Revisionary Breast Surgery

There are a couple different breast shape abnormalities in which the description double- bubble can be applied.

The first type of the breast “double-bubble” deformity is an obvious deformity of shape in which the round part of the breast with the implant sits at the normal level for a breast, but the natural breast tissue and nipple have sagged downward. This double bubble look can occur immediately following surgery or over time because of pregnancy, weight loss or gravity.

The second double-bubble breast deformity is sometimes seen after submuscular breast implant surgery, however it can be also be seen in both sub-muscular and over the muscle breast augmentation. This look of a double bubble can be caused because the patients natural crease is very sharp, indented or constricted, and produces an obvious groove between the nipple and the new post surgical crease is lower causing a bulge below. In some cases, this condition gradually clears up if the breast tissue at the breast crease stretch out , however if it does not, a breast revision surgery may be needed to suture the skin and breast tissue down and correct the double bubble look.
Generally there are four indications for the breast double bubble to be present.

1. The breast pocket or breast tissue is not sutured down.
2. The breast implants are sub-muscular and the breast tissue has slid off the breast implant.
3. There may be capsular contracture of the breast distorting the breast shape.
4. The breast implants are submammary and the breast itself has drooped downward.

The patient was very unhappy with her breasts. She is only 7 days post-op removal of her implants, replacement with saline implants overfilled to over 900cc’s and correction of the double bubble deformity.

At this time, she is EXTREMELY happy with her results.

Dr. Pousti took his time in the Operating room to give this patient the most symmetric result. He lowered the pocket on the the left side and improved the space between the breasts.

Before

These pictures were taken in the operating room immediately after surgery.

Before

Immediately after revisionary breast augmentation surgery with silicone gel implants and lowering of the left breast pocket.

The patient is extremely happy with her early results. She will return home and keep in touch with our office via email.

Before

After 6 months – patient sent picture via email.

After seeing the results that Dr. Pousti has achieved for other patients in the same situation, this patient decided to proceed with revisionary breast augmentation surgery and symmastia repair.

In the operating room, Dr. Pousti took his time marking the areas of implant mal-position. He wanted to correct the symmastia, improve the position of the breast implants and get a more symmetrical result for the patient. Symmastia – commonly referred to as “breadloafing” or “uni-boob”, occurs when two implants touch one another in the center of the chest. If the horizontal muscle that is connected to the sternum and goes across the implant is cut during surgery, then the implant can move toward the middle of the chest. Symmastia results from overly aggressive attempts to alter chestwall anatomy trying to increase cleavage in patients.

Immediate post-op pictures were taken of the patient in the operating room with an amazing result.

The Surgical Procedure

For correction of symmastia, the procedure can take from 2-3 hours depending on how much work is involved. Board Certified Plastic Surgeon, Dr. Pousti takes his time in the operating room to make sure that he does what he can to achieve the best result for the patient. The repair of symmastia requires additional surgery to move the implant back into the pocket of original placement. All sutures are internal – there are no new scars placed on the breasts.

* The tissue that encapsulates the implant is cut and rolled back to fit into the pocket.

* Tissue is sutured together to hold implant in place.

* The muscle is then sutured internally back in place, connecting the sternum.

* The incision is then sutured close.

These supportive bras are worn to give support to the area that was corrected with internal sutures. The “T-Bra” is worn for 3 months to continue to give support.

This patient is only days out of surgery and extremely happy with the separation of her breasts.

Dr. Pousti received an email from this patient stating: “I am a 44 years old and had breast augmentation in the mid 80s with silicone implants which were replaced in the mid 90s with saline implants due to contracture. The symmastia developed thereafter. In addition to the symmastia I have a tight tendon that shows through the skin on the left and something underneath one of the breasts that looks like an indentation from the scar from the second procedure. I recall after the second surgery the surgeon telling me he had “cut” something to improve cleavage. I have lots of rippling in the middle and since I lift weights can see my chest wall pulling against the implants when I do something strenuous – it looks pretty bad.”

After speaking with Dr. Pousti, she felt very comfortable proceeding with revisionary breast surgery. After seeing the results that Dr. Pousti has gotten for other patients in the same situation, this patient decided to proceed with revisionary breast augmentation surgery and symmastia repair. One of the more common problems that patients are seeking Dr. Pousti’s help for is symmastia. Symmastia – commonly referred to as “breadloafing” or “uni-boob”, occurs when two implants touch one another in the center of the chest. If the horizontal muscle that is connected to the sternum and goes across the implant is cut during surgery, then the implant can move toward the middle of the chest. Symmastia results from overly aggressive attempts to alter chestwall anatomy trying to increase cleavage in patients. This outcome is made worse by use of larger implants in thin patients, and is a problem for implants over or under the muscle, though submuscular implant placement allows the muscle to provide some softening of the transition to the cleavage area from the augmented breast mound.

Markings were performed to indicate the implant mal-position, where the use of alloderm would be helpful, and symmastia repair.

In the operating room, Dr. Pousti took his time marking the areas of implant mal-position. He wanted to correct the symmastia, improve the position of the breast implants and get a more symmetrical result for the patient. Dr. Pousti also used “Alloderm” to help get the best cosmetic result.

Intra-operative pictures were taken of the patient in the operating room with her implants removed.

The Surgical Procedure

For correction of symmastia, the procedure can take from 2-3 hours depending on how much work is involved. Board Certified Plastic Surgeon, Dr. Pousti takes his time in the operating room to make sure that he does what he can to achieve the best result for the patient. The repair of symmastia requires additional surgery to move the implant back into the pocket of original placement. All sutures are internal – there are no new scars placed on the breasts.

* The tissue that encapsulates the implant is cut and rolled back to fit into the pocket.

* Tissue is sutured together to hold implant in place.

* The muscle is then sutured internally back in place, connecting the sternum.

* The incision is then sutured close.

As you can see, before surgery, when pressure was placed on the outside of the breasts, the implants communicated.

After surgery, when pressure was placed on the outside of the breasts, the implants stayed separate.

The patient is communicating via email and has sent her post-op pictures to us. She is extremely happy with her early results.

“Here is a photo. I think it looks great! I’m very happy with the results. “

Testimonial:
My experiece with Dr. Pousti and his office has been excellent. I couldn’t be happier with my results. I am currently 14 days post op and feel great. I am back to work and haven’t taken pain medication since the first week following surgery. My recovery was much quicker and much less painful than I expected. Dr. Pousti not only repaired the symmastia but also gave me the look that I had requested. I am extremely happy that I had my repair performed by Dr. Pousti only regretful that I didn’t do it sooner.

This patient decided to fly out to La Jolla to meet with Dr. Pousti and discuss all of her options the day before her surgery. She felt very comfortable with Dr. Pousti’s experience in revisionary breast surgery.

Markings were performed the morning of surgery. The lines show where the patient wanted extra fullness.

In the operating room, Dr. Pousti and his staff take care to give the patient the best result possible.

The implants were removed.

New saline breast implants were placed and overfilled to 1175cc on the right side and 1275cc on the left to achieve as much symmetry as possible.

She is only 3 weeks out from surgery but EXTREMELY happy with the size, shape and symmetry of her new breasts.

Testimonial:
Wow! Where to begin! I came across Dr. Pousti after doing some extensive research over the Internet. I was very impressed with what I read on his website! I loved the fact that he is double board certified and specializes in extra large implants. I was very excited to get in contact with his office especially since there was a special area noted on the website for out of state patients……..since I live in Arizona. The office staff is so friendly and helpful and made it so easy to correspond with them and Dr. Pousti! It was as easy as sending some pics via internet and explaining my situation. Which had been a very long and depressing road up until coming across Dr. Pousti! I had four prior breast augs with two different doctors here in Arizona ALL resulting in my unhappiness, I never received the look I wanted which was the ” big,fake,round” look. I was even told by one of my doctors that I had to have my implants taken out completely because he said my body just couldn’t handle large implants! At that point I was so frustrated! But again I was reassured by Dr. Pousti’s credentials and felt very positive meeting with him. And let me tell you that couldn’t be more true! After the office staff worked with me on my schedule to plan a trip out there which was so easy to do! I was actually able to do my consult and surgery all in one trip which was great! When meeting Dr. Pousti at the consult I knew I had for sure chosen the right doctor, finally! He was so kind and reassured me that he could indeed give me the look I always wanted and fix my current problems that I was having. He treated me as if I was his only patient, so sincere and helpful! My husband and I felt very confident and comfortable proceeding with the surgery the next day. And I am so glad I did choose Dr. Pousti! Right now I am a little over three weeks past my surgery and I am FINALLY happy! I have the look I always wanted, but most of all I am happy and so pleased! And that is all thanks to Dr. Pousti and of course his wonderful staff! If you are reading this now…….know that this is the right doctor for you! He is amazing! Thanks again for all you have done!

She was extremely happy with her new body and enjoyed them for many years. After a few years, she decided that she would like to exchange her saline implants to silicone gel implants. She proceeded to have her extra large saline implants removed and replaced with smaller silicone gel implants. After Dr. Pousti examined her, they decided to proceed with implant exchange as well as breast lifting.

The saline implants were removed, silicone gel implants were placed and a breast lift was performed. She is so happy with her results.

Testimonial:
I first found Dr. Pousti in 2001 in my search for a Board Certified Plastic Surgeon. Not only was he Board certified but double board certified. I was interested in a Breast Augmentation and was VERY impressed with his mastering art of Cosmetic Surgery. Every picture that I saw on his website was just beautiful.
Once arriving to my initial consultation and meeting Dr. Pousti I knew that he was the surgeon that was to perform my surgery. His staff is first class and helped me with anything and everything I needed. During the consultation he explained the surgery itself in detail and spent a good amount of time with me and answered all of my questions. I never felt like I was rushed or just a number. He really took his time with me and made me feel really comfortable. He is very caring, respectful, compassionate about his work, genuine, has wonderful bedside manners and is just an all around great man. We looked through pictures that I wanted to use as a guide and met with his actual post-op patients that were in the office. I really thought that the patients that shared their wonderful experience with me was very helpful. Before I left his office I knew that I had to schedule my surgery.
My surgery went extremely well. Dr. Pousti was with me the whole time through the morning of my surgery. I really felt like he cared and he even took the time the night of my surgery to contact me to make sure that I was doing ok. I was very happy with my results/experience and decided to go larger in 2002 with Saline implants. The 2nd time around was even easier then the 1st. My incisions were near to nothing. I couldn’t ask for a better surgeon to perform surgery on me and that’s why he performed my 3rd!! I am now 3 weeks post-op from a Breast Augmentation with a lift and switched to Silicone implants. After having the larger implants I decided that I wanted a little more conservative size and downsized and switched to silicone. The 3rd time around I can and will say that I still have the up most respect for Dr. Pousti and the gift that he was given. He does amazing work and will continue to do so. I am VERY happy with my results and can’t wait to see the end result.
Dr. Pousti does amazing work as it speaks for itself. I have and will continue to refer my friends and family to him.
Thanks Dr. Pousti!!!!

Notice that the mal-position of the breast implants cause the nipple-areola complexes to be displaced to the side. Also notice the “double bubble” on the lower part of her breast pocket.

She met with Dr. Pousti the day before surgery to discuss the surgical procedure of removal of her current implants, replacement with high profile silicone gel breast implants, and correction of the mal-position of the implants.

Markings were performed the night before surgery. The “red” markings show the mal-position of the implants. The arrows show where the patient wants more fullness in her breasts.

In the operating room, care was taken to achieve as much symmetry as possible. At first, the markings were checked. You can see that when Dr. Pousti puts pressure on the breasts from the side, they communicate in the middle (symmastia). This was a concern for the patient.

The patient’s current implants were removed. During the removal of the implants, the right silicone gel breast implant was found to be ruptured.

After placement of the new, high profile silicone gel breast implants and correction of the implant mal-position with the internal suturing technique, the patients breasts show a great improvement in size, shape and position.

The patient is now 4 days out from revisionary breast surgery and very pleased with her results. She will wear the supportive bra as well as tape to support the area that was internally sutured.

Before —————– 4 days after

Symmastia – commonly referred to as breadloafing or uni-boob, occurs when two implants touch one another in the center of the chest. If the horizontal muscle that is connected to the sternum and goes across the implant is cut during surgery, then the implant can move toward the middle of the chest.

You can see here how the two implants communicate with eachother.

Markings were performed the night before surgery.

When Dr. Pousti put pressure on the outer sides of the breasts, you can see how the two implants touch eachother in the “red area”.

The “red” markings show the area where the implants communicate and where Dr. Pousti will perform the internal suture technique to separate the implants.

In the operating room, care was taken to achieve as much symmetry as possible. At first, the markings were checked. The operation time varies depending on what exactly would need to be performed. We will review this with you after you have been examined by Dr. Pousti.

For correction of symmastia, the procedure can take from 2-3 hours depending on how much work is involved. Board Certified Plastic Surgeon, Dr. Pousti takes his time in the operating room to make sure that he does what he can to achieve the patient’s results. The repair of symmastia requires additional surgery to move the implant back into the pocket of original placement.

• The tissue that encapsulates the implant is cut and rolled back to fit into the pocket.
• Tissue is sutured together to hold implant in place.
• The muscle is then sutured internally back in place, connecting the sternum.
• The incision is then sutured close.

The patient’s current implants were removed and after the internal suturing technique to separate the two sides, new silicone gel breast implants were placed.

Here you can see that with the internal suturing technique, separates the two breasts and even with pressure put on the outer part of the breasts, there is no communication between the breasts.

After the procedure, the patient will have supportive tape and a “thong bra” to support the areas where the internal suturing was performed. She will keep this bra on until directed by the office to take it off.

This patient is very early out of surgery and very happy with her results.

Her previous breast augmentation / breast lifting surgery had left her with asymmetry of the two breasts. She had capsular contracture of the right side (seen above) which was painful to the patient.

She was interested in removing her current implants, replacing them with larger silicone gel breast implants, capsulectomy of the right side and revisionary breast lifting to correct the placement and symmetry of her breasts.

She was very impressed by Dr. Pousti’s experience with revisionary breast augmentation surgery and the results she had seen on his website. She proceeded with scheduling revisionary breast augmentation, revisionary breast lifting (mastopexy) surgery with Dr. Pousti.

Markings were performed the night before surgery.

Dr. Pousti takes his time to plan the surgery to accomplish the patient’s goals. The red “markings” are to show the current implant placement while the blue “marks” show where the patient wanted more fullness.

In the operating room, Dr. Pousti and his surgical staff took great care to achieve the patient’s results. The patient’s current implants were removed, capsulectomy of the right side was performed, revisionary breast lifting was performed and new silicone gel breast implants were placed.

Here you can see that the patient’s right breast implant and the right capsule have been removed, the breast lift has been revised and a “sizer” has been placed to see what size implant would give the patient her desired result.

Here is the capsule tissue that was removed from the right breast. The capsular contracture of the right side was painful for the patient.

The patient’s after pictures were taken in the operating room. The patient will follow up with Dr. Pousti in a couple of days.