Breast Implant Revision, fat grafting, exchange implants, and internal mesh bra

Our patient underwent a saline breast augmentation through the axillary approach by another surgeon years ago and presented to our office with a few concerns. The biggest concern was asymmetry between the breasts making it difficult to find a comfortable bra because of the difference along the inframammary fold and also difference in upper pole fullness of the breasts. She also reported a lot of displacement of the implants laterally particularly on the right side and animation of the implants with pectoralis activation. She also desired to be a little larger with enhanced cleavage. After examining the patient we found that the right implant was too high with a larger pocket than needed particularly in the lateral aspect and both sides had significant animation. With the help of Vectra 3 D simulation and our examination we developed a plan to remove her current saline implants that were ~360 cc and switch the pocket from under the muscle to above the muscle. Also we would perform fat grafting 120 cc to increase coverage and disguise her implants while moderately enlarging the breast implants for closer cleavage of 485 cc. We used Durasorb absorbable synthetic mesh as an internal bra to support the implant position and stabilize the implant position.