Before & After Gallery
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Before & After Gallery - Breast implant revision surgery


  Breast implant exchange

Patient 1.   Conditions: severe capsular contracture, implants in too high positions, sensitive-painful breasts, submammary scars in wrong positions, nipples less sensible and looking down, glandular tissues are thin as a sheet of paper.  Previous history: breast augmentations performed by other surgeons with 15 years difference, 1 year ago for the last time, with multiple inflammatory complications; MRI showing damaged implants.
       
Implants: Before exchange: modest quality, not identifiable by serial numbers, different in profile and diameter, Eurosilicone, 220 ml. After exchange: Mentor, textured, cohesive silicone gel-filled, moderate profile, 350 ml right and 300 ml left. Pocket: partially submuscular, only the upper ¼ of the implants are covered by muscle. Procedure: removal of the implants using the previous submammary scars, thorough cleaning, release of the capsule, re-augmentation, later additional transplantation of the patient's own fat for contour correction. Cup: preop C, postop D. Age: 44. Children: 0. Postop photos are 5 months old.   





Patient 2.   Conditions: breasts asymmetric in size (the left one is bigger) and a little far from each other, minimal drooping, nipples-areolas looking distinctly outwards, Grade II. capsular contracture left.  Previous history: augmentation 10 years before by another surgeon through an axillary approach, but not with the endoscopic control, only "blindly".  8 years earlier we had already offered a correction because of the complications, but the patient waited 8 years when also an MRI examination proved the serious damage of the left implant penetrating through the capsule with the spreading of the silicone gel.
       
The seriously damaged left implant and the silicone gel spreaded among the tissues on the photo above, with a piece of the partially removed capsule sticking to the surface of the implant.
Implants: Before exchange: modest quality, Brazilian, Silimed, textured, 255 ml. After exchange: Mentor, textured, cohesive silicone gel-filled, moderate plus profile, 325 ml. Pocket: partially submuscular. Procedure: exclusively transaxillary, endoscopic. Implant removal, thorough cleaning, capsule release, re-augmentation. Cup: preop and postop C. Age: 30. Children: 0. Postop photos are 3 months old.





Patient 3.   Conditions: average thickness of pectoral muscles and fatty tissue, loose connective tissue, nipples-areolas looking down, Grade I. drooping, symmetric breasts, not more than Grade I. capsular contracture.  Previous history: 10 years earlier submammary breast augmentation performed by us, the patient didn't come for check-ups for 8 years, while 4 years before she suffered a car accident with frontal collision, we found ruptured implants on both sides at the implant exchange.
       
Implants: Before exchange: Mentor, textured, cohesive silicone gel-filled, moderate profile, 275 ml. After exchange: identical type, 350 ml. Pocket: partially submuscular. Procedure: submammary approach, removal of both damaged implants, capsule correction, thorough cleaning, re-augmentation, simultaneous correction-elevation of both areolas. Cup:  preop and postop also C. Age: 55. Children and breast feedings. Postop photos are 9 months old.






Correction of implant position and capsular contracture


Patient 4.   Conditions: asymmetric chest, severe capsular contracture (Grade III-IV.), asymmetric and malpositioned implants, therefore nipples-areolas looking into different directions, sterile inflammatory process around the released pectoral muscles between the two breasts.  Previous history: 2 years earlier endoscopic transaxillary breast augmentation by us, the patient had been wearing an unsuitable bra inproperly directly after the operation, started competiton sport too early despite prohibition, resulting in implant malposition, capsular contracture and inflammatory process provoked by irritation.
         
Implants: Mentor, textured, cohesive silicone gel-filled, moderate plus profile, 300 ml, which could be replaced in the course of the surgery. Pocket: partially submuscular. Procedure: through the previous axillary scars a totally endoscopic operation.  Thorough cleaning, multiple capsule correction (release and suture), correction of the malposition, re-augmentation placing back the original implants. This case demonstrates well what can be corrected through the axillary approach with endoscopic technique. Cup:  preop and postop also C. Age: 26. Children: 0. Postop photos are 4 months old.





Patient 5.   Conditions: average conditions, originally a small asymmetry in the fullness of the inner parts, minimal drooping, small difference in the height of the areolas (preop, 1st row). After a car accident, on the side of the injury the right implant moved and is remarkably lower, the left implant is higher, but this is its natural position since this happened close after the operation (after first op., 2nd row).  Previous history: photos 3 months after our endoscopic transaxillary breast augmentation (2nd row), the patient suffered a car accident 1 month after the operation resulting in bleeding and hematoma.
         
Implants: Mentor, textured, cohesive silicone gel-filled, moderate plus profile, 350 ml, which was intact and could be replaced in the course of the surgery. Pocket: partially submuscular. Procedure: totally endoscopic thorugh the previous axillary scar on the right side. Multiple capsular correction (release and suture in the lower portion) to fix the abnormal position, re-augmentation with the replacement of the implant. Cup:  preop A, postop C. Age: 28. Child and breast feeding. Postop photos are 4 months old.





Patient 6.   Conditions: average thickness of pectoral muscles, thin fatty tissue, broad and asymmetric breast bone, breasts slightly asymmetric, nipples-areolas looking outwards preop.  Previous history: photos 3 months after our endoscopic transaxillary breast augmentation (2nd row), the patient hadn't been wearing the bra and the band regularly right after the procedure, stuffed the bra full with gauze dressing, removed the taping of the skin which secures the implant position - resulting in an early malposition, downwards on the left and upwards on the right side.
       
Implant: Mentor, textured, cohesive silicone gel-filled, moderate plus profile, 350 ml, which could be retained.
Pocket: partially submuscular.
Procedure: through the original axillary scars on both sides, totally endoscopic. Multiple capsular correction to fix the malpositon without removing the implants.
Cup:  preop A, postop C
Age: 28
Children: 0
Postop photos are
4 months old.
 





Patient 7.   Conditions: slightly asymmetric breasts, the left nipple looking outwards, remarkably asymmetric bony chest wall with a bump on the lower ribs left.  Previous history: photos 3 months after our endoscopic transaxillary breast augmentation (2nd row), about 1 month after the operation the left implant slided up with 1.5 cm due to the asymmetric pectoral muscle and the concave chest wall, which had to be corrected by an additional operation.
       
Implant: Mentor, textured, cohesive silicone gel-filled, moderate profile, 275 ml left, 300 ml right
Pocket: partially submuscular
Procedure: through the original axillary scar on the left, totally endoscopic. Multiple capsule correction to fix the malposition without implant removal.
The implant could be kept during the correction.
Cup:  preop A, postop C
Age:24
Children: 0
Postop photos are
5 months old.






Breast implant exchange and simultaneous correction of mastopexy


Patient 8.   Anatomy, previous history: breast augmentation performed in another plastic surgery several years before, with undersized, saline filled subglandular implants from periareolar incisions. The implants were asymmetrically leaking and the breasts drooping.  Patient's wish: bulging moderately on the top, a full breast shape with breasts closer to each other.  Procedure: from the previous periareolar scars, removing the defective implants, re-augmentation and mastopexy.
       
Implants: Mentor, textured, cohesive gel filled, round, high profile,
325 ml.
Pocket: partially submuscular
Cup: preop B,
postop C
Age: 47
Children: 0
Postop photos are
5 months old.





Patient 9.   Anatomy, previous history: in another plastic surgery clinic, for the correction of the drooping breasts, an augmentation was performed with undersized (200 ml), saline filled subglandular implants from submammary incisions. Pectoral muscles are stronger than the average, drooping breasts somewhat distant from each other, areolas looking downwards, palpable capsular contracture.  Patient's wish: breasts bulging moderately on the top, closer to each other, correction of the drooping.  Procedure: from periareolar incisions, removal the saline filled implants and partially also the capsule, re-augmentation with the new implants placed partially under the pectoral muscle, periareolar mastopexy.
       
Implants: Mentor, textured, cohesive gel filled, round, moderate profile, 350 ml.
Pocket: partially submuscular
Cup: preop C, postop D
Age: 29
Children: 0.
Postop photos are
6 months old.





Patient 10.   Anatomy, previous history: average thickness of fatty tissue, loose connective tissue, drooping breasts after breast feeding. Years before, in another plastic surgery clinic, with the intention to correct the drooping breasts, through periareolar incisions, an augmentation was performed using subglandular PIP implants and an only "skin reduction mastopexy" without the real elevation of the glandular tissue.  Patient's wish: correction of the drooping, unnatural looking breasts, a fuller breast shape on the top and also on the inside.
         
Procedure: due to the extent of drooping, with periareolar + vertical incisions, removal of the PIP implants, with new implants matching the dimensions of the chest and the patient's expectation better a re-augmentation, placing the implants partially under the pectoral muscle, and a mastopexy elevating the gland above the muscle and fixing it to the muscle fascia.  Implants: Mentor, Siltex, cohesive I. gel filled, round, moderate plus profile, 350 ml.  Cup: preop C, postop C.  Age: 31.  Child and breast feeding before.  Postop photos are 6 months old.





Patient 11.   Anatomy, previous history: average thickness of fatty tissue, loose connective tissue. Years before, in another plastic surgery clinic, with the intention to correct the drooping breasts, first with periareolar + vertical incisions a mastopexy was performed, later on in a second operation, through submammary incisions an augmentation was performed using subglandular Mentor 225 ml implants. These implants were undersized in relation to chest anatomy, the subglandular placement increased the drooping. The volume of the breasts was slightly asymmetric.  Patient's wish: correction of the drooping, unnatural looking breasts, a fuller breast shape on the top, on the inside and also on the sides.
         
Procedures: OP 1. removal of the implants, due to the inflammatory process around them a re-augmentation this time was not possible. OP 2. because of the extent of the drooping and the volume difference between the glandular tissues, after the excision of the previous periareolar + vertical scars, a re-augmentation with postoperatively adjustable size expander implants placed partially under the muscle, and a mastopexy elevating the glandular tissue above the muscle and fixing it to the fascia. After this, in several sessions within 3 months, these implants were filled through the remote injection domes placed under the skin of the armpits, we reached the final volumes and a symmetric result, and the remote domes were removed in a 3rd operation. Implants: Mentor, Becker 50, round base, postoperatively adjustable size, double chamber expander implants with 300 ml total volume.  Cup: preop B, postop D.  Age: 21.  Children: 0. Postop photos are 1 year old.






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