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Breast Augmentation: Patient 31

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This 45 year old patient originally had her saline breast implants placed 25 years ago.  They were a bit hard with mild capsular contracture, had some rippling, and were smaller than she wanted.  Capsular contracture is scar tissue that forms in the "pocket" that surrounds the breast implant.  There are four stages of capsule.   Plastic surgeons refer to this as the Baker classification of capsules.  Stage 1 is soft and our goal as surgeons.  The tissue is soft, flexible and does not affect the shape or feel of the breast.  Stage 2 is firm but overall the breast looks normal.  Stage 3 is where we start to have problems as the breast is firm and the shape of the breast is abnormal as the scar contracts around the implant.  Stage 4 is the worst stage and at this point the capsule is firm enough that it causes distortion of appearance along with pain.  Surgeons do not usually reoperate on a patient for a stage 2 capsule but stage 3 and 4 often require surgery.  This patient was not as much concerned with the slight firmness but rather the size and rippling.  Via her original areolar incisions I opened up her pockets in order to release her capsules and to give her more central cleavage.  I placed larger 415cc silicone gummy cohesive implants to replace her 300cc saline implants.  Her result is an increased cup size as well as softer more enjoyable breasts!