This 29 year old from San Antonio, Texas was interested in breast revision surgery to correct the symmastia present after her previous breast augmentation. She felt extremely uncomfortable with her “uni-boob” and after two failed breast surgeries, she decided to research for a qualified surgeon to perform her revision surgery. She began researching online and found double board certified plastic and reconstructive surgeon, Dr. Tom Pousti. She reviewed several “before” and “after” pictures of symmastia repairs performed by Dr. Pousti and was extremely impressed.
After exchanging several emails and telephone calls, the patient decided to fly to California to have her breast revision surgery performed. Upon the patient’s arrival, Dr. Pousti examined the patient and determined that capsulorrhaphy, an implant exchange, and the use of allograft was needed to repair the patient’s current symmastia.
Dr. Pousti and the patient met in the pre-operative area prior to surgery to take measurements and perform markings. These markings are used as a guideline during surgery to try to achieve as much symmetry as possible and to determine where internal sutures will be placed.
The green shaded area indicates where pocket repair will be done to improve implant placement.
An incision around the areola was used to remove the placements previous implants. The patient and Dr. Pousti discussed having an incision almost around the entire areola to remove the patient’s scar from her previous breast augmentation in hopes that her new scar will be less noticeable.
In some breast revision cases, allograft is needed to help with coverage of the implant. Alloderm or allograft is made from donated human skin, but is processed to remove cells, so that a collagen structure is left over for the skin to grow on and around.
Once the allograft is securely placed, Dr. Pousti begins the capsulorrhaphy. Capsulorrhaphy, commonly known as internal sutures, was performed to repair the breast pocket. These permanent internal sutures close off a portion of the breast pocket to improve implant placement. The internal bra is permanent and was used to repair the patients severe symmastia. Symmastia or breed-loafing occurs when two implants touch one another in the middle of the chest. Symmastia is caused by a muscle being cut during surgery from overly aggressive attempts to achieve cleavage.
When the internal repairs were completed, Dr. Pousti used implant sizers to determine implant sizing. The sizer implants are filled with air until the patient’s desired breast size has been achieved. Once sizing is determined, the sizer implants are removed and the final implants are prepped for placement. Dr. Pousti used a 250cc silicone gel implant on the right breast and a 235cc implant on the left breast.
Before/After Breast Revision Surgery
