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Bottoming Out Patients

Ruptured Silicone Gel Breast Implant – Revision Breast Surgery

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This 24  year old from Ohio was interested in breast augmentation revision surgery.  She had a ruptured silicone gel breast implant that she wanted replaced and she wanted to increase her breast size and also wanted her “bottoming out” corrected as well.bilateral removal

As she was doing her research online, she was looking for the best plastic surgeon to perform her revision breast surgery.  She was willing to “fly in for surgery” if she found someone out of her area with the expertise.  She found Dr. Pousti and was very confident in his experience and proceeded to schedule her surgery date.

bilateral breast surgery

After meeting in person and discussing her goals, it was determined that her procedure would involve removal of her breast implants, internal bra (also known as capsulorrhaphy) to improve her breast implant placement on her chest wall and placement with larger silicone gel breast implants.

revision

The above photo shows the markings that are performed prior to surgery.  The “green arrows” indicate where the patient wants more “fullness” after surgery

 

implant exchange

Immediately after breast implant removal (above) and below photos show the ruptured silicone gel breast implant that was removed from the patient.

 

removal replace

capsulorraphy

revisioanry breast surgery

Above photo shows the right side with the capsulorrhaphy performed and a temporary sizer in place.

revision surgery

revision breast surgery

revisionary surgery

Immediately after breast augmentation revision surgery with 450cc silicone gel breast implants.

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Posted in Bottoming Out, Breast Pocket Correction, Breast Revision Surgery, Capsulorrhaphy (Internal Bra), Ruptured Implants


Breast Revision with Internal Bra, ADM and XL Breast Implants

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This 56 mother of 5 previously had breast augmentation surgery with 800cc silicone gel breast implants.  She had been considering revisionary breast surgery for 7  years and wanted to find a plastic surgeon who specialized in breast revision surgery.

re-augemntation

She was not happy with the right breast implant “bottoming out” and wanted “more round, fuller breasts”.  She saw Dr. Pousti’s work and read his reviews and decided to come in for evaluation.

bilateral re-augmmentation saline over filled
After examination and discussion of goals, it was determined that the patient would benefit from the internal bra procedure (also known as capsulorrhaphy) to improve breast implant placement  on her chest wall as well as using saline breast implants and overfilling them to a larger size.  The use of ADM (Acellular Dermal Matrix or Strattice) was also recommended for additional support on the lower pole of the right breast that had bottomed out.

revisionary

Markings and measurements are performed prior to surgery (see above photo) as the goals are discussed again in detail.
revision surgery (2)

Above photo shows the Strattice (ADM) used for this patients surgery.  Below photos show the internal capsule repair performed and temporary sizers in place to evaluate position and size.

capsulorraphy

 

revision

overfilled saline

Above photos show immediately after breast augmentation revision surgery, capsulorrhaphy, ADM and 1100cc overfilled saline breast implants

 

 

 

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Posted in AlloDerm, Bottoming Out, Breast Pocket Correction, Breast Revision Surgery, Capsulorrhaphy (Internal Bra), Overfilled Saline Breast Implants, XL Breast Augmentation


Revision Breast Augmentation with Internal Bra and AlloGraft Use

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This 50 year old patient from Orange County, California had been thinking about revision breast augmentation surgery for many years.  She was unhappy with the results of her previous breast augmentation surgery (performed by a different surgeon).  She did her research to find the best breast revision surgeon to help her achieve her goals.

revision breast surgery

She had implant mal-position – bottoming out and symmastia.  After discussing her goals with Dr. Pousti, it was determined that she would need to have the internal bra (capsulorrhaphy) to improve the bottoming out and symmastia as well as the use of ADM (Acellular Dermal Matrix) for both breasts.Internal Bra

The “green” markings below show the area medially where Dr. Pousti performed the internal capsule work to improve the contour of her cleavage.  He also performed the 2 layered technique with permanent sutures to improve the bottoming out of the breast implants.

breast revision surgery

The patient’s breast implants were removed and capsulorrhaphy was performed and ADM was placed (see below) to have a solid foundation for the placement of the new breast implants.

AlloDerm

Temporary sizers were placed (see below) to evaluate the position, size and symmetry of the breasts before the breast implants are chosen.

bottoming out

Below you see the patient immediately after her revisionary breast surgery with  an amazing improvement.

 

revisionary surgery

revision surgery

revision breast surgery

Breast augmentation revision surgery, correction of breast implant displacement medially and inferiorly, placement of 700cc silicone gel breast implants.

Patient Review:

After having BA and 2001 I was very disappointed with the outcome. I had gone to a doctor in Newport Beach he had put in 700 cc ‘s which I was happy with the size but they were a low profile and wrong for my 27 inch rib circumference. I developed a condition called symmastia, which left me with no cleavage at all, I was very self-conscious about it and couldn’t wear a lot of the cute tops my friends were wearing and only certain bathing suit tops. In 2008 I decided to try to fix this problem I went to a new doctor in Orange County who thought he could fix it I had the surgery and still the symmastia was exactly the same, not only that I obtained an infection which lasted for three months. I lived with this for another 9 years and as my 50th birthday was approaching I thought there has to be surgeon somewhere out there that could make this right, so I began my extensive research spending hours on the internet reading reviews and about different doctors knowledge on the subject. I went to 5 different consultations from Los Angeles to Orange County and the I found him Dr Pousti in La Mesa, even though I live in La Verne I was willing to make the 2 1/5 hour drive to meet him. Everything I read about him was very impressive, he was super knowledgeable and I was very impressed with the before and after photos. I made an appointment and knew right away this was the doctor I had been searching for, he and his staff were amazing. He explained in detail what needed to be done and was confident he could achieve what I was hoping for. He made me feel very comfortable with his experience dealing with the symmastia condition and answered every question honestly, and believe me I had a lot. The whole staff was super friendly and Daisy spent extra time with me showing me many before and after pictures and explaining what to expect during and after the surgery. I can’t say it enough I’m sooooo happy I went with Dr Pousti, he truly is blessed with a talent and a true artist!!!!

After living with this condition symmastia for 15 years I finally found a Doctor Who over exceeded my expectations. Dr. Pousti made me feel 100% confident with his knowledge and experience. The whole experience for me was amazing everybody at the surgery center was awesome and I’ll never forget after I woke up from surgery Dr. Pousti was standing there and told me he was able to give me the best of both worlds, the size I was hoping for and fixed the symmastia, and the bottoming out problem. I was told there was a possibility I would have to downsize to fix the problem and I was prepared for that, but he was able to do both keep my size and fix the problems, amazing!!!! It’s been exactly one week today and I’m feeling great I still have to keep my arms down take it easy but I’m so happy with the results.

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Posted in AlloDerm, Bottoming Out, Breast Pocket Correction, Breast Revision Surgery, Capsulorrhaphy (Internal Bra), Symmastia


Breast Augmentation Revision with Internal Bra, ADM and Overfilled Saline Breast Implants

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This 45 year old from Menifee California had been thinking about revision breast surgery for quite some time.  Her previous breast augmentation surgery (performed by a different surgeon) was performed many years ago and she was now ready to improve the bottoming out of her right breast and also increase breast implant size.

allograft

She was referred to Dr. Pousti by a friend and was very comfortable with Dr. Pousti’s experience with breast augmentation revision surgery as well as the XL breast implant size she wanted.

capsulorrhaphy

After examination and discussion of goals, it was determined that the internal bra (capsulorrhaphy) would be needed and ADM (also known as Strattice or AlloGraft) would be necessary on the right side for additional support.

internal bra

Below is the piece of Strattice used on the patients right breast.

Strattice

XL breast implants

overfilled saline breast implants

breast augmentation revision

Above shows the patient immediately after revision breast surgery with 1100cc overfilled saline breast implants as well as internal bra and ADM used on the right breast.  The incision will flatten / smoothen out as it heals.

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Posted in AlloDerm, Bottoming Out, Breast Pocket Correction, Breast Revision Surgery, Capsulorrhaphy (Internal Bra), Overfilled Saline Breast Implants, XL Breast Augmentation


XL Breast Implants and Correction of Bottoming Out with Internal Bra

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This 33 year old mother of 2 from Arizona was interested in revision breast surgery and had been thinking of this for over 10 years.  She did not like the size, shape, or position of her breasts.  She wanted to address the bottoming out of her right breast implant.  After doing online research to find the best plastic surgeon to help her with her breast implant revision surgery, she found Dr. Pousti and was pleased with his level of experience.

breast surgery

After many emails and discussions, she felt confident and proceeded to fly in for surgery.

revision surgery

Examination was performed and goals were discussed.  This patient wanted XL breast implants and so Dr. Pousti discussed saline overfilled breast implant surgery as well as potential risks associated with larger breasts implants with the patient.  The internal bra procedure was also discussed for correction of her bottoming out.

capsulorraphy

The patient’s silicone gel breast implants were removed.

saline implants

XL

Temporary sizers were placed (below) to determine the best implant size to achieve the patients’ goals after the internal capsule work was performed on the right breast.

saline over filled implants

Below photos show immediately before and after revision breast surgery with 1300cc and 1250cc overfilled saline breast implants.

breast procedure

saline overfilled breast implants

The patient is so pleased with the early outcome of her revision breast surgery.

 

2.22.1

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Posted in Bottoming Out, Breast Pocket Correction, Breast Revision Surgery, Capsulorrhaphy (Internal Bra), Overfilled Saline Breast Implants


Revision Breast Augmentation for Bottoming Out

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This 33 year old patient from Carlsbad, California (Northern San Diego County) previously had breast surgery but was now experiencing implant displacement of her right breast implant and needed revision breast surgery.  She wanted to fix the “bottoming out” and read that the internal bra (capsulorrhaphy) procedure was the best way to correct this.breast procedure

After in person evaluation and discussion of her goals, it was determined that Dr. Pousti would exchange the patient’s breast implants for larger breast implants and also perform the internal capsule work (capsulorrhaphy) on the right breast to improve placement of the breast implant on her chest wall.

capsulorraphy

saline implants

Above shows the markings and measurements of the patient with the “red arrows” indicating where the patient would like “more fullness”.

overfilled saline implants

Above shows the patient after removal of breast implants.

implant exachange

overfill

saline

Above shows the results after removal of 800cc breast implants and replacement with overfilled saline breast implants –1320cc on right side and 1200cc on left side.

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Posted in Bottoming Out, Breast Pocket Correction, Breast Revision Surgery, Capsulorrhaphy (Internal Bra), Overfilled Saline Breast Implants, XL Breast Augmentation


Revision Breast Surgery – Bottoming Out and Lateral Breast Implant Displacement

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This 27 year old from Canada previously had breast augmentation surgery (performed elsewhere) and ha been thinking about revision breast surgery for 5+ years. She was not happy with the “bottoming out” and “lateral displacement” (implants falling out toward her armpits).

breast procedure

She researched for the best plastic surgeon to perform her internal bra procedure as well as to increase her breast implant size.  She had read that Dr. Pousti performs capsulorrhaphy using 2 layers of sutures within the capsule for better placement of the breast implants on the patient’s chest wall.  She thought his technique provided with consistently nice results and so she proceeded to book surgery after her consultation.

capsulorraphy

Dr. Pousti performs markings and measurements prior to surgery and these act as a roadmap during the surgical procedure.

saline

The red “arrows” indicate where the patient is wanting more “fullness”

markings

The capsulorrhaphy is performed on the outer part (lateral aspect) of the breast implant pocket to bring the breast implants more medially (toward the cleavage) as well as under the breast to correct the bottoming out.

markings in office

impalnts

 

Markings and measurements are checked again prior to entering the operating room.

implant displacment

Below shows the patient in the operating room with the temporary sizer in place.  Dr. Pousti uses the temporary sizers to be able to evaluate size, shape and symmetry prior to placement of the breast implants.

revision

Due to the patients’ breast asymmetry, different size breast implants were placed.  Her 450 cc breast implants were replaced with larger high profile saline breast implants- 880cc on the right and 840cc on the left.

breast surgery

Below shows the patient with the steri strips and bolster dressing that will provide support to the area where the internal capsule work is performed.  The bolster dressing is kept in place for the first 4-6 weeks after surgery.

right after surgery

 

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


Internal Bra Technique

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This 33 year old patient from Texas was interested in revision breast surgery with larger breast implants.  She had been thinking about this surgery for over  7 years.  She was also in the medical field and so she researched for the best plastic surgeon to perform her breast augmentation revision surgery.

breast procedure
This patient was interested in the internal bra technique to address the positioning of the breast implants on her chest wall.  She wanted more fullness on top as well.
revision

bilateral breast re-augmentation silicone gel implants
The patient (below) showing the difference with size and fullness of the breasts after her breast surgery.  She is pleased with the early results of her surgery.
bilateral breast capsulorraphy

revision bilateral breast augmentation
Above: showing the patient “before” and immediately after revision breast augmentation with 700cc on each breast ultra high profile

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


Revision Breast Surgery with Use of Strattice and Internal Bra

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This 42 year old from Alpine, California had been interested in breast augmentation revision for quite some time.  Her previous breast surgery (performed by a different surgeon) was many years ago and now the patient was not happy with the size, shape or placement of the breast implants.  She was researching for the best breast augmentation revision surgeon and found Dr. Pousti.

breast augmentation revision

After examination, it was determined that the patient was a good candidate for revision breast surgery that would include revision mastopexy as well as the use of acellular dermal matrix and internal bra.

bilateral breast revision surgery

Markings and measurements were performed prior to surgery and planned procedure was discussed in detail with the patient one more time. Questions were answered and potential risks and complications were reviewed again.

bilateral breast capsulorraphy

 

To achieve the “round / perky” look the patient was wanting, Dr. Pousti discussed capsulorrhaphy and the use of Strattice for additional support.  The capsulorrhaphy procedure involves the use of sutures within the capsule that has formed around the breast implant to adjust the breast implant pocket for better placement on the patient’s chest wall.

bilateral beast augmentation

Above shows the Strattice being placed and below photos show one side completed compared to other side that has not been revised yet.

mastopexy

celular dermal matrix bilateral breast - Copy

bilateral breast re-augmentation silicone gel implants

Above, you will see the patient’s photos before and immediately after revision breast surgery with the use of 750cc ultra high profile breast implants.

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


Reduction of Breast Implant Size with use of Allograft and Internal Bra

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This 31 year old patient from Arizona previously had XL breast augmentation surgery. She was pleased for many years and as time went on, she decided that she would like to downsize her breast implants and proceed with revisionary surgery.  Dr.Pousti believed she would benefit from downsizing of the implants as well as a breast lift and Acellular Dermal Matrix or Allograft.

implant deflation

She and Dr. Pousti discussed proceeding in stages. The first procedure would be to “deflate” the saline breast implants to allow the breast skin to slowly bounce back and redrape.   Once the saline implants are completely deflated, Dr. Pousti will have a better idea of what procedure would be necessary to achieve the patients’ goals.  In order to achieve her goals, she would need to undergo a 2 stage procedure. They would first proceed with a in-office implant deflation and then a few months down the line when her skin has “bounced-back” they would proceed with the revisionary surgery to address her breast implant size, positioning, etc.

implant removal

Below shows the patient after the saline breast implants are deflated.

revisionary breast surgery

breast lift

The patient kept in close contact with the office and a few months down the line, returned for the second stage of her procedure, which would be placement of new, smaller silicone gel breast implants, internal bra (capsulorrhaphy), anchor breast lifting as well as the use of Allograft for additional support and coverage.

breast augmentation

Markings were performed in front of a full length mirror with Dr.Pousti the morning of her surgery. They went over the procedure and her goals once more in detail and answered any last minute questions that the patient may have.

allograft (2)

Allograft was placed in each breast in hopes of additional support to reduce chances of  bottoming out and/or displacement.

internal bra

allograft

During the surgery, the patient’s previous deflated saline breast implants were removed, breast lifting was preformed and 590cc smooth round ultra high profile silicone gel implants and ADM were placed.

The anchor breast lift procedure involves a surgical incision in a ring around the breast’s areola, along with a straight incision going from the bottom of the areola to the middle of the breast crease and an extension of the incision to the left and right underneath the breast crease allowing for maximum breast lifting.

The patient is currently healing very nicely and without any complications.

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Posted in AlloDerm, Bottoming Out, Breast Implant Size Reduction, Breast Lift with Implants, Breast Revision Surgery, Downsizing Breast Implant Size



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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