Procedures - Breast Plastic Surgery
Breast Enlargement: Augmentation
Breast Augmentation can enhance the natural appearing female breast, balance a size discrepancy between the breasts, restore the volume lost in the breast following pregnancy or be utilized as part of the reconstructive techniques following the treatments for breast cancer.
Most patients considering breast augmentation desire to enhance their self appearance which can lead to an improvement in self esteem. The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you’re physically healthy and realistic in your expectations, you may be a good candidate.
There are two natural components to the appealing breast. On is the size of the breast in relationship to your body size and the second is the position of the nipple. A low or drooping nipple is referred to as breast ptosis. Correction of breast ptosis should be done at or before breast augmentation and is referred to as a mastopexy or breast lift. Their are various types of mastopexyʼs from minor to major. A mastopexy is an additional surgical procedure. It can add additional costs and scars to your procedure. If your nipple position appears low which commonly occurs following pregnancy consult your plastic surgeon for the need for a mastopexy at the time of your augmentation to maximize your outcome and appearance.
Breast implants come in several different styles and ﬁlls. But, in general a breast implant is a silicone shell ﬁlled with either silicone gel or a salt-water solution known as saline. They have been around for decades and are one of the most studied man made medical devices in history. Consult with your plastic surgeon on which breast implant is best for you.
The method of inserting and positioning your implant will depend on your anatomy. The incision can be made either in the crease where the breast meets the chest (inframammary fold), around the areola (periareolar), in the armpit (axillary) or even the
umbilicus (belly button). Efforts are made to assure that the incision is placed so resulting scars will be as inconspicuous as possible.
Through the incision, the surgeon will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). The implants are then centered beneath your nipple and breast mound. The implant may interfere with breast examination by mammogram in the future. Consult with your plastic surgeon for the proper location of your breast implant. Plan for some time off after surgery. You may have to be off work for a week. Do not resume heavy physical activity until you wounds are completely healed and it is OK with your plastic surgeon.
For many women, the result of breast augmentation can be very satisfying, even exhilarating, as they learn to appreciate their fuller appearance. Regular examination by your plastic surgeon and routine mammograms for those in the appropriate age groups
at regular intervals will help assure that any complications, if they occur, can be detected early and treated. Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. Not what someone else wants you to be.
Breast Lift: Mastopexy
The natural history of the female breast is decent of the nipple over time. Over the years, factors such as pregnancy, nursing, and gravity take their toll on a woman’s breasts. As the skin loses its elasticity, the breasts often lose their shape and begin to sag. A Breast lift, or mastopexy, is a surgical procedure that temporarily raises and
reshapes sagging breasts. (No surgery can permanently delay the effects of gravity and aging) Mastopexy can and often also reduces the size of the areola, the darker skin surrounding the nipple.
The two components of the appealing female breast are the size of the breast in relationship to the patients body size and the position of the nipple. A mastopexy can re-position the patients nipple to a more youthful position. To restore the volume of the breast one should consider a Breast Augmentation at the time of the mastopexy. If your breasts have lost volume – for example, after pregnancy – breast implants inserted in conjunction with mastopexy can increase both their ﬁrmness and their size. Consult your plastic surgeon on which procedures are best for you. Remember that major mastopexy combined with breast augmentation can have a higher revision rate.
Many women seek mastopexy because pregnancy and nursing have left them with stretched skin and less ﬁrmness in their breasts. However, if you’re planning to have more children, it may be a very good idea to postpone your breast lift. While there are no special risks that affect future pregnancies, pregnancy and possible weight gain are likely to stretch your breasts again and offset the results of the procedure.
While a mastopexy is a lifting of the breast with a repositioning of the nipple superiorly it is not a Breast Reduction. Usually, with a mastopexy the patient could expect a decrease in cup size while with abreast reduction their can a decrease in 2 or more cup sizes following the procedure.
A mastopexy can be a minor or major procedure depending upon the amount of lift required to produce a more youthful breast. A Mastopexy can take one and a half to three and a half hours. Techniques vary, but the most common procedure involves an anchor-shaped incision. When the excess skin has been removed, the nipple and areola are moved to the higher/ lifted position. The skin surrounding the areola is then brought down and together to reshape the breast. Patients with relatively small breasts and minimal sagging, may be candidates for modiﬁed procedures requiring less extensive incisions. One such procedure is the Crescent Mastopexy in which a smaller crescent moon incisions are made around the superior areola, and the nipple is moved upward. If you’re having an implant inserted along with your breast lift, it will be placed in a pocket directly under the breast tissue, or deeper, under the muscle of the chest wall.
Recovery after a mastopexy is usually very rapid. However, if you have an augmentation at the time of the mastopexy care should be taken to allow for a complete healing and recovery which can take several weeks.
Reconstruction of a breast that has been removed due to cancer, trauma or other disease is one of the most rewarding surgical procedures available today. New medical techniques and devices have made it possible for surgeons to create a breast that can come close in form to matching a natural breast. Frequently, breast reconstruction is possible immediately following breast removal (mastectomy) so the patient wakes up with a breast mound already in place, having been spared the experience of seeing herself with no breast at all. But bear in mind, post-mastectomy breast reconstruction is not one simple procedure. There are often many options to consider, since a lot depends on your individual circumstances.
With advances in earlier detection of breast cancer the majority of patients are not treated with mastectomy ( loss of the breast). They receive a localized removal of the breast cancer ( Lumpectomy ) often with adjuvant radiation therapy. Some form of Chemotherapy is often added to assist in improving survival and decreasing the chances of recurrence of the breast cancer. At the time of the Lumpectomy the auxiliary lymph nodes are assessed for spread of the cancer. If they are positive the patient could require additional radiation to that area. Combination therapy of surgery, radiation and chemotherapy often can result in the best survival in breast cancer patients.
After discussion with your breast surgeon if it becomes evident that you will require removal of your breast (Mastectomy ) for whatever reason. It is at this point the patient should consider breast reconstruction. Ask for a referral to a plastic surgeon to discus the matter. He will advise you wether this would be an advisable procedure to consider. Some patients due to the aggressiveness of the breast cancer, need for extensive post operative radiation or poor health are not good candidates.
The best candidates for breast reconstruction are women whose cancer seems to have been eliminated by mastectomy. Still, there are legitimate reasons to wait and not have your breast reconstruction at the time of the mastectomy. Many women aren’t comfortable weighing all the options while they’re struggling to cope with a diagnosis of cancer. Others simply don’t want to have any more surgery than is absolutely necessary. Women with other health conditions placing them at a higher risk such as obesity, high blood pressure or smoking may also be advised to wait.
The common reasons given to support immediate breast reconstruction include the emotional and psychological impact of starting on the road to reconstruction at the time of mastectomy and the decreased ﬁnancial costs associated with combining two surgical procedures in one. Cosmetic results following immediate breast reconstruction tend to be more appealing as there is often less scaring. Often if radiation is required in the postoperative period immediate breast reconstruction will be deferred.
Breast reconstruction is divided into three basic groups. The utilization of artiﬁcial material ( implants and tissue expanders), autogenous tissue or utilizing your own body parts to build a breast and combinations of the artiﬁcial material and autogenous tissue. All these various procedures require stages of complete reconstruction the the lost breast. It is not with one operation.
Most patients presently choose utilization of artiﬁcial material ( implants and tissue expanders) for breast reconstruction. Many reasons are given but a quicker recovery and a less extensive procedure are often given as reasons by patients. Depending upon the size of the breast and the amount of skin that has to be removed the patient could require a tissue expander be placed or proceed directly to a permanent implant. A tissue expander allows for stretching of the skin envelope on the chest to allow for an appropriately sized permanent implant. The permanent implant and adjustment of the breast mound position are often done in a second procedure after the tissue expander has been removed. The ﬁnal two procedures are creation of the nipple and tattooing of the nipple areolar complex. Often a total of four staged procedures are required to complete breast reconstruction when artiﬁcial material is utilized for breast reconstruction.
Breast reconstruction with utilizing your own bodies tissue or autogenous breast reconstruction can be complicated and extensive surgical procedures. The patient must be screened to make sure they are an good candidate for these procedures are their presently limited sources where tissue can be taken to build a breast. Recovery can also be longer following these procedures. Often the excessive tummy skin and fat are utilized to build the breast. It is not a tummy tuck but your abdomen could be ﬂatter. Consult with your plastic surgeon to see if you are a appropriate candidate for autogenous breast reconstruction. Again, an average number of three to four staged procedures can be required to build a breast with autogenous breast reconstruction.
Combinations of of the artiﬁcial material and autogenous tissue for breast reconstruction are less common today than in the past. Sometimes the muscle of the back or the latisumus dorsi muscle is utilized with an implant or tissue expander to build a breast mound. With the advent of technology these types of procedures have become less common. Artiﬁcial structural ﬁllers like artiﬁcial dermis have decreased the need for such procedures.
The last issue with breast reconstruction is the contralateral or other breast. Often for symmetry the contralateral breast will either be lifted, reduced or augmented to better match the appearance of the reconstructed breast. Consult with your breast and plastic surgeon regarding the contralateral or other breast. Remember, breast reconstruction is a covered service by insurance carriers by Federal Law thanks the the efforts of the American Society of Plastic Surgeons ( ASPS ). It includes treatment of the contralateral or other breast to obtain symmetry. Breast reconstruction can have a signiﬁcant emotional and psychological effect on patients but requires a signiﬁcant effort and commitment by the patient to complete the process.
Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight of their breast from back and neck pain, skin irritation to skeletal deformities and breathing problems. Bra straps can leave indentations in their shoulders. Breast reduction, technically known as reduction mammaplasty, is designed for such women. The procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and ﬁrmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of her body.
Breast reduction is usually performed for physical relief rather than simply aesthetic improvement. Most women who have the surgery are troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort, such as, neck or back pain. Anticipate a decrease of at least two cup sizes with a breast reduction.
Breast reduction can be a covered service by an insurance carrier. Check to see if the procedure is a covered service if you have health care insurance. Often, the restriction or requirements set by insurance carriers for the coverage of patients who seek breast reduction can be severe and tasking.
Breast reduction is nearly always performed under a general anesthesia. Techniques for breast reduction vary, but the most common procedure entails an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. The surgeon removes excess glandular tissue, fat, and skin, and raises the nipple and areola into their new position. Liposuction may be used to remove excess fat from the armpit or ﬂank area. In most cases, the nipples remain attached to their blood vessels and nerves. However, in rare cases if the breasts are very tubular or pendulous, the nipples and areolar may have to be completely removed and grafted into a higher position. This will result in a loss of sensation in the nipple and areolar tissue.
After surgery, it may take several weeks to completely heal. Most patients become to active to quick. Allow your self time to heal before resuming heavy physical activity. Of all plastic surgery procedures, breast reduction results in the quickest body-image change. You’ll be rid of the physical discomfort of large breasts, your body will look better proportioned, and clothes can ﬁt you better.
Male Breast Reconstruction/Gynecomastia
Gynecomastia is a medical term that comes from the Greek words for “womenlike breasts”. It is actually quite common. Gynecomastia affects an estimated 40 to 60 percent of all men. It may affect only one breast or both. Certain drugs and medical problems have been linked with male breast overdevelopment, there is no known cause in the vast majority of cases.
For men who feel self-conscious about their appearance, male breast reduction surgery can help. The procedure removes fat and or glandular tissue from the breasts, and in extreme cases removes excess skin, resulting in a chest that is ﬂatter, ﬁrmer, and better contoured. Various forms of Liposuction are often added to the procedure to assist in the overall result.
The best candidates for surgery have ﬁrm, elastic skin that will reshape to the body’s new contours. Surgery may be discouraged for obese men, or for overweight men who have not ﬁrst attempted to correct the problem with exercise or weight loss. Also, individuals who drink alcohol beverages in excess and/ or smoke marijuana are usually not considered good candidates for surgery. These drugs, along with anabolic steroids, may actually cause gynecomastia. Therefore, patients are ﬁrst directed to stop the use of these drugs to see if the breast fullness will diminish before surgery is considered an option.
If excess glandular tissue is the primary cause of the breast enlargement, it will be excised, or cut out. The excision may be performed alone or in conjunction with liposuction.
If your gynecomastia consists primarily of excessive fatty tissue, your surgeon will likely use liposuction to remove the excess fat. In a typical procedure, an incision is made in an inconspicuous location–either on the edge of the areola or in the under arm area. Working through the incision, the surgeon cuts away the excess glandular tissue, fat and skin from around the areola and from the sides and bottom of the breast. Major reductions that involve the removal of a signiﬁcant amount of tissue and skin may require larger incisions that result in more conspicuous scars. In extreme cases where large amounts of fat or glandular tissue have been removed, skin may not adjust well to the new smaller breast contour. In these cases, excess skin may have to be removed to allow the removing skin to ﬁrmly re-adjust to the new breast contour. The nipple may have to replaced back on the chest as a skin graft. A small drain is usually inserted through a separate incision to draw off excess ﬂuids. To help reduce swelling, you’ll probably be instructed to wear an elastic pressure garment. It may be three months or more before the ﬁnal results of your surgery are apparent. Gynecomastia surgery can enhance your appearance and self-conﬁdence, but it won’t necessarily change your looks to match your ideal. Before you decide to have surgery, think carefully about your expectations and discuss them frankly with your plastic surgeon.
A Mommy Makeover refers to Aesthetic Breast & Abdominal Surgery on the post-pregnancy female. The Surgery is commonly directed at concerns patients have about their breasts or tummies which have occurred following having children. Issues of involuted and / or sagging breasts, excessive or lax abdominal skin and the appearance of still appearing pregnant many months following delivery are addressed. These surgery’s are typically performed in one surgical session. Thus, the laypersons terminology of a “Mommy Makeover.”
Cosmetic Surgical procedures of the Breast and Abdomen done in combination that are considered part of the Mommy Makeover have included:
– Breast: Augmentation, Mastopexy or Lift, Reduction, etc.
– Abdomen: Abdominoplasty (TT), Mini Abdominoplasty, Liposuction, etc.
Mommy Makeovers are not minor procedures and can require a longer recovery period. Each patients makeover is designed individually for the Mommy’s concerns. A link to Mommy Makeovers performed by Dr. Culbertson can be found here: Mommy Makeover Gallery.