Breast Augmentation (Enlargement)

Procedure: Enhance the size of breasts using prosthetics called breast implants.  Inflatable implants filled with saline are most commonly used, but note that silicone implants are once again available for use.  You and Dr. Vander Zee will discuss which type of implant to use.

Length: 1 to 2 hours.

Anesthesia: Local with sedation, or general.

In/Outpatient: Usually outpatient.

Side Effects: Temporary soreness, swelling, change in nipple sensation, bruising. Breast sensitive to stimulation for a few weeks.

Risks: Lack of implant permanence.  Surgical removal or replacement of the implants may be required to treat problems including: deflation; the formation of scar tissue around the implant (capsular contracture), which may cause the breast to feel tight or hard; bleeding or infection. Increase or decrease in sensitivity of nipples or breast skin, occasionally permanent.  Mammography requires a special technique.

Recovery: Back to work: a few days, unless job requires strenuous physical activity such as lifting, pushing or pulling. Physical contact with breasts: 3 to 4 weeks. Fading of scars: several months to a year or more.

Duration of Results: Variable. Implants may require removal or replacement.

Implant Shape - Mentor breast implants come in either round or contoured shapes. When contoured implants are placed under the chest muscle, they may assume a round shape after implantation. Together you and Dr. Vander Zee will select the option that is best for you and which is most likely to achieve the result you  desire.                                                                    

Implant Surfaces - Breast implant shells have a smooth or textured surface.  As a natural reaction to any device placed in the body, scar tissue will form around the breast implant surface, creating a capsule.  In some women, the capsule can tighten and squeeze the implant.  This is called capsular contracture.  Textured-surface implants were designed to reduce the chance of capsular contracture.  Some information in the literature on small numbers of patients suggests that surface texturing reduces the chance of severe capsular contracture, but clinical information from studies of a large number of women with implants shows no difference in the likelihood of developing capsular contracture with textured implants compared to smooth-surfaced implants.  You and Dr. Vander Zee will discuss which option is right for you.

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Breast Lift (Mastopexy)

Procedure: Raise and reshape sagging breasts by removing excess skin and repositioning remaining tissue and nipples.

Length: 1 to 3 hours.

Anesthesia: Local with sedation, or general.

In/Outpatient: Usually outpatient, but sometimes inpatient.

Side Effects: Temporary bruising, swelling, discomfort, numbness, dry breast skin. Permanent scars.

Risks: Thick, wide scars; skin loss; infection. Unevenly positioned nipples. Permanent loss of feeling in nipples or breast.

Recovery:  Back to work: 1 week or more. Strenuous activities: 1 month. Fading of scars: several months to a year.

Duration of Results: Variable. Gravity, pregnancy, aging, and weight changes may cause changes in shape or new sagging. Results may last longer or be enhanced when breast implants are inserted as part of the procedure.

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Breast Reduction

Breast reduction surgery is used to decrease the size, volume and weight of a woman's breasts. 

Heavy, pendulous breasts can cause severe back, neck and shoulder pain, along with shoulder grooving.  Skin irritation called intertringous dermatitis in the crease under the breast is also common and can be very resistant to treatment, particularly in the warmer months.  The goal of breast reduction surgery is usually to reduce the breasts to a size which is proportionate to the rest of the body. 

The type of incision used for breast reduction may vary, depending on the size and shape of your breasts and amount of reduction that is desired.  The Inverted “T”, No Vertical Scar, and Free Nipple Graft techniques are the most commonly performed breast reductions .

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Male Breast Reduction (Gynecomastia)

Procedure: Reduce enlarged, female-like breasts in men using liposuction and/or surgical removal of excess glandular tissue.  May sometimes be covered by medical insurance.

Length: 1 hour or more.

Anesthesia: General, local, or local IV sedation.

In/Outpatient: Usually outpatient.

Side Effects: Temporary bruising, swelling, numbness, soreness, burning sensation.

Risks: Infection. Fluid accumulation. Injury to the skin. Rippling or bagginess of skin. Asymmetry. Pigmentation changes (may become permanent if exposed to sun). Excessive scarring if tissue was cut away. Need for second procedure to remove additional tissue.

Recovery: Back to work: 3 to 7 days. More strenuous activity: 2 to 3 weeks. Swelling and bruising: 3 to 6 months.

Duration of Results: Permanent.

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Breast Reconstruction

Breast reconstruction is a surgical procedure to rebuild the contour of the breast, along with the nipple and areola (the pigmented area surrounding the nipple) if desired. Recent advances in reconstructive techniques have Breast Implant Choices given patients more choices when it comes to breast reconstruction, including the option to have breast reconstruction during the same operation in which the breast is removed.

Immediate Reconstruction
Single-stage immediate reconstruction with a breast implant or an expander/mammary implant. (See adjustable tissue expander/breast implants).
Two-stage immediate reconstruction with a tissue expander, followed by delayed reconstruction several months later with a breast implant.

Delayed Reconstruction
Single-stage delayed reconstruction with a breast implant (or an expander/mammary implant. (See adjustable tissue expander/breast implants).
Two-stage delayed reconstruction with a tissue expander, followed several months later by replacement with a breast implant.

Two potential advantages to immediate reconstruction are that your breast reconstruction starts at the time of your mastectomy and that there may be cost savings in combining the mastectomy procedure with the first stage of the reconstruction.  However, your initial operative time and recuperative time may be longer.

A potential advantage to delayed reconstruction is that you can delay your reconstruction decision and surgery until other treatments, such as radiation therapy and chemotherapy, are complete.  Delayed reconstruction may be advisable if your surgeon anticipates healing problems with your mastectomy, or if you just need more time to consider your options.

There are medical, financial, and emotional considerations to be considered when choosing immediate versus delayed reconstruction.  You should discuss the pros and cons of the options available in your individual case with your general surgeon, plastic surgeon, and oncologist.

Your surgeon will evaluate your existing chest tissue to determine if you have enough tissue to accommodate the desired size of breast implant.  If you choose a breast implant that is too large for your tissue, the edges of the breast implant may be visible through your skin or the implant may be more easily felt.  By choosing an implant that is too large for your tissue, you may increase the risk of having surgical complications.  Also, breast implants that are excessive in size may increase the effects of gravity on your body, which may cause your breasts to prematurely droop or sag.

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Nipple Correction (Inverted Nipple)

As many as 2% of American women have at least one inverted nipple, yet still the subject of nipple inversion is seldom discussed among friends or in the media.  Usually when people discuss breast enhancement, they are talking about enlarging, reducing or lifting their breasts.

Nipples are clearly an integral part of the breast.  They play a role in appearance, in sexuality, and in motherhood.  For women who have inverted nipples, inversion can affect their self-esteem and body image.  While several different surgical techniques have existed for inverted nipples, there is now a treatment that can provide long-term results.

Most cases of inverted nipples are congenital - in other words, people are just born with them.  However, some nipples become inverted after breastfeeding, when scar tissue builds in the milk ducts.  Nipples that become inverted after birth are usually caused by one of three things: not enough skin at the base of the nipple, constricted milk ducts, or scarring of the milk ducts due to breastfeeding.

Types of Inverted Nipples
There are three "grades" of inversion, which basically means three levels of severity. While some nipples may only be inverted some of the time and "come out" or become everted in response to cold or physical touch, others are more severely inverted and never come out.  Some women can breastfeed normally, while others will never be able to breastfeed.

• Grade 1. Nipples are inverted but can become everted manually (through stimulation) or in response to cold temperature.  They may remain everted for some time.  Milk ducts are usually not compromised and breastfeeding is possible. These are sometimes called "shy nipples."
• Grade 2. Nipples are inverted and are more difficult to evert.  The eversion almost never lasts and the nipple returns to the inverted state immediately.  Breast feeding may be possible, but this is not a sure thing.
• Grade 3. Nipples are severely inverted and never evert.  Milk ducts are often constricted and breastfeeding is not possible. Women with Grade 3 inverted nipples may also struggle with infections, rashes, or problems with nipple hygiene. 

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