» Breast Surgeries
Nipple Reconstruction - Breast Reduction - Breast Enlargement
Removal and Replacement of Breast Implants - Breast Reconstruction – Tram Flap
Breast Reconstruction Latissimus Flap - Breast Reconstruction Using Expander - Chest Enlargement for Men
Male Breast Reduction
Who Is A Candidate?
- Nipple reconstruction is an appropriate procedure for women who have had a mastectomy, with the loss of the nipple-areolar complex.
- Nipple reconstruction is usually performed in conjunction with or after completion of breast reconstruction.
Intended Results
- Creation of a visible nipple-areolar complex in the appropriate location on the breast.
- While a reconstructed nipple-areolar complex may never look totally natural, the psychological benefits from reconstruction can be significant.
Procedure Description
- The procedure can be performed on an outpatient or inpatient basis.
- If reconstruction is being performed as an isolated or independent procedure, local anesthesia with sedation or general anesthesia are both appropriate. If nipple reconstruction is being performed in conjunction with breast reconstruction, general anesthesia will usually be used.
- The nipple mound is usually recreated from local tissue flaps, where the nipple position is desired. The areola may be created from a full-thickness skin graft taken from the inner groin area or tattooed onto the existing skin.
Recuperation and Healing
- A dressing will be in place over the reconstructed nipple-areolar complex and a second dressing will be in place over the skin donor site in the groin (or wherever else is chosen for the donor site). The dressing will usually be in place for 1-2 weeks or more. The dressing is held in place with a brassiere.
- Initial discomfort is easily controlled with oral medication.
- Non-strenuous activities can be resumed in a day or two.
- It usually takes the skin graft (reconstructed areola) at least 2 weeks to be initially “healed”.
Other Options
- Many women choose not to have a nipple-areolar complex reconstruction following breast reconstruction. They feel that if they look normal in clothes, they are satisfied.
- Paste on nipple-areolar complexes can be purchased. For some women, creating symmetry in clothing is a satisfactory solution.
- Tattooing only may also be satisfactory.
Insurance Guidelines
- Usually covered by insurance.
BREAST REDUCTION*Who Is A Candidate?
- If you have large, heavy breasts, which may be the cause of breathing difficulties, back, shoulder and neck pain, poor posture, bra-strap indentations and chafing under the breasts.
- If you have excessive breast size, which may decrease a sense of attractiveness and self-confidence.
- If large breasts interfere with normal daily activities or with exercise.
Intended Result
- More attractive contour and smaller breast size.
- Freedom from health problems associated with excessively large breasts.
- Improved self image.
Procedure Description
- The procedure is done under general anesthesia on an outpatient basis or in the hospital.
- Incisions are made around the pigmented area (the nipple-areolar complex) and extend vertically below the nipple and in the fold under the breast. The nipple-areolar complex is moved upward to the desired location; excess breast tissue, fat and skin are removed.
Recuperation And Healing
- The incisions are covered with light dressings, and the breasts are placed in a bra. The bra holds the breasts symmetrically during initial healing.
- Initial discomfort subsides daily and can be controlled with oral medication.
- Scars will usually fade in 6-12 months.
- Surgery will probably reduce and possibly eliminate the ability to breast feed.
Other Options
- An additional procedure that would enhance the result is Liposuction of the axillary area, to reduce excess fat deposits.
Insurance Guidelines
- This procedure is commonly covered by insurance though insurance criteria are becoming more and more restrictive. Our staff will assist you in obtaining pre authorization.
BREAST ENLARGEMENT*Who Is A Candidate?
- Women who desire larger breasts.
- Women with a moderate degree of breast sagging and smaller breasts, whose problem can be solved by enlargement.
- Women who have one breast that is noticeably smaller than the other.
Intended Results
- Larger and more shapely breasts.
- A more positive self image.
Procedure Description
- The procedure is done on an outpatient basis under general anesthesia.
- A small incision is made under the breast, around the nipple, or under the arm, and a saline implant is inserted under the breast tissue or under the breast tissue and the underlying muscle.
Recuperation and Healing
- The patient goes home in an elastic bra. The bra helps hold the breasts in the correct position.
- Initial discomfort is controlled with oral medication.
- Sutures are usually removed in 7-12 days.
- Light activities can be resumed as tolerated. Aerobic activities can be started in about 3 weeks.
- Moving or sliding the implants within the breast pockets during the postoperative period may reduce the frequency of wrinkling.
Other Options
- An additional procedure that would enhance the result is a Mastopexy (breast lift) — if the breasts are saggy in addition to being small.
Insurance Guidelines
- This procedure is considered cosmetic and therefore is not covered by insurance. The patient is responsible for payment.
REMOVAL AND REPLACEMENT OF BREAST IMPLANTS*
Who Is A Candidate?
- Desire to have previously placed breast prostheses (implants) removed for symptomatic or medical-legal reasons and to have new implants inserted.
Intended Results
- Removal of implants.
- Possible removal of capsules (scar tissue) and residual silicone.
- Placement of new implants.
Procedure Description
- If only the prostheses are being removed and replaced by new ones, the operation can be done under local anesthesia sedation, or general anesthesia.
- If the capsules or scar tissue around the prostheses are also being removed, sedation and local or general anesthesia will be required.
- Usually the operation will be performed through the old incision (scar).
Recuperation And Healing
- If only implants are removed and replaced with new ones, pain will be minimal.
- If implants and capsules (scar tissue) are removed, the discomfort will be similar to the discomfort experienced after the initial augmentation procedure.
- Post operative discomfort should be controlled with oral medication.
- The patient will be discharged in an elastic bra.
- Sutures are usually removed in 7-12 days.
- Light activities can be resumed as tolerated. Aerobic activities can be started in about 3
weeks. - Moving or sliding the implants within the breast pockets during the post operative period
may reduce the frequency of wrinkling.
Other Options
- An additional procedure that might enhance the result is a Breast Lift (Mastopexy).
Insurance Guidelines
- If your implants are being removed because of symptoms, implant rupture, or deformity, insurance coverage may be available. Our staff will assist you in making preauthorization inquiries.
BREAST RECONSTRUCTION - TRAM FLAP*
Who Is A Candidate?
- If you have loss of breast tissue and skin following mastectomy -- one or both sides.
- If you have loss of breast tissue only following subcutaneous mastectomy.
- If you have a desire for larger breasts (uncommon).
Intended Result
- Reconstruction of a missing breast(s) or replacement of breast tissue.
Procedure Description
- A flap of lower abdominal wall flit, muscle (and usually skin), is transferred to the area of missing breast tissue with its own blood supply. In a standard TRAM Flap, the blood supply is within the rectus muscle(s) which is left attached at the lower edge of the rib cage. In a Free TRAM, the blood vessels are reconnected to vessels in the axilla. In a Turbocharged TRAM, the muscle is left attached superiorly, but the inferior vessels are connected in the axilla creating a double blood supply.
- The abdominal donor site is closed as in a Tummy Tuck, leaving a horizontal scar and a tighter abdomen.
- An attempt is made to create a “normal” breast mound and shape at the first operation, but subsequent smaller procedures are frequently necessary.
- Nipple/areolar reconstruction is performed at a later date and is elective.
Recuperation And Healing
- A TRAM Flap Breast Reconstruction is a major procedure performed in the hospital and requiring at least several days of hospitalization.
- Ambulation will begin the day after surgery and be reasonably comfortable within 10-14 days.
- Complete recovery usually takes about 6 weeks.
- The abdominal donor site causes the most discomfort during healing.
Other Options
- Additional procedures that will enhance the result are enlargement, lifting, or reduction of the opposite breast and nipple/areolar reconstruction.
Insurance Guidelines
- Almost always covered by insurance.
BREAST RECONSTRUCTION - LATISSIMUS FLAP*
Who Is A Candidate?
- If you are missing skin and breast tissue following a mastectomy.
Intended Result
- Creation of a “breast” that looks essentially normal in clothes and near normal without clothes.
Procedure Description
- A flap of skin and muscle is elevated from the upper outer back and rotated to the breast defect. The blood supply is left intact in the armpit (axilla).
- Usually, but not always, an implant is placed under the flap to provide the correct volume to the reconstructed breast.
- The back defect is closed directly.
- Nipple/areolar reconstruction is delayed until later and is elective.
Recuperation And Healing
- Breast reconstruction is a major procedure requiring several days of hospitalization.
- Discomfort of the back and reconstruction site will be present for several weeks.
- Full use of the area will require about six weeks of healing.
- All of the sutures will be removed within a month.
Other Options
- Additional procedures that would enhance the result are enlargement, lifting, or reduction of the opposite breast, and/or nipple (areolar) reconstruction.
Insurance Guidelines
- Usually covered by insurance.
BREAST RECONSTRUCTION USING EXPANDER*
Who Is A Candidate?
- If you have had a simple mastectomy, total mastectomy, or subcutaneous mastectomy and are missing both breast tissue and some skin.
- If you have had a modified radical mastectomy and are missing breast tissue.
- Reconstruction with an expander is usually not appropriate for women who have had a radical mastectomy. Consultation will determine whether expansion or some other type of breast reconstruction will be the most favorable in your particular case.
Intended Results
- Reconstruction of a breast that looks as normal as possible. A good result makes you look normal in clothes or a bra and reasonably normal without clothes.
- Restoration of a complete body image. A more positive self-image.
Procedure Description
- Step One: In the first operation an expander is placed under the skin and chest muscles. Saline is injected into the expander over a period of weeks or months via a “fill port”. The overlying skin expands and “grows” with continued expansion. When enough skin is present, the expansion process is terminated.
- Step Two: At the second procedure, the expander is removed and a permanent silicone or saline implant is placed.
- Possible Step Three: Nipple-areolar reconstruction, if desired, can be completed at a later time. It is possible that adjustment of the pocket where the permanent implant is placed may be appropriate at a future date in order to obtain the best possible result.
Recuperation And Healing
- Initial discomfort is controlled with oral medication.
- Sutures are usually removed in 7-21 days.
- Light activities can be resumed as tolerated. Aerobic activities can be started in about 3 weeks following either the 1st or 2nd stage procedure.
Other Options
- Enlarging, reducing, or lifting the opposite breast may be appropriate in order to have the reconstructed breast and the “normal” breast match.
- Other options for breast reconstruction include placement of an implant only (if adequate skin is present) and reconstruction with distant flaps -- i.e. -- latissimus dorsi flap or transverse rectus abdominus myocutaneous flap etc. Consultation will help determine which method is best for you.
Insurance Guidelines
- These operations are reconstructive and are almost always covered by insurance.
CHEST ENLARGEMENT FOR MEN*Who Is A Candidate?
- If you desire a filler, more muscular chest wall appearance in particular the “pecs” (pectoralis chest muscles).
- If you have an asymmetrical chest wall.
Intended Results
- An improved muscular appearance to your chest and a more positive self-image.
Procedure Description
- The procedure is done on an outpatient basis under sedation and local or general anesthesia.
- A small incision is made under the breast or in the arm pit (axilla). A firm implant (or implants) is then placed under the chest muscle (pectoralis).
Recuperation And Healing
- You will go home with your chest wrapped in an Ace bandage or you will wear a compression garment.
- Initial discomfort may be controlled with oral medication.
- The sutures will be removed in 7-10 days.
- You may resume light activities as tolerated and aerobic activities can be started in approximately 3 weeks.
Other Options
- An additional procedure that would enhance the result is Liposuction Liposculpture of the chest, axillary folds, or abdomen.
Insurance Guidelines
- This is a cosmetic procedure and is not covered by insurance.
MALE BREAST REDUCTION*Who Is A Candidate?
- If you are a man who has excessively large breasts.
- If you have excess or sagging tissue in your chest area, after losing a large amount of weight.
Intended Result
- A flatter chest with more masculine male contour.
Procedure Description
- Excess breast tissue or lit can be removed with liposuction, excision, or a combination of both.
- Excess skin can be excised.
- The procedure is usually done on an outpatient basis under general anesthesia, but can be done with sedation and local anesthesia.
Recuperation And Healing
- You will go home several hours after surgery to be cared for by a friend or relative.
- A compression vest or chest wrapping is usually indicated for a week or two after surgery to help reduce swelling.
- Sutures are usually removed within 7-10 days after surgery.
Other Options
- Additional procedures that will enhance the result are liposuction of excess fit in axilla (armpit area) or contouring and flattening of abdomen with liposuction and/or tummy tuck.
Insurance Guidelines
- This operation is occasionally covered by some, but not all, insurance companies. Pre-approval or denial is obtained from your insurance carrier before surgery.
NOTE:
The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.
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