Breast Implant Procedures
Advanced Art of Cosmetic Surgery Thomas M. DeWire, Sr., MD, FACS Specializing in Cosmetic Plastic Surgery Richmond, Virginia, USA
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Breast Implant Procedures |
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| Breast Augmentation Revision Surgery | |
| Visible Breast Implant Rippling |
| Visible Breast Implant Rippling | ||
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Visible implant wrinkling is a problem more often seen in women with thin skin and insufficient soft tissue coverage, and especially with textured implants, or implants placed over the muscle. The problem occurs in two main types: Shell Wrinkling seen at the outer and lower edges of the breasts, may be seen with any implant, but more often with implants over the muscle; and Traction Wrinkling, seen when the textured implant shell actually grabs the scar tissue surrounding the implant, and pulls the overlying skin and tissues inward. Traction wrinkling can actually pull the soft tissues away from the midline, causing less apparent cleavage, especially with heavily textured implants. |
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| Case 1: 42 year old with two year history of subglandular augmentation with McGhan style 468 textured anatomical implants is seen for correction of marked wrinkling, capsule contractures and abnormal shape and feel of the result. Note how the heavy texture of the implants actually pulls the tissues away from the midline cleavage over the sternum. |  |
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Near photos at left show the results of the revision with transfer of new smooth round Mentor saline implants to sub-muscular pockets and release of the old internal subglandular scar capsule contractures. Photo results are at 3 days, and thus show mild bruising. Approach was via mammary fold incisions to minimize disruption of the little breast tissue that was present. Note the marked improvement in the cleavage area by placing the implants submuscular with filling-out of the soft tissues adjacent to the breastbone, creating a greatly enhanced cleavage, and relieving the marked wrinkling and rippling. Also, note the breast shape is now much more natural at the implant margins. |
| The oblique near photo shows significant Traction Wrinkling of the upper pole of the right breast (left side of photo). This has been relieved by smooth implants in a submuscular placement, also allowing for much more natural slope to the breasts, and hiding of the implant edges, which were very visible in the pre-op state. |  |
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Note the odd shape of the left breast seen on the right in the far photo. This is due to a marked capsule contracture with the scant breast tissues hanging off of the very firm and scarred implant mound. Correction was effected by placing the new implants in oversized and sub-muscular pockets & post-op massage. | |
| Age:
37 Ht: 5'10" Wt: 135 lbs. Original Implants: McGhan 468 textured anatomical Volume: 495cc filled to 550cc Size: 36C-D New Implants: Mentor Smooth round saline Volume: 700cc filled to 775cc Size: 36D-DD |
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Note the very circumscribed appearance of the implants over the muscle in the far photo, and the much softer and natural appearance in the near photo. Again note the improved shape of the cleavage, as the texturing is no longer able to pull the soft tissues and skin away from the sternal cleavage area. |
| Link to larger versions of the above photos | |||
| Case 1 Problems | Analysis of Cause | Correction |
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Visible Implant Wrinkles |
Saline-filled implants are inherently more prone to rippling than silicone gel implants as a result of the physical interface between the liquid filler and the elastic silicone polymer shell . Attempts to markedly overfill the shells leads to less wrinkling, but cannot completely prevent it, and further lead to marked implant firmness. Heavy textured surface implants tend to cause traction rippling, and may ripple at the sides, as well. Further, the heavily textured implants are all very firm, and their tendency to form densely adherent scars worsens this abnormal firmness, since the scars are non-stretchable, and themselves are quite firm as well. Placement of the implants over the muscle is also much more likely to lead to visible implant wrinkling, especially in thin individuals, as there is little natural soft tissue present to hide the saline breast implants, and their tendency to show visible ripples. | Remove rippled textured implants and their surrounding sub-glandular scar capsules. Replace with sub-muscular smooth saline or silicone gel implants, my preference being for silicone gel, as it rarely ripples, except in the case of very large implants in a very thin patient. Maintain oversized vertical pockets to allow for normal appearing breast implant movement, and to prevent formation of internal constricting scars that can make the implants seem as if firm. Also, constricting capsule scar, while not as firm as a capsule contracture, will seem as firm as capsule contractures if pressure is placed on the implants, and this type of scar can also cause internal folding and knuckling of the implant shells, leading to early failure. |
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Prevention |
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Avoid over muscle implant placement
2) Avoid use of textured saline implants which are much firmer, and tend to marked rippling in thin patients, especially when placed over the muscle. 3) Avoid use of very large saline implants in patients with thin skin coverage. 4) Use vertically oversized pockets to prevent implant distortion and rippling. 5 Consider use of Silicone Gel Implants |
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Abnormal Breast Shape and Feel |
Analysis of Cause |
Correction |
| Allowing formation of constricting peri-implant scars will cause the implants to feel, and often appear unnatural in shape. Textured implants increase this tendency to formation of an intimate scar surrounding the implants, and thus the feel of unnatural firmness. | Maintain
oversized vertical pockets to allow normal appearing breast
implant
movement, and to prevent internal constricting scars that can make the
implant seem as if firm. Also, constricting capsule scar, while not
as firm as a capsule contracture, will seem as firm
as capsule
contractures if pressure is placed on the implants, and this
type of scar
can also cause internal folding and knuckling
of the implant shells, leading to early
failure.
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| See correction of Breast Shape Problems--under construction |
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| ©Copyright 1997-2013 Advanced Art of Cosmetic Surgery: Thomas M. DeWire, Sr, MD, FACS Revised: January 23, 2013 12:29 AM |
