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Breast Asymmetry Patients

Mommy Makeover with Use of AlloDerm

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This 35 year old patient from Canyon Lake, California, desired breast revision surgery and an abdominoplasty to achieve better proportions and feel more comfortable in her skin. She was referred to Dr. Pousti through a good friend of hers who is also a very satisfied previous patient. At her consultation, the patient received the opportunity to meet with Dr. Pousti, discuss the procedures of interest, and see hundreds of before and after photos from the double board certified surgeon.

before benelli lift and implant exchange with use of alloderm and abdominoplasty

She was post previous breast augmentation and presented with implant encapsulation, breast asymmetry, and a desire to improve breast size, shape, symmetry, and feel. Dr. Pousti recommended a stage 1 (Benelli) breast lift in order to raise the position of the areola and achieve a better outcome. After 3 pregnancies, the patient presented with excess skin and adipose tissue of abdominal wall associated with abdominal wall laxity.
side view before benelli lift and implant exchange with use of alloderm and abdominoplasty
The markings for the procedure are completed the evening prior to surgery and the measurements are double checked the following morning. The patient is able to express any last minute questions and the procedure is discussed between the patient and the doctor one last time.
markings for benelli lift and implant exchange with use of alloderm and abdominoplasty
The patient was experiencing capsular contracture which is excessive scar tissue buildup around the breast implant post surgery. The cause of capsular contracture is unknown, but it is the most common complication with breast augmentation surgery. There are different grades of capsular contracture ranging from mild to severe.
benelli lift and implant exchange with use of alloderm and abdominoplasty
The rate of capsular contracture has decreased from 20-30 years ago when all breast implants were placed above the muscle (sub-glandular). By placing the breast implants below the muscle (sub-muscular), the rate of capsular contracture has significantly decreased. Also, it is said that massaging of the implants helps decrease the chance of capsular contracture. When a patient is believed to be developing capsular contracture or hardening of the breasts, they may be placed on a medication called Accolate. This is an asthma medication that has shown to improve capsular contracture in patients at an early stage. When a patient develops severe capsular contracture, the treatment would be to return to the operating room and perform a capsulectomy on the patient.
implants from benelli lift and implant exchange with use of alloderm and abdominoplasty
AlloDerm, also known as ADM or is an acellular dermal matrix, derived from donated human skin tissue. Since AlloDerm is regarded as minimally processed and not significantly changed in structure from the natural material, the FDA has classified it as banked human tissue. It has been shown to reduce and even prevent the chance of capsular contracture from occurring.
allograft for benelli lift and implant exchange with use of alloderm and abdominoplasty
The Allograft is placed between the breast implant and the patients skin to add another layer of support.
alloderm for benelli lift and implant exchange with use of alloderm and abdominoplasty
Below, the abdominal muscle is show prior to the muscle correction. The black lines represent where the muscle will be brought together and repaired.
muscle repair for benelli lift and implant exchange with use of alloderm and abdominoplasty
The excess skin is removed to help the patient achieve her goals.
removal of excess skin for benelli lift and implant exchange with use of alloderm and abdominoplasty
The patient is shown immediately post Mommy Makeover and has bilateral 750cc Natrelle Silicone Gel Breast Implants.
before and after benelli lift and implant exchange with use of alloderm and abdominoplasty

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Posted in Abdominoplasty, AlloDerm, Benelli Lift, Body Contouring, Breast Asymmetry, Breast Lift, Breast Procedures, Breast Revision Surgery, Capsular Contracture, Limited Lift (Benelli Lift), Mommy Makeover


Breast Procedures and Body Contouring

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This patient from San Diego, California was interested in breast revision surgery in order to achieve better results due to her unhappiness with her results from another surgeon. She desired to correct the asymmetry in her breasts. Breast asymmetry is a condition where one breast is noticeably larger than the other. Patients may start with different sized breasts before surgery (most patients are not perfectly symmetrical). Some cases of breast asymmetry are more severe than others, but there are several surgical options to promote better symmetry. Different types of implants may be used, different volumes may be used to fill up the breast implants, or changes in the pocket dissection may be used to help achieve as much symmetry as possible.1. Before implant exchange and correction of breast pocket

She was originally referred to Dr. Pousti through internet research for a board certified plastic surgeon who could help her achieve her goals.

1. side view before  implant exchange and correction of breast pocket

The red lines represent where the patient desires to have more upper fullness.

1.  markings before implant exchange and correction of breast pocket

Her current implants are removed.

1. implant exchange for  implant exchange and correction of breast pocket

Dr. Pousti uses new saline breast implants to achieve the size and shape that the patient desired.

1.after  implant exchange and correction of breast pocket

9 months later, the patient decided that she desired to have a larger look.

2. Before adding cc's

She was already familiar with Dr. Pousti and impressed from her previous experience and decided to return to Pousti Plastic Surgery to help reach her goals.

2. side view before adding cc's

Her implants are removed and replaced to achieve 1420cc (right) and 1540cc (left) XL saline breast implants.

2. adding cc's

16 months post her XL breast augmentation surgery, the patient returned and desired to tighten her abdominal muscles through a tummy tuck. Since this is a specialty of Dr. Pousti’s, she again returned to him to help her achieve her goals.

3. before tummy tuck

Post-pregnancy issues are very common. Having a child is one of the most fulfilling experiences a person can have, with new life and energy to any family. Some women, however, feel somewhat self conscious about their new body post-pregnancy with symptoms including stretching or sagging of stomach muscles & skin, sagging or drooping breasts, breast deflation, weight gain in mid-section, thighs, & stomach, excessive fat deposits, and/or C section pouch.

3. side view before  tummy tuck

Dr. Pousti performs the markings for the surgery and discusses the procedure with the patient.

3. markings for  tummy tuck

Below, the abdominal muscle is repaired so that the core of the patient will tighten.

3.  tummy tuck

Her excess skin is removed in order to help her achieve her goals.

3. removal of excess skin for  tummy tuck a

6 months after her tummy tuck procedure, the patient desired to downsize her breasts. Dr. Pousti punctured each breast implant in 2 locations ad allowed the sterile water  of the implants to be absorbed by the body. The patient returned 4 months post that procedure and was ready to have her implants removed. Dr. Pousti recommended a breast lift and revision of her tummy tuck scar. The patient proceeded with surgery.

4. before breast lift, revision of tummy tuck scar, and lipo of abdomen

Again, the patient felt confident is choosing Dr. Pousti to help her achieve her goals.

4. side view before breast lift, revision of tummy tuck scar, and lipo of abdomen

The markings were performed the morning of surgery.

4. markings for breast lift, revision of tummy tuck scar, and lipo of abdomen

The breast is temporarily closed and a drain is put in place to prevent excess fluid buildup.

4. sizer for breast lift, revision of tummy tuck scar, and lipo of abdomen

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Posted in 2 Stage Procedure, Abdominoplasty, Body Contouring, Breast Asymmetry, Breast Lift, Breast Procedures, Breast Revision Surgery, Implant Exchange, Implant Removal, Liposuction, Overfilled Saline Breast Implants, XL Breast Augmentation, implant deflation


Mommy Makeover with Benelli Lift

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This 34 year old patient from San Diego, California, desired to have a mommy makeover procedure performed because she was unhappy with the look of her body after children. While looking online and researching for the most skilled plastic surgeon, she came across double board certified, Dr. Pousti. She came in for a consultation and determined she would be a good candidate for tummy tuck.before mommy makeover- tummy tuck and breast augmentation with stage 1 lift

He also recommended breast augmentation with the use of silicone gel breast implants and a benelli (stage 1) breast lift to help her achieve more fullness and cleavage with perky breasts. She proceeded with surgery.

side view before mommy makeover- tummy tuck and breast augmentation with stage 1 lift

The markings were performed the morning of surgery and the procedure was discussed in details to ensure there was clear communication between the patient and Dr. Pousti.

markings for mommy makeover- tummy tuck and breast augmentation with stage 1 lift

The abdominal muscle wall is repaired to help tighten the core of the patient.

muscle repair mommy makeover- tummy tuck and breast augmentation with stage 1 lift

Below is after the muscle repair is completed.

mommy makeover- tummy tuck and breast augmentation with benelli lift

Excess skin is removed from the patient to help her achieve her goals.

mommy makeover- tummy tuck and breast augmentation with stage 1 lift

The patient is shown immediately post surgery with bilateral 435cc silicone gel breast implants. She will recover for 4 weeks and continue to return to Dr. Pousti for follow-up.

after mommy makeover- tummy tuck and breast augmentation with stage 1 lift

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Posted in Abdominoplasty, Benelli Lift, Body Contouring, Breast Asymmetry, Breast Lift, Breast Procedures, Limited Lift (Benelli Lift), Mommy Makeover


Use of AlloDerm to Correct Implant Displacement and Palpability/Rippling

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This 59 year old patient from Nebraska flew in to have breast revision surgery performed by double board certified plastic surgeon, Dr. Pousti. She was unhappy with the the breast asymmetry she was experiencing. The patients right breast had significantly more volume than the left breast. On her left breast, the patient experienced implant displacement inferior with an area of significant palpability/rippling under her breast.before implant exchange with internal bra and use of acellular dermal matrix

She found Dr. Pousti while researching online for a board certified and skilled surgeon who could help her correct the problems she was having with her breasts.

side view before implant exchange with internal bra and use of acellular dermal matrix

Below shows the area of significant palpability/rippling under her breast.

implant exchange with internal bra and use of allograft

Her current implants are removed so they can be replaced with new implants.

implant exchange with internal bra and use of acellular dermal matrix

A sizer is used on the right breast to help Dr. Pousti determine which implant size would be the most beneficial in achieving the patients goals.

sizer for implant exchange with internal bra and use of acellular dermal matrix

AlloDerm, also known as ADM or is an acellular dermal matrix, derived from donated human skin tissue. Since AlloDerm is regarded as minimally processed and not significantly changed in structure from the natural material, the FDA has classified it as banked human tissue. AlloDerm is made from donated human skin. It is handled in much the same way as other transplantable organs. The tissue is processed to remove cells that might cause your body to reject the foreign tissue or react negatively to it. What’s left is the 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. This AlloDerm will help correct the palpability/rippling under the left breast.

allograft for implant exchange with internal bra and use of acellular dermal matrix

alloderm for implant exchange with internal bra and use of acellular dermal matrix

Below, the patient is immediately post surgery and has 1100cc (right) and 1050cc (left) XL saline overfilled breast implants.

after implant exchange with internal bra and use of acellular dermal matrix

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


AlloDerm to Correct Skin Deformity

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This 42 year-old patient from Van Nuys , California wanted breast revisionary surgery. The patient previously had breast augmentation surgery, performed by another surgeon but the patient was unhappy with the scar tissue formation and wanted breast augmentation revision surgery. After many years of living with this issue, the patient decided to research for the best Board Certified Plastic and Reconstructive Surgeon in San Diego and found Dr. Pousti on the Internet. The patient reviewed many of Dr. Pousti’s before and after pictures and decided to meet with Dr. Pousti. Dr. Pousti met with the patient and after examination determined the patient had encapsulation present in the left breast. Encapsulation, also called capsular contracture occurs when an excessive amount of scar tissue forms around the breast implant creating a capsule resulting in hard and painful breasts. Dr. Pousti recommended the patient have an implant exchange and capsulectomy procedure performed. After breast augmentation with breast implants, excessive scar tissue may form around the breast implant which causes the breast implants to harden (similar to what a contracted muscle feels like). The cause of capsular contracture is not known but it is the most common complication with breast augmentation surgery. There are different grades of capsular contracture from mild to severe. The rate of capsular contracture has decreased from 20-30 years ago when all breast implants were placed above the muscle (sub-glandular). By placing the breast implants below the muscle (sub-muscular), the rate of capsular contracture has significantly decreased. Also, it is said the massage helps decrease the chance of capsular contracture. before breast augmentation with use of allograft

After the incision was made on the patient’s areola to remove her left breast implant there was purulent fluid (pus) present that needed to be removed. Due to the unexpected findings breast implant removal of both sides was performed. Dr. Pousti felt that it was best not to proceed with re-augmentation until she is completely healed and infection free. 7 months later, the patient returned with interest of having breast re-augmentation performed to achieve her goals.

side view before breast augmentation with use of allograft

At her consultation, Dr. Pousti recommended the use of Acelluar Dermal Matrix to prevent encapsulation from occurring again and also to correct the skin deformity that was occurring on the left breast.

markings for breast augmentation with use of allograft

The markings were performed prior to surgery and the procedure was discussed in detail between the doctor and the patient.

alloderm for breast augmentation with use of allograft

AlloDerm, also known as ADM or is an acellular dermal matrix, derived from donated human skin tissue. Since AlloDerm is regarded as minimally processed and not significantly changed in structure from the natural material, the FDA has classified it as banked human tissue. AlloDerm is made from donated human skin. It is handled in much the same way as other transplantable organs. The tissue is processed to remove cells that might cause your body to reject the foreign tissue or react negatively to it. What’s left is the 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. Using this Acellular Dermal Matrix will help prevent the capsular contracture and correct the skin deformity.

breast augmentation with use of allograft

breast augmentation with use of alloderm

The patient is shown  weeks post surgery and very happy with her results.

after breast augmentation with use of allograft

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Posted in AlloDerm, Breast Asymmetry, Breast Procedures, Breast Revision Surgery


Correction of Chest Wall Asymmetry

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This 41 year old patient from California was interested in breast augmentation surgery in order to achieve more full breasts. She also desired to camouflage her chest wall asymmetry that she has had her whole life. This condition is called pectus excavatum. In pectus excavatum, also known as funnel chest, the sternum (breastbone) is depressed relative to the rest of the chest wall. Breast implants can be used to camouflage mild to moderate pectus excavatum.  Sometimes also referred to as asymmetric breast hypoplasia.

Before breast augmentation with pectus excavatum-chest wall asymmetry

Dr. Pousti has considerable experience with using breast implants to improve the appearance of the chest wall for patients with pectus excavatum. While researching, this patient felt confident in utilizing Dr. Pousti’s board certification and skill in breast augmentation to help her achieve her goal of larger breasts with less attention drawn to her chest asymmetry.

side view before breast augmentation with pectus excavatum-chest wall asymmetry

She came in for her consultation and was able to view hundreds of before and after photos in addition to meeting with Dr. Pousti.

angled view before breast augmentation with pectus excavatum-chest wall asymmetry

In the above photos as well as below, the chest wall asymmetry is demonstrated and indention is demonstrated.

breast augmentation with pectus excavatum-chest wall asymmetry

The patient is immediately post surgery and has 380cc (right) and 350cc (left) silicone gel breast implants.  Differential breast implant sizes are used to improve the breast asymmetry.

after breast augmentation with pectus excavatum-chest wall asymmetry

side view after breast augmentation with pectus excavatum-chest wall asymmetry

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Posted in Breast Asymmetry, Breast Procedures, Pectus Excavatum


Breast Lift with Implants

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This 24 year old patient from North Hills California was interested in breast augmentation surgery to achieve larger breasts with more fullness and cleavage.  She wanted to address her breast asymmetry as well.before mastopexy

While searching for the best plastic surgeon who was board certified to perform her surgery, she found Dr. Pousti.

side view before mastopexy

At her consultation, Dr. Pousti recommended also adding a breast lift with the augmentation. This would help the patient achieve the fullness she desired by raising her areolas and removing excess skin. The patient proceeded with surgery. Below, the sizer is used during the surgery to help Dr. Pousti best reach symmetry as well as the patients goals.

breast mastopexy

The patient is immediately post surgery and has 434cc (right) and 465cc (left) silicone gel implants. The difference in implant sizes helps the patient reach better breast symmetry.

after breast mastopexy

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Posted in Breast Asymmetry, Breast Lift, Breast Lift with Implants, Breast Procedures


Breast Asymmetry

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This 30 year old patient from Alaska had been interested in breast surgery for quite some time.  She not only wanted larger, more “perky” breasts but she wanted to address her breast asymmetry as well.  She decided to fly to San Diego to have her breast augmentation and breast lift procedure performed by Dr. Pousti because of his expertise with breast surgery procedures.before breast augmentation with lift

She was referred to Dr. Pousti from a satisfied previous patient. At her consultation, she met with Dr. Pousti and learned more about the procedure she was interested in, as well as viewing hundreds of before and after pictures of Dr. Pousti’s work. She felt confident in his double board certification and scheduled her surgery.

side view before breast augmentation with lift

Dr. Pousti discussed her breast asymmetry and determined that he would need to perform a benelli breast lift (incision around the areola) on her right side but a more extensive breast lift on her left side to achieve as much symmetry as possible.  The patient understood that perfect. Her markings were performed the night before surgery and were reviewed and discussed again the following morning.

markings for breast augmentation with lift

The “x” below represents where the areola is planned on being after surgery.

breast augmentation with lift markings

Below, the patient is in the midst of the breast lifting procedure. Her right breast only needed a stage one breast lift while her left breast needed a stage two breast lift.

breast augmentation with lift

The patient has bilateral 545cc high profile silicone gel implants.

breast augmentation with lift after

after breast augmentation with lift

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Posted in Areola/Nipple Procedures, Benelli Lift, Breast Asymmetry, Uncategorized


Revision Breast Augmentation with Capsulectomy and Internal Bra

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This 29 year old patient from Honolulu, Hawaii, flew in to have breast augmentation revision surgery performed by Dr. Pousti. She was unhappy with the results of a surgery previously performed by another surgeon. She desired to achieve her fullness and better shaped breasts.Before implant exchange with capsulectomy and capsulorrhaphy

She found Dr. Pousti while looking for the best plastic surgeon who specialized in breast revision surgery and had obtained a board certification.

Side view before implant exchange with capsulectomy and capsulorrhaphy

After communication via e-mail with Dr. Pousti, the patient decided to schedule surgery. Her pre-op visit was performed the day before surgery and the markings were completed the following morning. The surgery was discussed in details.  She had scar tissue that needed to be released on her left side.

Markings for implant exchange with capsulectomy and capsulorrhaphy

The implants were removed to prepare the breast for replacement and re-augmentation.

implant exchange with capsulectomy and capsulorrhaphy

Below, the patient is immediately post surgery and has bilateral 395cc silicone gel high profile implants.  The “red” line indicates where the scar tissue was released to help improve the breast shape and feel.

after implant exchange with capsulectomy and capsulorrhaphy

side view after implant exchange with capsulectomy and capsulorrhaphy

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Posted in Breast Asymmetry, Breast Procedures, Breast Revision Surgery, Capsular Contracture, Capsulorrhaphy (Internal Bra), Implant Exchange


Breast AugmentationRevision with Internal Bra

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This 29 year-old patient from Los Angeles, California was interested in breast revision surgery.  She previously had breast augmentation surgery in 2003 and breast revisionary surgery in 2008 (both preformed by another surgeon). She was unhappy with her results due to breast asymmetry, size and bottoming out of one side.

implant displacement

She had done a lot of research on who was the best plastic surgeon for revisionary breast augmentation surgery in Southern California and found Dr. Pousti. After seeing the results that Dr. Pousti had achieved for other patients in the same situation, this patient decided to proceed with revisionary breast augmentation surgery.  After meeting with Dr. Pousti, her breast augmentation revision was discussed.  Internal sutures (Capsulorrhaphy) would be used to improve the placement of the breast implants and the breast asymmetry.

implant exchange

Markings were carefully drawn out in detail, the morning of surgery. The arrows show the fullness that the patient wants to achieve.

capsulorrhaphy

Capsulorrhaphy (internal sutures) will be preformed to help with breast implant inferior and lateral displacement (see how the implant falls off to the side when the patient is laying down?)

internal bra breast revision

Before and immediately after breast revisionary surgery

breast revision

immediately after breast revision (side view)

breast revision with internal sutures

The patient’s old implants were removed and 800cc silicone gel implants were used to achieve the patient’s desired look.

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Posted in Breast Asymmetry, Breast Revision Surgery, Capsulorrhaphy (Internal Bra), Implant Exchange



Pousti Plastic Surgery Center
Pousti Plastic Surgery of San Diego
8851 Center Drive, Suite 300
La Mesa, California 91942
Phone: (619) 466-8851 or Email
 
Dr. Tom Pousti is a San Diego and La Jolla Plastic Surgery specialist. He has provided plastic surgery treatments to many San Diego and La Jolla facelift, tummy tuck, liposuction, breast augmentation, and rhinoplasty patients. His office is located in San Diego, and also serves the La Jolla, Riverside, Inland Empire and Temecula areas. Disclaimer


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