One of the most common problems seen in women after breast feeding is atrophy (shrinkage) and sagging of the breast. The best procedure to correct this problem is combining a breast augmentation with a breast lift. However combining the two procedures can sometimes be problematic. A mastopexy (breast lift) involves skin incisions around the areola and often a vertical incision as well. Placing a breast implant at the same time can place excessive tension on the wounds, resulting in poor scars. The two procedures are at odds with each other. The mastopexy procedure tightens the skin while the augmentation procedure expands the skin. Tension can also in terfere with circulation to the skin and occasionally lead to skin and even nipple loss. In some cases therefore when performing an augmentation mastopexy I use adjustable implants in order to decrease the tension on the skin during the healing phase.
Adjustable implants are available in a saline version (Spectrum) and a gel version (The Becker 50/50). The implant has a thin tube attached to it which can be brought out through the skin. An injection dome is attached to the filling tube allowing the implant to be adjusted and filled after the procedure.
The adjustable implant is positioned in the usual fashion. The saline implant normally placed sub muscularly (under the muscle). The adjustable gel implant can be placed above the muscle.
The implant is filled to the desired volume after completing the mastopexy. At the end of the procedure 25 – 50% of the saline is removed, reducing the tension on the incision and also reducing the pain postoperatively.
Five to seven days after surgery the implants are filled to the desired volume. Over filling results in more projection and symmetry (breasts even) can be obtained.
The fill tubes are then removed with a gentle pull, thus allowing the three-way valve to close. Once fill tube is removed, adjustments cannot be made.
The more complex cases such as marked asymmetry (Polands Syndrome) or constricted breasts (Tubular Breasts) improved results can be obtained by burring the fill tube and adjusting the volume over several months. This has been extremely successful and has normalized many major breast deformities some of my patients that have been unfortunate to have.
A minor procedure under local anesthetic is then required to remove the fill tube |