If you’re considering a breast lift

Pregnancy, nursing and gravity take their toll on a woman’s breasts over the years. The breasts often lose their shape and firmness and begin to sag as the skin loses its elasticity. A surgical procedure that raises and reshapes sagging breasts is called mastopaxy or breast lift. Breast implants can be inserted in conjunction with a breast lift to increase the breasts fitness and size. Mastopexy can also reduce the size of the areola.

The best candidates for breast lift

Be sure to discuss your expectations with your plastic surgeon before deciding to have surgery. Healthy, emotionally stable women who are realistic about what the surgery can accomplish are the best candidates for mastopexy. Women with small, sagging breasts usually realize the best results. However, breasts of any size can be lifted, but the results may not last as long in heavier breasts.

You may want to postpone your breast lift if you are planning to have children in the future. Pregnancy and nursing often leave women with stretched skin and less volume in their breasts. Pregnancy may offset the results of the procedure.

All surgery carries some uncertainty and risk

There is always a possibility of complications or a reaction to the anesthesia. Although bleeding and infection following a breast lift are uncommon, they can cause scars to widen. You will probably have noticeable and permanent scars following your surgery. A permanent loss of feeling in your nipples or breasts as well as unevenly positioned nipples can be results of the procedure.

Planning your surgery

It is important to discuss your expectations in an honest and open manner with your plastic surgeon. At your initial consultation, your doctor will examine your breasts and measure them. Be sure he discusses the variables that may affect the procedure such as your age, the size and shape of your breasts and the condition of your skin. Your plastic surgeon will discuss where the nipple and areola will be positioned and whether an implant is advisable.

Your plastic surgeon will describe the procedure in detail at your initial consultation. He will explain the surgery’s risks and limitations and make sure you understand the scarring that will result. Be sure you also discuss the type of anesthesia that will be used, the type of facility where the surgery will be performed and the costs involved.

Preparing for your surgery

Your surgeon may require you to have a mammogram before surgery, depending on your age and family history. He’ll also give you guidelines on eating and drinking, smoking and taking or avoiding certain medications and vitamins.

Where your surgery will be performed

An outpatient surgery center, a hospital or a surgeon’s office-based facility could be the site of your surgery. Although breast lifts are usually done on an outpatient basis, some patients may be admitted to the hospital for a day or two. 

Types of anesthesia

General anesthesia is most commonly used for breast lift surgery. This means you will probably sleep through the entire operation. The surgeon may use local anesthetic if a smaller incision is being made. A sedative will probably be used in conjunction with the local anesthesia. You will feel minimal discomfort and you’ll be awake but relaxed.

The surgery

A breast lift can take from 90 minutes to three hours. The most common technique involves an anchor-shaped incision that follows the natural contours of the woman’s breast.

The incision outlines the area from which breast skin will be removed. It also defines the new location for the nipple. The nipple and areola are moved to the higher position when the excess skin has been removed. The breast is reshaped by bringing together the skin around the areola. The surgeon usually places the stitches in a vertical line around the areola, extending downwards from the nipple area and along the lower crease of the breast.

Procedures that require less extensive incisions are available to women with relatively small breasts and minimal sagging. Doughnut or concentric mastopexy is one such technique. In this procedure, circular incisions are made around the areola and a doughnut-shaped area of skin is removed.

If your surgeon is inserting an implant while you have your breast lift, it will be placed in a pocket directly under the breast tissue or under the muscle of the chest wall.

After your surgery

You will have to wear an elastic bandage or a surgical bra over gauze dressings after your surgery. Your breasts will be swollen, bruised and uncomfortable for a day or two. Your surgeon can prescribe medication to help relieve any discomfort.

The bandages or surgical bra will be replaced with a soft support bra in a few days. This bra must be worn around the clock for three to four weeks over a layer of gauze. After a week or two, the stitches will be removed.

You can apply a moisturizer several times a day if your breast skin is dry following your surgery. Be sure to keep the moisturizer away from the suture areas and try not to tug at your skin.

The swelling after the surgery may cause you to lose some feeling in your nipples and breast skin. Over the next six weeks, the numbness will fade as the swelling subsides. Occasionally, the numbness may last a year or more.  Sometimes it could be permanent.

Getting back to normal

Expect to be up and around in a day or two. However, you shouldn’t expect to go back to work for a week or more, depending on how you feel. Also, avoid lifting anything over your head for three to four weeks.

Be sure to talk to your surgeon about resuming your normal activities. He may tell you to avoid sex for a week or more and to avoid strenuous sports for about a month. The operation should not affect your ability to breast-feed in the future if you should become pregnant.

Your new look

Even though your surgeon will work to make your scars as inconspicuous as possible, they are extensive and permanent. For many patients, the scars remain lumpy and red for months. They will gradually become less obvious and may eventually fade to thin white lines.

Be sure to remember that a breast lift won’t keep your breasts firm forever. The effects of gravity, aging, pregnancy and weight fluctuations will eventually take their toll again. Most women who have implants along with their breast lift find that their results last longer.

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If you’re considering breast reconstruction

One of the most rewarding surgical procedures available today is the reconstruction of a breast that has been removed due to cancer or other disease. Plastic surgeons can create a breast that can come close in appearance and form to matching a natural breast, thanks to new medical techniques and devices. In many cases, reconstruction is possible immediately following a mastectomy. When this is done, the patient wakes up with a breast mound already in place and is spared the experience of seeing herself with no breast at all.

The best candidates for breast reconstruction

Reconstruction is medically appropriate for most mastectomy patients. The best candidates for the surgery are women whose cancer can be eliminated by mastectomy.

Many women prefer to wait to have reconstructive surgery until after they have had their mastectomy and have had time to weigh all of their options. In some cases, women just don’t want to have any more surgery than is absolutely necessary. If a more complicated procedure using flaps of skin and underlying tissue must be used to reconstruct the breast, women may be advised to wait. Women may also be advised to wait to have the surgery if they have high blood pressure or obesity or if they smoke.

Be sure to be informed of all your options before deciding on reconstructive surgery. This will help you realize a more positive outlook for the future.

All surgery carries some uncertainty and risk

There are risks associated with every surgery and there are specific complications that could arise with breast reconstruction. Some of the risks include excessive scar tissue, bleeding, difficulties with anesthesia or fluid collection. If you smoke, your surgeon will advise you that nicotine can delay healing, resulting in prolonged recovery and conspicuous scars. On rare occasions, these complications are severe enough to require a second operation.

There is a remote possibility that an infection will develop within the first two weeks following surgery if an implant is used. The implant may need to be removed for several months until the infection clears. Your surgeon can insert a new implant later.

Capsular contracture is the most common problem associated with breast reconstruction. It occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast begins to feel hard. There are several ways to treat capsular contracture: the scar tissue can be removed or the implant can be replaced.

Breast reconstruction does not generally interfere with chemotherapy or radiation treatment if cancer recurs. Reconstruction has no known effect on the recurrence of disease in the breast. Your surgeon will probably recommend the continuation of periodic mammograms on the reconstructed breast as well as the remaining normal breast.

Planning your surgery

You may want to start discussing breast reconstruction with a plastic surgeon as soon as you’ve been diagnosed with cancer. Your breast surgeon and your plastic surgeon should work together to develop a strategy that will put you in the best possible condition for reconstruction.

At your initial consultation, your plastic surgeon will evaluate your health and explain which reconstructive options are most appropriate for your goals, anatomy, health, age and tissues. Make sure you are honest and open with your surgeon about your expectations. He should be frank with you about your options and the risks and limitations of each.

Be sure your surgeon explains the anesthesia that will be used, the facility where the surgery will be performed and the costs associated. Health insurance will probably cover all of the costs associated with reconstructive surgery. Be sure to check your policy for any limitations or restrictions.

Preparing for your surgery

You will receive specific instructions on preparing for your surgery from your oncologist and your plastic surgeon. They will provide guidelines on eating and drinking, smoking and taking or avoiding certain medications or vitamins.

Where your surgery will be performed

More than one operation will probably be required for your breast reconstruction. The first stage is usually performed in a hospital while follow-up procedures can be done at an outpatient facility. Your doctor may prefer to conduct follow-up procedures at the hospital as well, depending on the extent of the surgery required.

Types of anesthesia

The creation of the breast mound, which is the first stage of reconstruction, is almost always performed under general anesthesia. You will sleep through the entire operation. Local anesthesia combined with a sedative will probably be used for follow-up procedures.

Types of implants

You’ll want to discuss what type of implant your surgeon will be using. The silicone shell of a breast implant can be filled with a salt-water solution known as saline or silicone gel.

Because of questions that have risen about the safety of silicone gel-filled breast implants, the Food and Drug Administration has determined that gel-filled implants should only be used by women participating in approved studies. All medical patients will eventually have similar access to silicone gel-filled implants.

The saline-filled implant is available on an unrestricted basis, pending further FDA review. Talk to your plastic surgeon about any current developments.

The surgery

Skin expansion is the most common technique in breast reconstruction. It combines skin expansion and the subsequent insertion of an implant.

After your mastectomy, a balloon expander will be inserted beneath your skin and chest muscle. Your plastic surgeon will periodically inject a salt-water solution through a tiny valve mechanism buried beneath the skin. This solution will gradually fill the expander over several weeks or months. The expander may be removed in a second operation. A more permanent replacement will be inserted after the skin over the breast area has stretched enough. There are some expanders, however, that are designed to be left in place as the final implant. The nipple and the areola will be reconstructed in a subsequent procedure.

There are some patients who do not require a preliminary tissue expansion before receiving an implant. The first step for these women will be when the surgeon inserts the implant.

Flap reconstruction is an alternative approach to implant reconstruction that involves the creation of a skin flap using tissue taken from other parts of the body such as the back, buttocks or abdomen.

In one type of flap surgery, the tissue is attached to its original site, retaining its blood supply. The flap consists of the skin, fat and muscle with its blood supply. The plastic surgeon tunnels beneath the skin to the chest, creating a pocket for an implant, or creating the breast mound itself, without the need for an implant.

In another flap technique, the plastic surgeon uses skin from another part of the body and transplants it to the chest by reconnecting the blood vessels to the new ones in that region. Surgeons who perform this procedure must be experienced in microvascular surgery.

This type of surgery is more complex than skin expansion. Scars will be left at the site of the tissue removal and at the site of the reconstructed breast. Recovery generally takes longer with this procedure. However, when the breast is reconstructed entirely out of your own tissue, the results are more natural and the concerns over an implant are eliminated.

Your breast reconstruction will probably be completed in a series of procedures that occur over a period of time. The initial reconstructive surgery is usually the most complex. Follow-up surgery may be necessary to reconstruct the nipple or areola or to replace a tissue expander with an implant. An additional operation may be needed to enlarge, reduce or lift the natural breast to match the reconstructed breast.

After your surgery

For a week or two after the surgery, you will probably feel tired and sore. Your doctor can prescribe some medication that will ease your discomfort.

You’ll probably be released from the hospital two to five days after your surgery, depending on the extent of the procedure. Any stitches you have had will be removed in a week to 10 days. If a surgical drain was required to remove excess fluids, it will be removed within the first week or two after surgery.

Getting back to normal

You may be recovering for up to six weeks if you have had a combined mastectomy and reconstruction or a flap reconstruction alone. Your recovery time may be less if you have had reconstruction apart from the mastectomy.

Although reconstruction cannot restore normal sensation to the breast, some feeling may return over time. It may take as long as two years for scars to fade substantially, though they will never completely disappear. Your surgeon will advise you about getting back to normal activities. You will probably want to refrain from any strenuous sports, overhead lifting or sexual activity for three to six weeks following reconstruction.

Your new look

Your reconstructed breast may feel firmer and look rounder or flatter than your natural breast. It may not exactly match your opposite breast and it may not have the same contour as your breast before mastectomy. However, these differences will probably be apparent only to you. Most mastectomy patients find breast reconstruction dramatically improves their appearance and their quality of life following surgery.

The word gynecomastia is actually Greek for “woman-like breasts.” Although the condition is rarely talked about, it is actually quite common as it affects 40 to 60 percent of men. In the vast majority of cases, there is no known cause for gynecomastia.

The procedure can help men who feel self-conscious about their appearance. The plastic surgeon removes glandular tissue and fat from the breasts, resulting in a chest that is firmer, flatter and better contoured. In extreme cases, excess skin is also removed.

The best candidates for gynecomastia correction

The procedure can be performed on men of any age who are healthy and emotionally stable. The ideal candidates have firm, elastic skin that will reshape to the body’s new contours.

Overweight and obese men who have not tried to correct the problem with weight loss and exercise may be discouraged from having the surgery done. If you drink alcoholic beverages in excess or smoke marijuana, you may not be considered a good candidate for the surgery. These drugs as well as anabolic steroids, may cause gynecomastia. Your breast fullness may diminish if you stop using these drugs.

All surgery carries some uncertainty and risk

Complications from male breast-reduction surgery are infrequent and usually minor. However, there are risks with any surgery. Some of the risks include infection, excessive bleeding, adverse reaction to anesthesia, skin injury and excessive fluid loss or accumulation. Noticeable scars, permanent pigmentation changes or slightly mismatched breasts or nipples may result. A second procedure may be performed if the asymmetry is significant.

Following the procedure, you may experience the loss of breast sensation or numbness for as long as one year.

Planning your surgery

Be prepared to provide your surgeon with a complete medical history at your initial consultation. Also at your initial consultation, your surgeon will examine your breasts and check for causes of the gynecomastia. These could include the use of estrogen-containing medication or anabolic steroids or impaired liver function. You will be referred to a specialist if a medical problem is the suspected cause.

In extreme cases, your plastic surgeon may recommend a mammogram or breast x-ray. This will reveal the breast’s composition and rule out the slim possibility of breast cancer. Your surgeon can choose an approach that best suits your needs after learning how much fat and glandular tissue is contained within your breasts.

Be sure to ask your surgeon any questions during your initial consultation. He will discuss the recommended treatment as well as the costs involved. Treatment of gynecomastia may be covered by your insurance provider. Check your policy to be sure.

Preparing for your surgery

Your plastic surgeon will tell you how to prepare for your surgery. He will provide guidelines on eating and drinking and taking certain vitamins and medications. If you smoke, you should stop for at least one to two weeks before and after your surgery as smoking decreases circulation and interferes with proper healing.

 Where your surgery will be performed

The gynecomastia correction surgery is usually performed as an outpatient procedure and takes about an hour and a half to complete. In extreme cases, an overnight hospital stay may be recommended.

Types of anesthesia

General anesthesia is primarily used for gynecomastia correction surgery. However, in some cases, a local anesthetic will be used with sedation. During the surgery, you will be awake but very relaxed and insensitive to pain. For more extensive surgery, a general anesthetic will be used. This will allow you to sleep through the entire operation.

 The surgery

For men with excess glandular tissue, the plastic surgeon will cut out the tissue with a scalpel. This procedure may be performed in conjunction with liposuction. An incision is usually made in the underarm or on the edge of the areola. The plastic surgeon then cuts away the excess fat, glandular tissue and skin from around the areola and from the sides and bottom of the breast. More conspicuous scars result from a larger incision which may be required if there is a significant amount of tissue and skin to be removed.

Liposuction is usually used to remove excess fat if your gynecomastia consists primarily of fatty tissue. A small incision is made around the edge of the areola or in the underarm area. A cannula or a slim hollow tube, which is attached to a vacuum pump, is inserted into the incision. The surgeon uses the cannula to break up the fat and suction it out. Patients generally do not feel pain during this process.

If a large amount of fat or glandular tissue must be removed, excess skin may have to be removed. The removal will allow the remaining skin to firmly readjust to the new breast contour.

On some occasions, the plastic surgeon will make a separate incision to draw off excess fluids. Both incisions will be covered with a dressing after the procedure. To keep the skin firmly in place, the chest may be wrapped.

After your surgery

You will probably feel some discomfort for a few days after surgery. However, medications can be prescribed by your doctor to control such discomfort. Expect some swelling and bruising for a while after your surgery. Your doctor will probably tell you to wear an elastic pressure garment for a week or two to help reduce the swelling. Because of the swelling, it may take up to three months before you can see the final results of your surgery.

Your surgeon will probably encourage you to begin walking around the day of the surgery. You can return to work a day or two after the surgery. If you have had stitches, they will probably be removed one to two weeks after the procedure.

Your new look

Gynecomastia correction surgery can enhance you appearance and your self-confidence. The procedure will provide significant and permanent results.

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