Breast Reconstruction Patients

This 30 year old from Panorama City, California had breast augmentation performed previously and was interested in breast revision surgery. She wasn’t comfortable returning to her previous surgeon and understood the importance of researching for a new one. She searched the internet for experienced plastic surgeons in California and kept coming across Dr. Pousti’s website. She finally decided to schedule a consultation to meet with him and discuss her options. Her main concerns were her implants settling to the side, asymmetry, shape and overall appearance of her breasts.

During her consultation, she was able to  meet with Dr. Pousti’s previous patients who had revision breast surgery performed by him and was able to ask them questions and see their results. After hearing how pleased all of Dr. Pousti’s patients were with their surgical results, she knew she had found the right surgeon.

Measurements and markings were performed prior to the procedure to promote symmetry and more pleasing results. Upon examination it was determined that the patient’s best option was an implant exchange with capsulorrhaphy. The capsulorrhaphy procedure, also known as pocket correction or use of internal sutures/bra, involves closing a portion of the breast pocket to correct displacement of the implant.

The purple arrows indicate where the patient desired more breast fullness.

Dr. Pousti rechecks the markings of the patient’s breast multiple times prior to surgery and adjustments are made if needed.

Once the patient is in the operating room her previous implants are removed and Dr. Pousti begins work on the breast pockets. The pockets are opened up more towards the center of her chest to help achieve the cleavage she desired. Then internal suture repairs are done on the outer sides of the breast to correct implant malplacement.

After pocket correction is completed sizers are used. Dr. Pousti is able to fill the sizer implants to the patient’s desired look. Once the amount of volume the patient wants is achieved, the sizer implants are removed, and the permanent implants are placed with the correct amount of volume.

Before Breast Revision Surgery/After Breast Revision Surgery

Immediately after surgery, it is apparent the internal suture repair has allowed the implants to sit comfortably towards the center of the patient’s chest rather than falling to the side.

Before Breast Revision Surgery/After Breast Revision Surgery

Before Breast Revision Surgery/After Breast Revision Surgery

Dr. Pousti used Smooth Round Moderate Plus Profile Gel Breast Implants filled to 800cc to achieve the patient’s desired look.

The patient is now 1 week post-op and is very satisfied with her results.

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Posted in Breast Pocket Correction, Breast Procedures, Breast Reconstruction, Breast Revision Surgery, Internal Bra (Internal Sutures), Silicone Gel Implants

This 43 year old from Murrieta, California was interested in a breast lift and breast re-augmentation after her right breast implant had deflated. As a previous patient of Dr. Pousti’s, she knew she wanted to return to him for her revisionary breast surgery.

Upon examination, Dr. Pousti suggested the patient proceed with a two stage surgery meaning she would have her implant removal and mastopexy performed in one surgery and then once healed, a breast augmentation performed. Two stage procedures are often very beneficial to the patient when they are a good candidate. To avoid the risk of infection, breast asymmetry, and mal-position of the implants, the patient trusted Dr. Pousti’s advice and decided to proceed.

Markings were performed for the patient’s current implant removal and breast lifting surgery. The purple “x” indicates where the new nipple/areola complex will be post-surgery. During this time, the first stage of surgery is discussed in detail with the patient.

Before Implant Removal/Breast Lifting

During Implant Removal/Breast Lifting

After the patient’s previous breast implants were removed, the breast are lifted. The breast tissue is rearranged during this time and the nipple/areola complex is repositioned to give the breasts a much “perkier” appearance.

After Implant Removal/Breast Lifting

The patient is extremely happy with her breast lift results and cannot wait to heal to continue with the second stage of surgery consisting of a breast augmentation.

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Posted in 2 Stage Procedure, Breast Augmentation, Breast Lift, Breast Procedures, Breast Reconstruction, Breast Revision Surgery

This 37 year old patient from Menifee, California had a breast augmentation performed in 2000 by a previous surgeon and was very unhappy with her results. The patient did not like the fact that her breasts were very round and hard and at sometimes they were very painful.

After consulting with Dr. Pousti it was determined that the patient had capsular contracture present. This is also known as scar tissue which is formed around the breast implant. When scar tissue is present it can be very painful and if not fixed promptly it can become extremely painful.

After measurements and markings are done the patient is taken into the operating room to begin her revisionary breast surgery. The first step of the procedure is to remove her old breast implants and the scar tissue that has formed around them.

Once the implants and scar tissue is removed the patient’s breast pockets are then revised. Because she was interested in achieving more cleavage the pockets were opened up more in the center of the chest wall to allow for the implants to sit nicely.

Dr. Pousti used 350cc Silicone Gel Implants in the patient’s breasts to meet her size expectations.

Before Revisionary Breast Surgery

Immediately After Breast Revision

She is very happy with the results of her breast surgery.

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Posted in Breast Asymmetry, Breast Pocket Correction, Breast Reconstruction, Breast Revision Surgery, Capsular Contracture

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 22 year old patient from Europe had been very unhappy with the size and shape of her breast and had been interested in breast surgery for several years. After months of research the patient came across Dr. Pousti’s website and decided it was worth the travel from Europe to United States to have him perform her breast reconstruction surgery.  She was told that she had tuberous breasts and after doing her research, found that Dr. Pousti has significant experience with this procedure.

After being examined it was determined that the patient had a severe case of tuberous breast deformity. Tuberous Breasts have a very narrow base and usually a long skin envelope.

The patient and Dr. Pousti meet multiple times prior to surgery to discuss the breast augmentation procedure as well as correction of tuberous breasts. Measurements of the breast are taken and markings are made. These markings are used as guidelines to show where the breast pockets must be made and also indicate where incisions will be.

In severe cases of tuberous breasts, a breast lift can be done through an incision all the way around the areola, making the breast into a more rounded shape. After this is performed a sizer is set in place to determine the size of the implant needed to give the patient her desired look.

In this patients case 450cc Silicone Gel Implants were used to achieve her size goals.

Before Surgery

Immediately After Surgery

The patient is extremely happy with her breast augmentation results and has returned to her hometown in Europe. Dr. Pousti and his staff will keep in touch with the patient with follow ups via email and phone.

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Posted in Benelli Lift, Breast Asymmetry, Breast Procedures, Breast Reconstruction, Tuberous Breast Deformity

This 31 year old patient from Milan, Italy had breast augmentation performed 6 months ago by a surgeon in her country and was unhappy with her results. The patient desired an extra large look with the use of large implants. After being recommended by several colleagues to Dr. Pousti and communicating with him via phone and e-mail the patient decided to travel to San Diego, California to have him perform her revisionary breast procedure.

Measurements of the patients breast are taken prior to the revisionary surgery to determine if there is asymmetry present and to make sure it is accounted for.

Markings of the breast reconstruction surgery are performed in the office and are reviewed along with the entire procedure. In this patient’s case, she was not only looking to increase her breast size but also the outer fullness of her breast and cleavage.

The markings of the patients breasts are rechecked the morning of surgery and adjustments are done if needed. The purple arrow markings indicate where the patient desired more fullness and more projection.  Her left breast implant had also “bottomed out” and needed to have internal sutures placed.

The patient’s previous 274cc Silicone Gel Implants were removed through a periareolar incision.

Once implants are removed a sizer is used to determine the size of the new implant needed to give the patient her desired look. In order to meet this patient’s size goals 425cc High Profile Silicone Gel implants were used in each breast.

Before/After

The patient is very happy with the results of her revisionary breast surgery with extra large high profile augmentation.

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Posted in Breast Procedures, Breast Reconstruction, Breast Revision Surgery

This 27 year old patient from Ohio had been in communication with Dr. Pousti’s office regarding her interest in revisionary breast surgery and specifically correction of her symmastia. The patient had her original breast augmentation performed in 2006 and symmastia correction in 2008 with a previous surgeon. She was left unhappy with her results and decided to do more research to find a qualified surgeon with experience in breast revision surgery.

Symmastia occurs when the muscle between the implants lifts from the sternum causing a ‘breadloafing’ or ‘uniboob’ look.

Prior to the procedure the patient is examined by Dr. Pousti who then takes measurements and does the markings. Markings along with the entire symmastia repair procedure are reviewed with the patient in detail.

The red markings between the breast indicate where the symmastia is present and where correction must take place. To correct symmastia Dr. Pousti sutures the muscle back to the sternum internally.

In some cases, like this patient, the pectoral muscle is very damaged and allograft is needed to help cover the implant.

Symmastia correction can take anywhere from 2-3 hours depending on the complexity of the case.

Patients are asked to bring in pictures of their desired goals which are used in the operating room in conjunction with sizers to determine the size of the implant needed.

Before/After Symmastia Correction

This patient is post op removal of old breast implants, correction of symmastia with the use of internal suturing and allograft and re-augmentation with silicone gel implants.

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Posted in Breast Pocket Correction, Breast Procedures, Breast Reconstruction, Symmastia

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 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 21 year old patient from Fresno, California had been interested in mastopexy surgery for several years and after doing research finally decided to proceed with Dr. Pousti for her breast procedures. The patient had significant asymmetry present which she desired to fix along with breast enlargement using implants.

The patient met with Dr. Pousti in the office so that he could do measurements and discuss the procedure in detail with her. She wanted to increase the upper fullness of her breasts, which Dr. Pousti indicated with the arrow markings.

Dr. Pousti asks his patients to come up with a couple of pictures of breast that the patient likes and dislikes. This poster is brought into the operating room and is placed in an area visable by Dr. Pousti so that he can use it as a reference for the size and look the patient desires.

To give this patient symmetry and more of a perkier look Dr. Pousti performed a breast lift. The breast lifting procedure includes raising the patient’s nipple/areola complex and re-aranging the breast tissue to create firmer/perkier breasts. In some cases the areola is also reduced.

After the lift is performed sizers are placed. These sizers are similar to saline implants but are filled with air to the amount of CC’s that would be best for the patient. After the sizers are placed the incision is temporarily closed and the patient is placed in the sitting position. Once the size of the implant is determined Dr. Pousti removes the sizer and replaces it with the actual saline implant.

When the implants are in place Dr. Pousti places the patient in the sitting position again and compares her current look to the pictures she brought in to make sure that she is getting her desired look. Any adjustments that are needed are made at this time.

Immediately After Surgery

The patient is now only a few days out of surgery and is very happy with her results.

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