Enhancement
Breast enhancement is a term that has recently come into popular use, mostly when referring to breast enlargement (breast augmentation). Breast enhancement is probably more appropriate, because as well as enlarging breast, other interventions can be performed to enhance the appearance of the breast. The aesthetics of the breast include not only the size of the breast (the breast mound), but also the condition of the skin and the position of the nipple on the breast. Optimum outcomes in breast enhancement require a comprehensive evaluation of these qualities, as well as the patient's body type, width and size of the chest wall, and of course the patient's postoperative expectations. Since there is a wide variation in people's proportions, body shape and size, and breast shape and size, breast enhancement is highly individualized. It certainly is not a "one size fits all" operation. A myriad of options is available, regarding:
- placement of the incision (inframammary, peri-areolar, axillary, umbilical)
- placement of the implant (submuscular, subglandular, biplanar)
- type of implant (textured vs. smooth, round vs. anatomic, saline vs. silicone, high-profile vs. moderate-profile)
All of these choices actually allow the surgeon to enhance the breast in a highly individualized way. During your consultation, a thorough evaluation of the characteristics of the breast and your body type will be performed. The questions on implant style, volume, placement of the implant, and incision placement will be discussed and an individualized operative plan is formulated for each patient to yield the best result possible.
The following cases feature different implant styles, implant volumes, and surgical approaches, all tailored to yield the optimal result for each individual.
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BREAST LIFT
“Breast lift” is for women who don't necessarily want an increase in size of their breasts, but would like to restore a more youthful "perkiness". A breast lift also restores the nipple to a more forward pointing position on the breast if it is sagging downward. A breast lift can also be used to correct asymmetry of the position of the nipple or position of the breast on the chest wall. A breast lift is characterized by elevation of the skin off of the breast and tightening of the skin to lift the breast and reposition the nipple in a higher position. Frequently a breast lift is combined with breast augmentation to restore fullness to the breast and lift the breast at the same time.
A breast lift incision may be circumareolar (just around the areola), vertical, or an inverted “T” similar to a breast reduction incision. The type of incision generally depends on the amount of lift required and the compliance (or stretchiness) of the skin. The following cases will illustrate examples of the various techniques and degrees of breast lift or breast lift and augmentation.
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BREAST REDUCTION
Most plastic surgeons would agree that breast reduction patients are the happiest group of patients after surgery. Women with overly large breasts frequently complain of upper back pain, strain of the neck or upper shoulders, grooves from their bra straps, pain within the breasts themselves, and a rash forming under the breasts. They frequently are unable to find clothes that fit properly and have a hard time bra shopping. Frequently, physical therapy or chiropractic therapy has been tried, but is unsuccessful in alleviating their discomfort. Almost all patients experience improvement after breast reduction surgery, no matter what age group.
Most insurances cover breast reduction surgery, depending on certain conditions (the symptoms outlined above) and many require some form of documentation by a primary doctor, physical therapist, chiropractor, or neurosurgeon recommending breast reduction. Most insurances require at least 500 grams (one pound) of breast tissue per side to be removed at breast reduction surgery. For patients suffering from the above symptoms, this is typically not difficult to do.
At your consultation at Allegany Plastic Surgery, we will:
- document your symptoms associated with overly large breasts
- do a thorough physical exam and assess the expected amount of breast tissue that would be removed at breast reduction
- obtain prior authorization from your insurance company to proceed with surgery
The following cases are examples of breast reduction at various volumes from 500 grams to 2000 grams/side. All of these patients were happy to be smaller, "perkier", and free of their pain and muscle aches.
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BREAST RECONSTRUCTION
The decision for breast reconstruction can be a complex and almost overwhelming decision for many women. This is very trying period, and patients need as much education as possible, while at the same time undergoing the emotional stress of the cancer diagnosis. Many patients are seeking general information on reconstruction, even before making a decision for mastectomy vs. breast sparing surgery. Most of my breast reconstruction consults are between 45 minutes and an hour to help patients sift through all the options and data to make a decision that is right for them. Is reconstruction best done immediately at the time of mastectomy, or on a delayed basis later? Is using your body's only tissues better, or is some combination of your body's own tissues and implants, or expanders a better option? Is surgery required on the other breast? All of these considerations are important and are discussed.
The following cases show examples of immediate breast reconstruction, delayed breast reconstruction, the use of expanders, the use of immediate placement of implants, the use of breast reconstruction without implants, and using the body's own tissues. Each case is tailored to the specific desires of each patient.
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