Patients wanting breast enlargement usually fall into two categories: those who have never had much breast tissue and want to fill out their clothing better, and those who had fullness after pregnancy during breastfeeding and want to correct post-breastfeeding droopiness. As with all surgeries done by this practice, we believe that a good augmentation is one that results in a completely natural looking breast. Oversized implants can look out of proportion with the rest of the body and tend to “jump” off of a patient’s chest. We do not think this looks natural, and if this is what the patient is hoping for, they are probably better served by visiting a surgeon who shares their aesthetic values.
We partner with the patient to decide some vital things before getting started:
Breast Size - Most patients want to become a full C (or very, very low D) cup as that’s the size that is most aesthetically pleasing in clothing.
Saline vs. Silicone – While most implants we use are silicone, the choice is made in collaboration with the patient, based on their situation, anatomy and wants.
Incision Site - Four different incisions can be used to place implants, but the majority of our patients have infra-mammary (under the breast base) incisions, though in a few very specific situations, a trans-axillary approach might be utilized.
Implant Placement – Implants can be placed either directly beneath the breast tissue (sub-glandular plane) or beneath the breast tissue and muscle (sub-pectoral plane). While I more commonly place the implant in the sub-pectoral plane, placement is very much dependent on the patient’s anatomy.
While an implant alone can correct some droopiness of the breasts, it is sometimes necessary to tighten the breasts to bring the nipple into a higher, “younger” position. This procedure can be done alone or in combination with an breast augmentation procedure. We do all of our mastopexy procedures with limited peri-areolar scars and a single vertical scar, not a long, underlying horizontal scar (as some others do).
Breast Reduction patients are among some of our happiest. Overly large breasts create a downward pull on the back that can lead to chronic neck, back, and shoulder pain. This procedure not only reduces breast size, but also repositions the breast tissue higher on the chest, placing the weight back in balance.
We do virtually all Breast Reductions via a Vertical technique, which leaves a scar around the nipple/areolar complex and a vertical central scar (”lollypop” scar) that keeps upper breast tissues in place (leading to better long-term fullness), and avoids the long horizontal scar underneath the breast that can often extend around the side and the back.
Whole-body wellness also plays a part here. Women with overly large breasts can often have problems controlling their weight in part because aerobic exercise is painful or difficult prior to surgery. As a part of breast reduction surgery, we also work with patients to adopt a plan to slowly lower their body weight and total body fat to achieve optimal long-term results.
Male Breast Reduction (Gynecomastia Reduction)
While to 70% of adolescent boys will have some degree of breast development during puberty, most cases resolve on their own within two to three years. Some men however have ongoing breast fullness that can be bothersome, and even embarrassing. To correct this, in most cases we use Liposuction as the primary solution because it leaves minimal scarring. In some cases it is necessary to make incisions to remove dense glandular tissue, or adequately reduce very large male breasts. Even then, with the added scarring, the dramatically improved look under clothing makes even extensive procedures worth it to most patients.
The majority of women diagnosed with breast cancer choose to undergo breast reconstruction, either at the time of their mastectomy surgery, or at a later date. We understand that this choice is very personal; a decision made by the patient with the help of their general surgeon. As such, we work closely with surgeons to provide a variety of different types of immediate and delayed reconstructions (from tissue expander and direct-to-implant reconstructions, to autologous reconstructions that use the patient’s own tissues), all based on careful consideration of a patient’s desires and clinical situation.
There are a number of trends in breast reconstruction, including skin and nipple sparing mastectomies, and the ability to perform pre-pectoral reconstructions in younger, active women. These may be excellent options for patients with specific types of breast cancer, and we perform all of these new procedures for women who are able to clinically choose them.
Note: Many patients worry that they may also need work done on the opposite breast to match their newly reconstructed breast. Thanks to the Federal Woman’s Health and Cancer Rights Act passed by Congress, any surgery deemed necessary on the non-affected breast must be automatically approved by all insurance carriers.