Latest Updates: Cases of the Week

This 27 year old patient from Ramona, California was interested in several cosmetic procedures after giving birth. She found Dr. Pousti online and was very impressed with his mommy makeover procedure results. She expressed to Dr. Pousti during her visit that she was extremely unsatisfied with the results of her previous breast augmentation performed by another surgeon. She was also uncomfortable with her excess labia minora tissue and was interested in a labia reduction as well as an abdominal hernia repair.

Dr. Pousti examined the patient and felt the patient was a great candidate for a mommy makeover, which usually consists of several combined procedures. He confirmed the patient had capsular contracture of her right breast implant, capsulorrhaphy, and breast re-augmentation was needed to achieve the patient’s goals. Dr. Pousti determined the patient was a great candidate for a labia minora reduction as well as repair of the abdominal wall hernia.

Dr. Pousti and the patient met several times prior to surgery to discuss the surgical plan and post-operative care. Dr. Pousti performed markings of the breast and abdomen in the office with the patient.

These markings are done in a full length mirror so the patient can communicate her goals and concerns.

Dr. Pousti meets with the patient again in the surgery center to reinforce markings and make any necessary changes before surgery.

A small incision is made along the areola and the patient’s previous breast implants are removed. During removal A small incision on the areola was used to remove the patient’s previous breast implants. A capsulotomy was performed to remove the scar tissue around the right breast implant, releasing the tension around the implant caused by capsular contracture or encapsulation. Capsular Contracture can distort the shape and firmness of the breast causing severe pain to the patient.

Once the breast implants and scar tissue were removed, Dr. Pousti performed Capsulorrhaphy or internal suturing to repair the patient’s breast pocket. Capsulorrhaphy was performed on the left breast pocket both inferior and lateral to improve symmetry between two breasts.

After the breast revision is complete, sizer implants are used to determine implant sizing. The sizer implants are placed into the breast pocket and filled with air until the patient’s desired goal size has been achieved. The patient is sat upright several times throughout this process to check for symmetry and fullness. This allows Dr. Pousti to make any changes necessary prior to final implant placement. The sizer implants are then removed and the patient’s silicone gel implants are prepped for placement using the Keller Funnel method.

The Keller Funnel method uses a sterile oily funnel to easily squeeze the implant into the breast pocket using a no touch method, reducing the risk of contamination. Dr. Pousti used a 533cc silicone gel implant on the right breast and a 492cc silicone gel implant on the left breast. Different size implants are sometimes needed to achieve better symmetry and can be determined when using the sizer implants.

A labia reduction was performed to remove the excess minora tissue that can cause discomfort during exercise, intercourse, walking/or sitting and other daily activities. The procedure consists of achieving symmetry with the inner lips of the vulva while being cautious to not interfere with the clitoris and urethral opening.

The patient is extremely happy with her results.

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Posted in Breast Pocket Correction, Breast Revision Surgery, Capsular Contracture, Capsulorrhaphy (Internal Bra), Hernia Repair, Implant Exchange, Kenner Funnel, Silicone Gel Implants

This 33 year old patient from San Diego, California was unhappy with the size and shape of her breasts and was interested in breast surgery. Over the years she had lost volume in her breasts from breast feeding and wanted more fullness. Her breasts had become more “droopy”.

While speaking to a friend about finding a San Diego Plastic Surgeon who is experienced in  breast surgery procedures, her friend recommended her to Dr. Pousti. The patient decided to set up a consultation and meet with Dr. Pousti. During her examination, Dr. Pousti suggested that a breast lift (mastopexy) would be necessary, because of the volume lost in the breasts. Because the patient wanted a lot of fullness as well as “lifted, perky” breasts, she and Dr. Pousti decided that it would be in her best interest to do things in 2 stages. First would be the breast lifting part of the procedure, after the incisions have healed, she will return for the breast augmentation portion of the procedure.  After discussing the risks and complications of breast lifting surgery, the patient decided to proceed with surgery.

Prior to surgery measurements and markings are made the night before and rechecked the morning of the mastopexy surgery to make sure no adjustments need to me made.  These markings and measurements are key in achieving the best possible results for the patient.

Below the “x” markings on the patients breast indicates the new position of the nipple-areola complex. The blue lines also represent where the incisions need to be made.  The areola size will also be reduced during this breast lifting surgery.

With mastopexy, Dr. Pousti plans to move the nipple and areola complex to a more pleasing position. The superfluous breast tissue and skin will be removed and he will create the lifted “perky” look.

Right Side After Mastopexy Procedure

Immediately After Mastopexy Procedure

The patient is only 19 days post-op surgery and happy with her results.  She will wait for all incisions to heal and proceed with the breast augmentation surgery at a later date.

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Posted in Breast Lift, Implant Removal

This 33 year old from Trabuco Canyon, California was interested in breast revision surgery to correct the results of her breast augmentation performed by another surgeon. She did not like the size, placement, or shape of her breast implants and did not feel comfortable returning to her original doctor to have revision surgery performed. She researched several plastic surgeons in California and was extrememly impressed when she found double board certified plastic and reconstructive surgeon, Dr. Pousti. She read through several patient testimonials and reviewed many “before” and “after” photos and decided to meet with Dr. Pousti to discuss her concerns.

Dr. Pousti examined the patient and determined that she had “bottoming out” and implant mal position causing her implants to fall below her breast pocket and the areola complex to appear too high on her breast mound. The patient and Dr. Pousti discussed internal suturing to correct the breast pocket and implant position along with the pros and cons of saline vs. silicone gel breast implants. The patient decided to proceed with capsulorrhaphy (internal sutures) and an implant exchange using silicone gel implants.

Prior to surgery, Dr. Pousti and the patient met to take measurements and perform markings. Measurements are taken to determine where internal sutures are used to correct the breast pocket and improve implant placement, cleavage, and volume. Dr. Pousti encourages the patient to bring in goal pictures illustrating exactly what size and shape she would like to achieve with her breast revision surgery.

The red arrows indicate where the patient would like to achieve more fullness and the smiley face represents mild asymmetry between the breasts that will be corrected using different size implants. The same incision site on the areola from the patient’s previous surgery was used to prevent any further scarring. The patient’s previous breast implants were removed and a limited capsulectomy was performed to remove scar tissue that was found. Once the breast implants were removed, Dr. Pousti began capsulorrhaphy. Capsulorrhaphy, also known as an internal bra, was performed to correct the patient’s breast pocket. Internal sutures were placed both on the outer breast and lower breast pocket to correct the bottoming out and implant displacement.

After the first layer of internal sutures, implant sizers are used to preview the results and make any changes as necessary. The implant sizer is placed into the breast pocket and filled with air until the patient’s desired size has been achieved. Once sizing is determined, the sizer implants are removed and the second layer of capsulorrhaphy is performed.

Before and After Breast Revision Surgery

Dr. Pousti used a 492cc silicone gel implant on the right breast and a 533cc silicone gel implant on the left breast to achieve better symmetry.

Before and After Breast Revision Surgery

Before breast pocket repair, the patients implants fell to the side when lying flat, but remained upright after Capsulorrhaphy was performed.

Bolster dressings are worn following repair using internal sutures to help the breast tissue re-drape and to add support to the repaired breast pocket.

The patient is extrememly happy with her breast revision surgery.

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Posted in Bottoming Out, Breast Asymmetry, Breast Pocket Correction, Breast Revision Surgery, Capsular Contracture, Capsulorrhaphy (Internal Bra), Implant Exchange, Silicone Gel Implants

This 35 year old patient from La Mesa, California was interested in increasing her breast size with the help of breast implants. She had been considering breast enhancement surgery for several years and researched many plastic surgeons in San Diego County. She felt that none of the surgeons compared to double board certified plastic and reconstructive surgeon, Dr. Pousti. The patient was extremely impressed with his website and the amount of information regarding the breast augmentation procedure.

The patient met with Dr. Pousti in his office for a consultation and he determined she was a great candidate for breast augmentation surgery with silicone gel implants. Silicone implants are suggested for patient’s with less body fat and breast tissue because it decreases the chances of implant rippling. During her consultation, she was able to meet with some of Dr. Pousti’s previous patient to view their results and discuss the entire process from a patient’s aspect.

The patient and Dr. Pousti meet several times prior to surgery to discuss options and the procedure in detail.  During these visits the patient expressed that she wanted to achieve natural looking breasts with some fullness on top and some cleavage.

Once the patient is in the operating room a small peri areolar incision is made and sizers are set in place. Dr. Pousti uses implant sizers in the operating room to determine the size of the implant needed to achieve the patient’s desired look. Once sizing is determined, the sizer implant is removed and the silicone implant is prepped for placement using the sterile Keller Funnel method. The Keller Funnel method allows Dr. Pousti to administer the implant with a no touch method reducing the risk of contamination. Dr. Pousti places the patient in the upright position several times throughout the surgery to check for symmetry and fullness. Adjustments can be made where needed prior to final suturing.

457cc silicone gel implants were used in both breasts to give the patient the fullness and cleavage she was interested in.

The patient is post op breast augmentation with silicone implants and is very happy with her results.

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Posted in Breast Augmentation, Kenner Funnel, Petite Frame Breast Augmentation, Silicone Gel Implants

This 29 year old patient from San Pedro, California was unhappy with the size and shape of her breasts and was interested in a breast augmentation with breast lift. She was referred to Dr. Pousti by a friend of hers and previous patient of his. After looking through several “before” and “after” photos she was extremely impressed with the results Dr. Pousti was able to achieve for his previous patients and schedule a consultation. During her visits she expressed that she wanted to achieve perkier and fuller breasts. The patient also had mild asymmetry present and wanted that corrected as well.

Upon examination Dr. Pousti recommended a stage 3 lift with breast implants to achieve the patients goals. The patient and Dr. Pousti discussed the pros and cons of saline vs. silicone gel implants and decided to proceed with silicone gel implants. Dr. Pousti encouraged the patient to bring in several goal pictures addressing the size and shape she wanted to achieve. Measurements and markings of the breasts are performed prior to surgery to promote symmetry.

During the breast lift the breast tissue is reshaped and rearranged to give the breast a more youthful and “perkier” appearance. When combined with a breast augmentation, the breast can appear more fuller than just a breast lift alone. In the operating room, Dr. Pousti uses an implant sizer to determine the final implant size. The breast tissue is temporarily stapled together and an implant sizer is filled with air until the patient’s goal size and volume has been achieved. The patient is sat upright several times throughout this process to check for symmetry and fullness. The sizer implant is then removed and the sterile implant is prepped for placement.

For silicone gel breast surgeries, Dr. Pousti uses the Keller Funnel method. This method allows for a no contact technique when placing the implants, reducing the risk of contamination. 421cc silicone gel implant on the left breast and a 457cc silicone gel implant on the right breast to give the patient her desired look.

Before Breast Lift with Implants (Side View)

After Breast Lift with Implants (Side View)

The patient is post op mastopexy and breast augmentation with silicone gel implants and loves her new look.

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Posted in Breast Lift, Breast Lift with Implants, Kenner Funnel, Silicone Gel Implants

This 36-year old patient from Vista, California (North San Diego County) was unhappy with the loose skin around her arms and abdomen. The patient had lost a significant amount of weight from weight loss dieting and exercising.

After losing weight, she visited Dr. Pousti’s office and was very pleased with her consultation. All of her questions were answered by Dr. Pousti and this patient felt very comfortable proceeding with surgery. Dr. Pousti was one of the Southern California Plastic Surgeons this patient had visited and she liked the fact that he was double board certified in Plastic and Reconstructive Surgery as well as General Surgery.

She was worried about performing all of these procedures at the same time, but Dr. Pousti assured her that safety was his primary concern.

The patient wanted fullness back in her breasts. She was interested in arm lift surgery (brachioplasty), breast augmentation with silicone gel breast implants, breast lifting (mastopexy) as well as tummy tuck (abdominoplasty) surgery

The patient came into the Murrieta office the night before surgery to have tummy tuck markings performed. Dr. Pousti carefully measures and marks the patient as a guide for surgery.

The armlifting “markings” are performed the morning of surgery. Caution has to be taken to remove as much skin as possible to give a very natural look but not removing too much skin for a very tight and un-natural look.

In the operating room, Dr. Pousti performs the breast augmentation / breast lifting surgery with silicone gel breast implants to give the patient the “fullness” she was looking for.  Dr. Pousti sits the patient upright in the operating room (as seen above) with the temporary sizers in place to be able to see what adjustments need to be made in the size and shape of the breasts to achieve the patients goals.  The tummy tuck and liposculpture of the abdomen is performed. For the armlift procedure, Dr. Pousti uses a technique that hides the scar in areas so that they are minimally visible.

A 500cc silicone gel implant was placed in the right breast and a 450cc silicone gel implant was used in the left breast to achieve better symmetry.

The patient is now 14 months post-op and extremely satisfied with her results.

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Posted in Abdominoplasty, Arm Lift, Breast Lift, Breast Lift with Implants, Extended Tummy tuck, Mommy Makeover, Post-Weight Loss, Silicone Gel Implants

This 21-year old patient from San Diego, California was interested in male breast reduction surgery. He had a mild case of gynecomastia, and was uncomfortable with the shape and size of his chest.

During his visits with Dr. Pousti the gynecomastia procedure was explained in detail and the patient was able to see the results he was able to achieve for his patients. After several meetings the patient decided that Dr. Pousti was the right surgeon to perform his chest reconstruction surgery.

Breast Tissue Removed from Patient in Operating Room

During the gynecomastia, or male breast reduction procedure, incisions are made along the areola and the fatty tissue is removed from the breast. In some severe cases liposuction is also used to aide in removal. Once that is completed  the incisions are closed and the patient is left with a flatter and firmer chest.

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Posted in Gynecomastia, Male Breast Reduction, Procedures for Men

This 39 year old patient from San Diego was unhappy with the size and shape of her breasts after having her implants for several years. She was interested in revisionary breast surgery and came across Dr. Pousti’s website. She was very impressed with the results he was able to achieve for his patients and set up a consultation.

Upon examination Dr. Pousti explained to the patient that she would greatly benefit from a 2 stage procedure for her breasts. The first stage of the breast revision would consist of removal of the patient’s previous implants along with a mastopexy. Once healed from that procedure she would be able to proceed with the second stage which would be the augmentation.

Prior to surgery markings of the breast are made to ensure symmetry is achieved. These markings are used in the operating room as guidelines to where incisions need to be made. The patient’s previous breast implants are removed and the breast lift is performed. Dr. Pousti places the patient in the upright position several times over the course of the procedure to ensure that her goals are being met.

After about 4 months post the patient’s first stage procedure she is completely healed and ready for her second stage.

Before Breast Augmentation

Dr. Pousti used the same incision on the areola to place the silicone gel implants to avoid any further scarring. For silicone gel breast augmentation surgeries, Dr. Pousti uses the Keller Funnel method for placement of the implants. This technique uses a funnel with the narrow end placed in the areola. The funnel contains a coating that allows the implant to be easily squeezed through the funnel and into the breast pocket with a no contact method, decreasing the risk of contamination.

After Breast Augmentation

The patient wanted fuller and rounder breasts with some cleavage. Dr. Pousti used

The patient is very happy with her results from her first and second surgery.

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Posted in 2 Stage Procedure, Breast Augmentation, Breast Lift, Breast Lift with Implants, Silicone Gel Implants

This 29 year old from Pomona, California was interested in a breast augmentation and correction of her constricted breasts for 8 years. Constricted or tuberous breasts usually have a very narrow base and long skin envelope. She researched online and found double board certified plastic surgeon, Dr. Pousti. She was immediately impressed with Dr. Pousti’s experience in plastic surgery and his many patient testimonials.

Upon examination, Dr. Pousti determined the patient was a great candidate for breast enhancement surgery with a benelli lift to correct the patients constricted breasts. Dr. Pousti and the patient discussed saline vs. silicone breast implants and the patient decided to proceed with her breast enlargement and benelli breast lift with saline implants. The patient and Dr. Pousti met in the pre-operative area in the surgery center to perform markings. The markings are used as a guideline during surgery to try to achieve as much symmetry as possible and to also indicate incision locations.

Sizer implants are used during the breast augmentation when determining implant size. The sizer implant is filled with air until the patient’s goal size has been achieved. The patient is then sat upright to check for symmetry, fullness, and cleavage and then the final implants are prepped for placement. To correct the constricted breasts, a stage 1 benelli lift was performed to help round out the breast and allow the tight skin to loosen.

Before (Side View)

She wanted to achieve much larger breasts with an emphasis on cleavage and round on top with some “perkiness”.

After (Side View)

Dr. Pousti used moderate plus profile saline implants filled to 700cc on the left and 740cc on the right to achieve the patients goals.

The patient is extrememly satisfied with her breast augmentation and correction of constricted breast results.

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Posted in Benelli Lift, Breast Augmentation, Saline Implants, Tuberous Breast Deformity

This 24 year old from San Diego, California was interested in an extra large breast augmentation for about a year. She researched for a qualified surgeon with experience in breast enhancement surgery and found Dr. Pousti, a double board certified plastic surgeon. She was extrememly impressed with the “before” and “after” photos on his website and the results he was able to achieve for his previous patient’s.

Dr. Pousti examined the patient and determined she was a great candidate for breast enlargement surgery with the use of either silicone or saline implants. The patient wanted to achieve larger, rounder, and all around fuller breasts in the “DD Cup” range. To achieve her extra large breast augmentation goals, Dr. Pousti recommended the patient proceed with saline implants. Dr. Pousti and the patient met prior to surgery to perform markings. The markings indicate where the patient would like to achieve fullness and cleavage.

In the operating room, sizer implants are used to determine final implant sizing. The implants are placed in the breast pocket and filled with air until the patient’s goal size based on her goal pictures has been achieved. Dr. Pousti sits the patient upright with the sizer implants in the breast pocket to check for symmetry. Once sizing has been determined, the final implants are prepped for placement. To achieve a round and full look, smooth round moderate plus profile overfilled saline implants filled to 850cc were used.

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Posted in Overfilled Saline Breast Implants, XL Breast Augmentation