Dr. Alejandro Nogueira's Case #XF7M3VVQ

Base on the former explanations the options seem quite clear for any patient in similar circumstances, a common scenario in middle aged women after pregnancy and breastfeeding; first option is getting only a breast lift, this reshapes the breasts, raises the nipples and areolas and gets rid of the sagginess, however leaves very visible and stigmatizing scars on the breasts and reduce no less than 30% of the breast volume; second option is getting only breast implants, needless to say of anatomical shape otherwise the upper pole would stay empty and in large breast increases the shape would be like a fake balloon, however not getting the breast lift the nipples and areolas stay the same low, no lower either; finally and third option would be getting at the same time and in the same procedure a breast lift with underlying anatomical shaped implants breast augmentation, an combination providing the best and the worst from both previous options.

Experience tells that vast majority of patients with moderate grades of droopiness, like the case shown, opt for breast implants only and do not take the mastopexy to avoid the never desirable scars it entails; nevertheless there is a minority group of patients who are eager to get both breast lift and augmentation, which actually is the orthodox technical option for these cases, two issues found, two issues treated; furthermore, some seldom patients get only breast lift since their only goal is reshaping, they don't seek breast implants, they accept the scars and also find suitable the breast volume loss featuring the mastopexy techniques.

In any of the three previous options the patients are satisfied afterwards as long as they have been realistically informed, they have carried out a serious, realistic and honest introspective reflection about the pros and cons of each technical solution and discuss all their doubts with their Plastic Surgeon until they are fully cleared; it is always the right choice when the information acquisition stage has been accomplished up to its fullest and deepest point.

The patient in this case opted without any doubt for breast implants only without a breast lift, probably the best option for the patients who are reluctant to accept the scars of a mastopexy or are hesitant; it is due to be kept in mind that not doing a breast lift does not preclude its realization afterwards later on, since getting the mastopexy is always at patient's disposal at any future point, however taking the scars of a lift at first instance is always a irreversible decision, since there is no method to delete or even conceal them, thus breast lift procedures should be applied in highly motivated patients, psychologically stable and showing no trace of hesitation about them, or in such cases of extreme grade of mammary droopiness and deformity which can't acceptably work well without a mastopexy.

This case was managed with anatomical shaped implants, featuring macrotextured shell and cohesive gel filler inside, performed via the ideal areolar incision and in the optimal and less aggressive subfascial plane of placement.

The chest was featured with sunken chest deformity also called pectum excavatum, very lateral nipples and breast mounds location, which is conditioning the postoperative angulation of the breasts and the lateral placement of the implants, the eccentric or cross eyed location of the nipples within the breast mounds and the significantly uneven height of the nipple location level when compared both breasts; as can't be otherwise these issues remain unchanged after the augmentation mammoplasty.

In spite of the lateral location of the breasts it was possible achieving satisfactory cleavage fullness with minimal side protrusion of the implants.