BREAST ENLARGEMENT

Breast enlargement, or augmentation mammoplasty, enhances the body contour of a woman who is unhappy with her small breast size. Other purposes of this procedure include:

  • To correct reduction in breast volume after pregnancy.
  • To balance a difference in breast size.
  • As a reconstructive technique following breast surgery.

Augmentation mammoplasty is done on an outpatient basis in our surgical center, usually under general anesthesia. An implant (prosthesis) is placed through an incision, under the breast tissue or under the muscle. The incision can be made under the breast, around the nipple or under the arm. A breast implant is composed of an outer silicone shell filled with saline. The outer surface may be smooth or textured, and implants come in various shapes to meet the individual woman’s needs.
When the implant is placed sub muscularly under the breast, there is a lower chance of contracture (contraction of the tissue capsule surrounding the implant), and mammography is more reliable. There is also less risk of visible or palpable implant edges. However, some believe the implant has a more natural appearance when placed above the muscle, under the breast tissue. Your plastic surgeon can help you decide which placement and type of implant will work best.

Determining Implant Size

The shape of your augmented breasts depends on the implant. Implants may be round or teardrop-shaped (anatomical). The choice depends on the look you want to achieve: Anatomical implants produce a gentle slope, resulting in a fuller upper area, whereas round implants create a round curve in the upper part of the breast. Another factor to consider prior to surgery is breast width, which determines the amount of “cleavage” between your breasts and the outer curves, which you may want to balance with your hips.

Realistic expectations of this procedure are important. Women often think of breast size in terms of bra cup size. If you are currently a size “A” and wish to be a size “C”, there must be adequate existing breast tissue coverage; otherwise you will be warned of visible or palpable implant edges and other possible risks.

Post Operative Care

You must have someone drive you home and stay with you for 24 hours after surgery. You will experience some pain the first day or two that is easily controlled with pain pills. Some tightness in the breast area is also normal as your body adjusts to the implants.

You can move about freely after surgery. Wear a bra at all times (except when showering) during the first 2 weeks following surgery. Avoid heavy lifting for 2-3 weeks. Moderate exercise such as walking or stationary biking is allowed after the first week. Vigorous exercise such as jogging or aerobics may be resumed at 3-4 weeks. You will most likely be able to return to work within a few days, but you will need to avoid any strenuous activity for at least a couple of weeks.

During recovery, the breasts will be somewhat swollen. Within a few weeks, the actual shape and size will be evident. You may notice some asymmetry; however most breasts are naturally somewhat asymmetrical.

Possible Complications

Delayed wound healing may occur in persons with diabetes, history of radiation, autoimmune disease or smokers. Other complications include capsular contracture, bleeding, infection, or irregularity of the skin. It is important to have a thorough medical evaluation beforehand to address these potential risks. You also need to know that even a small hole in an implant can cause the saline to leak out, resulting in a "flat” implant and necessitating surgical replacement. This is completely avoidable, however, by taking proper precautions.

Conclusion

Augmentation mammoplasty is a safe procedure that has produced pleasing and satisfying results for many women. Those who are psychologically stable and have realistic expectations benefit the most. A preliminary consultation can help you determine whether breast augmentation is right for you.

BREAST LIFT

Breast lift surgery, or mastopexy, restores a more youthful appearance to a woman’s breasts. Over the years breasts can lose their shape and firmness due to pregnancy, nursing and loss of skin elasticity, causing them to sag. Mastopexy will raise and reshape breasts—slowing the effects of aging and gravity. This procedure can reduce the size of the areola, the darker skin surrounding the nipple.

Mastopexy is commonly performed in conjunction with breast augmentation(implants) to increase breast firmness and size. This may appeal to women who have lost breast volume after pregnancy. Pregnancy and nursing often result in stretched skin and therefore decreased volume. If you are planning a future pregnancy, it is advisable to postpone your breast lift as pregnancy will likely cause further stretching.

As with all plastic surgery, realistic expectations and emotional stability are important. Though breasts of any size can be lifted, women with smaller breasts enjoy longer lasting results.

The Procedure

Though not a simple operation, mastopexy is normally safe when performed by a qualified plastic surgeon. Mastopexy is occasionally performed in a hospital, but more often is done in an outpatient facility. Breast lifts are usually performed under general anesthesia. Local anesthesia may be used with a sedative if the incision is small; you’ll be awake but relaxed, and will feel minimal discomfort.

The surgery may take between 1 1/2 to 3 1/2 hours. A more common approach involves an incision along the natural contour of the breast where excess skin will be removed. The nipple and areola are then repositioned. The skin surrounding the areola is brought together to reshape the breast, with stitches around the areola and the lower breast area.

Possible Complications

As with any surgery, there are possible complications. A patient may suffer an adverse reaction to the anesthesia (rare), or experience bleeding and infection following a breast lift, causing scars to widen. Poor healing and wider scars are more common with patients who smoke.

Because milk ducts are left intact, mastopexy will not affect your ability to breast-feed.

For best results, follow your physician’s advice both before and after surgery.

After Surgery: What to Expect

After surgery, your stitches will be covered with gauze and an elastic bandage or a surgical bra will hold the breasts in place. Your breasts will be bruised, swollen, and you may experience some mild discomfort for a couple of days. Your doctor may prescribe pain medication. A soft support bra replaces the bandages or surgical bra after a few days. In the recovery stage, it is important to wear the bra at all times.

After a week or two, the stitches will be removed. Some noticeable, permanent scarring is normal, but easily covered by your bra or bathing suit. The scars may be red and lumpy for a few months, eventually fading and becoming less obvious. The procedure can also leave you with unevenly positioned nipples, or a permanent loss of feeling in your nipples or breasts.

To ensure proper healing, plan to stay at home for at least a week before returning to work. You will need to avoid lifting anything over your head for 3-4 weeks and avoid strenuous sports for a month.

BREAST REDUCTION

Breast reduction, or reduction mammoplasty, is for a woman experiencing health problems and/or extreme self-consciousness associated with very large, heavy breasts. The goal is to give the woman a more attractive contour with smaller, better-shaped breasts in proportion with the rest of her body. She will then benefit from freedom of health problems associated with large breasts and an improved self-image.

Medical problems associated with very large breasts include back and neck pain caused by the excessive weight, skin irritation, skeletal deformities and breathing problems. Bra straps may leave shoulder indentations. Large, heavy breasts also contribute to poor posture, and can interfere with normal daily activities such as exercise. Excessive breast size may also lead to a decreased sense of attractiveness and self-confidence.

The Procedure

Breast reduction is done under general anesthesia on an outpatient basis or in the hospital. The surgery 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.
Incisions are made around the pigmented nipple-areolar complex and extend vertically below the nipple and in the fold under the breast. The nipple-areolar complex is moved upward to the desired location. The incisions are covered with a light dressing.

Afterward, the breasts are placed in a surgical bra that will hold them symmetrically during initial healing. Initial discomfort subsides daily and can be controlled with oral medications. Scars will fade in 6-18 months. Surgery will likely reduce, but not eliminate the ability to breast-feed.
The result may be further enhanced by liposuction of the axillary area to reduce excess fat deposits. This is commonly covered by insurance. Our staff will assist you in obtaining preauthorization.

Recovery: What to Expect

When performed by a qualified plastic surgeon, breast reduction is a safe procedure. Nevertheless, as with any surgery, there is always a possibility of complications, including bleeding, infection, or reaction to the anesthesia. Some patients develop small sores around their nipples after surgery; these can be treated with antibiotic creams. You can reduce your risks by closely following your physician's advice both before and after surgery.

Much of the swelling and bruising disappears in the first few weeks following the surgery. Breasts may appear slightly mismatched, or have unevenly positioned nipples. Their new shape will be apparent within 6 months to a year, and will depend on hormonal fluctuations, weight changes and pregnancy.

Although your surgeon will make your scars as inconspicuous as possible, some permanent scarring is inevitable. Smokers are more likely to experience poor healing and wider scars. The scars will be red and lumpy in the months following the surgery, but the redness will fade and in time the scars will be less obvious. The good news is, your bra or bathing suit will cover whatever scars remain, and most likely, the scars will not prevent you from wearing low-cut tops.

Ability to Breastfeed

Because the surgery removes many of the milk ducts leading to the nipples, breast-feeding may no longer be an option.

Some patients may experience a permanent loss of feeling in their nipples or breasts. Rarely, the nipple and areola may lose their blood supply and the tissue will die. (The nipple and areola can usually be rebuilt, however, using skin grafts from elsewhere on the body.)

The End Result

Breast reduction produces the most dramatic results of all plastic surgeries. It ends the physical discomfort or large breasts and makes your body appear more evenly proportioned, and clothes fit better. Your new image will take some getting used to, as much as you desired the change. Give yourself—and your family and friends—time to adjust to the new you and, like most women, you will enjoy the benefits.

BREAST RECONSTRUCTION

Breast reconstruction offers much hope for a woman losing her breast to cancer. Reconstruction can often be performed immediately after the mastectomy, so the woman does not have to live with one breast. Depending on health conditions, however, a mastectomy patient may have to wait before undergoing reconstructive surgery. In either case, reconstructive surgery holds much promise that the post-operative breast can match the natural breast again.

The Surgery

When reconstructive surgery is performed immediately following mastectomy, a breast mound is created in place of the breast that has been removed. This is done in the hospital under general anesthesia. Dr. Camarata will work with your oncologist to ensure the best possible conditions for reconstruction.

Breast reconstruction usually involves more than one operation, and follow up procedures may be performed on an outpatient basis. Follow-up procedures may only require local anesthesia, and often involve a skin and tissue expander with a breast implant, and reconstruction of the nipple and areola. Sometimes surgery is the performed on the natural breast to match the reconstructed breast; however, this creates additional scars.

Once the breast mound is in place, your plastic surgeon may follow up with a skin expander and breast implant or flap reconstruction.

Recovery: What to Expect

This is the simplest of breast reconstructions. Blood transfusions are not required, and there is minimal pain and a short recovery time. In this procedure, a tissue expander is placed under the skin. Once sutures are removed, saline is added weekly to the expander. This stretches the skin as it expands.
When the skin has been sufficiently stretched, the tissue expander is removed replaced by a permanent breast implant in a two-stage procedure. Nipple reconstruction, if desired, is a separate procedure.

Advantages: Simplest surgery and shortest recovery from surgery. This is the favored procedure for persons who have heath problems or contraindications to extensive surgery.

Disadvantages: Multiple trips to the office over several weeks or months to undergo expansion. Capsule formation or poor cosmesis due to thin skin.

Possible Complications:

  1. Loss of breast skin requiring removal of implant. If you have undergone radiation this procedure is not advisable as you are at increased risk for skin loss.
  2. Noticeable outlines of the implant due to capsule formation
  3. Hard texture due to capsule formation
  4. Thin breast skin

Latissimus Dorsi
Myocutaneous Flap

This surgery involves moving the latissimus dorsi muscle and overlying skin from the back to the chest to create a new breast mound. The incision is usually made along the bra line so the scar will be concealed.

Blood transfusions are not usually required. A breast implant can be placed under the flap if necessary to balance a difference in size. Nipple reconstruction is done later.

Advantages: This is a very reliable procedure, which provides a good environment for an implant. The chances of capsule formation around the implant are reduced.

Disadvantages: Scar across the back. There may be decreased strength in the back due to muscle loss. Capsule formation may occur and result in the need for additional surgery.

Possible Complications:​

  1. Circulation problems with the flap
  2. Formation of capsule around the implant
  3. Symptoms from loss of shoulder muscle, such as decreased strength
  4. Loss of back skin requiring skin grafting
  5. Collection of fluid (seroma) under incision requiring needle aspiration

Rectus Abdominus
Myocutaneous Flap

This is the most complicated and the longest reconstructive procedure, involving about 4-5 hours of surgery. One of the rectus abdominus muscles is tunneled along with the overlying skin up to the chest. The breast mound is created to match the opposite site. A blood transfusion may be required. You may donate your own blood prior to surgery to be re-infused during the surgery.

Breast implants are not usually required. The tissue is generally adequate to match the size of the opposing breast. If the opposite breast is large or pendulous it can be decreased in size by a simultaneous breast reduction. Patients wishing to have this procedure must stop smoking six weeks prior to and six weeks following surgery. Failure to comply may result in death of the flap. A synthetic mesh is placed over the area where the muscle is moved. This strengthens the abdominal wall and minimizes the chance of herniation of the bowel. Nipple reconstruction is done as a second procedure. Some contouring of the new breast mound may be necessary at the same time.

Advantages: This provides the most natural looking breast reconstruction with the added benefit of a "tummy tuck". No implant is needed so capsule formation is not a risk. The scar is easily hidden with clothing.

Disadvantages: There is a risk of herniation of the bowel resulting from moving the rectus abdominus muscle. Abdominal strength is diminished. This is the longest procedure and has the greatest risk for requiring a blood transfusion.

Possible Complications:​

  1. Inadequate tissue requiring the use of a breast implant
  2. Poor circulation to the flap resulting in tissue loss
  3. Weakness or herniation of the abdominal wall.
  4. Placement of the umbilicus off center
  5. Collection of fluid (seroma) under the skin requiring needle aspiration.
  6. Infection, in particular of the mesh requiring surgery for removal.

Nipple Reconstruction

The reconstruction of a nipple adds a very pleasing final touch to the breast. This is a simple outpatient procedure that may be done with local anesthesia. An average time for this is about 1-2 hours. The goal of the surgery is to create a nipple that has the appearance of the nipple of the opposite breast. Skin is taken from the inner part of the upper thigh or from behind the ear. These areas tend to have a darker pigment, which will provide a better contrast to the breast tissue. As a second procedure the healed nipple can be tattooed to improve the color match of the opposite breast.

Possible complications:​

  1. Excessive scarring
  2. Shrinkage of the projecting part of the nipple
  3. Infection of the donor site or the newly created nipple
  4. Blood clot under the nipple, which may result in loss of all or part of the new nipple​

Reconstruction of the breast following mastectomy is a very rewarding procedure to both the patient and the surgeon. Many women describe a feeling of once again being whole. There are many materials available regarding breast reconstruction. There are support groups available where one can meet women who have gone through these procedures. Ask us for references, books and support groups in your area. Take advantage of these invaluable resources.