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San Diego Cosmetic Plastic Surgery

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Bottoming Out Patients

Allograft and Internal Bra for Bottoming Out Correction

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This 52 year old female from San Marcos, California was status post breast augmentation and breast revision surgeries.  She was unhappy with the displacement of her breasts implants (bottoming out) and the double bubble. She was referred to Dr. Pousti, a San Diego double board certified plastic surgeon.before implant exchange with capsulorrhaphy and use of alloderm

At her consultation, Dr. Pousti determined that the patient would be a good candidate for implant exchange and an internal bra. 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.

oblique view before  implant exchange with capsulorrhaphy and use of alloderm

The patient felt confident and proceeded with surgery. The procedures, possible risks, and goals were discussed between Dr. Pousti and the patient.

side view before  implant exchange with capsulorrhaphy and use of alloderm

Dr. Pousti makes proper markings to ensure that he achieves the best possible results.

markings for  implant exchange with capsulorrhaphy and use of alloderm

The patient’s previous implants are removed and an intra-operative sizer is used  for determining the best implant to use.

implant exchange with capsulorrhaphy and use of alloderm

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. Dr. Pousti used this to help with skin irregularities and support for bottoming out.

allograft

This patient is shown below with bilateral 1150cc XL Saline overfilled breast implants.

after  implant exchange with capsulorrhaphy and use of alloderm

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Posted in AlloDerm, Bottoming Out, Breast Revision Surgery, Capsulorrhaphy (Internal Bra), Double Bubble


Revision Breast Surgery with Internal Bra

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This 30 year old patient from New Jersey flew in to have her breast revision surgery performed by double board certified Dr. Pousti. After surgery (performed by another surgeon) the patient was unhappy with the size, rippling, and implant displacement she was experiencing. While doing online research, she found Dr. Pousti on websites such as realself.com and makemeheal.com.before implant exchange with capsulorrhaphy

She communicated with Dr. Pousti via email and decided to fly in for her procedure. At her consultation, Dr. Pousti recommended how he would correct her problem. He would start by removing her current implants to be later replaced with new ones. Then, he would correct and close off the pocket with capsulorrhaphy to achieve more upper fulness and position the areola correctly. He would then replace her breasts with larger silicone implants to prevent any rippling and achieve the patients size goals.

side view before implant exchange with capsulorrhaphy

The markings were performed the morning of surgery and the procedure was reviewed.

markings for implant exchange with capsulorrhaphy

The patient brought goal photos with her, as seen below, so that Dr. Pousti could reference them during her surgery and help achieve as close to the look the patient desired as possible.

goals for implant exchange with capsulorrhaphy

Her current implants were removed.

implant removal for implant exchange with capsulorrhaphy

A sizer is used to determine which implant will be used.

sizers for implant exchange with capsulorrhaphy

Below, the patient is shown immediately post surgery and has bilateral 695cc silicone gel breast implants.

after implant exchange with capsulorrhaphy

side view after implant exchange with capsulorrhaphy

The patient is shown only a few days post surgery. The bolster dressing will remain under her breasts for 4 weeks to allow the internal sutures to heal.

post implant exchange with capsulorrhaphy

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


Internal Bra to Correct Bottoming Out

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This 33 year old patient from New York flew in to have breast revision surgery performed by double board certified plastic surgeon Dr. Pousti. She desired to have breast pocket correction and achieve larger breasts. before remove-replace silicone gel with internal sutures

She came across Dr. Pousti while researching online for the most skilled surgeon to help her achieve her goals. She found google and realself very helpful in her process of research. She contacted Dr. Pousti via email and decided to proceed with surgery.

side view before remove-replace silicone gel with internal sutures

The markings were done the morning before surgery. The red arrows represent where the patient desires more upper fulness. In order to assist in achieving this, Dr. Pousti recommended using capsulorrhaphy (internal sutures). 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.

markings for remove-replace silicone gel with internal sutures

Her implants were removed so that she could have them replaced with new ones.

remove-replace silicone gel with internal sutures

The sizer is used to help Dr. Pousti determine the best size implants to use to help the patient achieve more upper fullness.

sizer for remove-replace silicone gel with internal sutures

The patient is immediately post surgery and has 595cc silicone gel high profile breast implants.

after remove-replace silicone gel with internal sutures

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


XL Breast Implants with Correction of Bottoming Out

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This 37 year-old patient from Carlsbad, California was interested in breast augmentation revision surgery. She previously had breast augmentation surgery (preformed by another surgeon) but was unhappy with the breast asymmetry and the “bottoming out” of her right side.  She wanted her breasts fuller, rounder, and significantly larger in size. She was referred to Dr. Pousti by a friend and met with him for a consultation and knew right away that he was the best plastic surgeon for her.

Before breast revision with internal bra

Dr. Pousti has significant experience in breast augmentation revision surgery as well as XL breast implants and knew what  needed to be done to achieve the patient’s goals.  It was decided that capsulorrhaphy (internal bra) would be performed with permanent sutures for better breast implant placement on the chest wall.

Side view before breast revision with internal bra

Markings ware made and used as guidelines during surgery.

Markings fro breast revision with internal bra

The arrows indicate where the patient wants more fullness.

breast revision with internal bra

Immediately after implant removal.

breast implant revision

The old saline implants were removed.

breast revision-implant exchange

Below is before and immediately after XL breast revisionary surgery with capsulorrhaphy.

After breast revision with internal bra

Side view after breast revision with internal bra

Saline implants were filled to 1,270cc to achieve the patient’s desired look.

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


Mommy Makeover

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This 28-year old mother of 2 from San Diego, California was interested in tummy tuck surgery and in breast revision surgery. The patient previously had breast augmentation surgery(performed by another surgeon) but due to her right breast implant “bottoming out” (migrating downward) she wanted breast augmentation revision surgery to achieve breast symmetry with more fullness on top. tummy tuck

She found Dr. Pousti online while researching board certified plastic surgeons with experience in Breast Augmentation Revisions.

After reviewing numerous before and after pictures and reading the testimonials of patients who had breast revision procedure and abdominoplasty, the patient scheduled for a consultation and after meeting Dr. Pousti, she scheduled for a “mommy makeover”

abdominoplasty

Markings were carefully drawn out in detail, the morning of surgery

body makeover

Capsulorrhaphy (internal sutures) will be preformed on the right side to help with breast implant inferior displacement “bottoming out”.

breast revision

Before and immediately after breast revision surgery

breast revision, capsulorrhaphy

Before abdominal muscle repair

abdominoplasty-muscle repair

intra-operative abdominoplasty

Immediately after mommy makeover

mommy makeover

545cc silicone gel-implants were used along with capsulorrhaphy (internal sutures) on the right breast to achieve the patient’s desired look.

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Posted in Abdominoplasty, Body Contouring, Bottoming Out, Breast Revision Surgery, Capsulorrhaphy (Internal Bra), Implant Exchange, Mommy Makeover


Breast Revision with Capsulorrhaphy

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This 31 year old female from Chicago previously had breast augmentation surgery /Breast lift and breast revisionary surgery both preformed by another surgeon in her area. She was unhappy with the shape, size and mal position of her current implants and wanted to have breast augmentation revisionary surgery again . After researching board certified surgeons who specialized in breast revisionary surgery she found Dr. Pousti and was immediately impressed with all of his outstanding reviews and photo gallery.  Right away  she knew that he was the right plastic surgeon for her.breast revision-implant exchange

breast revisionary surgery, capsulorrhaphy

You can see the lateral displacement of the implant

breast revision-implant

With all of his experience in breast revisionary surgery Dr. Pousti knew exactly what  needed to be done to achieve the patient’s goals.  It was decided that inferior capsulorrhaphy (internal bra) would be performed with permanent sutures. Her mastopexy (breast lift) scars would also be revised.

breast revision with internal bra

The markings are performed with the patient standing and laying down for accuracy. The red shaded area represents where capsulorrhaphy is performed to correct the breast implant pocket. Markings are checked several times prior to the start of surgery.

breast revision, capsulorrhaphy

Patients are encouraged to bring in photos or posters with the goal that they are trying to achieve.  Dr. Pousti uses theses photos as a guide in the OR.

breast revision-goal pictures

Before/ Immediately after breast revisionary surgery with capsulorrhaphy (internal sutures) and mastopexy(breast lift) revision

breast revision, internal sutures

breast reviionary surgery

750cc of silicone gel implants were used to achieve the patients desired look.

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


Breast Augmentation Revision with Internal Bra

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This 23 year- old patient flew in from Hawaii to have Dr. Pousti perform her revisionary breast surgery. She had breast augmentation / lifting surgery (preformed by another surgeon) but was unhappy with the  significant breast asymmetry and breast implant displacement.  She researched for a Board Certified Plastic Surgeon who is experienced in breast augmentation revision and found Dr. Pousti.. Impressed with Dr. Pousti’s before and after pictures, the patient contacted Dr. Pousti.breast revisionary surgery, capsulorrhaphy

After continuous communication through via e-mail and phone, the patient decided to fly in to San Diego and meet Dr. Pousti. After meeting and talking to the Doctor, the patient found that Dr. Pousti would be the best plastic surgeon for her complicated breast revision surgery.  She wanted more fullness on top, she wanted her breast asymmetry to be improved, she wanted the bottoming out to be improved.

implant exchange, capsulorrhaphy

Markings were made prior to surgery and then re-done on the operating room table.  When reviewing the markings and measurements, Dr. Pousti discusses the procedure again in detail with the patient.  The red arrows below indicate where the patient wants “more fullness”.  The patient will also need Capsulorrhaphy (internal bra) for better placement of the implants on her chest wall.  Dr. Pousti performs the internal suture technique with 2 layers of permanent sutures to improve the chance of a successful repair.

breast revision-capsulorrahpy

Before and Immediately after breast revision, capsulorrhaphy (internal bra), and mastopexy revision

breast revisionary surgery

breast revision-implant exchange, capsulorrhaphy

Old breast implants were removed and replaced with 800cc saline breast implants made by Mentor Corporation.

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


Breast Revision Surgery with Internal Bra

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A 41 year old female from Orange, California was interested in revisionary breast augmentation. The patient was unhappy with her previous breast augmentation surgery performed by another surgeon.  She is having complications with her left breast “bottoming out”.pre-breast revisionary surgery

The patient researched for the best Board Certified Plastic and Reconstructive Surgeon to perform her case and after reviewing many successful revisionary breast surgeries online, the patient found Dr. Pousti. The patient met with Dr. Pousti in his San Diego office to discuss her surgery in detail, and after careful consideration the patient scheduled for surgery.

before-breast revisionary surgery

Measurements and markings were carefully made.

markings prior to breast revision

markings prior to breast revisionary surgery

Dr. Pousti repaired the “bottoming out” using 2 layers of internal sutures to create an “internal bra (capsulorrhaphy) and a new pocket for the left breast implant.

before and after breast revisionary surgery, capsulorrhaphy

before and after breast revisionary surgery

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


Revisionary Breast Augmentation with Internal Bra

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This 34 year old female had previously had breast augmentation surgery performed by another surgeon in Northern San Diego Area.  She started off with slight tuberous breasts but after her first surgery, she was not happy with her results and was interested in correction of her implant mal position (bottoming out and symmastia).    She had lost sensation on her right breast and was also experiencing pain on that side.

Revisionary Breast Surgery

The implants had “bottomed out” and were also too close together in the cleavage area (symmastia). She researched for a Board Certified Plastic Surgeon with experience in Breast Augmentation Revision Surgery and found Dr. Pousti.Implant Exchange Silicone

After meeting the patient and examining her, Dr. Pousti stated that she was a good candidate for Revision Breast Surgery.  He recommended capsulorrhaphy (internal bra) medially as well as on the lower part of her breasts.  Dr. Pousti uses 2 layers of permanent sutures for the breast pocket correction and asks patients to watch the arm movement and heavy lifting after surgery to ensure that the repair is successful.Breast Revision

Markings are performed and measurements are taken the night prior to surgery.  Dr. Pousti plans his surgery and discusses everything with the patient in detail.  The red arrows indicate where the patient wants “more fullness” and the red shaded area in the middle indicates where the permanent sutures will be placed to correct the medial implant map-position.

Breast Augmentation Capsulorrhaphy

Below shows the patient in the operating room
Before surgery — Immediately after Breast Revision Surgery

Revision of Brest

She had bilateral breast implant removal, bilateral capsulorrhaphy and re- augmentation with new silicone gel breast implants.

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


Breast Augmentation Revision

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A 35 year old female from Vista,  California was interested in Revisionary Breast Surgery.  Unhappy with the bottoming out of her current Breast Implants (surgery performed by another surgeon) she wanted Breast Augmentation Revisionary to correct it.  before breast revisionary surgery

After researching the internet for Board Certified Plastic Surgeons she found Dr. Pousti.  She was impressed with his credentials and multiple before and after photos of previous patients.  She met with him for a consultation to discuss her goals.  Dr. Pousti examined her and said that she would be a great candidate for Revision Breast Augmentation Surgery.  He also discussed how she would benefit from Capsulorrhaphy (Internal Sutures- Internal Bra) to achieve her goal.  Complications and risks of surgery were also discussed in great detail.

pre-breast revision

markings-imp;ant exchange, capsulorrhaphy

Markings are made prior to surgery and are used as a guidelines for surgery as well as for patient education.

prior breast revision markings

The blue arrows (below) show where the patient wants “more fullness”.

markings-Implant Exchange Breast Revision

The red lines indicate where Capsulorrhaphy (internal sutures) will be preformed to improve the bottoming out.

capsulorrhaphy markings

prior breast revision markings

Dr. Pousti encourages his patients to bring in goal photos or poster boards and these are used during surgery.

patient's goal photos

Below: After Implant Deflation

implant deflation breast revision

Before/ Immediately after Breast Revisionary Surgery -
Capsulorrhaphy, Implant
Exchange-Saline Overfilled Implants

markings-Implant Exchange Breast Revision

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



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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