This case demonstrates the importance of correct diagnosis in breast implant revision. It also highlights the subtle but important differences between a good and a great breast augmentation.
The patient is a 35-year-old nurse who had had a silicone gel breast augmentation 5 years earlier by another plastic surgeon. She had never been satisfied with her results: the underside of both breasts was flat. She also commented that the upper breasts also seemed too empty.
She had seen her original surgeon who diagnosed a capsular contracture and told her she needed the scar tissue removed (capsulectomy) to fix her breast shape. Shenever proceeded with that surgery.
When she came to see me, I was unconvinced that she had a capsular contracture. Breast implants with capsular contracture are hard; hers were soft.
Capsular contracture usually develops over time with the breasts looking fine initially; her problems were there from the outset.
Breasts with capsular contracture often bulge on top as the scar tissue pushes the implant upward; her upper breasts were empty.
In surgery, I found that her textured 350cc silicone gel implants had never fully descended into the breast implant pockets, creating the flattened appearance at the bottom of the breasts. The scar tissue was thin and normal everywhere.
I replaced her implants with 425cc smooth silicone gel implants and released the lower scar capsule to create a more natural-looking result.