Breast Revision Surgery Patients

This 37 year old from Ramona, California was interested in revisionary breast surgery. She was unhappy with her previous breast augmentation results. She was unsatisfied with the shape, placement, and size of her current breast implants performed by another surgeon. She was referred to Dr. Pousti by a close friend of hers after expressing her concerns.

Upon examination, Dr. Pousti determined the patient was suffering from implant mal-position and would benefit from revisionary breast surgery. After discussing the risks and complications associated with implant exchange surgery, the patient decided to continue with the plan of removing her current implants pocket correction and re-augmentation with new breast implants.

Dr. Pousti met the patient again before proceeding to surgery to perform markings. The purple arrows indicate where Dr. Pousti will achieve more fullness to create a more appealing aesthetic result.

The patient and Dr. Pousti meet several times prior to the breast surgery to discuss options. On the final meeting markings of the breasts are done.

Dr. Pousti has the patient stand upright during markings to promote symmetry. He tries his best to achieve the most desirable look possible for all of his patients and understands that each case is unique.

A small incision is then made on the areola to remove the patient’s previous implants. Typically Dr. Pousti will use the previous incision site to avoid additional scaring.

Once the implants are removed, Dr. Pousti is able to repair the pocket and open it up to allow the new implants to settle naturally. Dr. Pousti used the ‘Keller Funnel Method’ to place the silicone gel implants. The Kenner Funnel is a no touch method of inserting breast implants and helps prevent contamination. It also helps reduce the chance of bacteria coming in contact with the implant.

After the new implants have been placed, Dr. Pousti sits the patient in the upright position to assure symmetry has been achieved.

Dr. Pousti used moderate profile plus 750cc silicone implants to achieve the patient’s goals.

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

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Posted in Breast Pocket Correction, Breast Revision Surgery, Silicone Gel Implants

This 22 year old patient from San Diego, California had breast augmentation surgery performed by a previous surgeon and was left with unsatisfactory results. The patient was not happy with the overall appearance of her breasts but the breast shape bothered her the most. She did not feel comfortable returning to her previous surgeon and knew that she would have to do research to find a surgeon that was experienced with revisionary breast surgery. During her search she came across Dr. Pousti several times and was very impressed with the vast amount of experience he had with breast revision procedures.

Upon examination it was apparent to Dr. Pousti that the patient had a severe case of ‘Symmastia’. Symmastia occurs when the skin near the cleavage area separates from the sternum; causing the implants to be malpositioned medially. This can cause the breasts to form a ‘bread-loaf‘ appearance.

The patient and Dr. Pousti meet several times prior to the revisionary breast surgery to discuss options and go over the procedure in detail. In this patient’s case the best option was to go with symmastia repair and an implant exchange. The first step of this surgery is to take measurements of the patients chest and mark the areas where correction is needed.

When the patient is in the operating room she is placed in an upright position and markings are re-checked. If any adjustments are needed they are done at this time. The red area indicates where the symmastia repair will need to be done.

The patient’s current breast implants are taken out through a small incision along the areola. To avoid additional scaring the previous incisions were re-used. Once the implants are removed Dr. Pousti begins work on the ‘breast pocket’. A breast pocket is an open pocket created under the muscle where the breast implants sits.

During symmastia repair Dr. Pousti uses internal sutures to re-attach the skin to the sternum in the center of the patient’s chest. Sizers are then used to determine the size of the implant Dr. Pousti will need to use in order to achieve the patient’s desired look.

300cc Silicone Gel Implants were used in both breast to meet her goals.

As you can see when the patient is in a lying down position the symmastia correction has improved the appearance of the chest and the patient no longer has ‘tenting‘ present.

After the procedure is completed, bolster dressings are applied. The dressings help add support to the internal sutures and help ensure that implant malplacement does not reoccur.

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A “thong bra” is then given to patient to wear post surgery and is used to stabilize the area after symmastia reconstruction. This will allow the sutured area between the breasts to heal properly without excessive pressure being applied.

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Posted in Breast Augmentation, Breast Pocket Correction, Breast Procedures, Breast Revision Surgery, Silicone Gel Implants, Symmastia

This 30 year old from Apple Valley, California was interested in revisionary breast surgery. She was unsatisfied with her results from her previous surgeon. She did not like the shape, size, or placement of her breast implants and she also suffered from implant malposition resulting in symmastia. She researched the internet for experienced breast revision surgeons and found Dr. Tom Pousti. After reviewing many symmastia and breast revision repair cases, she felt optimistic that he would be able to achieve the same results with her and decided to drive to see Dr. Pousti.

Upon examination, Dr. Pousti determined the patient not only had symmastia, but “bottoming out” of her implants as well. Symmastia appears when two implants are touching one another often creating a “uni-boob”. Symmastia often happens if the horizontal muscle that is connected to the sternum is cut during surgery and after overly aggressive attempts to achieve cleavage are made.

The patient and Dr. Pousti met again to discuss the procedure in detail along with recovery. Markings were done the night prior to surgery and were reinforced the morning of surgery. In order to achieve her desired look, internal sutures were used to repair her cleavage area and to also create an “internal bra” for the new position of the implants and to fix the bottoming out of the implants.

Dr. Pousti removed the patient’s previous implants through a small incision of the areola.

Immediately After Symmastia and Bottoming Out Repair

He replaced the patient’s previous implants with 475cc Silicone Gel Breast Implants. After repairs were made, the patient has two distinct breast pockets.

Bolster dressings are worn for several weeks to protect the repaired area during recovery.

The patient is very happy with her results.

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Posted in Breast Augmentation, Breast Procedures, Breast Revision Surgery, Internal Bra (Internal Sutures), Silicone Gel Implants, Symmastia

This 38 year old from San Diego, California was interested in revisionary breast surgery and revision of her previous abdominoplasty. She was unsatisfied with the results of her surgeries and did not feel comfortable returning with her previous surgeon. She began researching experienced plastic surgeons in the San Diego County. After reading about double board certified Dr. Tom Pousti, the patient and her husband decided to meet with him in person.

During her consultation, Dr. Pousti examined the patient and felt she would benefit from a two stage procedure. A two stage breast procedure often has less risks and complications then performing a breast lift and breast augmentation at once. The patient decided she wanted to proceed with implant removal, mastopexy, and tummy tuck revision procedures and once healed she would then continue with a breast re-augmentation.

Dr. Pousti met with the patient the night prior to surgery to perform markings and discuss the implant removal and mastopexy procedures in detail. The patient was also unhappy with the bunched up skin on her lower abdomen. Dr. Pousti agreed the patient would benefit from removal of her current adipose tissue on her lower abdomen.

In the operating room, Dr. Pousti removed the patient’s previous implants and performed a breast lift. The patients right breast was temporarily stapled together until comparisons between the left and right breast can be made while the patient is now only lying down, but also sitting up. Once the breasts are symmetrical final suturing is done.

Since the patient decided to proceed with a two stage surgery, once she is healed from her breast lift, she will continue with her breast re-augmentation.

The patient is extremely satisfied with the results from her implant removal, breast lift, and tummy tuck revision surgeries and cannot wait for her breast re-augmentation in the near future.

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Posted in 2 Stage Procedure, Breast Lift, Breast Revision Surgery, Revisionary Tummy Tuck

This 39 year old from Chula Vista, California had been interested in revisionary breast surgery. She had experienced a deflation to her right breast implant and was extrememly unsatisfied with the unevenness of her breasts. The patient understood the importance of finding a board certified surgeon and after researching the internet she found double board certified surgeon, Dr. Pousti. She felt his experience with removing and replacing implants outweighed that of any other surgeon.

The patient met with Dr. Pousti several times, and wanted him to perform her breast re-augmentation procedure. Dr. Pousti discussed all of the risks and complications associated with a breast revision surgery.

Before Implant Exchange

The asymmetry of the patient’s current breast implants are extrememly noticeable. Even while the patient was wearing clothes, she felt extrememly uncomfortable.

Once the patient is in the operating room her previous breast implants are removed through a small incision along the areola. Sizers are then set in the breast pockets to determine the size of the breast implant need to meet the patient’s desired look.

After Implant Exchange

Dr. Pousti replaced the patient’s previous implants with 600cc Silicone Implants. The patient is still very fresh from surgery but is extremely happy with the results of her revisionary breast surgery.

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Posted in Breast Asymmetry, Breast Augmentation, Breast Procedures, Breast Revision Surgery, Implant Removal, Silicone Gel Implants

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 24 year old patient from Livermore, California had been interested in revisionary breast surgery after she was left with unsatisfactory results from her previous surgeon.  After doing further research she came across board certified plastic surgeon Dr. Pousti and was impressed with his experience with breast revision surgery and decided that it was worth the travel to have him perform her surgery.

The patient was also interested in extra large implants and was having difficulty finding surgeons willing to go over 800ccs.

Prior to her surgery the patient and Dr. Pousti meet several times to discuss revisionary options and the breast procedure in detail. The last appointment before surgery measurements of the patient’s breasts are taken and markings are made. The markings are rechecked again in the operating room and adjustments are done if needed.

For the first step of the revisionary breast surgery the patient’s previous breast implants are removed.

Once the implants are removed Dr. Pousti revises the breasts pockets for the new implants. The patient had expressed that she was unhappy with the appearance of her breasts while she was lying down. To fix this Dr. Pousti used internal sutures to prevent the implants from falling to the sides. Sizers are then used to determine the size of implant needed to meet the patient’s size goals.

Before/After Implant Exchange with Overfilled Implants and Pocket Revision

800cc Saline implants overfilled to 1530ccs were used in this patient and she is extremely happy with the initial results of her surgery.

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

This 21 year old patient from Lakeside, California was interested in removing her current implants and replacing them with much larger implants. She decided to proceed with Dr. Pousti for her breast procedure after finding out that he was very experienced with plastic and reconstructive surgery. She had procedures performed by him before and felt very comfortable with his work.

During her visit with Dr. Pousti extra large breast augmentation options were discussed. Upon examination, Dr. Pousti felt it would be in the patient’s best interest to also have her breasts lifted during her surgery to achieve an overfilled perky look.

The patient decided to continue with breast re-augmentation and breast lift. The patient met with Dr. Pousti to take measurements and perform markings so symmetry would be achieved.

Below, it is very apparent that the right breast is “perkier” than the right after lifting and replacing the implant. The right breast is temporarily stapled until comparisons between the two breasts can be made and symmetry is achieved, following final sutures.

Dr. Pousti used Smooth Round Moderate Plus Profile Saline Implants filled to 1050cc on the right and 1100cc on the left. The left breast was overfilled slight larger than the right to achieve symmetry.

The patient is very happy with her breast lift and extra large breast augmentation results.

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Posted in Breast Augmentation, Breast Lift, Breast Lift with Implants, Breast Procedures, Breast Revision Surgery, Overfilled Saline Breast Implants, XL Breast Augmentation

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 22 year old from Santa Clara, California (Northern California) was interested in revisionary breast surgery after being left unsatisfied with her results from her breast augmentation with a previous surgeon due to asymmetry and bottoming out . She realized how important choosing her surgeon was and researched online for a board certified plastic surgeon who had experience with breast augmentation revision. She found Dr. Pousti, a double board certified plastic surgeon, and after reviewing his website containing “before” and “after” photos of revisionary patients, she decided to schedule a consultation to meet with Dr. Pousti.

At her consultation, she was able to meet with patients of Dr. Pousti’s, who underwent a similar surgery and talk to them in private about their experience.  Talking with Dr. Pousti’s patients in person and viewing their results showed the patient how confident Dr. Pousti is with his work. With careful thought, the patient felt comfortable proceeding to surgery with Dr. Pousti. The patient met with Dr. Pousti again to discuss the surgical plan tailored to meet her goals. Markings were meticulously performed with accuracy.

To correct the patient’s asymmetry and bottoming out Dr. Pousti felt revisionary breast surgery including internal sutures (internal bra) would be in the patient’s best interest. The capsulorrhaphy procedure, also called internal sutures, consists of pocket correction, where a portion of the breast pocket is closed, which will correct displacement of the implant, the cause of asymmetry and bottoming out.

Before Breast Revision

Patient had “bottoming out” present on her right breast, creating asymmetry.

Removal of The Original Implants

One incision was made on each breast and the original breast implants were removed and internal sutures were used to repair the breast pocket and to create the new breast fold. The old implants were replaced with silicone gel implants placed below the muscle.

After Breast Revision

Capsulorrhaphy was performed.

Before Breast Revision

When the patient is laying flat, the breasts will fall to the side.

After Breast Revision

When the patient is laying flat, her breasts now remain in the center of her chest.

Bolster dressings are applied for additional support to the sutured breast pocket.

The patient is still very fresh from her surgery, but is extrememly pleased with the intial results from her breast revision procedure.

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Posted in Breast Pocket Correction, Breast Revision Surgery, Internal Bra (Internal Sutures), Sub-glandular Breast Augmentation