Case Number: 341
- Before After
This patient has had two difficult experiences with cosmetic surgery. Her first bad experience was with a breast implant technique called, "total submuscular breast implantation." This breast implant was placed underneath the muscle above the breast (the pectoralis) but it also included placement under another muscle below the breast. While this might seem like a good idea, in practice what happens is the implant is often held in an high position and the patient's breast tissue drapes over the implant in an unnatural fashion. In this case, you can see in the side view, the implant is far too high and that the breast is sagging over the implant in an unattractive fashion. In the front view it's not quite as obvious but in person, this problem is obvious.
The patient had a second problem: her liposuction. It is not completely clear what this surgeon's technique was, but he produced the results you see in terms of overly aggressive hip liposuction and an exceedingly irregular lower abdomen liposuction. The marks you see are from right before the touch up surgery to guide us. He also produced irregularities in the inner thighs and a pubic area which still had fat in it and did not look very good either. This patient had the confidence to allow us to attempt to correct both problems in a single procedure. We are still awaiting her "after" photographs of her final result. At this point, she looks like she is going to do very well.
In order to correct the breast problem, the following was done. The patient did not want more scars on the breast, and she of course wanted her implants lowered. Her scar originally was in the upper areola as can be faintly seen in the photographs. This scar was used to make the incision to access the old breast implant, which contained 425 cc's. We replaced this with a 450 cc silicone implant, and broke up the muscle underneath the breast, which was holding the implant up in this unnatural fashion. The implant settled into the new pocket and the result was pleasing. Because the muscle had to be cut, careful attention had to be paid to any bleeding, and this surgery took over 2 hours. The area around the nipple was stitched at the end and the implant stayed in the same pocket from above (under the muscle) but, below was in the new pocket (over the muscle). Therefore, the implant ended up in the traditional place that an implant usually goes, underneath the muscle on the top of the implant and underneath the breast tissue in the lower half of the implant.
In order to correct the liposuction, small cannulas of just 3 mm diameter had to be used in multiple areas. The following were worked on: the total torso, which goes from the area above the bra line down to the area above the buttocks, the whole abdomen area with the exception of the lower middle abdomen which was already too thin, and the pubic area. Her legs were corrected by liposuctioning the right leg more than the left leg in a very careful, considered fashion. This patient also desired arm liposuction and we performed this at the same time as well. All of this took over 3-1/2 hours with two experienced licensed individuals working on her.
I recommend that patients looking for liposuction or breast surgery carefully research their surgeons and be sure that the experience level of the physician involved is sufficient so that the patient has a good feeling that they can have an excellent result. While this individual has a very high self-image and she did not seem to let the problem she had with her body bother her very much, other patients we have seen have had their self-images damaged by such surgery. This patient cannot expect to have the kind of result she would have if she had experienced surgeons perform her surgery initially. However, she is much improved now.