Plastic Surgery Cosmetic Breast Surgeons Anne Nickodem, M.D.

Implants for augmentation are saline or silicone gel. Both types of implants have been approved by the United States Food and Drug Administration (USFDA) for use in breast augmentation and reconstruction. Depending on skin tone, volume of breast gland tissue, nipple position and the patients desired size; the appropriate implant volume is recommended.

Breast implant surgery is contraindicated in women with untreated breast cancer or pre-malignant breast disorders, active infection anywhere in the body, or individuals who are currently pregnant or nursing. Individuals with a weakend immune system (currently receiving chemotherapy or drugs to suppress the immune system), conditions that interfere with blood clotting or wound healing, or have reduced blood supply to the breast tissue from prior surgery or radiation therapy treatments may be at greater risk for complications and poor surgical outcome. According to the USFDA, a woman must be at least 18 years of age for cosmetic breast augmentation.

Breast enlargement is accomplished by inserting a breast implant either behind the breast tissue or under the chest muscles. Incisions are made to keep scars as inconspicuous as possible, usually under the breast, around the lower part of the areola, or in the armpit. Breast implants are manufactured in a variety of shapes, sizes, and with either smooth or textured surfaces. The method of implant selection and size, along with surgical approach for inserting and positioning breast implants will depend on your preferences, your anatomy and your surgeon's recommendation. The shape and size of the breast prior to surgery will influence both the recommended treatment and the final results. If the breasts are not the same size or shape before surgery, it is unlikely that they will be completely symmetrical afterward.

Conditions which involve sagging of the breast or diminished skin tone (stretch marks) may require additional surgical procedures (breast lift) to reposition the nipple and areola upward and to remove loose skin.

Patients undergoing augmentation mammaplasty surgery must consider the following:

Augmentation mammaplasty with saline/gel-filled implants is an elective surgical operation. Alternative treatment would consist of not undergoing the surgical procedure or use of external breast prothesis or padding, or the transfer of other body tissues to enlarge/rebuild breast size. Risks and potential complications are associated with alternative surgical forms of treatment.

The removal of breast implants that have been placed either for cosmetic or reconstructive purposes is a surgical operation. Breast implant removal may be performed as a single surgical procedure or combined with additional procedures such as the following: removal of scar tissue surrounding the breast implant, breast biopsy, removal of escape silicone gel, secondary breast augmentation, breast lift (mastopexy). Implants that are found to be damaged or ruptured cannot be repaired; surgical removal or replacement is recommended. There are options concerning general versus local anesthesia for breast implant removal.

Breast implant removal is an elective surgical operation. Alternative treatment would consist of not undergoing the surgical procedure or additional procedures. Risks and potential complications are associated with alternative surgical forms of treatment.

Gynecomastia surgery is a procedure to remove excess fat, glandular tissue and/or skin from overdeveloped or enlarged male breasts. In severe casses of gynecomastia, the weight of excess breast tissue may cause the breasts to sag and stretch the areola (the dark skin surrounding the nipple). In these cases, the position and size of the areola can be surgically improved and excess skin may need to be reduced. Gynecomastia may result from hormonal changes, heredity, disease, or the use of certain drugs, and can present unilaterally (one breast) or bilaterally (both breasts).

There are a variety of different techniques used by plastic surgeons to treat gynecomastia. Gynecomastia surgery can be combined with other forms of body-contouring surgery, including liposuction, or performed at the same time with other elective surgeries.

Alternative forms of management consist of not undergoing the surgical procedure or wearing undergarments to help mask the appearance of large breasts. In selected patients, liposuction has been used to reduce the size of large breasts. Risks and potential complications are associated with alternative forms of treatments.

Mastopexy

Breast lift or mastopexy is a surgical procedure to raise and reshape sagging breasts. Factors such as pregnancy, nursing, weight change, aging and gravity produce changes in the appearance of a women's breasts. As the skin loses it's elasticity, the breasts often lose their shape and begin to sag. Breast lift or mastopexy is a surgery performed by plastic surgeons to raise and reshape sagging breasts. This operation can also reduce the size of the areola, the darker skin around the nipple. If your breasts are small or have lost volume after pregnancy, breast implants inserted in conjunction with mastopexy can increase both firmness and size. The best candidates for mastopexy are healthy, emotionally stable women who have realistic expectations about what this type of surgery can accomplish. Breasts of any size can be lifted, but the results may not last as long in women with heavy, large breasts. Mastopexy does leave permanent, noticeable scars on the breasts, and the breasts will be smaller than your current size. There are a variety of different surgical techniques used for the reshaping and lifting of the female breast.

Mastopexy is an elective surgical operation. Alternative treatment would consist of not undergoing the surgical procedure or wearing supportive undergarments to lift sagging breasts. If breasts are large and sagging, a reduction mammaplasty may be considered. Risks and potential complications are associated with alternative surgical forms of treatment.

The open capsulectomy is a surgical operation performed to treat scarring which occurs around breast implants or to revise the shape of the pocket where the implant is placed. This usually involves surgical removal or cutting of scar tissue that forms around a breast implant and the placement of a new breast implant.

Scar tissue, which forms internally around a breast implant, can tighten and make the breast round, firm, and possibly painful. Excessive firmness of the breasts can occur soon after the original surgery or years later. The incidence of symptomatic capsular contracture can be expected to increase over time. Capsular contracture may occur on one side, both sides or not at all. Calcification can occur within the scar tissue that surrounds breast implants. Treatment for capsular contracture may require surgery, removal of the capsule layer, implant replacement, or implant removal.

Individuals wit old, damaged or broken implants may consider open capsulectomy surgery and breast implant exchange as a way to maintain the long-term results from their original surgery, whether for cosmetic or reconstructive purposes. You may be advised by your surgeon to consider replacing of your breast implants with new ones, irrespective of how long you have had them. In some situations, you may be advised to consider new breast implants with a textured outer surface or to consider saline-filled implants. Patients undergoing open capsulectomy surgery and breast implant exchange must consider the possibility of future revisionary surgery. Breast implants do not have an indefinite lifespan and will eventually require replacement surgery.

Depending on the extent of the scarring problem, it may be necessary to place the implant in a deeper location, underneath the pectoralis muscle on the chest. Incisions for the open capsulectomy procedure may be placed in different locations than those used for the original surgery. If the breasts are not the same size or shape before surgery, it is unlikely that they will be completely symmetrical afterward. Conditions which involve sagging of the breast or diminished skin tone (stretch marks) may require additional surgical procedures (breast lift) to reposition the nipple and areola upward and to remove loose skin.

Open capsulectomy and breast implant exchange is an elective surgical operation. Alternative treatment would consist of not undergoing the surgical procedure, romoval of your breast implants (explantation), use of external breast prothesis or padding, or the transfer of other body tissues to enlarge/rebuild breast size. Risks and potential complications are associated with alternative treatments that involve surgery.

Reduction Mammoplasty

Women who have large breasts may experience a variety of problems from the weight and size of their breasts, such as back, neck, and shoulder pain, and skin irritation. Breast reduction is usually performed for relief of these symptoms rather than to enhance the appearance of the breasts. The best candidates are those who are mature enough to understand the procedure and have realistic expectations about the results. There are a variety of different surgical techniques used to reduce and reshape the female breast. There are both risks and complications associated with reduction mammaplasty surgery.

Reduction mammaplasty is an elective surgical operation. Alternative treatment would consist of not undergoing the surgical procedure, physical therapy to treat pain complaints, or wearing undergarments to support large breasts. In selected patients, liposuction has been used to reduce the size of large breasts. Risks and potential complications are associated with alternative surgical forms of treatment.

There are a variety of surgical techniques for breast reconstruction. Breast cancer patients who are medically appropriate for breast reconstruction may consider tissue expander breast reconstruction, either immediately following mastectomy or at a later time. The best candidates, however, are womem whose breast cancer, as far as can be determined, seems to be eliminated by mastectomy and other treatments.

Breast reconstruction with tissue expansion is a two-staged process. It first involves the use of a silicone rubber ballon-like tissue expander, which is inserted beneath the skin and chest muscle. Saline is gradually injected into the tissue expander to fill it over a period of weeks or months. This process allows the skin on the chest to be stretched over the expander, creating a breast mound. In most cases, once the skin has been stretched enough, the expander is surgically removed and replaced with a permanent breast implant. Some tissue expanders are designed to be left in place as a breast implant.

There are legitimate reasons to delay breast reconstruction. Some women may be advised by their surgeon or oncologist to wait until other forms of necessary cancer treatment are completed or disease staging has been accomplished. Other patients may require more complex breast reconstruction procedures. Women who smoke or have other health conditions such as obesity may be advised to postpone sugery. Individuals with a weakened immune system (currently receiving chemotherapy or drugs that suppress the immune system), conditions that interfere with blood clotting or wound healing, or have reduced blood supply to the breast tissue from proir surgery or radiation therapy treatments may be at greater risk for complications and poor surgical outcome. In any case, being informed or your options concerning breast reconstruction can help you prepare for a mastectomy with a more positive outlook on the future.

The shape and size of your breasts prior to surgery will influence both the recommended placement of the tissue expander and the final shape of your reconstructed breast. Tissue expander breast reconstruction cannot produce an exact replica of the removed breast. Breasty symmetry surgery on the opposite breast may be needed to produce similar size. The nipple and darker skin surrounding it (the areola) may be reconstructed in a subsequent procedure after the breast mound is created through tissue expansion.

Tissue expander breast reconstruction is an elective surgical operation. Alternative treatment would consist of not undergoing the surgical procedure or use of external breast prosthesis or padding, or the transfer of other body tissues for breast reconstruction. Risks and potential complications are associated with alternative surgical forms of treatment.

There are a variety of surgical techniques for breast reconstruction. Most mastectomy patients are medically appropriate for breast reconstruction, either immediately following breast removal or at a later time. The best candidates, however, are women whose cancer, as far as can be determined, seems to be eliminated by mastectomy. Ther are legitimate reasons to delay breast reconstruction. Some women may be advised by their surgeon or oncologist to wait until other forms of necessary cancer treatment are completed. Other patients may require more complex breast reconstruction procedures. Women who smoke or who have other health conditions such as obesity or high blood pressure may be advised to postpone surgery. In any case, being informed of your options concerning breast reconstruction can help you prepare for a mastectomy with a more positive outlook on the future.

Breast reconstruction has no effect on altering the natural history of breast cancer or interfering with other forms of breast cancer treatment such as chemotherapy or radiation.

The TRAM flap technique of breast reconstruction invovles the use of abdominal muscle flap(s) made from the rectus abdominus muscle. This muscle and a portion of lower abdominal skin and other tissue is repositioned to the chest wall region in order to reconstruct a breast mound. The muscle flap maintains its own blood supply, and helps nourish the tissue that is transferred to the chest wall region. Following the reconstruction of the breast mound, the lower abdominal incisions are closed. There are several variations on the surgical technique of TRAM abdominal muscle flap breast reconstruction, including microvascular surgery, to attach the flap to the chest region. In some cases, your plastic surgeon may recommend that a breast implant be inserted underneath the muscle flap to give the breast mound additonal projection.

Muscle flap techniques of breast reconstruction are useful in the following situations:

Contraindications to TRAM abdominal muscle flap breast reconstruction procedure exist:

A separate consent form for the use of breast implants in conjunction with breast reconstruction with TRAM abdominal muscle flap is necessary.

TRAM abdominal muscle flap breast reconstruction is an elective surgical operation. Alternative treatment would consist of the use of external breast prosthesis or padding, tissue expansion breast reconstruction, saline breast implants or the transfer of other body tissues for breast reconstruction. Potential risks and complications are associated with alternative techniques of breast reconstruction that involve surgery.

Nipple reconstruction involves the restoration of the of the nipple-areolar complex lost due to injury, breast cancer, or other conditions. A variety of different techniques exist for reconstruction of the nipple and its surrounding areolar tissue. These include the use of skin grafts taken from other regions of the body, local flaps of breast skin that are shaped into a nipple, or the sharing of tissue from the opposite nipple-areolar region. Additional techniques such as tattooing may be used to add color to the tissue if needed.

Nipple reconstruction surgery is an elective surgical operation. Alternative treatment would consist of not undergoing the surgical procedure or the use of external nipple-areolar prosthesis. Risks and potential complications are associated with alternative surgical forms of treatment.

This information is only intended as an introduction to the various procedures. It should not be used to determine whether you will have the procedure performed nor to guarantee the result. The best method of determining your options would be to see a board-certified plastic surgeon for a thorough history and physical examination. Only at this time could your candidacy for any procedure be determined. The information provided is not intended to serve as medical advice.