Bottoming Out Patients

This 45 year old from Lancaster, California had been interested in Revisionary Breast Surgery. She was unhappy with the position, shape, and symmetry of her current breast implants.  The left nipple/areola pointed “up and out”and made the patient very uncomfortable in and out of clothes. The patient did her research to find the most experienced plastic surgeon in regards to revisionary breast augmentation surgery and found Dr. Pousti.

Dr. Pousti examined the patient and discussed revisionary breast augmentation surgery.  They discussed how her left implant had “bottomed out” and how capsulorrhaphy (internal bra) would be beneficial to reach her goals.   Below, the arrows indicate where the patient wished for more “fullness” and how an inferior capsulorrhaphy (internal sutures) would help her achieve that goal.

Below – in the operation room – with the patient’s breast implants removed.

Using the Keller Funnel to place the silicone gel breast implant after the internal pocket work is completed.

Immediately after the surgery is completed in the operating room – you can see the improved symmetry.

The patient is extremely happy with her results.  She understands that it takes time for everything to heal and settle.

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

This 32 year old patient from Torrance, California (Los Angeles County) was interested in Revision Breast Surgery.  She had previously had breast augmentation surgery and her breast implants were placed subglandular (over the muscle). The breast implants presented severe rippling along the medial aspects of each breast (cleavage area). She was extrememly displeased with the breast asymmetry present.

She researched for an experienced Breast Revision Plastic Surgeon and found Dr. Pousti.  She and Dr. Pousti discussed her options and decided on the following…..The surgical plan was to remove the subglandular saline breast implants and replace the implants, if possible, in the submuscular position (under the muscle). The patient was aware that a breast lift and/or the use of allograft might be necessary and had given Dr. Pousti the “OK” to proceed with these procedures if he decided it was necessary once he was in the operating room.

Once Dr. Pousti was in the operating room, he was able to remove the subglandularly placed breast implants and replace them with submuscular silicone gel breast implants. Dr. Pousti also performed pocket work to improve teh placement of the breast implants on the chest wall.  No mastopexy or use of allograft was necessary. A successful sub muscular re augmentation was achieved.

This patient now has 525cc Silicone Gel Breast Implants placed “under the muscle”.  Due to the pocket correction, bolster dressings were applied to give support to the repair.  She will continue to keep the bolster dressing on and limit her activity while she recovers from her revisionary breast surgery.

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Posted in Bottoming Out, Breast Asymmetry, Breast Revision Surgery, Sub-glandular Breast Augmentation

This is a 30 year old patient from Kalispell, Montana interested in a  revision breast re-augmentation after being left unsatisfied with her results from a previous surgeon. She was unhappy with the shape, symmetry, and placement of her previous implants. She also complained of relative right breast implant position being too far to the mid line of her chest and lower than her left breast.  The left breast had more scar tissue build up as well.

She searched for a good Plastic Surgeon who had experience with revisionary breast surgery and found San Diego Plastic Surgeon, Dr.Tom Pousti.  She needed to have her breast implants replaced and positioned better on her chest.  The scar tissue was also bothering her and she wanted that removed.

The patient underwent removal of the anatomic shaped breast implants she previously had placed and Dr. Pousti replaced them with new cohesive gel breast implants.

Internal suture repair, of the right breast area, and further bilateral breast implant pocket adjustments were done. Re -augmentation was completed with round and smooth Silicone gel breast implants.

This is the patient directly after re-augmentation surgery.  Note the better size and symmetry of the breasts.  She will have swelling and bruising that will subside with healing.

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

This 35 year old mom from Vista was not happy with the bottoming out of her right breast implant.  She had previously had several breast augmentation surgeries and so she was looking for the best plastic surgeon with experience in revisionary breast surgery.

She found Dr. Pousti online and was impressed by his work with breast implant revisions and especially correction of “bottoming out”.  Dr. Pousti discussed the use of permanent internal sutures (internal bra) to correct the placement of the implants on her chest as well as the use of AlloGraft for more support of that lower area.  The patient decided to not proceed with the AlloGraft but felt comfortable with Dr. Pousti’s expertise and proceeded with revision breast augmentation surgery and the use of the internal sutures to correct the bottoming out.

Measurements are performed the morning of surgery and the specific procedure is discussed again with the patient.  The lower part of the right breast is where the internal sutures will be placed.  The patient will have to limit her arm movement as well as lifting anything heavy for a few months.  The internal sutures need to heal completely.  IF the patient starts too soon with the activity, she may damage the internal repair.

Below is in the operating room with the breast implants removed.

Below is immediately after the revisionary breast augmentation surgery and internal bra repair.

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

This 34 year patient from Cardiff, CA had breast augmentation with silicone gel implants performed in 2010 and started ‘bottoming out’. Bottoming out is most common with patients that have very thin skin and happens when the breast pocket cannot carry the weight of the implant.

The patient met with Dr. Pousti and went over all the potential risks that may occur during her revisionary breast surgery. With correction of the bottoming out of the implants, the placement of the implants will be better on her chest wall and her nipple-areola will be centered on her breast mound (not pointing upward as they currently are).

Measurements of the breasts are taken prior to surgery and markings of the entire revisionary breast surgery procedure are performed. The red arrows marked indicate where more fullness is desired by the patient.

The blue lines along the bottom of the patient’s breast show where Dr. Pousti will close the breast pocket for better implant placement. To correct the “bottoming out “, internal suturing with permanent sutures is used to fix the breast pocket. These sutures are permanent sutures that allow for better implant placement.  The patient was also interested in increasing upper volume in her breast.

This patient underwent removal of her previous breast implants, internal suturing for bottoming out repair and re-augmentation with silicone gel implants. She is very happy with the results of her revisionary breast surgery.

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Posted in Bottoming Out, Breast Revision Surgery, Internal Bra (Internal Sutures)

This 30 year old patient from East Helena, Montana was interested in revisionary breast surgery and revisionary surgery of her previous mini abdominoplasty. She was unhappy with her prior breast augmentation surgery and mini tummy tuck that was performed by a different surgeon.  Her breasts had “bottomed out”, she had no fullness on top and there was significant breast asymmetry (left one was larger than the right).  Her tummy was irregular, lumpy and the excess skin was still present.

While searching online, the patient came across Board  Certified Plastic and Reconstructive Surgeon Dr. Pousti. Being from out of state the patient did an extensive amount of research before setting up a email consultation with Dr. Pousti.  This patient actually flew out to meet with Dr. Pousti.  Because she had gone through surgery previously with a poor result, she wanted to make sure this time she had a good result.  After emailing back and fourth and meeting with the doctor, she was very pleased with what she heard and saw and decided to fly in for surgery for revisionary breast surgery and for a revisionary extended tummy tuck.

Marking were made the morning of surgery.  Markings are performed so that Dr. Pousti can take measurements prior to surgery.  The Markings are also used to explain the procedure in detail to the patient. The red markings below indicate where the patient wants fullness in her breasts. The blue “football like” markings indicate the extra abdominal skin that will be removed during the tummy tuck procedure.

Immediately After  Revisionary Breast and Revisionary Tummy Tuck Surgery

Dr. Pousti achieved the patients goals of more fullness and roundness by using  saline breast implants and using a larger size for the right breast vs. the left breast to accommodate for the difference in breast size.

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Posted in Abdominoplasty, Bottoming Out, Breast Revision Surgery

This 37 year patient from Oceanside, California had breast augmentation with silicone gel implants performed in 2010 and started ‘bottoming out’. Bottoming out is most common with patients that have very thin skin and happens when the breast pocket cannot carry the weight of the implant. The patient had a lot of trust in Dr. Pousti and decided to go with him for her revisionary breast surgery.

To correct bottoming out, internal suturing to fix the breast pocket must be performed. These sutures are permanent sutures that allow for better implant placement.  The patient was also interested in increasing upper volume in her breast.

Measurements of the breasts are taken prior to surgery and markings of the entire revisionary breast surgery are done. The red arrows marked indicate where more fullness is desired and the red lines along the bottom of the patient’s breast show Dr. Pousti where the breast pocket must be closed.

Once the previous breast implant is removed and pocket correction is performed a sizer is set in place to determine the size of the new breast implant needed to give the patient her desired look.

The patient is placed in an upright position with the sizer in place and her look is compared to the pictures she brought in. If any adjustments are needed they are marked up at this time.

To give meet this patient’s size goals and give the the look she wanted a 375cc Silicone Gel Implant was placed in the patient’s left breast and a 350cc Silicone implant was placed in her right breast.

Immediatly After Surgery

After the revisionary breast surgery and bottoming out repair, a bolster dressing is applied to the patient. This bolster dressing is designed to add stability and support the internal suturing that was performed so that no added pressure is put on the pocket walls.

Only a few days post breast reconstruction

This patient underwent removal of her previous breast implants, internal suturing for bottoming out repair and re-agumentation with silicone gel implants. She is very happy with the initial results of her revisionary breast surgery.

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Posted in Bottoming Out, Breast Pocket Correction, Breast Reconstruction, Breast Revision Surgery, Internal Bra (Internal Sutures)

This 39 year old patient from Corona, California was unhappy with the appearance of her breast and abdomen and was interested in breast reconstruction and abdominoplasty. The patient had 2 previous breast surgeries performed by her surgeon in Long Beach but was still unhappy with her results.

The patient found Dr. Pousti online and was impressed with his experience and positive reviews. Upon examination it was determined that the patient was a good candidate for correction of ‘bottoming out’ and medial mal-position of her implants with the use of Alloderm as well as abdominoplasty surgery.

The patient and Dr. Pousti meet the day prior to surgery to discuss options, concerns and post op care instructions for the tummy tuck and revisionary breast procedures. Measurements and markings are also performed at this appointment. The markings serve as a guideline to where the incisions should be. The markings also help show where adjustments are needed.

Once measurements are checked the patient’s previous breast implants are removed through a periareolar incision.

Once the implants are taken out, markings are made where the alloderm will be used. Alloderm is used in patients that have very little breast tissue and who need more coverage in certain areas . The square above indicate the location the alloderm will be placed.

After the alloderm is set in place sizers are used to help determine the size of breast implant need to give the patient her ideal look. Sizers are similar to saline implants but are filled with air instead. The amount of cc’s is measured and then sterile Silicone Gel breast implants that match the size are placed.

The patient is placed in a upright position and her look is compared to the pictures that she has brought in. Adjustments are then made if needed.

During the tummy tuck procedure the excess abdominal skin is removed and muscle repair is performed. In this patient’s case she also had an umbilical hernia repaired as well.  It will take a few months to 1 year for the breast implants to settle into the pocket.

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Posted in Abdominoplasty, Bottoming Out, Breast Pocket Correction, Breast Revision Surgery

This 48 year old patient from Corona, California was interested in revisionary breast surgery after her previous surgeon left her with unsatisfactory results. The patient had her first breast augmentation performed by a previous surgeon in 1988 then had them removed in 1998. The patient had her third breast surgery by a surgeon in 2010. The patient was still very unhappy with the appearance of her breast and decided to do a little more research for find a qualified surgeon that specialized in breast reconstruction. While doing her research the patient came across a blogging site and kept coming across Dr. Pousti’s name. She visited his website and was very impressed with his work.

The patient was interested in increasing her breast size but also wanted them rounder and fuller with an emphasis on cleavage.

The Red arrows indicate where more fullness needs to be created. These markings are performed prior to surgery along with measurements to ensure that good symmetry is achieved.

The patients previous breast implants were removed and the breast pockets were revised. Then sizers (similar to saline implants but filled with air instead) are placed to determine the size of breast implant needed to give the patient her desired look. In this patients case an 800cc Saline implant overfilled to 920cc was used in her left breast and a 800cc saline implant overfilled to 960cc was used in her right breast.

The patient was also very unhappy with the appearance of her breasts when she was lying down. To correct this problem Dr. Pousti performed breast pocket revision with internal sutures (internal bra).

Before Surgery

Immediately After Surgery

The patient is very happy with her results.

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Posted in Bottoming Out, Breast Asymmetry, Breast Pocket Correction, Breast Procedures, Breast Reconstruction, Breast Revision Surgery, XL Breast Augmentation

This 33 year old patient from Abbotsford, Canada was post-op breast augmentation surgery performed by a surgeon in Canada in 2008. She was left unhappy with the size and appearance of her breasts and decided to do some research to find a surgeon that was not only board certified but also experienced in revisionary breast surgery. The patient contacted Dr. Pousti via email and after several correspondence and reviewing his work she decided that he was the right surgeon for her breast implant revision.

The patient had silicone gel implants placed above the muscle through an incision under the breast done by her previous surgeon. The patient was not happy about the gap in between the breast, no cleavage, the bottoming out of the implants and the lack off upper fullness.

At the patient’s consultation,Dr. Pousti  took measurements and made markings on the breasts. Dr. Pousti explained the entire procedure to the patient.  In order to give this patient her desired look, Dr. Pousti explained that her current breast implants would have to be removed, pocket correction(internal bra) would be performed and allograft would be used along with saline implants.

The markings are performed the day prior to surgery and are re-checked again the morning of. The red arrows indicate where the patient would like more fullness and the horizontal lines towards the bottom of the breast show where the breast pocket must be closed.

The patients previous silicone breast implants were removed and then measurement were re-checked. After the implants are removed Dr. Pousti performed the capsulorrhaphy (breast pocket revision) by using permanent internal sutures (internal bra) to hold things in place .

In this patient’s case she was a good candidate for Allograft due to her thin skin and lack of  breast tissue.

To give the patient her size goals Dr. Pousti used 650cc Saline implants overfilled to 700ccs in each breast.

During her email correspondence the patient expressed her concerns with the appearance of her breast when she was would lie on her back. To fix this problem Dr. Pousti performed pocket correction.

Before/After (laying on back)

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Posted in Bottoming Out, Breast Pocket Correction, Breast Procedures, Breast Revision Surgery, Overfilled Saline Breast Implants