Real Patient Case: Breast Reshaping After Previous Silicone Injection

A 24-year-old female patient from Malaysia came to Dr. Koko Vietnam with a history of previous silicone injections to both breasts.

This case follows her journey from preoperative medical assessment and breast examination through surgical planning, treatment and the early postoperative stage.

Before Surgery: Medical Assessment

Before surgery, the patient underwent a medical assessment to determine whether she was medically suitable to proceed with the planned procedure.

The medical team reviewed her medical history, previous surgeries, current medications, allergies and general health condition.

Depending on the individual case and medical requirements, preoperative assessment may include tests such as a complete blood count, blood clotting tests, liver and kidney function tests, blood glucose testing, infectious disease screening, electrocardiography and other examinations when indicated.

Why Is Preoperative Assessment Important?

The assessment helps the medical team:

• evaluate the patient’s health before anesthesia and surgery

• identify factors that may increase risks during or after surgery

• identify conditions that may require further evaluation or treatment before surgery

• help the anesthesiologist and surgeon prepare an appropriate plan for the individual patient

For this patient, the medical history recorded no known medical conditions or allergies, no current cough, cold or flu symptoms, and no use of dietary supplements.

Her preoperative assessment indicated that she was medically suitable to proceed with the planned surgery.

Breast Condition Before Surgery

According to the medical history provided by the patient, she had previously received large-volume silicone injections of approximately 500 cc into each breast.

Clinical examination showed both breasts had a large volume with significant soft-tissue stretching and sagging. The lower part of each breast was noticeably elongated, while the nipple and areola were positioned lower on the breast together with stretched skin and breast tissue.

Assessment from the front and side showed severe breast sagging, recorded in this case as Grade IV ptosis. Changes in breast shape and symmetry were also present, with the breast tissue extending downward and outward.

The skin showed multiple folds and signs of stretching associated with the large breast volume.

In addition to the changes in breast shape, the patient reported that the size and condition of her breasts made everyday activities such as standing, sitting and lying down uncomfortable.

On examination, both breasts also felt firm and irregular in areas, with palpable lumpiness and loss of the normal soft texture of the breast tissue.

Surgical Planning Before the Procedure

Before surgery, the surgeon performed a detailed breast examination, assessing the degree of sagging, the amount and condition of breast tissue, breast base width, nipple and areola position, and the proportions of the breasts in relation to the patient’s body.

Based on this assessment, the surgeon marked the planned surgical lines directly on the skin. These markings showed the areas requiring adjustment and helped guide the planned reshaping of the breast tissue and repositioning of the nipple and areola.

The preoperative markings are an important part of surgical planning. They help identify the areas to be treated, the direction in which the tissue will be repositioned, and the intended breast shape and position.

In this case, the patient had large breast volume and severe sagging together with a history of previous silicone injections. The surgical plan therefore focused on removing silicone and affected tissue where indicated, reshaping the remaining breast tissue, and correcting the significant sagging.

There is no single breast shape or surgical design that is appropriate for every patient. Planning needs to consider the patient’s anatomy, tissue condition and individual treatment goals.

Place the photos showing the surgical markings here.

During Surgery: From Planning to Breast Reshaping

Final Checks Before Surgery

Before beginning the procedure, the surgical team reviewed the patient’s medical information, health assessment, surgical plan and the measurements that had been agreed upon.

The surgeon also rechecked the markings on both breasts, including:

• the body midline

• the central axis and position of each breast

• nipple and areola position

• the inframammary fold

• areas of skin and tissue planned for adjustment

• the markings used to guide breast reshaping and tissue repositioning

These markings act as a surgical guide, helping the surgeon translate the preoperative plan into the steps performed during surgery.

Preparation of the Surgical Area

After anesthesia was administered according to the planned anesthetic approach, the surgical area was prepared using sterile technique.

The surgical team disinfected the area and placed sterile drapes so that only the treatment area remained exposed.

The surgeon then proceeded according to the preoperative markings while repeatedly assessing the relationship between both breasts throughout the procedure.

In cases involving significant sagging or stretched breast tissue, treatment may involve more than changing breast volume. The surgeon may also need to reposition soft tissue and adjust the nipple and areola according to the surgical plan.

The operating-room images show that the preoperative markings remained visible during surgery, allowing the surgeon to compare the original plan with the tissue position throughout the procedure.

Place the operating-room image showing the markings here.

Incisions According to the Surgical Plan

The surgeon made the incisions according to the markings prepared before surgery.

For patients requiring breast lifting and reshaping, incision patterns can vary depending on the degree of sagging, skin quality, amount of tissue and the planned correction.

In this patient’s early postoperative images, the incision pattern can be seen around the areola and extending vertically downward from the areola.

These images show the early postoperative stage and not the final healed result.

Treatment of the Internal Breast Tissue

After creating the planned surgical access, the surgeon proceeded with dissection and treatment of the breast tissue according to the surgical plan.

The goal was not only to remove silicone and affected fibrotic tissue where indicated, but also to:

reposition the soft tissue → correct the sagging → improve projection → reshape the upper and lower breast poles → improve balance between both breasts

Throughout this stage, the surgeon continued to assess soft-tissue thickness, skin tension and the relationship between both breasts.

This is one reason breast reshaping must be individually planned rather than applying the same breast size or shape to every patient.

Breast Reshaping and Tissue Repositioning

This stage requires careful planning because the remaining breast tissue needs to be repositioned according to the patient’s anatomy and the surgical design.

The surgeon rearranged the breast tissue to bring the breast into the planned position and adjusted excess skin where required.

The nipple and areola were also repositioned according to the preoperative markings.

The aim was to create a more balanced relationship between:

nipple and areola → upper breast pole → lower breast pole → breast fold → body midline

When the two breasts are not identical before surgery, the surgeon also needs to take those natural differences into account rather than trying to create two mechanically identical breasts.

Checking Breast Balance Before Closure

Before closing the incisions, the surgeon reassessed the overall breast shape.

This included checking:

• the relative height of both breasts

• nipple and areola position

• breast projection

• the inframammary fold

• upper and lower breast fullness

• overall balance when viewed from the front

The appearance of the breasts while the patient is lying on the operating table is not the only consideration. The surgeon also plans for how the breasts may appear when upright and how the tissues may change during healing.

Hemostasis and Closing the Incisions

After completing the breast reshaping, the surgical team checked the operative area and controlled bleeding before closure.

The tissues were then closed in appropriate layers according to the surgical technique used, followed by wound care and dressing.

In the early postoperative images from this case, the closed incision lines can be seen around the areola and extending vertically below the areola.

Immediately after surgery, swelling, bruising, tightness and an unsettled breast shape may still be present.

This stage should not be used to judge the final surgical result.

After Surgery: Early Recovery and Breast Shape Changes

The postoperative images show the nipple and areola area together with the closed surgical incisions during the early recovery stage.

The patient’s care does not end when the incisions are closed.

After surgery, she continued to be monitored during recovery, including assessment of her general condition, pain, surgical wounds and any signs requiring medical attention.

During the following weeks and months, the soft tissues continue to adapt and swelling gradually decreases. Breast shape can continue to change throughout the healing process.

Swelling, bruising, tightness and an appearance that is not yet fully settled can occur during the early postoperative period.

Postoperative care may include keeping the wounds clean and dry according to medical instructions, taking prescribed medication, wearing a support garment when recommended, limiting certain activities and attending scheduled follow-up appointments.

The images on this page document the patient’s surgical journey and early recovery. Individual healing, recovery time and results vary from patient to patient.

A Beautiful Breast Shape Starts With the Right Plan

A beautiful breast shape is not created by following one standard formula. It starts with understanding the patient’s anatomy, tissue condition, proportions and individual goals.

From medical assessment and surgical markings to tissue reshaping, breast balance and postoperative follow-up, each stage requires careful planning.

Every patient is different. The goal is to create a breast shape that is appropriate for the individual body while keeping patient safety, realistic expectations and careful surgical planning at the centre of the treatment process.

Considering Breast Reshaping Surgery?

If you are considering breast reshaping, breast lift, correction after previous breast procedures or another breast concern, you can begin with an online consultation before travelling to Vietnam.

Send clear photos, relevant medical information and explain what you would like to change.

Photos → Initial Assessment → Personalized Treatment Plan → Individual Quotation

The Dr. Koko Vietnam international patient team assists with communication and consultation coordination, while medical assessment and treatment decisions are made by the appropriate licensed medical professionals.

Start Free Online Consultation

Dr. Koko Vietnam
Ho Chi Minh City, Vietnam

A beautiful result begins with individual planning. Patient safety remains a priority throughout the surgical journey.