Dr. Alejandro Nogueira's Case #KK6X7DIJ

Additionally the implants were placed too high, eccentric from the nipple areola complex, their base width was chosen too narrow without any anatomical criterion according to patient's ribcage dimensions, and they were of round profile which is not the best choice in general breast augmentation but much less or even unwise in skinny patients; all the former lead to a coconut or fake balls look, extremely wide cleavage separation and bottom level outcome.

Finally the patient suffered a moderate to severe grade of breast droopiness and this issue was, very specifically, one of the main goals why she was seeking surgery; therefore a breast lift mastopexy was planned and applied with Wise, inverted T or anchor pattern and superior pedicle.

Revision mammoplasties are of very high difficulty in skinny patients with ruptured or aged implants, because the cover is poor and sometimes unreliable, the vascularity scarce, the visibility of any tiny lack of prosthetic adjustment total, they lack support for plasties and other revision techniques and the mandatory capsulectomy or periprosthetic capsule removal is a very delicate maneuver due to having such thin mammary tissue supply above the implant.

This case was managed with a complete, meticulous and very delicate capsulectomy via areolar incision, like the previous surgery was done and as it is required in revisions and capsulectomies, during which all the calcifications were removed, the ruptured prosthesis explanted and their leaking silicone totally eliminated to obtain a healthy and fleshy bed of tissues to host the new implants.

Then the pockets for the implants were redefined, the inner cleavage and the inframammary creases mobilized and expanded to achieve good nipple areola complex centricity, and new implants were inserted in the ideal subfascial plane of placement.

The new implants were chosen state of the art highly cohesive gel filled, anatomical shaped and macrotextured at the shell, chosen with better suited dimensions, wide enough to the patient's frame, optimizing the lower pole and the cleavage, achieving an amazingly natural look and increasing the volume to a large size based on patient's wishes.

The mastopexy provided an optimal location for the nipple areola complex, suitable and nicely shaped breast mounds and perfect fit to the new implants.