Implant exchange and delayed fat grafting Corrects Breasts, Raleigh, NC*

This 36-year-old woman had prior breast augmentation with silicone gel breast implants via periareolar incisions by another plastic surgeon. She had tethering of the periareolar scars causing an indentation and her surgeon attempted to improve it with 2 separate surgeries including one time during an implant exchange. Neither operation was successful. She wanted improvements in her cleavage and fuller upper breast profile and also improvements in her scar. She saw Dr. Lyle who recommended exchange to somewhat higher profile breast implants via the inframammary fold approach-avoiding the previous incision. She also had scoring of the scar tissue directly under her nipple. Additional fat grafting of the areola postoperatively was performed. She had significant improvement in the tethering as well as a more optimal outcome in terms of her breast size and cleavage position. Periareolar incisions were popular during the period of time that saline breast augmentation predominated. However with the return of gel implants, this approach had limited usefulness because of the difficulty of placing breast implants safely through this incision. There is increased potential of contamination with native breast bacteria since the incision goes through breast tissue. Inframammary fold approach generally avoids this. This patient also demonstrated one of the potential complications of this approach with unfavorable scarring and tethering of the incision and areolar distortion