brunette woman skin breast augmentation surgery

Breast Augmentation

Breast augmentation involves using breast implants (saline or silicone) to increase the size of the breasts. Not only are they designed to increase the size of a woman’s breasts, but they can also be used to correct a certain degree of droopiness (ptosis) that may have been developed with pregnancies, weight loss, and normal aging.

  • Patients who have naturally small-sized breasts (A and B cup) and want to have fuller breasts to help fill out their clothing often decide upon implants sized in the 325 cc to the 375 cc range. It is important to note, however, that the size must be uniquely tailored to the patient’s own body frame. A 350 cc implant placed in a taller patient with wider shoulders may actually look too small, while the same 350 cc implant placed in a shorter patient with narrow shoulders may produce an oversized ‘DD’ look. Most of my patients want to achieve a natural, non-surgical look with full but sloping upper pole fullness, in the C to very low D-cup range. When the augmented breasts appear to jump unnaturally off of the chest, an oversized implant has typically been used. Both Saline and Silicone implants are available for use. The pros and cons of both (cost, feel, appearance, weight, etc.) should be carefully reviewed before making a final decision.

ocean water wave breast augmentation surgery best candidates

Best Candidates

Patients who have had children and want to re-establish the breast fullness they had while breastfeeding are also excellent candidates for breast implants. These patients also tend to have a degree of drop (ptosis) to their breasts that can be corrected with implants alone if not too severe. These patients tend to get the most natural look of all because of this pre-existing ptosis.

Types of Breast Augmentation

Implants can be placed either in a submuscular (underneath the pectoralis major muscle) position, subglandular (on top of the pectoralis muscle) position, or in a dual plane (combination of both) position. The ideal choice of placement depends very much upon a patient’s unique anatomy. Dr. Lober sees a lot of personal trainers and competitive bodybuilders, and these patients almost always request subglandular placement to avoid the “activation deformity” that can be seen when the pectoralis major muscle is activated during exercise. Women with pre-existing ptosis also see a better correction of the ptosis when the implant is placed in a subglandular position.

Choices of incision placement for augmentation include periareolar (underneath the nipple complex), inframammary (underneath the breast base), trans-axillary (underneath the arm), and trans-umbilical (through the belly button). Again, the specific choice is very much dependent upon the patient’s anatomy and goals.

Choices of implant type (saline versus silicone; implant size; smooth versus textured; round versus anatomic; etc.) will ultimately be decided based upon the patient’s desires. These options will be discussed in detail with the patient by Dr. Lober during the initial consultation.

woman barefoot beach water breast augmentation surgery recovery

Surgery & Recovery

All Breast Augmentation Surgeries are performed in the privacy of our on-site Surgery Center. The procedure itself generally takes a little over one hour to perform. No drains are used, and sutures are all absorbable. Patients are encouraged to resume light activities immediately following surgery and can return to moderate activities (including driving) within 4 to 5 days. Full exercises can be resumed at 14 days (with some restrictions on chest muscle exercises).

plants field breast reduction surgery

Breast Reduction

If a woman’s breasts are so large that they begin to cause chronic back, neck, and shoulder pain, a breast reduction may become medically necessary (and also be covered by Insurance). This procedure is designed not only to reduce the weight of the breasts, but also to re-position that weight higher up on the chest wall to achieve better balance and reduce tension on the back muscles.

Types of Breast Reduction

The same incisions used for Mastopexy procedures are also used for Breast Reduction procedures. An “anchor” shaped Inferior Pedicle Reduction is used by many surgeons in this country because of its simplicity and its reliability. It is a very formulaic procedure that produces a circular scar around the nipple/areolar complex, a midline vertical scar, and a long horizontal scar underneath the base of the breast (that oftentimes can extend almost all the way to the back). This style of reduction produces a nicely shaped breast at the time of surgery. Unfortunately, it can be more prone to “bottoming out” over the years, producing a flattened upper pole of the breast and a sagging lower pole. Dr. Lober still uses this procedure on select patients (who have a very short nipple to inframammary fold distance).

More commonly, however, he prefers to utilize the less formulaic and more sculptural Vertical Breast Reduction for a number of different reasons. First, the scars are limited to the periareolar and vertical scars only, reducing total scar length by almost one half. Second, closure of the vertical pillars pulls the lateral breast tissue inward, helping to avoid “dog ear” folds of tissue underneath the arms (which the older procedure actually can accentuate). Third, he believes that the improved shape of the breast is better maintained long-term by the Vertical Reduction, with less “bottoming-out”. Finally, the Vertical Reduction intrinsically produces a higher inferior inframammary fold, while the older Inferior Pedicle Reduction intrinsically produces a lower inframammary fold.

Surgery & Recovery

All Breast Reduction Surgeries are performed on an outpatient basis, either in our own Surgery Center, or in a local Hospital Outpatient Facility. The surgery itself is generally two hours long. No drains are used, and sutures are all absorbable. Patients can expect to return to light activity within several days, including driving. Those with “desk” jobs can return to work within 5 to 7 days. Those with physically demanding jobs (manufacturing, retail, nursing, etc.) should be able to return to work within 10 to 14 days.

  • With either style of procedure, Breast Reduction patients are in general a very happy patient group. They run the spectrum of very young patients who are having difficulty controlling their body weights or engaging in athletic activities to older, more mature patients who are tired of wearing tight bras and dealing with chronic back pain for years on end. For older patients, the decision to undergo a Breast Reduction is often an easy one. For younger patients, who may be very much concerned with any scars on their breasts, the decision to proceed with surgery must be very carefully considered. (In these patients, Liposuction of the breasts alone may be a good ‘bridge’ procedure to reduce the breasts enough to limit discomfort and physical restrictions).

stacked stones rocks sunset breast reconstruction surgery

Breast Reconstruction

Most women undergoing Mastectomy for Breast Cancer ultimately decide to proceed with Breast Reconstruction Surgery to restore the breast shape and volume that has been lost due to the Mastectomy procedure. Breast Reconstruction Surgery can either be performed immediately at the time of Mastectomy, or in a delayed fashion, once the mastectomy has completely healed and adjuvant treatment (chemotherapy and radiation) has been completed.

Types of Breast Reconstruction

The most common procedure used today is the Tissue Expander/Implant Reconstruction. With this method, a Tissue Expander is placed at the time of Mastectomy. This expander is slowly enlarged with saline injections in the office until the desired size and shape are achieved. Once a final volume has been reached, the expander is left in place for another 8 to 12 weeks to allow for adequate relaxation of the expanded skin. The expander is then removed and replaced with a permanent implant.

Latissimus Reconstruction can be performed using tissue from the upper back. This procedure is often used in patients in whom Radiation Therapy is going to be used as a necessary adjuvant treatment.

Autologous Reconstructions can also be performed using excess abdominal tissues (TRAM Flap). This procedure is often used in patients in whom Radiation Therapy is going to be used as a necessary adjuvant treatment.

woman sand dunes breast reduction surgery recovery

Surgery & Recovery

The decision to proceed with Breast Reconstruction, along with the type of reconstruction to be utilized, must be a collaborative effort between the Patient, her Breast Surgeon, her Reconstructive Surgeon, and her Oncologist. Operative times can vary anywhere between one hour and four hours. Similarly, hospitalization times can vary anywhere between one to four days. More specific details can be provided at the time of consultation.

water splash breast lift surgery

Breast Lift

Many women can develop laxity of the breasts and descent of the nipple/areolar complexes (ptosis) as a result of pregnancy, weight loss, aging, or simple genetics. Furthermore, many women are also born with a natural discrepancy between the breasts, with one breast being different in size (and sometimes in shape) than the other. BREAST MASTOPEXY can be utilized to not only reposition the nipple/areolar complex into a higher, “younger” position, but also to equalize the breasts in order to achieve improved symmetry.

Types of Breast Lift

If only a small amount of elevation is required, a Periareolar Mastopexy can be performed that confines the scar to a simple circle around the nipple/areolar complex. Dr. Lober only performs this procedure in a very select group of patients because 1) the degree of improvement is very limited, 2) a permanent suture (which can be disturbingly palpable) is required to maintain a set areolar diameter, and 3) the areolar diameter can become unnaturally large if either absorbable sutures are used or if the permanent suture fails.

Other surgeons often perform mastopexies with an additional long, horizontal inframammary scar (“anchor” pattern), but Dr. Lober prefers to avoid this older-style Inferior Pedicle Mastopexy approach.

Much more commonly, he performs a full Vertical Mastopexy to achieve a more significant correction of the ptotic breasts. This procedure incorporates a scar around the nipple/areolar complex and a single vertical scar immediately below the nipple/areolar midline (“lollypop” pattern). Other surgeons often perform mastopexies with an additional long, horizontal inframammary scar (“anchor” pattern), but Dr. Lober prefers to avoid this approach. The Vertical Mastopexy not only has fewer scars, but also produces a breast mound that is intrinsically higher on the chest than the older-style Inferior Pedicle Mastopexy.

pink white lotus flowers lilly pond breast lift surgery recovery

Surgery & Recovery

Patients can expect to experience their greatest amount of discomfort in the first several days if the implant is placed below the Pectoralis Major Muscle (because of stretch being placed on the muscle itself). Postoperative discomfort is markedly reduced when the implant is placed on top of the muscle (in a subglandular pocket). Patients are encouraged to resume light activity within the first 2 to 3 postoperative days, and most are able to drive comfortably within 5 to 7 days. Moderate exercise can be resumed within 5 to 7 days, and more intense activities can usually be resumed within 14 days.