The ability of the Cosmetic and Reconstructive surgeon is only limited by the knowledge and understanding of the patient. Breast enhancement surgery is a perfect example of cosmetic and plastic surgery's ability to identify, treat and meet the needs of a broad spectrum of patients. The most highly publicized aspect of breast enhancement surgery is breast augmentation or breast enlargement surgery. This, however, is only a small segment of the much larger spectrum of breast enhancement procedures. Many patients suffer from conditions that can be corrected by surgery but due to a lack of information they are unaware these procedures exist. These procedures include mastopexies (breast lifts), reduction mammaplasties (breast reductions), and combination procedures.
Who’s a candidate?
The effects of time, sun and gravity are inescapable and affect everyone. Childbirth and breast-feeding can also dramatically impact the appearance of the breast. Ptosis (sagging) of the breast is one of the most common findings in patients who have had children. It will be made worse with time and changes in weight. Patients usually fall into four categories:
1) Breasts which sag but are of relatively normal size,
2) Breasts which become smaller after pregnancy but still sag,
3) Breasts which become larger after pregnancy and sag,
4) Large breasts which sag.
Each of these patient groups will benefit from breast enhancement surgery to restore them to a more normal appearance.
Breast Lifts
Breast lift (mastopexy) surgery will help those patients where sagging, also known as Ptosis, is the primary concern. A mastopexy or breast lift can be combined with an augmentation in patients where the breasts are also small. A breast lift is used when the skin of the breast has relaxed and the breasts now sag. The amount of this sag is measured by the position of the nipple-areolar complex relative to the crease under the breast. When the complex is at the level of the crease this is grade II Ptosis, below the crease is grade III Ptosis, and if the nipple points toward the ground, this is grade IV Ptosis. The type of mastopexy or lift is determined by the amount of sag and how to best reproduce a natural appearing breast.
What are the risks?
Mastopexy procedures are not risk free and should be considered major surgery. The risks of surgery include swelling,bruising, tenderness, infection, asymmetry, abnormal scarring, and decreased or altered sensation. The surgery is usually done under a general anesthetic, although the smaller doughnut mastopexies can sometimes be done under local anesthetic. Recovery varies on the complexity of the procedure. Physical activity should be restricted for the first week to ten days after surgery. The breasts will be swollen and tender during this time. The complexity of the procedure will determine the length of time before you can return to full activities. Your physician and their staff will direct you to the specific restrictions you will face.
Breast Reduction
Breast reduction (reduction mammaplasty) surgery is used when the breasts are large. It reduces the size of the breasts, repositions the nipple areolar complex, and changes the size of the areola. Excessively large breasts can produce a number of symptoms making breast reduction surgery a medically indicated procedure. Symptoms of neck, back, and shoulder pain, skin irritation, numbness in the hands, poor posture, and decreased motion are common. Removal of the excessive breast tissue can reduce and possibly eliminate many of these symptoms. Breast reduction surgery is a major procedure done under a general anesthetic. It can often be done as an out-patient but many patients will need a one to two day hospital stay.
Before and After Pictures (Actual Patient of J. Eric Lomax, M.D.)
| BEFORE | | | |
| AFTER | | | |
What are the risks?
Recovery from breast reduction varies in severity depending on the amount of tissue removed and the intensity of the pre-operative symptoms. Often the post-operative discomfort is not as severe as the pre-operative symptoms, making this procedure relatively painless in some patients. The risks of breast reduction surgery include but are not limited to all of the same risks seen in breast lift surgery plus poor healing of the flaps, drainage from the incisions, and asymmetry.
What about scarring?
Mastopexy procedures range from the relatively small doughnut mastopexy to the more complex keyhole or anchor mastopexy. When only a small lift is required as with mild grade II Ptosis minimal skin excision around the areola is performed to reposition the nipple areolar complex. This results in a scar which completely surrounds the nipple areolar complex but is obscured by the transition from the normal skin of the breast to the darker skin of the areolar tissue. When the sag or Ptosis is more significant the nipple-areolar complex will require greater movement to place it in the proper position. This will result in the addition of a vertical scar below and connected to the scar around the areolar complex. With grade III and grade IV Ptosis even more precise procedures are required to correct the sag and give the patient a more natural appearing breast. This may result in scars in the crease below the breast extending up to and around the nipple areolar complex. This procedure is called a keyhole or anchor mastopexy. Remember the goal of all of these procedures is to provide the patient with the most naturally appearing breasts as possible. These procedures are performed as same day surgeries and do not routinely require hospital admission.
Expectations
Discuss your expectations with your surgeon openly so that he/she can work with you to recommend the surgical procedure that would be best to achieve your desired goals.
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