The patient is a 50 year old woman who complained of sagging of her breasts over time and loss of overall tone of the breast. She was especially bothered by the loss of breast tissue in the upper part of her breast which she thought made her breasts look older and she noted that she could see the outline of her pectoralis (pec) muscle because her breast was so low. She was very adamant that she did not want to have a breast lift because of the resultant scarring. Since the patient had a lot of breast tissue and a thick pec. muscle, she would have very good coverage of the implant to decrease rippling and so she chose a saline breast implant. The patient was less concerned about the size of her breast and more about her shape. At surgery a submuscular pocket was fashioned to the natural edges of the breast. A sizer, or temporary implant was first placed and filled to its full volume which was limited by the overlying breast and muscle to determine the volume that would completely fill the space and achieve a natural and full appearance and to get the breast volume out to the edges of the natural breast. The patient had liked the idea of a 420 cc. implant volume prior to surgery and so, since the sizer was to be used to measure the volume that would give the best shape, a range of implant sizes was available for the patient from 390 to 450 cc. Sizing for this patient did yield a volume of 420 cc. and so the sizer was removed and a 420 cc. saline implant was chosen and placed.
Postoperatively the patient was most happy that the implant gave her the upper breast fullness she desired without needing to have a breast lift and resultant scarring. She also liked that her breasts appeared back where they belonged. She also liked that the chest and the breast appeared as one unit, and not as separate areas, chest and breast as before her surgery.
