-year-old patient had breast augmentation with Silimed polyurethane foam-covered anatomical gel implants in the submuscular dual plane. At two and a half weeks postoperative, a double fold was noted. The discussion included transfer of implant to subglandular position, the cause of double fold, freeing of the inframammary fold, delaying surgery to see if double fold resolves, polyurethane foam-covered prostheses and lowering of the inframammary fold.