Increasing the volume of the breast is typically performed with a round or shaped silicone implant or round saline implant. Occasionally, small breast augmentations can be performed with fat taken from elsewhere on your body. Over the past several years, there have been a number of new implants approved by the FDA which has given us the ability to fine tune the best implant to your body shape, size and comfort. We utilize implants from Mentor, Sientra and Allergan.
Although some patients have a sense of the postoperative size they are looking for, we can help guide you utilizing our VECTRA surface imaging software or silicone sizers. This essentially allows you to try on a number of different options during your consultation. Most of our patients want a more natural look which allows us to emphasize moderation in your implant choice. We will have a detailed discussion about your size interest and activity level in order to ensure that your size choice will fit with your lifestyle and your aesthetic goals.
During your consultation we will also discuss incision options, implant position, and your recovery from surgery, as well as providing a comprehensive financial quote.
Breast Augmentation & Mastopexy (Lift)
This combined operation allows us to reshape your breasts by elevating the nipple and reshaping the lower portion of the breast (mastopexy), in addition to adding volume to the upper aspect of the breast with an implant (augmentation). If your nipple is at or below the level of the breast fold, or if you have a considerable amount of your breast tissue beneath this fold, the mastopexy or lift may be a necessary addition to your augmentation. The lift involves raising the nipple, and often removing some of the breast tissue along the central lower portion, in order to tighten the lower shape. This results in any one of a number of scar patterns ranging from a crescent above the nipple in the most mild cases to, more commonly, either a lollipop or even an anchor-shaped scar.
Understandably, many patients shy away from the thought of the lift because of additional scarring, additional expense, or additional potential for complications. Unfortunately, this is an operation that, if you need it, you need it (to achieve the best cosmetic result). Opting instead for the breast augmentation alone will almost certainly end in disappointment in the final result. Rarely, there is so much sagging (or ptosis) to the breast that we will recommend staging the two procedures rather than combining them in order to minimize the risk of complications.
Breast Mastopexy (Lift)
For patients interested in improving the shape of their breast, including elevating the nipple and addressing extra skin and breast tissue along the lower breast, a mastopexy alone can help. As we remove the excess breast skin and redundant tissue and tighten the overall skin envelope of the breast, the overall breast size will be reduced. How much reduction in size really depends on how much excess there is to begin with. One important point to a mastopexy alone is that the shape of the upper aspect of the breast will not change. If the upper portion is what you are looking to alter, then an implant will likely be necessary.
Fat Transfer Augmentation
Although not for everyone, this is a great solution for some patients that desire a very small increase in the volume of their breasts (typically 1 cup size or less). We can surgically transfer fat from one area of your body to your breasts, if you have an adequate donor site that can serve as a source for fat via liposuction. Typical sites for the liposuction include your lower abdomen, flanks or outer thighs. This technique can avoid the inherent limitations associated with implants, such as rupture, but does also have the potential to fluctuate size with large weight swings, and ultimately the result is determined by how well the fat is incorporated. This is a procedure that can be repeated for larger augmentations.
Particularly large breasts can create considerable strain in your neck, mid or upper back and shoulders, and can impair normal activities such as exercise, hinder posture and create difficulty finding bras and clothes. There are more similarities than differences between a breast lift and breast reduction. Both involve a lifted breast appearance and both will reduce the size of the breast with the primary difference being how much breast tissue is removed. For those patients with considerable symptoms, this operation can be truly life-changing and our breast reduction patients are typically some of our happiest patients!
The amount of breast tissue removed also has big implications for insurance coverage. Some insurance companies specifically exclude this procedure so make sure you check with them first to ensure it is a covered benefit. We will discuss your current symptoms, as well any methods you may have tried to reduce these symptoms such as Physical Therapy or specialty bras. We will work with you to submit your case to your insurance in an attempt to obtain coverage. Unfortunately, insurance companies appear to be getting increasingly stingy about providing coverage for this procedure in recent years, and ultimately this will be largely determined by the amount of weight we anticipate removing from each breast.
Two high risk factors for complications following breast reduction include smoking and obesity. To this end, we will not consider performing this operation on smokers (or those on nicotine substitutes). Also, for best results, we will strongly encourage you to reduce your weight until your Body Mass Index (BMI) is 30 or less.
Gynecomastia Reduction (Male Breast Reduction)
Male breast development is a very normal developmental stage and is common in adolescents. It almost always resolves spontaneously after a couple of years. For those patients where it persists, this can be a very socially difficult issue. Many patients find themselves avoiding shirtless activities such as swimming, changing for gym class, or during sports. Surgical correction of gynecomastia most commonly involves a combination of liposuction to the chest as well as often a small incision at the lower border of the areola to remove the more stubborn fibrous breast tissue beneath the nipple. We will limit some of your activities for a few weeks as the area heals as well as using a compression garment (yes, a Mansierre, a Bro, you can pick your Seinfeld term). There can also be external influences that can lead to gynecomastia or recurrent gynecomastia such as some endocrine disorders, steroid or marijuana use, or other medications.
FTM Top Surgery
There are numerous important components to a successful transition. Certainly a strong social network and a professional support system can smooth the journey through hormonal therapy and surgical transformation. With ongoing testosterone therapy, you will see considerable changes associated with your breasts, but additional procedures are necessary to create a masculine chest. The surgical options available can vary based on your existing breast shape. For those with small breasts, we may consider liposuction of the tissue and a modest incision around your areola to remove the more fibrous tissue. For those patients with larger or more pendulous breasts, a larger incision over the lower border of your pectoralis muscle may be necessary to remove the breast tissue and excess skin. This also requires either a free nipple graft, or a repositioning and resizing of your nipples and areolas. We find the dramatic before and after transformations to be inspiring and exciting for all of us.
MTF Top Surgery
We encourage patients undergoing MTF Top Surgery to remain on hormonal therapy for a minimum of 6-12 months prior to surgery in order to maximize the breast tissue available to soften the appearance of a breast implant. After that, the surgery is otherwise quite similar to a traditional breast augmentation in terms of incision, implant options and recovery. Both saline and silicone options are available from Mentor, Sientra, and Allergan. We will discuss sizing at your consultation based on your desires, frame size, and available skin and tissue. During surgery, we will inject a long-acting local anesthetic into the tissues to enhance your comfort and help reduce the need for post-op pain medications. Recovery and return-to-work guidelines will vary depending on your profession, ranging from a few days for most patients to 4-6 weeks for those with strenuous, physical professions.