This is the type of operation where money surgeons would do this in 2 to 3 stages. I did this in one surgery. This is one of the more challenging surgeries because she presented with 20-year-old saline implants above the muscle with no records. She always felt they were too big and too heavy. For our surgery, I removed her old implants from above the muscle, placed new Allergan style SCM silicone implants 310cc under the muscle and did a Brazilian lift on top of that. She now has good upper pole fullness which she was lacking before.
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