Cases of the Week

Below are the most recent additions to Cases of the Week.

Please click on the procedure list on the right side of the page to view the latest entries for a particular procedure.


Correction of Tuberous Breast Deformity

This 27-year old patient from San Diego, California had always felt insecure with the size and shape of her breast and was interested in breast enlargement and correction of her tuberous deformity.

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4.5 left

While searching the internet for ways to improve tuberous breast she found Dr. Pousti and was impressed that not only was he a double board certified plastic surgeon but also that he had many years of experience with her specific problem.

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Dr. Pousti  released the constricted areas and lowerd the breast fold for a natural breast shape.

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In order to achieve the patient’s size goals the breast pockets were improved and breast augmentation with 700cc Saline breast implants were used.

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Correction of Constricted Breasts

This 25-year old patient from Riverside County was unhappy with her appearance due to constricted breasts. She was interested in breast augmentation surgery to enhance her body proportions and improve symmetry. To create symmetry Dr. Pousti plans to release the constricted breast tissue and lower the breast fold on the right breast.

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Markings and measurements are made prior to surgery so that the patient’s size goals and desired look can be achieved.

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The red arrows above indicate the constricted area and where the pocket must be lowered.

DSC04593 OR frontal markings

Before surgery

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The skin underneath the right breast fold will relax and both implants will settle. In order to achieve the patient’s desired ‘natural’ look 295cc Saline breast implants were used submuscularly (implants placed under the muscle).

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Revionary Breast Surgery with use of AlloDerm

After multiple procedures in 2003 and again in 2009, all from previous surgeons, this 36-year old patient ended up with a condition called symmastia. Symmastia – commonly referred to as “bread loafing” or “uni-boob”, occurs when two implants touch one another in the center of the chest. If the horizontal muscle that is connected to the sternum and goes across the implant is cut during surgery, then the implant can move toward the middle of the chest. Symmastia results from overly aggressive attempts to alter chestwall anatomy trying to increase cleavage in patients. This outcome is made worse by use of larger implants in thin patients.

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Due to symmastia and rippling, the patient was very unhappy with the results of her surgery and she experienced pain on the sternum area. After months of discomfort this patient decided to proceed with revisionary breast surgery by a different surgeon. She found Dr. Pousti while searching for a board certified plastic surgeon experienced in symmastia.

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The “red marks” above are where Dr. Pousti will be placing the pieces of AlloGraft to help support the internal sutures.

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After Implants are removed more measurements and markings are made then internal sutures are used to create new breast pocket.

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To improve rippling, due to the lack of breast tissue and thinning of the skin, AlloDerm was used to create an extra layer of coverage between the implant and the skin.

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The internal sutures hold the implants in their new position.

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A symmastia bra, also known as a ‘thong bra’, has to be worn after surgery to stabilize the area. This will allow the sutured area between the breasts to heal properly without excessive pressure being applied to the area.

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700cc silicone-filled breast implants were used in both breasts with submuscular placement.

Updated pictures will be soon posted, sent via e-mail by the patient.

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Mommy Makeover

This 24-year old stay-at-home mother from El Cajon, California found Dr. Pousti on the Internet and was interested in breast augmentation surgery Dr. Pousti performed her surgery in 2008.

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Dr. Pousti used saline breast implants filled to 625cc on both breasts, made by Mentor Corporation to achieve her desired look.

The patient is now 2-years post op breast surgery and is very pleased with her results. After she has healed and recovered from her breast implant surgery, the patient decided to have tummy tuck surgery (abdominoplasty). The patient was so impressed with Dr. Pousti’s work on her breasts, and wanted him to perform her tummy tuck surgery.

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The patient had 1-pregnancy, even with dieting and exercising the patient could not get rid of her stretch markings and her extra abdominal skin from losing elasticity from the pregnancy.

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1.28 markings with dr 2

1.28 markings front

The night before surgery the patient met with Dr. Pousti to perform markings. The patient brought in her favorite bikini to show Dr. wear to hide her incision. Liposuction would also be performed to have better contouring of the sides and hips. The patient is extremely happy with her new mommy makeover.

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Breast Reduction Revision

This 38-year old patient from Del Mar, California is post-op breast reduction surgery, over the years she became unhappy with they scars and wanted to re-lift her breasts and perform a  scar revision.

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She was impressed with Dr. Pousti’s  experience with revisionary breast surgery.

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Breast Augmentation Surgery with Nipple Reduction

This 32-year old patient from San Diego, California was uncomfortable with the projection of her nipples and wanted surgery to reduce the nipples in size, while enhancing her breast size and shape.

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She was interested in breast augmentation surgery and nipple reduction.

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Before Nipple reduction

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Immediately after surgery

In order to reduce the nipple projection, the tip of the nipple will be removed and sutured closed. Depending on the severity of the case, sometimes the skin along the neck of the nipple will be removed. In those circumstances, the tip of the nipple is then sutured to the bottom of the nipple, creating a shorted nipple length.

The patient wanted to look extremely natural and in order to achieve her desired look, Dr. Pousti used saline breast implants and were filled to 370cc in both breasts, placed under the muscle. The patient loves her results.

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Breast Reconstruction Surgery – AlloGraft

This 31-year old patient from Coronado, California previous breast surgery performed by another surgeon in 2008. She was unhappy with the results of her right breast, after several attempts to correct the malposition with her previous surgeon she decided to search for an experienced revisionary breast surgeon.

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With reoccurring encapsulation in her right breast, the patient was interested in breast reconstruction surgery. She had heard about Dr. Pousti from a friend and that he is a double board certified plastic and reconstructive surgeon with many years of experience and training. She met with Dr. Pousti in his La Jolla office to express her concerns, and decided to proceed with breast revision surgery of her right breast.

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DSC04563 laying down markings

Markings were performed on the right breast. You can see the degree of asymmetry between the right and left breast.

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Along with performing capsulorrhaphy (internal sutures), Allograft would be added to the right lower breast to strengthen the breast pocket.

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AlloGraft: Collagen structure (fiber-like proteins) and other proteins naturally found in skin. This structure acts as a frame for your tissue to grow into and around.

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AlloGraft in place for breast reconstruction.

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Dr. Pousti decided that her previous saline breast implant was able to be safely re-used and filled to match the left breast for symmetry.

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Immediately after surgery.

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A bolster dressing is made to hold and protect the corrected areas. Typically, this dressing is worn for about 2-weeks while in the internal suture are healing.

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Breast Implant Revision Surgery

This 54-year old patient from Canyon Lake, California was unhappy with the results of her previous surgeries and wanted her breasts to look more natural. She is post breast augmentation surgery in 2003 and revisionary breast surgery in 2005 performed by another surgeon.

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3.31 left side

The patient found Dr. Pousti on the Internet and loved the results he had achieved for his previous patients and decided to meet with Dr. Pousti. During her consultation, she expressed that she was uncomfortable with the shape of her breasts and felt that they were too “pointy” and that there was too much space in between the cleavage.

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The morning of surgery, Dr. Pousti performed markings on the patient as a map and guide to achieve the look she desired.

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Her previous high profile breast implants were removed and “new” breast pockets were created.

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New moderate profile saline breast implants were used and filled to 625cc in both breasts with submuscular placement.

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Breast Revision with Tummy Tuck Surgery

This 40-year old patient wanted to get rid of her stretch marks and excess loose skin post-pregnancy. The patient exercises daily, and even with regular exercise she could not lose the extra skin. She was very unhappy with her  body. She decided that she would undergo the mommy makeover surgery.

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4.8 left side

The patient is post op breast augmentation surgery performed by another surgeon, she was unhappy with the placement and wanted to remove her previous implants and replace with new larger silicone gel breast implants with better shape and also increase space between her cleavage.

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Markings were performed the night before surgery.

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In the O.R., Dr. Pousti takes his time to do markings for the breast revision surgery.

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Internal sutures were used to create an internal bra for the new position of the implants.

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After the repairs are made,  sizers are placed and filled to the patient’s desired look.

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Before surgery, Dr. Pousti marks in red where the pocket correction will be made.

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Immediately after surgery, with some pressure on the side of the breasts, you can see the increased space in the cleavage area.

The patient is now 1-year post-op surgery with new 600cc silicone gel breast implants placed under the muscle. She is extremely happy with the results of her surgery.

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Tummy Tuck with Breast Lift Surgery – Mommy Makeover

This 36-year old patient from Murrieta, California wanted Mommy Makeover surgery, she was unhappy with the body changes from having 2 children.

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She wanted to reduce the size of her breasts with breast reduction surgery, along with tightening her abdominal muscles and also remove the excess skin and stretch marks from pregnancy (tummy tuck surgery). After losing her pregnancy weight, the patient decided to meet with Dr. Pousti to discuss Mommy Makeover options.

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The night before surgery, the patient came in with her favorite bathing suit to have markings performed. The bathing suit is used a guide to plan where to hide the tummy tuck incision area.

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Measurements were made to ensure as much symmetry as possible and to map out the mommy makeover procedures.

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The patient’s right breast was larger than her left breast, and she was very concerned with breast symmetry. Dr. Pousti takes his time to make sure to achieve the patient’s desired look.

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After the completed breast reduction/breast lift surgery, the weight of the removed tissue from the right breast was 515 grams and 385 grams was removed from the left breast. Dr. Pousti checked for symmetry before, during and after the completed breast surgery, while the patient is  in the upright and laying down position.

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Here, Dr. Pousti shows the muscle laxity (separated abdominal muscles) after pregnancies. The markings show the extent of the separation.

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Once the muscles brought together and are repaired, the patient will have a tighter, flatter, and a more narrow stomach. Liposuction was also performed to contour the flanks and hips was well.

The patient is now 4-weeks post-op surgery and is very happy with her results.

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