AlloDerm Patients

This 25 year old patient from Escondido, California was interested in breast augmentation revisionary surgery. She had a prior breast augmentation performed by a previous surgeon but was not pleased with the implant position on her chest wall. While searching on the internet, she searched for surgeons who have experience with revisionary breast  surgery and found Dr. Pousti, a Board Certified Plastic and Reconstructive Surgeon. She looked at several before and after pictures and set up a consultation with Dr. Pousti.

The patient learned that her case was more complicated than she thought after she finally met with Dr. Pousti. The patient had bilateral implant malposition. On the right side the implant was too far medially placed, meaning it was closer toward her midline- on the left side, the implant was also too far medially placed and slightly bottomed out.  The patient was experiencing rippling as well. The implant malposition results nipple/areola complexes appearing off-centered, the nipples look as if they are pointing outward.

Detailed markings are made prior to surgery so that Dr. Pousti can review the procedure in detail with the patient.  The blue markings above indicate where the implant malpostion takes place. This is the area where capsulorrhaphy (internal sutures) will be performed to assist in better positioning of the breast implants on the chest wall.  The green markings above indicate where the allograft will be placed.  The allograft is used to give an extra support for the capsulorrhaphy as well as reducing the chance of rippling in that area.  The red arrows in the above photo indicate where Dr. Pousti will perform capsulotomy to open up the pocket.

The left breast pocket was repaired with internal suturing technique (Capsulorrhaphy) to prevent dislocation of the breast implant as well as using AlloGraft, a cellular tissue specially-prepared tissue for reconstructive surgery.

Immediately After  Breast Revisionary Surgery

Dr. Pousti placed 475cc silicone gel implants in both her left and right breast after reviewing the photos the patient had brought in as her “goal” photos.  The size of the breast implant is chosen after temporary sizers are placed and the patient is sat up multiple times on the operating room table to make sure size, shape and pocket dissection are as symmetrical and accurate as possible.

She is 5 days post op and extremely happy with her results.

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Posted in AlloDerm, Breast Revision Surgery, Internal Bra (Internal Sutures)

This 41 year old patient from Huntington Beach, California had her original breast augmentation a surgery performed by a previous surgeon and had also undergone breast reconstructive surgery in past as well. The patient was unhappy with the positioning of her breast implants and felt that they were placed too far medially on both sides.

The left breast implant was also placed too low on her chest wall compared to the right. Because of the implant mal position, the nipple areola complexies look relatively off center on the breast mound.

Prior to the patient’s revisionary breast surgery, measurements and markings are performed. These are checked the morning of surgery in the operating room, as well, to ensure good symmetry is achieved.

The patients previously placed implants were removed and the breast implant pockets were opened superiorly and laterally. Internal capsulorrhaphy technique (internal bra) was used to repair the medial aspect of each breast implant pocket and the lower implant pocket on the patient’s left side (relative bottoming out).

Because of the patient’s previous history of failed repair, allograft was also used to reinforce the capsulorrhaphy along the cleavage area (medially).

Below you can see the area of capsule that was repaired shaded in red.The area shaded in blue demonstrates the allograft usage to reinforce the repair. After completion of the pocket adjustments, Silicone Gel Implants were placed.

You can see relative improvement of the areala on the patients breast mound ( no longer pointing outward). The areola is more centered on the breast mound after the revisionary breast procedure.

The patient is placed in the upright position several times throughout the procedure to ensure good symmetry as well as good correction of the implant malposition issues. After the procedure, the skin tenting is also supported using tape bolster dressings are also used to provide additional support in the repaired area.

Before/Immediately After

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

This 42 year old patient from San Diego had her breast surgeries performed by a different surgeon in 1998 and again on 2002 and was still unhappy with her results. The patient decided to do more research and find a surgeon experienced in revisionary breast surgery.

Prior to surgery measurements and markings are made to indicate where the pocket correction needs to take place for better breast implant placement on the chest wall. In this patients case allograft had to be used due to the patient’s thin skin. The squares marked show where the allograft will be used.

The patient’s current breast implants were then removed, one of which was deflated.

Once the old implants were removed the sterile allograft is then set in place.

Sizers are then used to determine the size of the breast implants needed to give the patient her desired look.

The patient is then placed in an upright position to see if any adjustments need to be made to the breast pockets.

She is now 2 months post op removal of current implants, allograft and re augmentation with silicone implants.

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Posted in AlloDerm, Breast Pocket Correction, Breast Procedures, Breast Revision Surgery

This 29 year old female from Honolulu, HI had breast augmentation in the Philippines in 2005 which caused her to develop symmastia. Symmastia occurs when the muscle is separated from the chest wall. When the separation is present the implants touch causing a ‘uni-boob’. 3 years later the patient had breast surgery performed again by her previous surgeon in an effort to correct her symmastia. Unfortunately it is not guaranteed that the symmastia will not reoccur after repair, especially with surgeons that aren’t specialized in this type of reconstruction. In this patient’s case the symmastia repair performed by her previous surgeon did not help and the patient decided to do more research on surgeons that specialize in revisionary breast surgery and symmastia repair. During her search she came across Dr. Pousti and was very impressed with his experience in symmastia repair.

During symmastia repair Dr. Pousti uses internal sutures re re-attach the muscle to the chest wall. Dr. Pousti also wanted to create more upper fullness on the right breast as well to achieve bilateral symmetry.

When the patient is in the prone position the presence of symmastia is even more visible. There is malposition of the nipple/areola complexes due to the symmastia.

After all measurements are markings are done the patient’s current breast implants are removed so that internal suturing can begin.

Along with internal sutures, Dr. Pousti will use AlloDerm. AlloDerm is donated tissue used for revisionary breast surgeries in patient that have thin skin.

Once the symmastia repair is performed a 371cc Silicone implant was placed in the left breast and a 397cc Silicone implant was placed in the patient’s right breast.

Bolster Dressing, consisting of a layer of gauze, is placed to secure the symmastia repair site.

Before

Immediately After Surgery

After surgery with Bolster Dressing and Support Bra

The patient is extremely happy with her results and is very thankful that she found Dr. Pousti.

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Posted in AlloDerm, Bottoming Out, Breast Pocket Correction, Breast Procedures, Breast Reconstruction, Breast Revision Surgery, Implant Removal, Internal Bra (Internal Sutures), Symmastia

This 38-year old patient from Kansas found Dr. Pousti on the internet after researching for an experienced revisionary breast surgeon.

The patient had breast augmentation surgery performed by a another surgeon, and was very unhappy with the shape, size, and mal-position of her breast implants and wanted to improve her look.

The patient wanted more fullness on top and more symmetry between the 2 breasts.

While in the laying down position, she didn’t like how her implants shifted to the side.

The patient was also concerned with the appearance of rippling on her left breast.

Markings were performed the night before surgery and then re-done the morning of surgery.   Dr. Pousti plans to create more cleavage and fullness on top by correcting the breast implant pockets with internal sutures and he will use an AlloGraft to improve the rippling of the left breast (see markings above).

AlloGraft tissue used for many revisionary breast surgeries to provide an additional layer of support to the patient.

Immediately after surgery.

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

This 36-year old out-of-town patient was interested in revisionary breast surgery. The patient is status post breast augmentation surgery in 2003 and revisionary breast surgery in 2003 and again in 2009.

Due to symmastia and rippling, the patient was very unhappy with the results of her surgery and she experienced pain on the sternum area.

The patient researched for a Board Certified Plastic and Reconstructive Surgeon who is experienced in symmastia repair to perform her breast revision surgery. The patient found Dr. Pousti on the Internet after reading excellent reviews she called to discuss her case. The patient knew Dr. Pousti was the best surgeon for her.

Symmastia – commonly referred to as “bread loafing” or “uni-boob”, occurs when two implants touch one another in the center of the chest. If the horizontal muscle that is connected to the sternum and goes across the implant is cut during surgery, then the implant can move toward the middle of the chest. Symmastia results from overly aggressive attempts to alter chestwall anatomy trying to increase cleavage in patients. This outcome is made worse by use of larger implants in thin patients.  The “red marks” above are where Dr. Pousti will be placing the pieces of AlloGraft to help support the internal sutures.

Her previous implants were removed, and internal sutures were used to establish the “new” breast pocket.

AlloDerm was also used to improve the rippling by putting an extra layer of coverage between the implant and the skin due to the patient’s thin skin and minimal breast tissue.

The internal sutures create an “internal bra” to hold the new implants in it’s new position.

With the symmastia repair, improved appearance of her breasts by creating separation in her cleavage.

700cc silicone-filled breast implants were used in both breasts with submuscular placement.

Updated pictures will be soon posted, sent via e-mail by the patient.

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Posted in AlloDerm, Breast Revision Surgery, Symmastia

This 31-year old patient from Coronado, California was unhappy with the results of her right breast from her previous breast surgery performed by another surgeon in 2008. She wanted  revisionary breast surgery.

With reoccurring encapsulation in her right breast, the patient was interested in breast reconstruction surgery. She had heard about Dr. Pousti from a friend and that he is a double board certified plastic and reconstructive surgeon with many years of experience and training. She met with Dr. Pousti in his La Jolla office to express her concerns, and decided to proceed with breast revision surgery of her right breast.

Markings were performed on the right breast. You can see the degree of asymmetry between the right and left breast.

Along with performing capsulorrhaphy (internal sutures), Allograft would be added to the right lower breast to strengthen the breast pocket.

AlloGraft: Collagen structure (fiber-like proteins) and other proteins naturally found in skin. This structure acts as a frame for your tissue to grow into and around.

AlloGraft in place for breast reconstruction.

Dr. Pousti decided that her previous saline breast implant was able to be safely re-used and filled to match the left breast for symmetry.

Immediately after surgery.

A bolster dressing is made to hold and protect the corrected areas. Typically, this dressing is worn for about 2-weeks while in the internal suture are healing.

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Posted in AlloDerm, Breast Pocket Correction, Breast Procedures, Breast Reconstruction, Breast Revision Surgery, Capsular Contracture, Internal Bra (Internal Sutures)

This 21-year old patient wanted revisionary breast surgery to correct the mal-position of her right breast and to remove her saline breast implants and replace them with larger breast implants.

The patient is from Philadelphia and flew into San Diego, California to have breast revision surgery performed by Dr. Pousti.

You can see the mal-position of the right breast; the breasts were asymmetric and she was unhappy with the appearance. She wanted more cleavage, fullness and breast projection.

In order to repair and correct the mal-position of her left breast, internal sutures were used and placed to position the breast more medially (middle), then AlloGraft (a surgical graft tissue) to strengthen the repaired areas.

Here you can see the placement of the AlloGraft tissue.

The patient without implants, Allograft and internal sutures in place.

New saline breast implants were placed submuscularly and filled too 960cc in both breasts.

She is extremely happy with her results and sends updates and pictures via e-mail daily.

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Posted in AlloDerm, Breast Asymmetry, Breast Pocket Correction, Breast Procedures, Breast Reconstruction, Internal Bra (Internal Sutures), Overfilled Saline Breast Implants, XL Breast Augmentation

This 36-year old patient from San Juan Capistrano, California was interested in extra large breast implants for several years. She is post breast augmentation surgery in 2002 performed by another surgeon and revisionary breast surgery in early 2010.

The patient was unhappy with the size and shape of her previous breast surgeries and researched for a surgeon who is experienced in overfilling implants safely to achieve her desired look. She found Dr. Pousti on the Internet.

Along with her size, she was also unhappy with the position of her implants, her right breast sits to her side and she wanted more cleavage.

The left breast pocket was repaired by using AlloGraft (acellular tissue is specially-prepared tissue for reconstructive surgery) and Capsulorrhaphy (prevent recurring dislocation of the implant by suturing a tear in the capsule) reconstruction were performed in the left breast.

In order to achieve her desired look, smooth, round saline breast implants were used and overfilled to 1500cc in both breasts with submuscular placement.

Before surgery

Immediately after surgery

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Posted in AlloDerm, Breast Revision Surgery, Overfilled Saline Breast Implants, XL Breast Augmentation

This 25-year old patient from New York was very unhappy with her previous breast augmentation surgery in 2005, 2 revisionary breast surgery attempts in 2007 and again in 2008 (performed by another surgeon) to correct the mal-position of her implants.

The patient has the beginning stages of symmastia (implants merging together in the center of the chest), and excessive rippling. The patient found Dr. Pousti while searching for a Board Certified Reconstructive Surgeon on the Internet. The patient was impressed with Dr. Pousti’s experience with symmastia correction and decided to fly into San Diego for her 5^th revisionary breast surgery.

Dr. Pousti discussed her options with her and also discussed the internal suturing technique that would be used to correct the pocket position of the implants.

Markings were performed the night before surgery and details of her surgery was again disscussed.

The morning of surgery, Dr. Pousti re-measures and reinforce all makrings for the planned procedure.

Internal sutures were used to correct the symmastia and “bottoming out”, and “internal bra” was created to hole the implants in the “new” position. Alloderm was used in the cleavage area where the patient experienced rippling.

AlloDerm

After the symmastia and “bottoming out”, Dr. Pousti again measures and marks the appropriate areas where the AlloDerm would be placed.

Immediately after surgery.

The patient is now 14-months post-op surgery and is happy with her results.

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Posted in AlloDerm, Bottoming Out, Breast Asymmetry, Breast Revision Surgery, Symmastia