35-44 year old woman treated with Breast Augmentation

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A mother of 3 who is bothered by a delated appearance of her breasts after breast feeding. She was a D cup when breast feeding. She feels that her breasts are “flat” and not as full as before children. She wants to have a natural appearance after surgery. She is 5’^” and 130 lbs and is shown before and again, 6 weeks after bilateral subglandular placement of 375 cc smooth round moderate profile saline implants through an inframammary incision.
Discussion: Her case is more complicated because she has early drooping of the breast with her nipples being located at to just below her breast fold. If the implant is placed below the muscle, the breast may fall off of the mound ( a “waterfall” effect) and look like a rock in a sock.) A breast lift could be performed but would add a visible scar around the areola. She has elected for a subglandular placement. With the implants above the muscle, the implants will drop with the breast and avoid the potential waterfall effect. This is one benefit of the subglandular approach. She is willing to accept the tradeoffs of a potentially higher rate of capsular contracture and the possibility of more visible ripples with time- her tissues are thick enough with a caliper test of 3.5 cm that this may not be a problem in her case.
She has also elected to have saline implants. Although they have a higher chance of having ripples it is easier to tell if they have leaked down the road without an ultrasound or an MRI.

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