BREAST AUGMENTATION

It is important to stress that augmentation will not correct severely drooping, pendulous or sagging breasts: this requires a breast lift that may be coupled with augmentation.  Finally, if you have had previous augmentation surgery and are unsatisfied with the results, want to increase or decrease your breast size, or have complications from the previous operation, a revision breast augmentation can be performed.

 

How to prepare for the surgery?

 

Aside from the usual laboratory exams requested to make sure your risk of incurring cardiopulmonary complications as a result of general anesthesia is low, you will probably need a baseline mammogram and/or breast ultrasound before and after surgery, to help detect future changes in the breast that might otherwise be difficult to diagnose due to the presence of implants.

 

In particular, you should be ready to answer questions regarding your reason for wanting this procedure and your desired outcome, a history of previous breast surgery, mammograms or a family history of cancer.

 

 

Risks and complications?

 

Complications are uncommon but may occur despite meticulous technique, and those specific to breast augmentation include unfavorable scarring, poor healing, bleeding, changes in sensation, formation of firm scar tissue or “capsule” around the implant, rupture of the implant, skin changes over the implant, persistent pain and the need for revision surgery.  Much has been said about the risk of cancer and autoimmune disease associated with breast implants, but there are no conclusive studies proving a link between them.  Finally, implants are not guaranteed to last forever, and surgery might be needed in the future to replace them.  Other conditions such as weight loss, pregnancy or menopause may likewise alter the appearance of your breasts after augmentation, and you may need further revision surgery.

 

How is it done?

 

This procedure is done under general anesthesia, usually in an outpatient setting.  The incisions are placed inconspicuously and there are several options including incisions beneath the breasts (inframammary), at the nipple margins (periareolar), or in the armpit (transaxillary), depending on the size of the implant, preferences and other considerations.  There are also several options for positioning of the implant, depending on those same factors.  The implant may be placed beneath the pectoralis muscle (submuscular) or directly behind the breast tissue but on top of the muscle (subglandular).

 

Your choice of implant, whether silicone or saline, will be determined not only by the size you want, but by the existing anatomy of your breast, your body type, and elasticity of your skin.  Silicone implants feel more like natural breasts;  however, should they leak, they will not be absorbed and expelled by the body (unlike saline implants) and need to be assessed regularly by your surgeon.

 

What to expect after surgery?

 

The results are immediately visible, but complete recovery takes time as swelling subsides and the incision lines mature and fade.  Initially, you will be advised to reduce exercise and normal activity for a short period of time to be determined by your surgeon, and you will notice soreness and swelling that tends to resolve in a few weeks.

 

Again, although the results are long-lasting, they are not permanent and you may need revision or replacement surgery in the future for a variety of reasons already mentioned earlier.

Also known as augmentation mammoplasty, this is one of the most commonly requested cosmetic procedures and involves the use of implants to create a fuller look in patients with fully developed yet “small” breasts, to correct the “deflated” appearance of breasts after pregnancy, breastfeeding or marked weight loss by restoring volume, or simply to correct differences in size between one’s breasts.  It is also performed in breast reconstruction after injury or mastectomy for whatever reason.  Either way, this procedure often helps patients improve their appearance as well as boost their self-esteem and is an excellent option for patients who are unsatisfied with their breast size.

BREAST LIFT

As women age, breasts tend to droop, sag, lose their form and shape due to a combination of changes during and after pregnancy, breastfeeding, weight loss and the inescapable effects of gravity.  Whatever the cause, the end result is flat, elongated, and pendulous breasts, for which the most appropriate procedure is a mastopexy or “breast lift” to reshape the breasts.  This type of surgery is also indicated if your nipples are at a level beneath the crease of your breasts, your nipples point downwards, or one breast is drooping lower than the other.

 Other common related complaints include decreased breast volume and enlargement of the nipple and areola, which are addressed by a concomitant augmentation and/ or nipple-areolar reduction procedure. There are several variations on how this can be performed, but the basic premise involves removing excess skin, firming and tightening the breasts, and resituating the nipples back to a central position.  This is often done under general anesthesia and on an outpatient basis.

 

How to prepare for the surgery?

 

Aside from the usual laboratory exams requested to make sure your risk of incurring cardiopulmonary complications as a result of general anesthesia is low, you will probably need a baseline mammogram and/or breast ultrasound before and after surgery, to help detect future changes in the breast that might otherwise be difficult to diagnose due to post-surgery changes in the tissue.

 

In particular, you should be ready to answer questions regarding your reason for wanting this procedure and your desired outcome, a history of previous breast surgery, mammograms or a family history of cancer.

 

Risks and complications?

 

Complications are uncommon but may occur despite meticulous technique, and those specific to mastopexy include unfavorable scarring, poor healing, bleeding, changes in nipple/ breast sensation, breast contour irregularities, asymmetry, swelling and bruising, persistent pain, fat necrosis, seroma, excessive firmness, partial or total loss of the nipple areolar complex, and the need for revision surgery.   Furthermore, this procedure may make interpretation of mammograms and breast ultrasounds difficult, you may have difficulty breastfeeding in the future, and breast changes during and immediately after pregnancy may offset the benefits of mastopexy.

 

How is it done?

 

This procedure is performed under general anesthesia in an outpatient setting.  There are several variations in technique, the choice of which depends on your breast size, shape, degree of sagging, size and position of your nipple areolar complex, and skin elasticity. Incisions are commonly placed just around the areola or around the areola then vertically down to the breast crease to create a “keyhole” configuration.  The underlying breast tissue is then lifted and reshaped, while excess skin is removed and the nipple areolar complex is resituated to a more youthful, “perky” position.

 

It is important to note that although some of the incision lines are hidden in the inframammary fold and natural creases of the breast, others will be visible and permanent, but improve over time.  More importantly, the results are almost immediately appreciable and you will be glad to see your breast restored to a more youthful position.

 

 

What to expect after surgery?

 

Dressings and bandages will be applied after surgery and you may need to wear a special bra to support your breasts during the initial healing phase.  A small tube may also have been placed temporarily to drain excess blood and fluid that might otherwise accumulate beneath the skin.  The final results will be apparent over the course of a few months, as your breasts settle in their new position and the incision lines fade.  A breast lift is long-lasting, but not permanent.  Over time, your breasts may continue to change due to aging and revision surgery might then be appropriate.  Also, future pregnancy, breast feeding and weight loss plans should be discussed with your surgeon, as these may negate the benefits of a mastopexy.

 

BREAST REDUCTION FOR FEMALES

While most Asian women yearn for a more impressive bustline, there are women who experience medical and postural problems due to excessively large and heavy breasts. Health issues range anywhere from skin irritation in the inframammary crease and severe, painful bra-strap indentations to debilitating neck and back pain due to the weight of the breasts.  Most also suffer from extreme self-consciousness as a result.

In these cases, breast reduction surgery, also known as reduction mammoplasty, is the appropriate procedure to undertake.  It is particularly suited for women whose breasts are debilitatingly heavy, breasts which hang low with nipples positioned below the inframammary crease, and enlarged areolas with stretched skin.  It involves removing a proportionate amount of breast tissue, fat and skin, as well as reducing the size of the nipple areolar complex, if necessary.  It is performed on an outpatient basis, usually under general anesthesia.

 

How to prepare for the surgery?

 

Aside from the usual laboratory exams requested to make sure your risk of incurring cardiopulmonary complications as a result of general anesthesia is low, you will probably need a baseline mammogram and/or breast ultrasound before and after surgery, to help detect future changes in the breast that might otherwise be difficult to diagnose due to post-surgery changes in the tissue.

 

In particular, you should be ready to answer questions regarding your reason for wanting this procedure and your desired outcome, a history of previous breast surgery, mammograms or a family history of cancer.

 

Risks and complications?

 

Complications are uncommon, but may occur despite meticulous technique, and those specific to breast reduction include unfavorable scarring, poor healing, bleeding, infection, changes in nipple/ breast sensation, breast contour irregularities, asymmetry, swelling and bruising, persistent pain, fat necrosis, seroma, excessive firmness, possible inability to breastfeed, partial or total loss of the nipple areolar complex and/or intersection of incision lines, and the need for revision surgery.

 

Furthermore, this procedure may make interpretation of mammograms and breast ultrasounds difficult, you may have difficulty breastfeeding in the future, and breast changes during and immediately after pregnancy may offset the benefits of mastopexy.

 

How is it done?

 

This procedure can performed on an outpatient basis under general anesthesia.  There are a number of options with respect to technique, and these involve excision of excess skin and glandular tissue, and removal of excess fat through liposuction or excision, or a combination thereof.  The initial incisions may be placed around the areola in a circular pattern, in a keyhole or racquet pattern, or in an anchor or inverted T pattern.

 

Once the incisions are made, the nipples are repositioned and, if necessary, the areolae may be reduced by excision.  The underlying tissue is then reduced, lifted and reshaped, the incisions are brought together to envelop the now significantly smaller breasts, and sutures are placed deep within the breast to support this new shape.  The incisions are closed and visible, but mature over time and fade.

 

 

What to expect after the procedure?

 

Dressings and an elastic bandage will be applied to your breasts immediately after the operation, to support healing and minimize the inevitable swelling and bruising that occurs.  A temporary drain or tube may have also been placed to drain any excess blood or fluid that might otherwise accumulate beneath the skin.

 

The results of your breast reduction will be immediately apparent in terms of decreased weight and size.  Swelling subsides over a few weeks, while the incision lines will fade over several months.  Your new reduced breast size will allow you to engage in more physical activities, with markedly reduced to no pain, and enhance your self-esteem by giving you a more proportionate figure.  However, there may be changes that accompany aging, weight loss or gain, and pregnancy that may affect your results in the long-term.

 

BREAST REDUCTION FOR MALES

The presence of “man-boobs” and the psychological distress it causes are the primary indication for breast reduction or reduction mammaplasty in men.  This condition of overdeveloped or enlarged breasts in males is called gynecomastia and is characterized by excess breast fat and/or glandular development in one or both breasts.  It is classified according to size and appearance of breast tissue as well as presence of excess skin.  It is a relatively common condition with several possible causes, including the use of certain medications, hormonal changes, hereditary conditions and certain diseases.

Breast reduction in males, also known as Gynecomastia Surgery, can involve not only liposuction of fatty tissue, but also excision of excess breast tissue through nipple incisions, resulting in a flatter, well-contoured chest.  This is an excellent procedure for men whose breast enlargement has stabilized, is not due to modifiable factors such as medication, and who are without severe medical illnesses causing the gynecomastia.  It may also be of benefit to a select group of adolescents with the understanding that secondary procedures may be necessary later on.

 

 

How is it done?

 

This procedure is performed on an outpatient basis, under local or general anesthesia, depending on your case.  If the breast enlargement is primarily due to excess fat, liposuction alone may suffice.  Liposuction is performed using a thin hollow tube inserted through tiny incisions to loosen the fat, which is subsequently removed by suction.  If, on the other hand, the gynecomastia is caused by excess glandular tissue and skin, or if enlarged areolae are present, excisional techniques are used. In some instances, both liposuction and excision may be appropriate.

 

Risks and complications?

 

Complications are uncommon, but may occur despite meticulous technique, and those specific to breast reduction include unfavorable scarring, poor healing, bleeding, infection, changes in nipple/ breast sensation, breast contour irregularities, asymmetry, swelling and bruising, persistent pain, fat necrosis, seroma, partial or total loss of the nipple areolar complex, and the need for revision surgery.

 

 

What to expect after the procedure?

 

Dressings and elastic bandages are applied immediately after the operation and maintained for a few days to support healing and minimize swelling.  A temporary drain might be in place to drain excess blood or fluid that might otherwise accumulate underneath the skin. The sutures will be removed on the 5th to 7th day, and although the incision lines may be quite visible initially, they mature and tend to fade, though not completely, over a period of 6 months to a year.

 

More importantly, the results of reduction mammoplasty are almost immediately apparent once swelling subsides, and you will have enhanced self-confidence, whether in something as simple as wearing a t-shirt or just engaging in physical activities or situations that require exposing your bare chest.  It is important to note, however, that the results of your surgery depend on your avoidance of the very factors that may have caused your gynecomastia in the first place.

 

 

 

BREAST RECONSTRUCTION

Women diagnosed with breast cancer must often undergo deforming surgery that may involve removing virtually all breast tissue along with the skin and nipple areolar complex or a significant amount of breast tissue resulting in asymmetric, deformed mounds.  Breast reconstruction is, therefore, an emotionally rewarding procedure for women who have lost their breasts for whatever reason, and can be performed to restore symmetry, and rebuild as natural-looking a breast as possible.  This entails several stage procedures and patience on the part of the patient, but the results are often more than satisfactory, with improved self-image and quality of life.

Reconstructive procedures are appropriate for those who have a positive outlook on their disease and are able to cope with their diagnosis and what reconstruction actually entails.

 

Depending on the initial indication for breast surgery and need for adjuvant therapy, reconstruction can be performed during the same operation or delayed for months, and usually requires multiple staged procedures.  There are several techniques available for reconstruction, and range from the use of implants to the use of one’s own tissues to form natural-looking flaps, and a combination of such methods is often employed.  Unlike most other plastic procedures, this is usually done under general anesthesia and involves an inpatient stay.

 

Risks and complications?

 

Complications are uncommon, but may occur despite meticulous technique, and those specific to breast reconstruction include unfavorable scarring, poor healing, bleeding, infection, changes in nipple/ breast sensation, breast contour irregularities, asymmetry, swelling and bruising, persistent pain, fat necrosis, seroma, partial or complete loss of flaps and loss of sensation at donor and reconstruction sites if flap surgery is performed, implant rupture or capsular contracture if implants are used, and the need for revision surgery.

 

It should be stressed at this point that the reconstructed breast will not have the same sensation or feel as the original breast.  Also, there will be permanent scarring at the donor and reconstruction sites that may fade with time, but will never completely disappear.

 

How is it done?

 

These procedures are performed under general anesthesia in an inpatient setting, and a variety of options exist, depending on your case.

 

Flap techniques (TRAM, latissimus dorsi, DIEP, etc) are utilized to reposition your own skin and soft tissue from one site (abdomen or back) to your chest wall, with or without a breast implant.  This is necessary when previous radiation therapy or the mastectomy itself does not leave enough tissue for coverage.  Tissue expansion is another technique that involves inserting a device that stretches skin slowly, to allow enough coverage for an eventual implant.  Recovery is easier but it takes longer than flap procedures because of the length of time required to expand the tissue.  Breast implants can be placed immediately after skin-sparing mastectomy, or can be combined with a flap technique or tissue expansion. Finally, the nipple and areola can be reconstructed through a variety of techniques.

 

Although only one breast may be diseased and removed, reconstruction may entail surgery on the remaining breast as well in order to achieve symmetry, whether through a mastopexy, reduction or augmentation.

 

What to expect after breast reconstruction?

 

Dressings and elastic bandages will be placed immediately after your surgery to support healing and minimize swelling.  There may also be a temporary tube inserted to drain any excess blood or fluid that might otherwise accumulate underneath the skin.

 

Final, lasting results of reconstruction can be appreciated immediately and can lessen the emotional pain that often results from a mastectomy.  As time passes, incision scars fade somewhat and some breast sensation may return.  All in all, the benefits of reconstruction outweigh the risks, especially with respect to improved self-esteem, physical proportions and, hence, quality of life.

 

 

BREAST : GALLERY

AUGMENTATION

BREAST  LIFT

REDUCTION : FEMALE

REDUCTION : MALE

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