•Breast revision •30 years old white female •Previous augment and periareolar mastopexy •Switched to 550cc moderate plus smooth silicone with capsulotomy and vertical mastopexy

This is a 30 year old healthy white female. Her only previous surgery was a breast augmentation preformed nine years ago. She is 5’6” and 150lbs and she has not had any children. Her bra size was a 34B-C and she had 350cc implants placed subpectorally at the time of her augmentation. Upon examination to appears that she probably had a tubular component when the surgery was first performed. Postoperatively she was never completely happy. The breasts still had some residual ptosis, the nipple areola were pointy and she felt that she did not have enough volume, particularly in the lower pole. IN order to improve her appearance, having initially done a phone consultation she underwent a re-do augmentation with capsulotomy, particularly in the inferior portion where it was done in a spoke wheel fashion to allow lower pole expansion. Her implants were replaced with 500cc high profile smooth silicone followed by a periareolar mastopexy to elevate and flatted the nipple areola. Her postop recovery was uneventful. She was seen back at two weeks at which point the sutures were trimmed. Examination showed a nice correction of the tuberous appearance. Her breasts are round and full with a nicely elevated areola and no residual pointiness. She is quite pleased with her surgical outcome even at two weeks time. She knows that this will continue to improve over time.

This is a 26 year old white female who 7 years ago underwent bilateral sub pectoral augmentation with saline implants. Approximately 4 years later she started developing bottoming out on the right side and a mild capsule on the left. She is 5 feet, 6 inches tall, 125 pounds and her bra sized is a 32C. Her desire was to correct the asymmetry with the bottoming out and increase her bra size. In order to achieve these results, she would require a right internal capsulorrhaphy and on the left side a capsulotomy with change of her implants. She underwent revision with the right internal capsulorrhaphy and bilateral, superior capsulotomies. Her 370 cc saline implant was replaced with 500 cc moderate plus smooth silicone. Her post-operative course was unremarkable and because of her previous surgery, she only had a mild degree of pain. Photos obtained at 2 months which show that she has achieved her desired results. Both breasts are full and symmetric. There is no further separation between the two and the internal capsulorrhaphy or internal bra has been completely successful. There is further bottoming out and the nipple/areolas are now at the same height. She is back to normal activities and is pleased with her results.

This is a 48 year old white female. She is 5’7” and 138lbs. In 2008 she underwent a bilateral subglandular augmentation with implants in the 200cc range. She unfortunately developed a capsule on the left side and underwent a left open capsulotomy in 2010 by her surgeon. At about the same time she also developed a capsule on the right which was not treated. Upon examination in my office she had bilateral Bakers Class III capsules. The breasts were quite firm, tender and she had glandular ptosis. Her bra size was a 34C. We discussed options which would include bilateral complete capsulectomies, removal of the implants, which were silicone and placing new implants in a submuscular position. Her desire was to be slightly larger. Having weighed her options she decided to proceed and underwent bilateral capsulectomies with a change of implants to the subpectoral position. She was re-augmented with 300cc moderate plus smooth silicone prosthesis and because of the slight excess tissue on the left; a left periareolar mastopexy was also performed. Her postoperative course was uneventful and three months postoperatively she has shown no signs of re-encapsulation. The breasts are soft and nicely positioned without the abnormal high sitting tight encapsulated breasts that one sees in a subglandular augmentation. The incisions are healing nicely and she is ecstatic with her new natural appearing breasts.

This is a 42 year old healthy white female who is a body builder. She is 5’9” and 158lbs, which is herstable weight. She works out frequently and underwent breast augmentation three years ago. The augmentation was in the subglandular position utilizing 450cc smooth silicone implants. Examination showed the classic melon appearance with the breasts sitting low on the chest. She also had a bakers class II capsule. Her desire was to create a more natural appearing breast, but at the same time maintaining her body building activities. In order to achieve her desired result she underwent an exchange of implants which were then placed in the subpectoral position utilizing a 490cc moderate profile smooth silicone, because of her wide base with. At the same time she underwent a vertical mastopexy for the redundant tissue. Her postoperative course was completely unremarkable. Photos obtained at two months show that she is healing nicely. The breasts are tight, more natural in appearance and now sitting in an appropriate position on her chest. The melon appearance has been removed and she now has natural appearing cleavage. She can now go braless and will gradually resume her activities as the gym.

This is a 35 year old white female. She is 5’2” and 125lbs. She has not had any children. She works out frequently and is a non-smoker. She had subpectoral implants placed thirteen years previously through a periareolar incision. On the left side she had a periareolar lift. The textured saline implants had become firmer over the years and her desire was to be larger and at the same time revise the appearance of her areola. Her previous implants were 300cc that had been over filled to 330cc and her desire was to go up at least one cup size. In order to achieve her desired result using a periareolar approach she underwent a superior capsulotomy, replacement of her implants with 500cc moderate plus smooth silicone and a re-do periareolar mastopexy. Her postop healing was unremarkable and three months later she is well healed. The breasts have a more natural shape and at the same time achieved that larger size. The areola are now better positioned and sized. She is quite happy and is back doing all of her normal activities.

This set of before and after photos features a 30 year old white female (5’ 4” ; 135 lbs) who 7 years ago underwent subpectoral breast augmentation utilizing 275cc saline implants. Unfortunately, both breasts developed "double bubble deformity" shortly after surgery (with the left breast being worse off than the right) as a result of her surgeon using a standard submuscular approach despite the fact that her breasts were slightly tuberous in nature and thus required 1.) release of the lower pole and 2.) a dual-plane augmentation. She also wished to correct the difference in size that was present between the 2 breasts. In summation, her goals for surgery were to increase the size and symmetry of both breasts, remove/correct the double bubble and reposition the implants to their proper position (in order to achieve a more naturally shaped, tear-drop appearance). To achieve these ends, she underwent bilateral inferior capsulorrhaphies (aka "internal bra") to remove the double bubble in both breasts, release of the superior pocket through a superior capsulotomy and replacement of original implants with 425cc Moderate Plus Smooth Saline implants that were filled to 450cc on the right and 490cc on the left. Her postoperative course was unremarkable (re: complication free) and photos taken 3 months after surgery show beautiful, naturally shaped breasts with properly positioned implants. She no longer has to rely on her bra to create cleavage and the implants no longer slip from under her bra or bathing suit top. She is very pleased with her result and so am I.

This is a 33 year old white female 5’ 1” 115 lbs and very fit. She had two augmentations 10 years ago. The first was subglandular with saline which resulted in significated rippling. She was then switched to a combination of silicone and saline implant which developed a bakers class 2 capsule on both sides resulting in the round typical melon like appearance with some drooping. In order to correct her situation she would require removal of her old implants and replacement in a sub muscular position. At the same time she would require vertical mastopexy to remove the excess skin and reposition the nipple areola in the appropriate position on the breast. Her desire was to be in the D cup range. She underwent the procedure with a 475 cc moderate plus smooth silicone prosthesis was used. Her postoperative course was unremarkable and after several months the implant have settled into an excellent position creating a natural breast mound with proper position of the nipple areola complex. She had no further problems with capsular contracture and photos taken a year later demonstrate well healed scars and a very natural and attractive breast.

This set of breast augmentation before and after photos features a 41 year old white female in good health (5'1", 110 lbs) whose bra size was a 32 C at time of consult. Ten years ago she had subglandular breast augmentation done in Orlando Florida (275cc saline implant overfilled to 300cc). She had one child after the subglandular augmentation and did try to breastfeed. Unfortunately she developed a painful firm capsule on the right side resulting in an abnormal appearance. She also had that melon like appearance that can develop overtime with a subglandular augmentation. An attempted secondary procedure failed to correct the Baker Xlass 3 capsule. In order to correct this, I performed a complete capsulectomy on the right breast (since the capsule itself was quite calsific) and a partial capsulectomy on the left. I then placed 300cc Moderate Plus smooth silicone implants in a sub pectoral position through periareolar approach. She had a uneventful postoperative course with normal healing and photos taken 3 months later she show no evidence of capsule re-formation. The breast are soft, natural in appearance, not distorted, and no longer painful. The patient is pleased with her result and so am I.

This set of breast augmentation before and after photos features a 53 year old white female who underwent sub-glandular breast augmentation approximately 30 years ago in Massachusetts. She did reasonably well for many years but gradually developed a firm Baker Class 3 capsule on the right side and slightly less capsule on the left. This resulted in distortion and pain in both breasts. Mammography confirmed bilateral rupture of the implants. In order to correct this significant problem I performed a bilateral complete capsulectomy, removed the ruptured material from the subglandular position and inserted new, 375cc implants into the subpectoral plane. Postoperately, the patient has recovered beautifully. She was back doing most activities within two weeks. Photos taken 3 months after surgery show breast that are soft with no distortion. She is pain free and both breasts have a well proportioned, perfectly shaped and completely natural appearance.

This set of breast augmentation before and after photos features a 36 year old woman (5'8", 140 lbs) from Albany NY who had undergone breast augmentation by another plastic surgeon in a neighboring state utilizing a trans-umbilical approach ("tuba" or 'through the belly button'). Unfortunately, the right implant was placed too high which produced an unsatisfactory look. She also presented with a moderate capsule contractor which required correcting as well. To add a bit more complexity to the case, the patient also requested to be significantly larger - a full D cup bra size. I addressed all of these issues by performing a bilateral capsule release - more so on the right than left - and replaced her prothesis with 600cc moderate profile smooth silicone implants. Photos taken 3 months later show that her breasts have revised to a much more appealing symmetry and enlarged to her desired 38 D bra size. They are soft, perky and provide plenty of upper pole fullness. Most importantly, the patient is much much happier and confident as a result of her breast revision surgery.

This set of breast augmentation revision before and after photos features a 21 year old young woman (5'3", 122 lbs) from Massachusetts who 3 years ago underwent bilateral subpectoral augmentation with 350cc tear drop (anatomic) saline implants. This unfortunately left her with a severe double bubble deformity and loss of her inframammary fold position. The majority of each implant became situated below the nipple areolar complex - with the right breast implant being slightly lower than the left. This occurred because the inframammary fold was improperly disrupted during her original augmentation. This very difficult problem was corrected with bilateral internal capsulorrhaphy, which recreated the inframammary fold and closed the lower pole of the previously created breast pocket. Her saline breast implants were replaced with 500cc Moderate Plus Smooth Silicone Gel breast implants since she wished to be a full C Cup bra size post surgery. Photos taken 6 weeks after surgery show that the breasts are looking and healing wonderfully. They appear and feel as breast should. The prosthesis are ideally positioned and the nipple to inframammary fold distance has been reconstructed to an appropriate length (namely, 6-7cm). Suffice to say, the patient no longer feels self conscious about her breasts. Instead, she feels ecstatic about finally having the breasts she always wanted.