Dr. Alejandro Nogueira's Case #UEJLM69D

To begin with, this was not at all an easy case of breast augmentation since the patient was severely hypoplastic with barely any breast tissue, very slim, actually could be considered of skinny frame; such cases require maximum technical precision because any suboptimal adjustment is going to be obvious and noticed as unsightly effects; unaware of this circumstance and or insufficiently skilled to face this patient's case challenges, the previous surgeon carried ahead a very poor surgical work.

The implants were placed in an eccentric location, riding too high and cross eyed; subsequently there is a derivate issue after achieving correct centricity of the breast implant beneath the nipple, since this centricity requires lowering the inframammary crease to a desired level compatible with perfect implant placement and lower pole fullness.

Other major deformity was the dynamic animation muscle flex deformity, due to the use of a submuscular or dual plane with insufficient release of the pectoralis muscle; such a basic mistake is unacceptable and can't be understood like any kind of muscular intolerance or individual idiosyncrasy, it is a well known issue and preventing it is also widely known, the pectoralis muscle needs extensive release not to lead to embracement or incarceration and dragging of the implant.

Additionally the implants were chosen with their base width 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.

Does anyone notice anything strange on the patient's right side breast, left side by observer's eye? Looks weird, doesn't it? Both breasts look botched but the patient's right side one has ridges and a very strange shape not compatible with the expectable spherical dome contour from round implants. That implant was placed flipped upside down by the previous surgeon; yes, as it sounds, that prosthesis was placed inverted and was another preoperatively detected issue to be fixed.

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 aged 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.

Note that in the subfascial plane it is physically, anatomically and literally impossible any kind of animation or muscle flex deformity.

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 an extra large size based on patient's wishes.