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Breast Augmentation

Breast augmentation, also known as mammoplasty, is a surgical procedure where we place implants to enhance the shape and size of your breasts. Breast implants are silicone shells filled with either saline (salt water) or a cohesive silicone gel. It is a great procedure for patients who desire to be bustier. However, it will not correct breasts that sag too much. Any natural deformities, such as outwardly pointing nipples, will also be exaggerated and additional secondary procedures may be necessary to achieve beautiful, symmetric breasts.
During the consultation process, we will discuss the various options available to you:

  1. type of implant (saline vs silicone)
  2. scar placement/route of implant placement
  3. where the implant will be placed

Type of Implant:
Implants are silicone shells that can be filled with either saline or viscous silicone. Saline and silicone implants weight approximately the same.

Saline implants are approximately half the cost of their silicone counterparts and allow a range of fill sizes for each implant. This is especially helpful when a patient has asymmetrical breasts and we’re trying to make it more symmetrical. When silicone implants leak/rupture, the fluid gets absorbed by your body without any side effects. However, saline implants run the risk of feeling like a bag a water and having visible rippling, especially in the cleavage area.

Silicone implants usually don’t have problems with rippling and feel much more natural. However, they have their own drawbacks. Silicone implants come in pre-filled sizes so it is harder to correct breast asymmetry. When they leak, it could get into the surrounding tissue and lymph nodes and is nearly impossible to remove completely.

Scar placement/route of implant placement:
Breast implants can also be placed via 3 different routes:

  1. Axilla
  2. Nipple
  3. Inframammary fold

Implants placed through axillary incisions leave the breast skin unscarred. Using this type of incision, placement of implants is technically more difficult and preclude the placement of excessively large silicone implants. Although traditionally a popular choice, it has fallen out of favor more recently due to concerns that these scars could potentially be visible when the arm is raised when wearing bikini’s or tank tops.

Nipple incisions allow the scar to be hidden in the junction of the darker areola skin and lighter breast skin. Implant placement through this route requires the breast tissue be divided. It also risks distorting the round shape of the nipple-areolar complex from assymetrical nipple scarring.

Incisions in the inframammary fold are more conspicuous but can often be hidden behind a rejuvenated breast. Surgery is technically easier, larger implants can be placed, and the scar often heals quite well.

Implant Location:
Breast implants can be placed in one of two locations:

  1. Subglandular/subfascial location
    When implants are placed underneath your native breast tissue, results are more natural and your recovery is much faster. Patients must have sufficient native breast tissue to be good candidates for this type of placement. Anatomically, this procedure makes more intuitive sense. However, you are at greater risk for having a capsular contracture. Routine daily massaging exercise may help decrease this risk.

  2. Submuscular location
    Implants can also be placed underneath your pectoralis major muscle. This technique allows the breast implant to be hidden under both your native breast tissue and your muscle. It is ideally suited for patients who have very small breasts and lack sufficient tissue to mask the presence of an implant and have a more natural looking result.

Advantages of this procedure include the recruitment of your chest muscle to enhance your breast volume, decreased likelihood of capsular contracture compared to subglandular breast agumentations, and less likelihood of visualizing the presence of a breast implant.

Disadvantages of this procedure include longer post-operative recovery times from having to divide your chest muscle, less anatomically intuitive implant placement, potential arm weakness with certain movements, and risk having post-operative motion artifacts.

Motion artifact is a term used to describe situations when your breast implants jumps around when you tighten your chest muscles. It is unpredictable which patients will develop this problem. However, those with strong pectoralis major muscles are at greater risk.

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Breast Lift (Mastopexy)
A breast lift, also known as a mastopexy, is a procedure where sagging breasts can raised and reshaped to counter the effects of age and gravity, giving your breast a more youthful appearance. There are various types of techniques for performing a breast lift.  It can also be combined with an augmentation (mastopexy-augmentation) to rejuvinate brests that not only sag, but have become deflated.

Reasons for Considering a Breast Lift:

  1. Elevate the breasts due to sagging caused by the effects of aging and gravity.
  2. Firm the breasts if they have lost substance due to pregnancy and subsequent breast-feeding.
  3. Re-align your nipples/areolas if they point down or to the side.
  4. Bring back natural suppleness after weight loss.

Insurance companies will often pay for your surgery if you meet certain criteria. Schedule a consultation and we can help determine if you’re a good candidate for this procedure and if your insurance company will cover your surgery.

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Breast Reduction
Breast reductions (or reduction mammaplasty) not only make your breasts smaller and lighter, but molds them into a more ideal breast shape. Skin, fat, and breast tissue are removed during this procedure. Depending on the technique used, the nipple areola complex, along with nipple sensation and the ability to breast feed, can often be preserved. Without such a heavy weight on their chests, women are able to lead healthier and more comfortable lives.

Reasons for Considering a Breast Reduction:

  1. Disproportionate size of your breast to the rest of your body
  2. Restriction of physical activity due to the size and weight of your breasts
  3. Painful bra strap marks on your shoulders
  4. Back, neck or shoulder pain caused by heavy breasts
  5. Difficult to mange rashes along your inframammary fold

If you suffer from the above-mentioned symptoms, your insurance company will often cover the cost of the surgery. Schedule a consultation so that we can help you determine if you meet your insurance company criteria for paying for your procedure.

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Male Breast Reduction for Gynecomastia

During the course of their lives, males are likely to develop prominent breast tissue during three stages in their development. First, when the are neonates and maternal estrogens are still dominant in their systems. Secondly, when they hit puberty. During puberty, hormone imbalances and fluxuations result in a relative estrogen excess compared to testostornes. The final stage where men are likely to develop gynecomastia is when they become elderly. Older individuals also have a relative decrease in their testosterone levels.

Gynecomastia can be categorized into one of four types:

  1. Physiologic
  2. Pathologic
  3. Pharmocologic
  4. Familial

The first step in treating gynecomastia is to determine its etiology. Physical examination, laboratory and imaging studies need to performed to rule out non-physiological causes of gynecomastia. Once life-threating causes, such as cancer or organ failure, are ruled out, the cosmetic aspects of gynecomastia can easily be treated using either advanced liposuction techniques or direct surgical excision to re-establish a male chest contour. The optimal technique for correcting gynecomastia depends upon the nature and severity of the gynecomastia.

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