Dr. Alejandro Nogueira's Case #RXBAD4KD

The breasts also show a mild to moderate grade of breast droopiness, which was a subject of thorough preoperative discussion in order to take the most suite technical option balancing pros and cons for the patient.

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.

The patient also suffered a mild grade of tuberous breast deformity, mainly featured by a conical shape, slight areolar herniation and a significant raise of the inframammary crease level; this was treated with glandular plasties, a lower pole expansion with inframammary crease lowering and a periareolar skin resection to flatten the areolas in.

The case was managed 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.

The breast droopiness remains intact, neither worse nor better than preoperatively, since no breast lift was wished by the patient; should she have wished a lift then a lollipop incision Lejour mastopexy would have been indicated and applied; anyhow this is an available option at any moment in the future.

It is remarkable how the cleft nipples as well as inverted nipples present in this patient did noticeably improve without any direct surgery on them but just due to the push out effect of the breast implants.