Latest Updates: Cases of the Week

This is a 29 year old male from Tempe, Arizona who had a history of pectus excavatum. He underwent reconstruction using the ravitch procedure at the age of three and again at the age of twenty-two.

He is currently unhappy with the appearance of his anterior chest wall (depressed). He also suffers from bilateral gynecomastia. He underwent reconstruction with a custom made silicone implant.

First step was the construction of a moulage.

The moulage was then used as a template for construction of a solid silicone implant.

The patient was then taken to the operating room where previous incisions were used to insert the silicone implant to fill the chest wall concavity-depression.

The patient’s previous inframammary incisions were used to perform partial subcutaneous mastectomy to decrease the size of each breast.

Subcutaneous tissue was removed from the breasts to treat the patients gynecomastia and even out the chest.

The combination of filling in the central chest wall concavity as well as decreasing the size of the breast on each side of the concavity, served to smoothen out the appearance of the anterior chest wall nicely.

Here you can see the “depression” is significantly better after the implant is placed.

Four drains were used for the procedure and a compressive dressing was applied.

The patient is now only 10 days post surgery and is healing nicely.

Click here to see full details on this patient

Posted in Chest Wall Reconstruction, Correction of Chest Wall Deformity, Gynecomastia

This 38 year old patient from Temecula, California (Riverside County) was interested in reducing the size of her breasts.  She previously had a breast lift (mastopexy) by another surgeon but decided to have Dr. Pousti perform her breast reduction surgery.  She didn’t want her breasts too small but did want to address the asymmetry of the breasts.

Markings were performed and measurements were taken the night prior to surgery.  The procedure of Breast Reduction Surgery was discussed in detail with the patient.

The markings below show what areas of breast tissue will be removed and where the new nipple/areola complex will be moved to.

In the operating room, the measurements are re-checked.

Before Breast Reduction Surgery

With one side “reduced”.

Bilateral Breast Reduction Surgery completed.

Click here to see full details on this patient

Posted in Breast Reduction

The 23 year old patient from Colorado Springs, Colorado was very unhappy with the results of her breast augmentation surgery, which was performed by a surgeon near her hometown. She decided to look into plastic surgeons that were experienced with breast augmentation revisionary surgeries and came across Dr. Pousti’s website.

After traveling to California and meeting with Dr. Pousti she immediately felt comfortable with him and decided to proceed with revisionary breast surgery. The patient met with Dr. Pousti quite a few times before her procedure to review the breast revision in detail.

Markings of the patient’s breasts are performed prior to surgery to indicate changes that are needed. The red arrows marked indicate where the patient wants more fullness and helps Dr. Pousti determine where the breast pocket revision needs to take place. Once these markings are completed the previous breast implants are removed through small incisions along the areola (usually the same incision that was originally used will be used again to prevent more scars).

The patient is placed in an upright position several times during the procedure to ensure symmetry is achieved. Once the old implants are removed and breast pocket correction is performed, sizers are set in place. These sizers help determine the size of the implant Dr. Pousti will use and also help him see what the potential results will look like before anything is finalized.

To meet the patient’s size goals and meet her desired look Saline Overfill implants were used. The patient has 1,110 cc on both sides.

The patient is a extremely happy with her revisionary breast surgery results.

Picture sent from patient a few months post op surgery .

Click here to see full details on this patient

Posted in Breast Pocket Correction, Breast Revision Surgery, Overfilled Saline Breast Implants

This 40 year old from Ohio was interested in getting revision breast surgery.  She was not happy with the size of her current breast implants and she also didn’t like how they “fell out to the side” when she laid down.  She had heard that San Diego Plastic Surgeon, Dr. Pousti, had expertise with the internal suture technique (capsulorrhaphy) and so she decided to travel to San Diego to meet with Dr. Pousti.

After meeting and having Dr. Pousti examine the patient, they discussed removing her current implants, replacing them with new breast implants and also performing lateral capsulorrhaphy (internal sutures) to help with better placement of the breast implants on the chest wall.

Markings were performed the night prior to surgery and the procedure was discussed in detail.

In the operating room, the “red arrows” indicate where the patient wanted “more fullness”.  Below, is the patient with her breast implants removed.

Immediately in the operating room with the new implants placed to achieve the patients goals.

Below you can see how her breast implants went off to the side (toward her armpits) when she laid down and after the internal capsule work (internal bra), the implants stay in their correct position when the patient is lying down.

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Posted in Breast Pocket Correction, Breast Procedures, Breast Revision Surgery, Internal Bra (Internal Sutures)

This 23 year old patient from El Cajon, California (San Diego County) was very unhappy with her breast asymmetry.  She didn’t like how the right side was so much larger then her left side. She also did not like how “droopy” they were.  She wanted them “lifted”, more “perky” and larger.  She met with San Diego Plastic Surgeon Dr. Tom Pousti to discuss her options.

Dr. Pousti discussed a 2 Staged Procedure procedure for this patient.  The first surgery would be a right side breast reduction as well as bilateral mastopexy. After all incision lines are healed, they would return to place the breast implants to achieve her size goals.  The night prior to surgery, Dr. Pousti meets with and makes measurements for the upcoming surgery.

Very precise measurements are taken.  As you can see, there is significant difference in size of the breasts and Dr. Pousti will do his best to achieve as much symmetry as possible.

In the operating room after the left breast is “lifted”.

Dr. Pousti takes his time and sits the patient upright many times to look for size, symmetry.

Here is the patient after recovery from the first procedure and ready to proceed with getting her breast implants placed.

After650 cc silicone gel implants are placed in the operating room.

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Posted in 2 Stage Procedure, Breast Asymmetry

This 36 year old female from Encinitas, California was interested in breast surgery after having and nursing 3 children. The patient wanted more fullness in her breasts and decided to do some research on surgeons that were experienced in breast augmentation surgery and mommy makeovers. She came across Dr. Pousti’s website online and was impressed with the amount of information and before/after pictures he provided.

Prior to surgery the patient and Dr. Pousti meet several times to insure that he understand the patient’s desired goals and that the patient understands what is realistic as far as results go. During the final appointment before surgery measurements of the patients breasts are done and markings are made to help with symmetry and incision locations.

In the operating room these markings are re-checked and last minute adjustments are made for the breast augmentation/ breast lifting surgery.

In this patient’s case she was interested in increasing her breast size but still maintaining a ‘natural look’. To achieve these goals Dr. Pousti used sizers so that he would know what size implant he needed to use. Once these sizers are in the breast pocket the patient is put in a upright position and examined. Any changes to the breast pocket or sizing of the breast are marked up at this time to be fixed before the actual breast implants are placed.

700cc High Profile Silicone Gel Implants were used along with a benelli lift to give the patient her desired look.

Immediately After Surgery

She is post op breast augmentation/mastopexy and very pleased with her new look.

Click here to see full details on this patient

Posted in Benelli Lift, Breast Lift with Implants, Mommy Makeover

This 30 year old patient was interested in Body Contouring Surgery after massive weightloss. She had lost 80lbs after having gastric bypass surgery and was interested in revisionary breast surgery along with abdominoplasty. She wanted an extra large, overfilled implant.

This patient is from Austin, Texas and after doing extensive research online decided that the travel to San Diego, California to see  board certified plastic surgeon Dr. Pousti, was well worth it.

During her visits with Dr. Pousti he explained the revisionary breast procedure and abdominoplasty surgery in detail. Dr. Pousti explained the potential risks and complications associated with both tummy tuck surgery as well as getting extra large breast implants.  The patients understood and agreed to proceed with surgery.

Click here to see full details on this patient

Posted in Abdominoplasty, Extended Tummy tuck, Overfilled Saline Breast Implants, Post-Weight Loss, XL Breast Augmentation

This 48 year old patient from San Diego, California had been unhappy with the size and shape of her breasts for several years. She decided to do some research for a San Diego plastic surgeon that was experienced with breast procedures and came across Dr. Pousti. The patient was very impressed with his experience with mommy makeover procedures (commonly used to describe a combination procedure) and after meeting with him she knew he was the right Plastic  Surgeon for her.

Upon examination it was determined that the patient was an excellent candidate for breast augmentation with a mastopexy. Prior to surgery measurements of the patient’s breasts were taken and markings were made to indicate exact incision lines for the breast procedure. The entire procedure is reviewed again with the patient and she is given the chance to get her last minute questions answered.

The markings are re-checked in the operating room before the breast surgery.

Before the full incisions are made a small incision is created so that a sizer can fit in. This sizer helps determine the size of the breast implant  needed to meet the patient’s desired size goals.

A ‘cookie cutter’ is used so that the breast areolas are symmetric and proportional.

The incisions are then made and the breast tissue is re-arranged to make the breasts lifted and “more perky”. The sizer is set in place again to double check on the size of the implant needed. In this case 600cc Silicone Gel Implants were the perfect size for the patient’s expectations.

During Surgery

Immediately After Surgery

The patient is extremely happy with the her new body and the results of her breast augmentation/mastopexy.

Click here to see full details on this patient

Posted in Breast Lift with Implants, Breast Procedures

This 42 year old African American from Rancho Cucamonga, California (Riverside County) was experiencing neck, back and shoulder pain due to her large, heavy breasts.  She was interested in reducing the size of her breasts as well as “lift” the breasts and achieve a “perkier” look.  She was looking for the best Breast Surgeon in Southern California for her specific surgery and found Dr. Pousti.

She met with Dr. Pousti and discussed breast reduction surgery as well as the potential risks and complications associated with this procedure.  The patient saw many examples of Dr. Pousti’s work and proceeded with scheduling surgery

Before performing the breast reduction surgery, Dr. Pousti makes measurements to help him achieve the best symmetry for the patient.  The “x” indicates where the new nipple/areola complex will be.

Above, you can see one side “lifted” and “reduced in size” in the operating room.

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Posted in Breast Lift, Breast Procedures, Breast Reduction

This 57-year old patent from Winchester, California had lost a significant amount of weight, and had excessive skin around her abdominal area.  She wanted Body Contouring after Massive Weightloss and was looking into Tummy Tuck Surgery.

She was very unhappy with her body proportions and was interested in a tummy tuck surgery to remove all her unwanted abdominal skin.

Markings are performed the night prior to surgery and then checked again the morning of surgery.  Careful measurements are taken to achieve more symmetry for the patient.

When the markings are performed, Dr. Pousti discusses the procedure in detail with the patient again in detail and answers questions pertaining to the tummy tuck procedure.

In the operating room, you can see the extent of excess skin, which will be removed from the abdominal area.  Recovery can take up to one year (for swelling to subside and for the skin to re-drape).

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Posted in Abdominoplasty, Body Contouring