Dr. Alejandro Nogueira's Case #J78CQYEA

Additionally the breasts are sitting too lateral, with lateral nipples and side boob prominence, which is another anatomical feature not only conditioning the surgical planning but also a congenitally conditioned abnormality to be very seriously considered by the surgeon in order to prevent an eccentricity deformity; such lateral breast are candidates to three strategies; one is ignoring the nipple areola complex location and ignore the breast mound location, to set the implants eccentric to the nipple areola complex well close together in the midline to achieve a full and tight cleavage, but this would produce an aberrant deformity of cross eyed breasts with nipples laterally eccentric located at the sides of the breasts; the second technical approach is setting the implants centred beneath the nipple areola complex but oversized in width with the aim of filling up the cleavage but exceeding the anatomical limits of the real mammary base, which would cause a severe side boob deformity; finally, the only acceptably technical design is carrying ahead a perfectly fitted and anatomically adapted augmentation mammoplasty, in which the breast implants are centred with precise correspondence to the nipple areola complex and the width of the prostheses is matching the real anatomical base and limits of the mammary mound, in which the patient understands her peculiar chest features; the latter is the only approach leading to brilliant results like is seen on this case, in spite the cleave is wide apart and the breast mounds laterally located, but this is how the patient was born and the augmentation mammoplasty is only such thing, augmenting the breasts in their size, and not else thing, keeping in mind other tempting technical options would necessarily lead to a poor result and a certain revision in the future.

Another challenge in these skinny patients with such high grade of breast hypoplasia and slim body frame is achieving naturalness and prevent fake looks, rippling, visible kinks and any deformity due to the cutaneous transparency; this was accomplished with modern anatomical shaped implants filled with cohesive gel, which is the golden standard nowadays, placed in the minimally invasive and non aggressive safe subfascial pocket, the technique of choice to prevent complications and bad results. This is feasible even with somehow large implants like in this case which the patient sought an important size increase for her new boobs.

The main challenge in these skinny patients with such high grade of breast hypoplasia and slim body frame is achieving naturalness and prevent fake looks, rippling, visible kinks and any deformity due to the cutaneous transparency; this was accomplished with modern anatomical shaped implants filled with cohesive gel, which is the golden standard nowadays, placed in the minimally invasive and non aggressive safe subfascial pocket, the technique of choice to prevent complications and bad results.

This is feasible even with large implants like in this case in which the patient expressly sought a relatively large size for her new breasts, in spite of which an absolutely natural look can be achieved by means of using ;UPDATEd and modern anatomical implants.

Note how the anatomical implants are providing the fullness and naturalness wished by any woman at the upper and medial regions of the cleavage; this universal advantage acquires an extraordinary importance the lesser the cover is, the smaller the breast and the skinnier the patient is; cases like this patient who would be managed with round implants would doubtlessly end in a fake ball look and insufficient fullness of the upper pole.

Note the remarkable cleavage and narrow separation, unfeasible using submuscular plane placement of the breast implants; only the subfascial plane allows the construction of such beautiful chest.

Being the areolas so small and the implants large it was deemed unavoidable practicing an inframammary crease incision to perform the augmentation mammoplasty, which lead to an awesome outcome in terms of beauty, naturalness and compliance with patient's wishes; it is remarkable how the submammary incision is never made at the original or naturally born submammary crease but at the new one that has to be preoperatively marked, foreseen and mentally constructed by the surgeon, so that the scar ends concealed within the new submammary crease, which is always lower than the original one.