Breast Surgery

Plastic surgeons perform breast augmentation to increase a patient’s breast size, improve her body proportions, and correct breast asymmetry. With offices in Wilmington and Jacksonville, Wilmington Health provides breast augmentation for many women in greater North Carolina. The following is a basic description of the surgery.

ARE YOU A CANDIDATE FOR BREAST AUGMENTATION?

The following are some of the common reasons for women to choose breast augmentation:

Dissatisfaction with breast size: An increase in breast size can give you a more feminine appearance and more wardrobe options. After breast augmentation, a patient will often say she feels more confident wearing a low cut top or that her appearance has improved with her current wardrobe.

Lack of proportion due to small breast size: One of the keys to success with this procedure is choosing the right breast implant size. With the help of a good plastic surgeon, you can choose an implant size that brings your body into balance and enhances your natural feminine shape.

Loss of breast fullness/volume: The aging process can cause a loss of fullness in a woman’s breasts, leading to the appearance of a “deflated” or “flattened” chest. With breast augmentation, your plastic surgeon can restore fullness to bring back volume in an area plastic surgeons call the “upper pole.”

Breast asymmetry: When breasts have a noticeable size discrepancy, a woman may feel self-conscious in certain situations, or she may avoid wearing certain clothing items. By enlarging a breast that is noticeably smaller, this asymmetry can be corrected.

BREAST IMPLANT OPTIONS

Aside from the basic saline versus silicone dilemma, there are many considerations when it comes to choosing the right breast implants. Taking into account your preferences, goals, and your body type, your provider can help you choose the right breast implants. The doctor can explain various details about breast implant volume, projection, diameter, texture, and shape. In general, you want to choose an implant that is proportional with your body shape while still achieving a satisfactory increase in breast size.

SURGICAL TECHNIQUES

Breast implants can be surgically placed through a variety of established techniques. The most common techniques involve an incision in one of these four locations:

• Inframmary fold, also known as the breast crease
• Periareolar, the lower half of the areola
• Transaxillary: through a small incision near the armpit
• Transumbilical: through a small incision in the navel

If you’re choosing saline breast implants, any of these incision locations may be used. Silicone implants, however, are limited to the first two options listed. After the incision is made, the doctor can place your implants above or below the chest muscles. Placement partially under the chest muscles is another option for certain patients. During your consultation, your provider will recommend the right technique to achieve the results you desire from breast augmentation.

This surgery is typically performed under general anesthesia, so you’ll be asleep for the operation. After your provider performs the surgical incision, he creates a pocket for each implant by lifting the breast tissue and skin. The implant is then inserted on each side (over or under the muscle) in a central location below the nipple. The incisions are then closed with sutures, adhesive, and/or surgical tape. 

Breast reduction is a common surgical procedure that reduces breast size in women who experience pain, irritation, and self-consciousness regarding their body shape. Also known as reduction mammaplasty, this surgery removes fat, skin, and glandular tissue from the breasts, while lifting and reshaping them to exhibit a more youthful appearance.

Large breasts (also known as female breast hypertrophy or macromastia) can cause a variety of problems. Some of the most common issues associated with large breasts are the following:

• Excess breast weight
• Back, neck, or shoulder pain
• Shoulder grooves from bra strap
• Restricted movement
• Limited clothing options
• Infection or inflammation in breast crease

ARE YOU A CANDIDATE FOR BREAST REDUCTION?

If you have voiced complaints about one or more of the conditions listed above, you may be a good candidate for breast reduction. Good candidates are healthy non-smokers who are capable of understanding the risks and benefits involved. For example, candidates should be aware of the possibility that breastfeeding ability can be disrupted and changes in nipple sensation can occur.

WHAT HAPPENS DURING BREAST REDUCTION

There are several techniques to meet the needs of different patients. Your provider will choose a technique for you depending on your breast size and position. In some rare cases, liposuction alone can sufficiently reduce breast size. Most patients will benefit from a more extensive technique.

A typical breast reduction requires about four hours under general anesthesia. Your provider makes a keyhole shaped incision around the areola, removes a significant amount of fat and glandular tissue from the breasts, and removes skin to shape and reposition the breasts. The incisions are closed with sutures and covered with gauze and tape.

AFTER BREAST REDUCTION: WHAT TO EXPECT

The recovery period is about one to two weeks, during which you will need to wear a special recovery bra to provide extra support. Surgical drains may be necessary to remove fluid during this time. You will likely experience some swelling, bruising, and aching in your breasts. Discomfort can usually be managed well with pain medications.

BREAST REDUCTION AND INSURANCE COVERAGE

Because breast reduction is performed for therapeutic reasons, it is possible to get health insurance coverage for the procedure. Ask your health insurance provider for information about coverage. You may need to document health problems related to pain and other symptoms associated with macromastia.

POSSIBLE COMPLICATIONS/SIDE EFFECTS

Like all surgical procedures, breast reduction has some uncertainty and risk involved. Possible adverse events include but are not limited to bleeding, infection, unfavorable reaction to anesthesia, breast asymmetry, unsatisfactory aesthetic results, scarring, and loss of sensation in the nipples. Ask your provider for more details if you are concerned about complications of breast reduction.

A breast lift can elevate breasts that are sagging, restoring them to a more youthful position. Technically known as mastopexy, this procedure is the only method proven to lift breasts after they have descended below a certain point. For some patients, a breast lift can decrease the size of the areolas or increase breast fullness when combined with breast augmentation.

ARE YOU A CANDIDATE FOR BREAST LIFT SURGERY?

To determine if you are a candidate for this surgery, it’s best to schedule a consultation with your provider.

Breast ptosis is the clinical term for breast sagging, and it can be measured to help your surgeon design a plan for correction. To measure ptosis, plastic surgeons typically use some form of the Regnault classification, such as the following:

• Mild ptosis: Your nipples are level with the breast crease.
• Moderate ptosis: Your nipples reside below the breast crease.
• Severe ptosis: Your nipples are the lowest point on your breast and point downward.

HOW A BREAST LIFT CORRECTS BREAST PTOSIS

By removing skin and excess glandular tissue, the breasts become firmer and also get elevated to a higher position on the chest wall. This procedure is typically performed under general anesthesia, while local may be an option for select patients. Your provider will choose a technique based on an evaluation of your condition. Common incision techniques include the inverted T incision or a donut incision, with the former being reserved for cases of moderate to severe ptosis.

During surgery, the excess skin is removed; breast tissue is reshaped; and the nipple/areola is repositioned. The incisions are closed with sutures (usually dissolvable) and covered with gauze and tape.

AFTER YOUR BREAST LIFT

Your provider will send you home with instructions, medications, and a special post-operative bra to wear during recovery. Expect about one to two weeks of downtime after a breast lift; then you’ll need to limit your activities for up to six weeks to ensure proper healing. Some bruising, swelling, discomfort, and changes in skin sensation are common during this time. The incision scars will be noticeable at first but should gradually fade and flatten out over time. Although the aging process will continue after your surgery, the results of your breast lift will be long lasting.

POSSIBLE ADVERSE EVENTS/COMPLICATIONS

Common side effects of a breast lift include temporary bruising, swelling, discomfort, numbness, and dry skin. Like all surgical procedures, an inherent risk of complications is something the patient should be informed about. Possible adverse events include but are not limited to bleeding, infection, poor healing, scarring, disrupted breastfeeding, asymmetry, loss of sensation in the nipples/breast, and adverse reaction to anesthesia. Discuss these possibilities with the doctor if you are concerned.

If you have undergone a breast augmentation and achieved unsatisfactory results, a revision procedure with your provider may be recommended for you. The goal of this surgery, whether it’s a simple or complex procedure, is to:

1. Correct aesthetic problems related to breast implants
2. Address complications of previous breast augmentation

Although breast implants do not have an expiration date, they often need to be replaced after several years. For this reason, you should form a partnership with a qualified plastic surgeon to prepare for the possibility of necessary revisions. There are many possible reasons for a revision procedure: you may change your preferences, your aesthetic results may change during the aging process, or an unexpected event (a complication or medical issue) may occur.

REASONS FOR REVISION

The following are some of the more common reasons for corrective breast augmentation or revision breast surgery:

Visible implant rippling: In some patients, the edges or folds of a breast implant can show on the skin. This can often be prevented by choosing silicone implants or placing the implants in a sub-muscular position. Rippling can often be corrected with a volume adjustment or a switch to silicone implants.

Implant deflation: Breast implants can rupture because of trauma or general wear and tear over time. They may also be defective, in which case you should investigate a manufacturer’s warranty to pay for replacements and possibly surgery. If a saline implant fails, you will probably know it immediately. The saline is safely absorbed by your body and poses no health risk, but the change will be noticeable on the affected breast. To detect a rupture with a silicone implant, an MRI is usually necessary.

Capsular contracture: This occurs when scar tissue forms around the implant, constricting the capsule. There are varying degrees of severity when it comes to this condition. If your implants have become displaced or distorted over time, you may need to see a plastic surgeon to correct capsular contracture.

Breast ptosis: Large or surgically enlarged breasts are generally more prone to breast ptosis, i.e. breast droop. When your skin elasticity decreases throughout the aging process, you may notice a gradual descent of your breasts. There are various techniques in breast lift surgery (mastopexy) to correct this condition. Some may involve placement of implants during the same procedure (augmentation mastopexy).

Change in preferences: Some patients choose to remove the saline implants they originally chose years ago and switch to a silicone gel breast implant that has a more natural consistency. Others may decide that their circumstances have changed and breast implants no longer fit into their lifestyle.

BREAST IMPLANT REMOVAL OR REPLACEMENT SURGERY: HOW IT WORKS

Removing breast implants is a relatively simple surgical procedure. However, the potential for an undesirable aesthetic outcome is strong. In some cases, implants can be removed and the breasts resemble their pre-augmentation size and appearance. However, if you have had breast implants for many years and are now choosing to remove them, it is unlikely that your skin will contract to a satisfactory degree. In these cases, your provider may recommend breast lift surgery to tighten the breast tissue and remove excess skin.

Replacement surgery is also relatively simple. The implants are typically approached through the same surgical incision as your first procedure. On each side, the implant is removed and the breast pocket is prepared for the replacement implant. Afterward, the recovery time is often shorter than the original breast augmentation surgery.