Surgical Procedures

Breast Procedures

Breast Augmentation (Augmentation Mammaplasty)
Breast Lift (Mastopexy)
Breast Reduction (reduction mammaplasty)
Breast Implant Removal
Male Breast Liposuction (Gynecomastia)
Breast Revision/Reconstruction


Breast Augmentation (Augmentation Mammaplasty)

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Procedure Overview:
Breast Augmentation (Augmentation Mammaplasty) - Enhances the size and shape of breasts using inflatable implants filled with saline. In some cases silicone implants can be used at the discretion of the surgeon and with patient consent.

Anesthesia Options:
General anesthesia is most commonly performed in my facility.

Risks and Benefits:
There are many risks associated with a breast enhancement. Everyone who is interested in the procedure should review the risks as provided by the implant manufacturers. Briefly, the risks include, but are not limited to, bleeding, infection, hematoma, contracture, sensory disturbance, asymmetry, deflation and rupture and implant malposition. Fortunately, many of these risks are uncommon and the very high satisfaction rate associated with implants is a testament to the fact that women are generally very pleased with their results. The benefits are typically enormous—enhanced self esteem, improved breast shape, increased fullness and improved body proportion.

Recovery:
This is generally a few days with most patients. Some may take longer. We typically use a post operative “pain pump” which delivers a numbing medication to the breast pocket and provides for significant relief. Someone must stay with you overnight immediately after surgery. I recommend waiting about 10 days to two weeks before exercising and I would limit that amount of chest work for about a month. If it hurts, you should avoid that particular activity. It takes several weeks for the implants to “drop”. Massage generally starts about a week after surgery if indicated. Motrin or Aleve can be used after the first five days or so for pain relief without narcotics. Sutures are absorbable and don’t require removal. Silicone scar strips are used on the incisions when they no longer have any crust (about two weeks). This should be used for six months to obtain the finest scar. Discomfort associated with breast implants is greater when implants are placed below the muscle. Please refer to my Breast Implant Article for much greater detail about a breast augmentation.

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Breast Lift (Mastopexy)    View Photos

Procedure Overview:
A mastopexy is a procedure that tightens and lifts the breasts. There are many procedures that can be used to achieve this goal, the most common being a “vertical” approach that results in a lollipop shaped scar. A Mastopexy can be performed with or without the addition of a breast implant. Many patients prefer a breast implant with a Mastopexy because of the superior breast fullness provided by the implant that can’t be achieved with a lift alone. Performing a lift and an implant at the same time is a challenging surgery that is associated with a higher degree of complications and asymmetries and should only be performed by an experienced surgeon. A Mastopexy in a larger breast is not recommended as the lift generally won’t last.

Anesthesia Options:
General anesthesia recommended.

Risks and Benefits:
The risks associated with a Mastopexy alone include bleeding, infection, asymmetry, wound healing problems and hypertrophic scars. The risks for complications is much greater when combining a Mastopexy and breast implant. The revision rate (additional procedures available to fine tune the results), is much higher for an augmentation/Mastopexy. There are additional costs associated with each and every revision. There will be a greater potential for sensory disturbances of the nipples after a Mastopexy. The benefits of a simple Mastopexy is improved breast shape and appearance. The improvements from a Mastopexy/augmentation can be quite dramatic—a deflated, saggy breast can look perky and youthful.

Recovery:
It is similar to a breast augmentation—a few days of pain meds and then back to activities. It takes a bit longer for the breast to settle after a Mastopexy and implant and the breasts may look a bit unnatural and tight in the immediate post operative period. Because of the longer scars associated with a Mastopexy, there will be more attention focused on scar healing and scar strips.

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Breast Reduction (Reduction Mammaplasty)    View Photos

Procedure Overview:
A breast reduction refers to any plastic surgical procedure that reduces the size of the breast. Patients complain of heavy breasts associated with back, neck and shoulder pain. They are limited on activities because of their size. Finding clothes that fit is difficult and they simply aren’t fun. This is a popular procedure and generally the outcome is very rewarding to patient and surgeon (I call it “happy surgery”.) It involves removing breast tissue and excess breast skin as well as elevating the nipples and reducing the diameter of the areola. The goal is to create smaller breasts with improved shape.  Techniques for breast reduction vary, but the most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. Another alternative might just result in a vertical scar alone without extension into the crease beneath the breast. Liposuction breast reduction does not involve scars but it is limited to fatty breasts that have minimal sag. An amputative breast reduction involves using the nipple areola complex as a skin graft on the smaller breast mound (with loss of sensation), but generally with the benefit of a wonderful shape.

Anesthesia Options:
General anesthesia recommended.

Risks and Benefits:

Swelling of the breast is common that lasts for weeks. It’s also not uncommon to have a small area of skin at the bottom of the breast that takes longer to heal. Scars can be lengthy but are generally well accepted and only rarely do they become spread. Sensory changes can occur at the nipple-areola complex. Smoking is contraindicated. Breast feeding may be compromised.

The benefits are enormous. Patients feel liberated after this procedure. Weight loss is very common because of your new confidence and the ability to exercise without your breasts getting in the way! Improved shape with perkier breasts makes patients look younger and makes it appear like they have lost weight. Neck, back and shoulder pain are generally improved significantly.

Recovery:
You will be up and around on the day of surgery, but you should limit the use of your arms to routine activities. You may feel some pain for the first couple of days-especially when you move around or cough and some discomfort for a week or more. Your surgeon will prescribe oral medication to lessen the pain. You should avoid lifting or pushing anything heavy for three or four weeks. The stitches we use are generally dissolvable. You may have drainage tubes for a day or two after surgery. Most women can return to work (if it's not too strenuous) and social activities after several days to up to one week.  Molding the breasts with an appropriate bra is beneficial as is long term breast support with a good bra. Silicone scar treatments are important and should be used for six months or longer.

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Breast Implant Removal    View Photos

Procedure Overview:
Breast implant removal simply means removal of the implant. Patients seldom decide they no longer want their implants, so removal is typically part of a reconstructive or revision of a previous breast enhancement. The three most common reasons for breast implant removal are change of size and shape, implant leakage or rupture, and capsular contracture. Saline implants tend to be easier to remove than silicone implants. A capsulectomy refers to the removal of the thin layer of scar tissue that forms about every breast implant. A capsulotomy refers to cutting of the implant capsule, often to free it up to move in a preferred direction (more cleavage for instance).

Anesthesia Options:
Simple removal of saline implants can be performed under local anesthesia and can take ten minutes. Silicone removal may need IV sedation or general anesthesia. When implants are removed as part of a revision or reconstruction general anesthesia is recommended.

Risks and Benefits:
Breast retraction after implant removal can be very good in a young patient with good skin and breast tissue. In older patients with poor skin quality oftentimes the breast would look collapsed and deflated without an implant. Sagging may also become more apparent after breast implant removal. Some women suffer from psychological distress after breast implant removal. Removal of breast implants is uncommon because most patients can’t imagine not having the fullness even if they have problems with their enhancement. The benefits from removal can be great if they are causing you anxiety for whatever reason. I have seen some cases when the breast looked better after implant removal!

Recovery:
Recovery from breast implant removal surgery is usually quick, with many patients returning to everyday activity within a few days. It’s important to compress the breast area after implant removal to help the skin to retract as best possible.

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Male Breast Liposuction (Gynecomastia)    View Photos

Procedure Overview:
Male Breast Liposuction (Gynecomastia) - This procedure reduces enlarged breasts in men using liposuction and/or removal of excess glandular tissue. Most incisions are around the areola. Advanced cases may require removal of skin excess with a longer scar across the chest. Poutiness of the nipple area alone can be treated with tissue removal. Excessive fat and glandular tissue would best be treated with liposuction and tissue removal. There are medical conditions that cause breast enlargement (tumors, marijuana use, medications).

Anesthesia Options:
Local anesthesia to general anesthesia depending on the complexity and your level of tolerance.

Risks and Benefits:
Moderate pain, bruising and swelling are to be expected. Hematoma (blood collection) is probably the most common complication. Uneven skin retraction can lead to skin irregularities. Additional procedures may be needed for irregularities. The benefits are GIGANTIC in most cases as men don’t want breasts. The psychological damage from this condition should not be underestimated. The improvement in body self image (and the ability to wear a T shirt) is wonderful.

Recovery:

You will feel some discomfort for a few days after surgery. However, discomfort can be controlled with medications prescribed by your surgeon. Although the worst of your swelling will dissipate in the first few weeks, it may be 12 months or more before the final results of your surgery are apparent. Recovery is a few days at most. Compression garments are essential. Deep massage of healing tissue is very beneficial.

For more thorough information, see my article on Gynecomastia.

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Breast Revision/Breast Reconstruction    View Photos

Procedure Overview:

This category of breast implant patients involves those women who have had a previous breast augmentation and are not completely satisfied with their results or they are having problems related to their enhancement. It has been estimated that up to 40% of breast surgery patients are not completely satisfied with their outcome. The most commonly seen problems include asymmetrical implants, hard implants with capsular contractures. Other issues related to the implants are rippling along the edges, thinning of the breast tissue or "rock in the sock deformity" with bottoming out of implants that were placed above the muscle and have fallen with time or pregnancies.

Sometimes patients desire a tightening of the breast skin or a “lift”. Breast revisions encompass a large variety of complicated procedures to produce the desired result. It is not uncommon to need additional procedures to obtain the best result. The FDA has approved the use of silicone gel implants. This has resulted in a dramatic increase in the number of patients who want to exchange their saline implants for the silicone variety. Some women what to change their implant size (and I know this may come as a shock to you) and the vast majority of women I see in my office desire smaller implants!

Breast revisions typically involve exchanging implants (saline to silicone), adjusting the pocket to soften the breast and move the implants to a more appropriate position and adjusting the location of the implant (usually moved to a submuscular position). Tightening of the skin envelope or "mastopexy" may be suggested to obtain the most desirable shape to the breast. High riding implants sometimes found after a transaxillary augmentation (arm pit incision) can be corrected by lowering the implants after I adjust the pockets. Laterally displaced implants (those that move under the arm over time because of back sleeping or excessive opening of the lateral pocket at your original procedure) may require internal sutures to close off the pocket and repositioning of the implant.

Anesthesia Options:
Most breast revisions require the use of a general anesthetic.

Risks and Benefits:
The risks from a breast revision procedure are typically greater than that of a first time enhancement. All issues that can occur with a breast implant can occur again. The rate of capsular contracture has been reported to be higher with each additional procedure. It is unlikely that perfect results will be obtained but my experience has been that the overwhelming majority of patients are very happy with their decision to undergo additional surgery. Additional procedures may be needed at additional fees. The benefits of softer breasts after you have had contracted ones is enormous. Natural looking, attractive breasts is certainly the main benefit.

Recovery:
Recovery is about the same or slightly longer than that of a primary breast enhancement which is typically four or five days. I see patients once a week for about three weeks to make sure you are massaging your breasts correctly so that they remain soft and natural and symmetrical in appearance.

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