Christine A. Petti, MD

Internal Bra Suture Surgical Technique is used to Customize the Implant Pocket to the Specific Diameter of the Implant Chosen for a Natural Breast Shape with Projection and Cleavage

I create an underwire bra conformation with sutures along the natural lateral breast fold and the inframammary fold.  Imagine a tailor creating a Dolce and Gabbana-type corset design along the outer breast and long the normal under fold of the breast.  This will hold the chosen implant on the top of the chest and the implant will fit in the pocket like a hand in a kid glove.  I also use it to create definite cleavage that will be maintained over time as the lateral sutures of the internal bra will prevent outward movement of the implant, as this lateral implant drift will widen or truly eliminate "cleavage".  I use this technique on all of my breast implant redo's (revisions of patients referred to me with contractures, asymmetries, rupture, and other problems that require re-operation), which are a large part of my breast implant practice. I also use this technique on first time breast augmentations when the skin brassiere is stretched and not ideal. Like my professor said, "anyone can do the easy ones." I love the challenge of breast augmentation and the internal bra is a staple of natural and long-lasting breast implant surgery.  




Christine Petti

You have succeeded in losing and maintaining a healthy weight which is half the battle.   The remainder remains in the hands of the most qualified plastic surgeon of your choice.  I feel you are an excellent candidate for breast augmentation, breast lift, full abdominoplasty and liposuction of hips and flanks if you are in good health and are also a good candidate for general anesthesia.  I have extensive experience and if you would desire a consultation, I would be happy to evaluate you, do breast measurements, discuss your choice of implant types and projection and then inform you of the options, review some before and afters to educate you on the realistic results of these surgeries.  I hope that you can visit my website and YouTube channel to see my results and my surgical expertise.  I wish you the best in your pursuits as you have worked hard and it is not time for you to partner with a great plastic surgeon of your choice and comfort.  Christine Petti

I would advise laser-assisted liposuction, also termed Smartlipo as this can be used to target the fat and also tighten the skin, especially in the areas of the multiple folds of the lateral and posterior back.

In my 28 years of experience in plastic surgery and 6 year experience with laser-assisted lipoplasty, I have found that if I combine skin tightening laser settings, as well as the settings to target destruction of the fat cells, I can get good results, especially in the back where the dermis is thick and can retract postoperatively.  

You have significant back rolls, that are multiple and vertically stacked so I will be very honest and tell you that you may need a 2nd session in which the laser can be used to just tighten the skin further after you wait ~ 6 months from the Smartlipo procedure.  This 2nd session can be done with a minimally invasive technique that would require going inside and under the dermis, using the previous Smartlipo incision sites and avoiding additional new scars.  However, I am excited to tell you, I can also offer you SculpSure, which is a noninvasive laser procedure that can be used to treat the skin rolls in 25 minutes with no downtime.  I have used ScupSure on post op liposuction patients and seen very good results with additional skin tightening and textural changes.  

SculpSure is not FDA approved for skin tightening, but many physicians using the device, including me, are seeing some skin tightening with SculpSure.  It would be an "off label" use of SculpSure if we discussed using it for "skin tightening".  It is FDA cleared for fat reduction.  

Using SculpSure alone for your back rolls from the get go would not be recommended, just so you understand.  There is too much for the noninvasive technique to conquer, but after a Smartlipo procedure, it may be used as adjunct.

Many surgeons do not use Smartlipo laser-assisted liposuction, but may have other techniques that you may consider, but this is what works best in my hands and has been proven in my patient population over time.

It would be worth considering these options, that are much less deforming and leave a more natural results with minimal scars, in my opinion.

I personally do not do body lifts or back lifts, as I do not want to deal with unsightly scars in my patients and I have laser devices that can be used in the OR or non invasively that can offer options that obviate the need for large, permanent unsightly, and sometimes even terribly painful raised scars.  

You will never have the back of a person who never had skin stretch, but there can be significant improvements that you may enjoy, if you are realistic in your expectations.

I wish you the best.

You may be a good candidate and happy with a lower blepharoplasty-I would recommend a transconjunctival approach, which is an approach that uses no external scar.  
It is not unusual, the hereditary "bags" that you describe and appear to be present on the photos.  It is hard to judge just from the photos.
I would love to have a look at your cheeks and the projection of your cheek bones.
If you have truly the "bags" or excessive fat protrusions of the lower eyelid--associated with--flat cheekbones, then, perhaps both a lower blepharoplasty, and also some filler in the cheeks (I may recommend Voluma), to give more projection, would also enhance the results of the lower eyelid surgery.  All the anatomy should be assessed and discussed at the time of your plastic surgery consultation.  The desire and "need" for fillers in the cheek, like Voluma, can always be assessed and performed after the lower blepharoplasty, so this is not absolute and there would be time to reassess after we see the results of the blepharoplasty.  Do not feel that you are different.  This is quite common, and I think that if you are a true candidate, and if you go through with the surgery, you will be very happy.  You do not need and external lower eyelid incision, so please avoid this approach!

You have the potential for a great result from Allergan Natrelle cohesive silicone gel breast implants.
In my surgical experience, patients with your characteristics, are good candidates for silicone gel implants placed under the pectorals major muscle.   To be certain, however of the validity of any surgical decision, a complete consultation, exam and breast measurements are necessary, so my statements may need modification, after this occurs.
The Allergan Natrelle (Style 15) round, shaped implant is a cohesive gel implant and can be smooth or textured.  Textured may help lower the rate of hardening, medically termed capsular contracture.  
Textured implants are designed to decrease contracture and the surface of the implant incorporates itself to blend in with the overlying pectoral muscle and breast tissue, so that meticulous technique is required for placement in the pocket.  Once they are positioned, it is imperative that they are in a good position,
The Allergan Natrelle (Style 410) shaped, anatomical implant is a natural shape.  Since it is not a circle, it is a textured implant surface.  Why?  It is so the implant stays in the most natural position in the breast pocket that is dissected to custom fit and be tailored to the exact shape and size of the implant and desired breast. 
I have a special technique I use when working with this implant and the shape has been outstanding with good cleavage, good projection, upper pole natural fullness, lateral (outer) breast fullness and create a secure and defined inframammary fold.  The shaped implant comes in a multitude of styles - with varying height, width and projections.  I tailor the choice of the implant to the patient's anatomy and desired "look" for the postoperative outcome.  
The 410 implant gives a beautiful shape in my opinion, however it is a trickier implant to use technically, so some surgeons do not like to use it and condemn it.  I have used the shaped saline implants (the previous McGhan Style 468 textured saline) in the past for over a decade, when the silicone gel implants where on a FDA-moratorium for cosmetic use.  Therefore, I am facile, and enjoy using the shaped, anatomical, natural-shaped implants.  Why?  Because they are full and have a very aesthetically appealing shape and are firm.  And the patients are happy!  Some surgeons condemn the firmness too, but they are what I call naturally or ideally firm, similar to the firmness of a young and youthful breast, not hard - or - undesirably firm.  
My patients have been very happy with the 410 shaped implant.  I have extensive experience use the 410 shaped implant when replacing previous implants, as revisional surgery, which is a major portion of my breast implant practice--many saline and round gel implants with the anatomical, shaped implants.  The outcomes have been good.  Many times,  women who seek primary (1st time) breast augmentation,  will make a choice to go quickly into a breast augmentation with little scope of knowledge and also many base their choices on price.  In many circumstances, these types of decisions lead to the need for the patient to have another surgery to correct their original result and this is what I also specialize in, with regard to my practice and expertise.  
In terms of longevity, the Allergan Natrelle Style 410 implant is widely used in Europe and has been there for over ~ 20 years.  They have been available here, in the USA, since 2013.  
The gel in the 410 shaped implant is highly cohesive (commonly referred to as "gummy bear" implants) and so, if there is rupture, the gel will stay in or near the shell of the implant and there will not be a big "spill" of the free silicone gel into the pocket, where it can penetrate the tissues- breast, muscle, chest wall (ribs, lymph nodes), etc.  MRI is used to detect rupture and it is best detected early, so MRI's are recommended every 3 years after the initial silicone breast augmentation (for any type of silicone implant, not just the 410) and the every other year.  
I am an advocate for the female patient and I like for my patients to be informed of both the short and long-term decisions with regard to breast augmentation with saline or silicone gel breast implants.
This is such an important decision.  I repeat that and hope that you find this answer beneficial to your needs to make the best decision for you.
I do not use Mentor gel or saline breast implants, so I have not commented on this manufacturer of breast implants.  I do not use the Sientra gel implants, as I find they have more wrinkling than the Allergan, Natrelle Style 410 implants.  
If  you are interested in Mentor saline or gel or Sientra gel implants, you should seek a surgeon that uses these implants and has long-term experience with them.