Neil J. Zemmel, MD, FACS
Megan J. Goff, PA-C
Rachel M. Duke, NP, CANS
Short Pump Office
11934 W Broad Street, Suite 200
Richmond, VA 23233
804-464-3801

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Breast Augmentation Revision

Back to Gallery!Breast Augmentation Revision Gallery

Patient 1

BeforeAfter*

Age: 47 years
Height: 5’ 4”
Weight: 127 pounds
Preop: 34 B
Postop: 34 C
Implant Size: 275 cc moderate plus silicone implants
Incision/Location: inframammary, submuscular pocket reassignment
Notes:  This patient underwent silicone breast augmentation in her early 20s and presented with bilateral ruptured silicone implants with extracapsular gel on the right side.  Her original surgery was performed via an inframammary incision (in the crease) on top of the muscle (subglandular).  Removal of both ruptured implants and removal of extracapsular gel was required.  The patient desired reaugmentation in order to maintain shape and volume.  She selected a 275 cc moderate plus profile implant.  Her new implants were placed beneath the muscle (pocket reassignment) to give a more natural look and to reduce the risk of recurrent capsular contracture.  Her previous inframammary incision was used.  Her shape and contour are much improved, and she has a natural contour.  Patient shown 5 months after surgery.

Patient 2

BeforeAfter*

Age: 44 years
Height: 5’ 4”
Weight: 110 pounds
Preop: 32 D/DD
Postop: 32 D/DD
Implant Size: 450 cc Left 475 cc Right smooth round high profile silicone implants
Incision/Location: Previous inframammary incision used, submuscular
Notes: This patent underwent previous breast augmentation elsewhere in 1999 with texture saline implants with a fill volume of 450 cc on both sides. She experienced deflation of the left implant and presented for revision. Both implants where replaced through the previous inframammary incision and placed in the submuscular (beneath the muscle) position. The upper portion of the breast pocket (superior capsulotomy) and inner portion (medial capsulotomy) were opened to shift the implant into a more favorable position. This gave a smoother upper pole contour and significantly narrowed the distance between both breasts. She has an overall much more pleasing breast contour. Patient shown 3 months after surgery.

Patient 3

BeforeAfter*

Age: 55 years
Height: 5’ 1”
Weight: 125 pounds
Preop: 36 C
Postop: 36 D
Implant Size:  400 cc smooth round moderate plus silicone
Incision/Location: inframammary, submuscular pocket reassignment
Notes:  This patient was found to have ruptured silicone implants by MRI which required explantation.  Her original implant were place over 30 years ago elsewhere.  The patient desired replacement with new silicone implants.  The original implants were placed in the subglandular position (on top of the pectoralis muscle).  A pocket reassignment to the submuscular position was performed (the implant was placed under the muscle).  The previous subglandular pocket was closed with sutures.  The overall breast is more natural, more symemetric, and portional to her body shape. This patient is shown shown 6 months after surgery.

Patient 4

BeforeAfter*

Age: 29 years
Height: 5’ 5”
Weight: 112 pounds
Preop: 32 D/DD
Postop: 32 D
Implant Size: 450 cc smooth round moderate plus profile saline
Incision/Location: Periareolar, submuscular
Notes: This patient underwent bilateral breast augmentation in 2005 elsewhere with a texture anatomic silicone implant. Her implants were placed under the muscle (submuscular) via an inframammary (crease) incision. She presented with severe distortion of both implants, rippling, and bottoming out. She sought revision to improve the overall shape. Revision of both breasts was performed with reopening the upper portion of the pocket (capsulotomy), raising the crease approximately 3.5 cm per side (capsulorraphy), and closing down the outer portion of the right and left pockets (capsulorraphy). Aceullar dermal matrix reinforcement (Alloderm) of the lower part of the breast was also performed to thicken the soft tissue covering of the implant and to stabilze the crease. This gave a much improved contour, raising the breast and producing a rounder portional shape. The patient elected to place a saline-filled implant. Patient shown 6 months after surgery.

Patient 5

BeforeAfter*

Age: 40 years
Height: 5’ 6”
Weight: 150 pounds
Preop: 34 D
Postop: 34 DD
Implant Size: 475 cc moderate plus silicone implants
Incision/Location: inframammary, submuscular placement
Notes: This patient underwent previous breast augmentation with saline implants elsewhere. She presented with a right saline implant deflation requiring replacement. She also desired a fuller cup size but wished to maintain a natural, full tear drop shape. Bilateral implant replacement was performed with 475 cc smooth round moderate profile gel implants. The new implants were placed in the submuscular position via her previous inframammary incision. She has a fuller more proportional shape, and is shown 4 months after surgery.

Patient 6

BeforeAfter*

Age: 62 years
Height: 5’ 2”
Weight: 165 pounds
Preop: 36 C
Postop: 36 C
Implant Size: 350 cc moderate plus silicone implants
Incision/Location: full mastopexy, submuscular pocket reassignment
Notes:  This patient was found to have ruptured silicone implants by MRI which required explantation.  Her original implants were place over 25 years ago elsewhere.  The patient desired replacement with new silicone implants.  The original implants were placed in the subglandular position (on top of the pectoralis muscle).  A pocket reassignment to the submuscular position was performed (the implant was placed under the muscle).  The previous subglandular pocket was closed with sutures.  A full breast lift was performed to improve overall shape and to position the nipple higher in a more pleasing position.  This patient is shown shown 4 months after surgery.

Patient 7

BeforeAfter*

Age: 46
Height: 5' 4"
Weight: 140
Preop: 34 C
Postop: 34 C
Implant Size: 400cc high profile smooth round saline
Incision/Location: Submuscular, periareolar
Notes: Patient experienced deflation of 15 year old left saline breast implant performed elsewhere. Reexploration, open capsulotomies and pocket revision performed on both sides with implant replacement. Patient shown 3 months after surgery.

Patient 8

BeforeAfter*

Age: 38
Height: 5’ 5”
Weight: 145
Preop: 34 B
Postop: 34 D
Implant Size: 300cc moderate profile smooth round silicone
Incision/Location: submuscular, full mastopexy
Notes: Patient underwent breast augmentation with full lift, abdominoplasty, liposuction of the flanks and hips. Patient shown 4 months after surgery

Patient 9

BeforeAfter*

Age: 48 years
Height: 5’ 4”
Weight: 110 pounds
Preop: 34 B
Postop: 34 C
Implant Size: 335 cc right 325 left smooth round moderate plus profile saline
Incision/Location: Periareolar, submuscular pocket reassignment
Notes: This patient underwent bilateral breast augmentation with saline implants in 1997 elsewhere and presented with rupture of both implants. Her original surgery was performed via an incision in the crease of the breast (inframammary), and on top of the muscle (subglandular). Bilateral breast implant exchange was performed. Submuscular placement (pocket reassignment) was performed to reduce the risk of capsular contracture and to provide a more stable soft tissue cover for both implants. The previous pocket was closed with sutures. The patient elected to have a saline implant placed. She now has significantly improved volume and shape, and a natural contour. She is shown 6 months after surgery.

Patient 10

BeforeAfter*

Age: 39
Height: 5’ 6”
Weight: 130
Preop: 36 C
Postop: 36 D
Implant Size: 400cc moderate plus smooth round silicone
Incision/Location: Submuscular, periareolar
Notes: Patient experienced traction rippling and lateral displacement of 10 year old 300 cc saline implants performed elsewhere. Reexploration, open capsulotomies, lateral capsulorrhapies to medialize the implants and reaugmentation performed. Patient shown 4 months after surgery. Patient also underwent simultaneous liposuction of the abdominal wall and flanks.

Patient 11

BeforeAfter*

Age: 35 years
Height: 5’ 1”
Weight: 110 pounds
Preop: 32 C
Postop: 32 full C
Implant Size: 350 cc smooth round moderate plus profile silicone
Incision/Location: Periareolar, submuscular; Periareolar lift also performed
Notes: This patient underwent bilateral breast augmentation in 2004 elsewhere with saline implants. Her implants were placed under the muscle (submuscular) via an transaxillary (underarm) incision. She presented with sagging, areola enlargement and asymmetry after having two children. She desired lift, areola reduction, an increase in size, and an overall rejuvenation of shape.

Bilateral implant exchange from saline to smooth round, moderate plus profile silicone implants was performed via a periareolar approach. The upper portion of the pocket was reopened to increase her upper breast fullness. The inner portion of the breast pocket was opened to improve the contour of her cleavage. A periareolar lift (Benelli lift)was finally performed to lift and tight the breast skin and reduce the areola diameter. These maneuvers gave a much improved shape, better symmetry, and a more natural feel. Patient is shown 5 months after surgery.

Patient 12

BeforeAfter*

Age: 55 years
Height: 5’ 4”
Weight: 160 pounds
Preop: 36 C/D
Postop: 34 DD
Implant Size: 550 cc right 560 left smooth round moderate plus profile saline
Incision/Location: Inframammary, submuscular
Notes: This patient underwent previous bilateral breast augmentation with saline implants in 2005 elsewhere and presented with rupture of the left implant. Her previous surgery was performed via an incision in the crease of the breast (inframammary), and under the muscle (submuscular). Bilateral breast implant exchange was performed with superior and medial capsulotomies. The upper and inner portion of the both breast pockets were reopened to improve contour. This gave additional fullness to the upper portion of the breast and improved cleavage. The patient elected to have a saline implant placed but desired additional volume. She now has greatly improved volume and shape, and a natural contour. She is shown 6 months after surgery.

Patient 13

BeforeAfter*

Age: 36 years
Height: 5’ 11”
Weight: 169 pounds
Preop: 36 D
Postop: 36 D/DD

Implant Size: 500 cc Left 550 cc Right smooth round moderate plus profile silicone implants
Incision/Location: Previous periareolar incision used, submuscular
Notes: This patent underwent previous breast augmentation elsewhere in 1999 with saline implants with a fill volme of 450 cc. She developed capsular contracture and severe shape distortion on the left side and underwent multiple revisions elsewhere without success. She presented to Richmond Aesthetic Surgery and Dr. Zemmel for additional revision.

The operative plan consisted of implant exchange to a larger silicone implant. Both implants where replaced through the previous periareolar incision. Complete capsulectomy was performed on the left side, including lower pole radial scoring to improve the roundness of the lower pole. The left inframammary fold was raised 2 cm with a double layered capsulorraphy suture. The left implant was brought more medial (towards the center) with a lateral capsulorraphy suture. Aceullar dermal matrix (alloderm) was placed internally along the lower portion of the left breast to increase the soft tissue thickness and reduce the risk of repeat capsular contracture. A lateral capsulorraphy was performed on the right side to medialize this implant. Finally, a periareolar lift was performed on both sides to tighten the skin and reduce areolar diameter.

She is shown 4 months after surgery and has markedly improved shape and texture. Both breasts are soft with a natural feel, and without capsular contracture. This patient is extremely pleased with her result.

Patient 14

BeforeAfter*

Age: 48 years
Height: 5’ 4”
Weight: 130 pounds
Preop: 36 C
Postop: 36 C

Implant Size: 400 cc moderate plus silicone implants
Incision/Location: Inframammary
Notes: This patient underwent previous breast augmentation with saline implants through an inframammary incision elsewhere. She sustained a rupture of the left implant with complete deflation. She presented to Dr. Zemmel for replacement desiring a more natural feeling implant. Bilateral implant exchange to silicone implants and upper pole and medial pole capsulotomy was performed. She now has a more symmetric, natural look and is shown 4 months after surgery and is quite pleased with her result.

Patient 15

BeforeAfter*

Age: 66 years
Height: 5’ 5”
Weight: 145 pounds
Preop: 36 C
Postop: 36 C
Implant Size: Right 425 cc Left 450 cc smooth round moderate plus silicone
Incision/Location: inframammary, submuscular pocket reassignment

Notes: This patient underwent previous breast augmentation in 1974 at a major academic medical center with silicone implants placed on top of the muscle through an inframammary approach. She subsequently developed capsular contracture and received multiple closed capsulotomy procedures without success. In 2003 she underwent revision with removal of her original silicone implants and replacement with saline implants through her original incision placed in the subglandular position. This was performed by a separate surgeon elsewhere. She then experienced a saline rupture in 2012 and was revised again using a 350 cc moderate plus profile silicone implant placed in the subglandular position (over the muscle) through an inframammary approach.

She presented to Dr. Zemmel’s practice with severe distortion of both breasts, multiple contour irregularities, and asymmetry. Of note, the patient has a pacemaker located in the left upper chest.

Revision breast augmentation was performed. Bilateral implant exchange to a 425 cc (right) and 450 cc (left) was performed. Open capsulotomy of the upper and medial poles of the breast were performed to improve upper breast contour and cleavage. The lower portion of the breast was treated with aggressive radial scoring and capsulectomy. Her previous inframammary incision was used.

She is shown 6 months after surgery and is very pleased with her results. The overall breast is more natural, more symemetric, and portional to her frame. The scar and sever shape distortion of the breasts has been improved. Her breast implants are soft and mobile without capsular contrature.

Patient 16

BeforeAfter*

Age: 39 years
Height: 5’ 2”
Weight: 135 pounds
Preop: 34 C
Postop: 34 D
Implant Size: 350 cc moderate plus silicone implants
Incision/Location: periareolar, submuscular placement
Notes: This patient underwent previous breast augmentation with saline implants elsewhere in 2005. She presented to Dr. Zemmel with areolar enlargement and sagging of both breasts. She desired a smaller, rounded, less full result. She also requested areolar reduction, and wishes to have improved texture and feel of the implants. Bilateral implant replacement was performed with 350 cc smooth round moderate profile gel implants. The new implants were placed in the submuscular position and a full mastopexy (full lift) was performed. A mini-abdominoplasty (tummy tuck) was performed at the same time. She has a fuller more proportional shape, and is shown 4 months after surgery. She is pleased with her result.

Patient 17

BeforeAfter*

Age: 44 years
Height: 5’ 6”
Weight: 160 pounds
Preop: 36 D
Postop: 36 D/DD

Implant Size: 450 cc moderate plus silicone implants
Incision/Location: inframammary, submuscular pocket reassignment
Notes: This patient underwent silicone breast augmentation in 1991 elsewhere via an inframammary subglandular approach. In recent years she has noticed progressive hardening of both implants with the left worse than the right. She also has experienced severe shape distortion of the left implant with superior and lateral subluxation. She presented to Dr. Zemmel for implant replacement and improvement in shape and texture.

Bilateral implant exchange was performed through her previous inframammary incision. Both implants were found to be ruptured upon removal. Complete capsulectomy (removal of the old capsule) was performed. Pocket reassignment to the submuscular plane was performed using smooth round moderate plus profile 450 cc silicone implants. The patient desired a natural tear drop shape to the breast and wished to avoid any further incisions. She therefore declined a concurrent breast lift.

She is shown 4 months after surgery with a natural, symmetric result. Her breasts are soft, and her implants are mobile. She is very comfortable and pleased with her new look.

Patient 18

BeforeAfter*

Age: 44 years
Height: 5’ 4”
Weight: 160 pounds
Preop: 36 C/D
Postop: 36 C/D

Implant Size: 500 cc moderate plus silicone implants
Incision/Location: periareolar, submuscular
Notes: This patient underwent saline breast augmentation in 1998 elsewhere via an inframammary submuscular approach. In 2008 she then underwent reaugmentation with larger silicone implants. In 2014 she began to experience tightness of the right breast with distortion of shape. She presented to Dr. Zemmel and Richmond Aesthetic Surgery surgery for revision, implant replacement and improvement in shape and texture.

In surgery the right implant was found ruptured. The implant, implant material and capsule were completely removed. The upper and medial portions of the pocket were reopened. Anterior capsulectomy was also performed to improved roundness and projection. The left implant was found to be intact. This implant was removed and the upper and medial portions of the pocket were opened as on the right side to improve contour.

Both implants were replaced with 500cc smooth round moderate profile implants. Her contour, text, and volume are significantly improved. She is shown 4 months after surgery and is very pleased with her results.

Patient 19

BeforeAfter*

Age: 43 years
Height: 5’ 6”
Weight: 140 pounds
Preop: 36 D/DD
Postop: 36 D/DD

Implant Size: 425 cc Right 450 cc Left moderate plus silicone implants
Incision/Location: periareolar, submuscular, full mastopexy performed
Notes: This patient underwent saline breast augmentation in 1998 elsewhere via an inframammary submuscular approach. In 2013 she then underwent reaugmentation with a larger saline implant and a full mastopexy (breast lift). In She presented to Dr. Zemmel and Richmond Aesthetic Surgery surgery for revision, implant replacement and improvement in shape, texture, and symmetry. She desired a full, augmented look.

Bilateral implant exchange using smooth round moderate plus profile silicone implants was performed in conjuction with full mastopexy and scar revision. A substantial lower pole resection was performed. (A large amount of tissue was removed from the bottom part of the breast). This reduced the amount of sag on each side and increased upper breast fullness. The areolar diameters are now equal and her scars are less visible and are more hidden. She is shown 4 months after surgery and is pleased with her results.

Patient 20

BeforeAfter*

Age: 42 years
Height: 4’ 10”
Weight: 100 pounds
Preop: 34 B
Postop: 36 C
Implant Size: Right 360 cc Left 340 cc moderate plus profile saline implants
Incision/Location: Inframammary, submuscular
Notes: This patient underwent previous breast augmentation in with saline implants placed in the submuscular plane via an inframammary approach. She experienced rupture and deflation of the left implant. She presented to Dr. Zemmel and Richmond Aesthetic Surgery surgery approximately 8 months after deflation of the left implant and breast asymmetry. She also desired more fullness and improved shape from her original breast augmentation.

Bilateral implant exchange and pocket revision was performed. The implants were replaced with smooth round moderate plus profile saline implants. Fill volumes of 360 cc on the right and 340 cc on the left were used. The right breast pocket was revised to give more lower pole roundness and upper pole fullness. The left breast pocket was completely closed and was reopened creating an entirely new pocket. She is shown 5 months after surgery and is pleased with her results.

Patient 21

BeforeAfter*

Age: 40 years

Height: 5’ 9”

Weight: 135 pounds
Preop: 36 C
Postop: 36 full C
Implant Size: 475 cc moderate plus profile silicone implants
Incision/Location: Inframammary, submuscular
Notes: This patient underwent previous breast augmentation in 2003 with saline implants placed in the submuscular plane via an inframammary approach. She experienced rupture and deflation of the left implant in 2014. She presented to Dr. Zemmel and Richmond Aesthetic Surgery surgery with deflation of the left implant and breast asymmetry. She also desires more fullness and improved shape from her original augmentation.

Bilateral implant exchange and pocket revision was performed. The implants were replaced with smooth round moderate plus profile silicone implants. A 475 cc implant was used to increase fullness. The upper and medial portion of the pockets were opened to give upper pole fullness and increase cleavage. Capsulotomies were also performed to round out the lower pole of the breast. She is shown 5 months after surgery and is pleased with her results.

Patient 22

BeforeAfter*

Age: 65 years

Height: 5’ 5”

Weight: 135 pounds
Preop: 36 A
Postop: 34 C

Implant Size: Allergan Style SRM Silicone R 397cc L 371 cc
Incision/Location: Inframammary

Notes: This patient underwent bilateral transaxillary submuscular breast augmentation with dual lumen saline-silicone implants in 1984. She had an uneventful postoperative course and over the last few years experienced hardening of the breasts and shape change. Of note, the right breast implant migrated upward and outward from its original position. She presented to Dr. Zemmel desiring improved shape and symmetry and to relieve the hardening of both breasts.

Bilateral revision breast augmentation was performed through the patient’s previous inframammary incision. Ruptured dual lumen saline silicone implants were found. The entire implant, implant gel, and the breast implant capsule was removed. The breast pockets were then reshaped to improve symmetry. Finally she received new Allergan Style SRM Silicone implants. She is shown 4 months postoperatively. She has significantly improved symmetry, and the breasts are soft and mobile. She is very pleased with her results.

Patient 23

BeforeAfter*

34 year old who underwent previous breast augmentation with 300cc textured saline filled implants placed in the submuscular plane via an inframammary incision. She presents with breast asymmetry and dissatisfaction with her appearance. The right breast is narrow with lateral rib show. She also has asymmetry of the upper breast poles, and volume differences between the breasts. She also is desiring contour improvement of the abdominal wall and flanks.

Revision breast augmentation with implant exchange from saline to silicone was performed. 485 cc Allergan SRM silicone implants were placed via a periareolar approach. The superior and lateral portions of the pocket were reopened to improve contour. Both implant pockets were rounded to give a more symmetric shape. This improved upper breast fullness and improved cleavage. Liposuction of the abdomen and flanks was performed and 170 cc of autologous fat was transferred to both breasts. This improved tissue thickness, added volume, and smoothed the contour of each breast.
She is shown 4 months after surgery and is very pleased with her result.

Patient 24

BeforeAfter*

Age: 34 years

Height: 5’ 3”

Weight: 120 pounds
Preop: 36 A
Postop: 34 C

Implant Size: moderate plus silicone implants 300cc
Incision/Location: Periareolar, dual plane II

Notes: Patient shown 4 months after surgery.

This patient underwent breast augmentation in 2005 with saline implants placed via a Periareolar incision in the submuscular position. She experienced bottoming out of the left implant which was revised with a partial correction. She also complained of severe animation deformity of both breasts, with the left worse than the right. Finally a second surgeon removed both implants in 2010 and attempted a muscle repair to lessen the animation deformity. This left her with severe scar tissue an did not successfully treat the animation. She had a child 2 years later which left her with volume loss of each breast. She presented to Dr. Zemmel for correction of the volume loss, improved shape and symmetry, and treatment of the animation deformity.

Revision breast augmentation was performed via the previous Periareolar incision. The pockets were reopened and the pectoralis major muscles were released from the overlying breast tissue creating a dual plane type II pocket. The lower edge of the left pectoralis major muscle was wrapped in Alloderm to prevent reformation of scar tissue between the skin, breast, and muscle. This prevented recurrence of the animation deformity on the more effected left side. Smooth round moderate plus profile silicone implants were then placed.
The patient is shown 4 months after surgery and is very pleased with her new results.

Patient 25

BeforeAfter*

Age: 39 years
Height: 5’ 6”
Weight: 155 pounds
Preop: 36 C
Postop: 36 C
Implant Size:  None
Incision/Location: full lift performed
Notes: This patient underwent breast augmentation in 2004 with 475 cc saline implants placed under the muscle via an inframammary incision. She later decided to deflate and remove the implants. In 2013 she underwent an office based implant deflation procedure elsewhere. The implants subsequently deflated. She now requests removal of the implants and a full lift.

Full mastopexy (lifting) was performed with complete removal of the ruptured saline implants and total removal of the breast capsule.  Her breasts are now lifted and the nipple position and breast contour is improved. She is very pleased with her results. She is shown 5 months after surgery.

Patient 26

BeforeAfter*

Age: 42 years
Height: 5’ 10”
Weight: 140 pounds
Preop: 34 C
Postop: 34 C
Implant Size:  Moderate plus profile 325 cc
Incision/Location: Periareolar
Notes: This patient underwent breast augmentation in South America in 2004 with a textured 275 cc silicone PIP implant.  A periareolar submuscular approach was used.  She now presents with breast asymmetry, right and left grade II capsular contracture and a wide intermammary distance (wide cleavage).

Implant removal and replacement was performed. Her previous periareolar incision was used and total capsulotomy was performed on both sides. Her pockets were reopened medially to improve her cleavage. Moderate plus profile 325cc smooth round implants were placed. She is shown 4 months after surgery and size, shape, symmetry and overall contour are significantly improved. She is very pleased with her results.

Patient 27

BeforeAfter*

Age: 42 years
Height: 5’ 4”
Weight: 125 pounds
Preop: 36 C
Postop: 36 C
Implant Size:  Allergan Inspira Style SRM 520 cc
Incision/Location: Periareolar
Notes:This patient underwent breast augmentation in 2001 with 400c saline implants placed via transaxillary approach elsewhere. She was then revised in 2004 by a second surgeon elsewhere. She now presents with complaints of breast asymmetry, breast sagging, and contour irregularities.

Revision breast augmentation was performed via a periareolar incision. The upper and inner portions of the pocket were opened to improve upper pole and medial pole fullness. This improved cleavage significantly. A larger silicone implant was placed in a dual plane II position. Liposuction of the abdomen and flanks and autologous tissue fat transfer were performed.  Fat grafting was performed along the medial and upper poles of the breasts to improve contour and fullness in the upper and medial pole. She is very pleased with her results and is shown 4 months after surgery.

Patient 28

BeforeAfter*

Age: 35 years
Height: 5’ 8”
Weight: 115 pounds
Preop: 34 C
Postop: 34 C
Implant Size:  Allergan Inspira Style SRM R 405cc L 360 cc
Incision/Location: Periareolar, submuscular
Notes: This patient underwent breast augmentation via an inframammary incision in 2011 with 360 cc saline implants placed under the muscle elsewhere. She was displeased and underwent revision by the same surgeon in 2012 with a pocket revision and implant replacement. She then experienced tightening of the left breast, shape distortion with superior subluxation of the left implant and grade 3 capsular contracture. She also experienced lateral subluxation of the right implant.

She present to Dr. Zemmel for revision in 2016. Bilateral revision augmentation via a periareolar incision was performed. The pockets were revised with a inferior and lateral capsulorraphy on the right side. This raised the right breast crease and prevented the implant from falling to the side of her chest.  The left breast capsule was completely removed to relieve the tightness and pain. The left breast crease was also raised with a capsulorraphy to improve symmetry. Her implants were replaced with silicone implants to improve texture and feel. To optimize symmetry two different implants were used. She is shown 5 months after surgery and is very pleased with her outcome. She has excellent symmetry. Her implants are soft and she is pain free.

Patient 29

BeforeAfter*

Age: 58 years
Height: 5’ 7”
Weight: 165 pounds
Preop: 36 D
Postop: 36 D
Implant Size:  Allergan Inspira Style SRM 360 cc
Incision/Location: Inframammary
Notes: This patient underwent breast augmentation in 2000 at a major medical center in Maryland with saline implants placed in the subglandular position. She has developed hardening of the breasts (grade 4 capsular contracture), distortion of breast shape and pain over a number of years. She presents for revision to improve shape and relieve the tightness and discomfort.

Revision breast augmentation was performed via an extended inframammary incision. Total removal of the capsule and removal of her old implants was performed. 275 cc saline filled smooth round McGhan implants were removed. The previous subglandular pocket was closed with sutures, and the pectoralis muscle was raised creating a new pocket (pocket reassignment). A 360 cc Allergan SRM silicone implant was placed bilaterally. The patient is shown 4 months after surgery.  Her contour, shape, and symmetry are significantly improved. Her breast are now soft and she is pain free and very pleased with her results.

Patient 30

BeforeAfter*

Age: 46 years
Height: 5’ 8”
Weight: 133 pounds
Preop: 36 C
Postop: 36 D
Implant Size:  Allergan Inspira Style SRM 485 cc
Incision/Location: Full lift, submuscular
Notes: This patient underwent breast augmentation with 425 cc implant in the subglandular position in Colorado in 1999. She had an uneventful course until 2016 when she experienced rupture of her right implant. She presented for revision.

Revision breast augmentation was performed in conjunction with a full lift (mastopexy). The previous saline implants were removed including the right ruptured implant. The previous subglandular pocket was closed and the pectoralis muscle was raise creating a new pocket (pocket reassignment). 485cc Allergan SRM silicone implants were placed and the full lift was performed. The patient now has symmetric breasts which are fuller, softer, which excellent contour. She is shown 5 months after surgery and is very pleased with her results.

Patient 31

BeforeAfter*

Age: 57 years
Height: 5’ 4”
Weight: 12 pounds
Preop: 36 D
Postop: 36 full C
Implant Size:  Allergan Style 15 339cc
Incision/Location: Full lift, submuscular
Notes: This patient underwent previous breast augmentation 2007 elsewhere via an inframammary incision using 425 cc saline implants elsewhere. She underwent a subsequent revision in 2008. She now presents for improvement symmetry and shape wishes to downsize her implants. She feels her breasts are low on her chest, and are heavy. She is also desiring cosmetic improvement of the abdomen and flanks and is requesting liposuction of these areas.

Revision breast augmentation was performed through a full lift incision. The previous implants were removed and the pockets were reopened in the upper pole and medial poles to improved upper pole and medial pole contour. Her implant also would fall towards the sides when laying down. Lateral and inferior capsulorraphy were performed to stich the pocket closed on the sides and from the bottom. This moved the implants up and towards the center. Allergan Style 15 339cc silicone implants were placed and full lift was performed. Finally, liposuction of the abdomen and flanks was performed.  Autologous tissue fat transfer (fat grafting) was performed to improve the upper and medial pole contours. She is shown 4 months after surgery and is very pleased with her new shape.

*Individual Results May Vary

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