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34 year old physician and mother of two, 5’6” tall, for Breast Augmentation, San Clemente in Orange County, CA requested moderate enlargement. Rhinoplasty (nose reshaping) simultaneously. Bra size change A-B to full C cup.
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Note low position of nipples before procedure. 420 ml Natrelle textured saline implants placed in submuscular position through Inframammary approach, with slight lowering of Inframammary crease.
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Point of Interest   (Positioning implants centrally behind nipples vs. repositioning nipples centrally over implants)
In the beautiful, youthful breast, the nipple is centrally located, and represents the most forward projecting point of the breast. When a round implant is placed beneath a breast with an eccentrically placed nipple, such as this patient who presents with her nipples low on the breast, almost at the level of the inframammary crease (crease demarcating the bottom of the breast), the surgeon must make adjustments in the procedure to centralize the nipple in front of the breast implant. To centralize the nipple for a patient whose nipples are near the bottom of the breast at the crease, either nipples should be lifted (mastopexy/breast lift) or the crease should be lowered (as in this patient), or a combination of these two maneuvers should be incorporated). Otherwise, the nipple may remain below the center of her augmented breast, and the center of the implant, its most projecting area, will be above the nipple. This results in an abnormal, artificial appearing breast. The picture below is an example of breast augmentation with nipples below center of implant, a problem to avoid. This problem can be corrected by lifting the nipples up to the most projecting point of the implant, or by lowering the inframammary crease (crease at bottom of breast) allowing implants to drop so that center of implant is behind nipple.
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