Breast Reduction

Breast reduction, or reduction mammoplasty, is for a woman experiencing health problems and/or extreme self-consciousness associated with very large, heavy breasts. The goal is to give the woman a more attractive contour with smaller, better-shaped breasts in proportion with the rest of her body. She will then benefit from freedom of health problems associated with large breasts and an improved self-image.

Medical problems associated with very large breasts include back and neck pain caused by the excessive weight, skin irritation, skeletal deformities and breathing problems. Bra straps may leave shoulder indentations. Large, heavy breasts also contribute to poor posture, and can interfere with normal daily activities such as exercise. Excessive breast size may also lead to a decreased sense of attractiveness and self-confidence.

The Procedure
Breast reduction is done under general anesthesia on an outpatient basis or in the hospital. The surgery removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple.

Incisions are made around the pigmented 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. The incisions are covered with a light dressing.

Afterward, the breasts are placed in a surgical bra that will hold them symmetrically during initial healing. Initial discomfort subsides daily and can be controlled with oral medications. Scars will fade in 6-18 months. Surgery will likely reduce, but not eliminate the ability to breast-feed.

The result may be further enhanced by liposuction of the axillary area to reduce excess fat deposits. This is commonly covered by insurance. Our staff will assist you in obtaining preauthorization.

Recovery: What to Expect
When performed by a qualified plastic surgeon, breast reduction is a safe procedure. Nevertheless, as with any surgery, there is always a possibility of complications, including bleeding, infection, or reaction to the anesthesia. Some patients develop small sores around their nipples after surgery; these can be treated with antibiotic creams. You can reduce your risks by closely following your physician's advice both before and after surgery.

Much of the swelling and bruising disappears in the first few weeks following the surgery. Breasts may appear slightly mismatched, or have unevenly positioned nipples. Their new shape will be apparent within 6 months to a year, and will depend on hormonal fluctuations, weight changes and pregnancy.

Although your surgeon will make your scars as inconspicuous as possible, some permanent scarring is inevitable. Smokers are more likely to experience poor healing and wider scars. The scars will be red and lumpy in the months following the surgery, but the redness will fade and in time the scars will be less obvious. The good news is, your bra or bathing suit will cover whatever scars remain, and most likely, the scars will not prevent you from wearing low-cut tops.

Ability to Breastfeed
Because the surgery removes many of the milk ducts leading to the nipples, breast-feeding may no longer be an option.

Some patients may experience a permanent loss of feeling in their nipples or breasts. Rarely, the nipple and areola may lose their blood supply and the tissue will die. (The nipple and areola can usually be rebuilt, however, using skin grafts from elsewhere on the body.)

The End Result
Breast reduction produces the most dramatic results of all plastic surgeries. It ends the physical discomfort or large breasts and makes your body appear more evenly proportioned, and clothes fit better. Your new image will take some getting used to, as much as you desired the change. Give yourself—and your family and friends—time to adjust to the new you and, like most women, you will enjoy the benefits.

BACK TO TOP

---

Breast Reconstruction

Breast reconstruction offers much hope for a woman losing her breast to cancer. Reconstruction can often be performed immediately after the mastectomy, so the woman does not have to live with one breast. Depending on health conditions, however, a mastectomy patient may have to wait before undergoing reconstructive surgery. In either case, reconstructive surgery holds much promise that the post-operative breast can match the natural breast again.

The Surgery
When reconstructive surgery is performed immediately following mastectomy, a breast mound is created in place of the breast that has been removed. This is done in the hospital under general anesthesia.

Dr. Ayala will work with your oncologist to ensure the best possible conditions for reconstruction.

Breast reconstruction usually involves more than one operation, and follow up procedures may be performed on an outpatient basis. Follow-up procedures may only require local anesthesia, and often involve a skin expander with a breast implant, and reconstruction of the nipple and areola. Sometimes surgery is the performed on the natural breast to match the reconstructed breast; however, this creates additional scars.

Once the breast mound is in place, your plastic surgeon may follow up with a skin expander and breast implant or flap reconstruction.

Skin Expander with Breast Implant
This is the simplest of breast reconstructions. Blood transfusions are not required, and there is minimal pain and a short recovery time. In this procedure, a tissue expander is placed under the skin. Once sutures are removed, saline is added weekly to the expander. This stretches the skin as it expands.

When the skin has been sufficiently stretched, the tissue expander is removed replaced by a permanent breast implant in a two-stage procedure. Nipple reconstruction, if desired, is a separate procedure.

Advantages: Simplest surgery and shortest recovery from surgery. This is the favored procedure for persons who have heath problems or contraindications to extensive surgery.

Disadvantages: Multiple trips to the office over several weeks or months to undergo expansion. Capsule formation or poor cosmesis due to thin skin.

Possible Complications:

Loss of breast skin requiring removal of implant. If you have undergone radiation this procedure is not advisable as you are at increased risk for skin loss.
Noticeable outlines of the implant due to capsule formation
Hard texture due to capsule formation
Thin breast skin
Latissimus Dorsi Myocutaneous Flap
This surgery involves moving the latissimus dorsi muscle and overlying skin from the back to the chest to create a new breast mound. The incision is usually made along the bra line so the scar will be concealed.

Blood transfusions are not usually required. A breast implant can be placed under the flap if necessary to balance a difference in size. Nipple reconstruction is done later.

Advantages: This is a very reliable procedure, which provides a good environment for an implant. The chances of capsule formation around the implant are reduced.

Disadvantages: Scar across the back. There may be decreased strength in the back due to muscle loss. Capsule formation may occur and result in the need for additional surgery.

Possible Complications:

Circulation problems with the flap
Formation of capsule around the implant
Symptoms from loss of shoulder muscle, such as decreased strength
Loss of back skin requiring skin grafting
Collection of fluid (seroma) under incision requiring needle aspiration
Rectus Abdominus Myocutaneous Flap
This is the most complicated and the longest reconstructive procedure, involving about 4-5 hours of surgery. One of the rectus abdominus muscles is tunneled along with the overlying skin up to the chest. The breast mound is created to match the opposite site. A blood transfusion may be required. You may donate your own blood prior to surgery to be re-infused during the surgery.

Breast implants are not usually required. The tissue is generally adequate to match the size of the opposing breast. If the opposite breast is large or pendulous it can be decreased in size by a simultaneous breast reduction. Patients wishing to have this procedure must stop smoking six weeks prior to and six weeks following surgery. Failure to comply may result in death of the flap. A synthetic mesh is placed over the area where the muscle is moved. This strengthens the abdominal wall and minimizes the chance of herniation of the bowel. Nipple reconstruction is done as a second procedure. Some contouring of the new breast mound may be necessary at the same time.

Advantages: This provides the most natural looking breast reconstruction with the added benefit of a “tummy tuck”. No implant is needed so capsule formation is not a risk. The scar is easily hidden with clothing.

Disadvantages: There is a risk of herniation of the bowel resulting from moving the rectus abdominus muscle. Abdominal strength is diminished. This is the longest procedure and has the greatest risk for requiring a blood transfusion.

Possible Complications:

Inadequate tissue requiring the use of a breast implant
Poor circulation to the flap resulting in tissue loss
Weakness or herniation of the abdominal wall
Placement of the umbilicus off center
Collection of fluid (seroma) under the skin requiring needle aspiration
Infection, in particular of the mesh requiring surgery for removal
Nipple Reconstruction
The reconstruction of a nipple adds a very pleasing final touch to the breast. This is a simple outpatient procedure that may be done with local anesthesia. An average time for this is about 1-2 hours. The goal of the surgery is to create a nipple that has the appearance of the nipple of the opposite breast. Skin is taken from the inner part of the upper thigh or from behind the ear. These areas tend to have a darker pigment, which will provide a better contrast to the breast tissue. As a second procedure the healed nipple can be tattooed to improve the color match of the opposite breast.

Possible complications:

Excessive scarring
Shrinkage of the projecting part of the nipple
Infection of the donor site or the newly created nipple
Blood clot under the nipple, which may result in loss of all or part of the new nipple
Reconstruction of the breast following mastectomy is a very rewarding procedure to both the patient and the surgeon. Many women describe a feeling of once again being whole. There are many materials available regarding breast reconstruction. There are support groups available where one can meet women who have gone through these procedures. Ask us for references, books and support groups in your area. Take advantage of these invaluable resources.

BACK TO TOP

---

Breast Lift

Breast lift surgery, or mastopexy, restores a more youthful appearance to a woman’s breasts. Over the years breasts can lose their shape and firmness due to pregnancy, nursing and loss of skin elasticity, causing them to sag. Mastopexy will raise and reshape breasts—slowing the effects of aging and gravity. This procedure can reduce the size of the areola, the darker skin surrounding the nipple.

Mastopexy is commonly performed in conjunction with breast augmentation (implants) to increase breast firmness and size. This may appeal to women who have lost breast volume after pregnancy. Pregnancy and nursing often result in stretched skin and therefore decreased volume. If you are planning a future pregnancy, it is advisable to postpone your breast lift as pregnancy will likely cause further stretching.

As with all plastic surgery, realistic expectations and emotional stability are important. Though breasts of any size can be lifted, women with smaller breasts enjoy longer lasting results.

The Procedure
Though not a simple operation, mastopexy is normally safe when performed by a qualified plastic surgeon. Mastopexy is occasionally performed in a hospital, but more often is done in an outpatient facility. Breast lifts are usually performed under general anesthesia. Local anesthesia may be used with a sedative if the incision is small; you’ll be awake but relaxed, and will feel minimal discomfort.

The surgery may take between 1 1/2 to 3 1/2 hours. A more common approach involves an incision along the natural contour of the breast where excess skin will be removed. The nipple and areola are then repositioned. The skin surrounding the areola is brought together to reshape the breast, with stitches around the areola and the lower breast area.

Possible Complications
As with any surgery, there are possible complications. A patient may suffer an adverse reaction to the anesthesia (rare), or experience bleeding and infection following a breast lift, causing scars to widen. Poor healing and wider scars are more common with patients who smoke.

Because milk ducts are left intact, mastopexy will not affect your ability to breast-feed.

For best results, follow your physician’s advice both before and after surgery.

After Surgery: What to Expect
After surgery, your stitches will be covered with gauze and an elastic bandage or a surgical bra will hold the breasts in place. Your breasts will be bruised, swollen, and you may experience some mild discomfort for a couple of days. Your doctor may prescribe pain medication. A soft support bra replaces the bandages or surgical bra after a few days. In the recovery stage, it is important to wear the bra at all times.

After a week or two, the stitches will be removed. Some noticeable, permanent scarring is normal, but easily covered by your bra or bathing suit. The scars may be red and lumpy for a few months, eventually fading and becoming less obvious. The procedure can also leave you with unevenly positioned nipples, or a permanent loss of feeling in your nipples or breasts.

To ensure proper healing, plan to stay at home for at least a week before returning to work. You will need to avoid lifting anything over your head for 3-4 weeks and avoid strenuous sports for a month.

BACK TO TOP

---

Breast Enlargement

Breast enlargement, or augmentation mammoplasty, enhances the body contour of a woman who is unhappy with her small breast size. Other purposes of this procedure include:

To correct reduction in breast volume after pregnancy.
To balance a difference in breast size.
As a reconstructive technique following breast surgery.

Augmentation mammoplasty is done on an outpatient basis in our surgical center, usually under general anesthesia. An implant (prosthesis) is placed through an incision, under the breast tissue or under the muscle. The incision can be made under the breast, around the nipple or under the arm. A breast implant is composed of an outer silicone shell filled with saline (the FDA has restricted the use of silicone gel implants). The outer surface may be smooth or textured, and implants come in various shapes to meet the individual woman’s needs.

When the implant is placed sub muscularly under the breast, there is a lower chance of contracture (contraction of the tissue capsule surrounding the implant), and mammography is more reliable. There is also less risk of visible or palpable implant edges. However, some believe the implant has a more natural appearance when placed above the muscle, under the breast tissue. Your plastic surgeon can help you decide which placement and type of implant will work best.

Determining Implant Size
The shape of your augmented breasts depends on the implant. Implants may be round or teardrop-shaped (anatomical). The choice depends on the look you want to achieve: Anatomical implants produce a gentle slope, resulting in a fuller upper area, whereas round implants create a round curve in the upper part of the breast. Another factor to consider prior to surgery is breast width, which determines the amount of “cleavage” between your breasts and the outer curves, which you may want to balance with your hips.

Realistic expectations of this procedure are important. Women often think of breast size in terms of bra cup size. If you are currently a size “A” and wish to be a size “C”, there must be adequate existing breast tissue coverage; otherwise you will be warned of visible or palpable implant edges and other possible risks.

Post Operative Care
You must have someone drive you home and stay with you for 24 hours after surgery. You will experience some pain the first day or two that is easily controlled with pain pills. Some tightness in the breast area is also normal as your body adjusts to the implants.

You can move about freely after surgery. Wear a bra at all times (except when showering) during the first 2 weeks following surgery. Avoid heavy lifting for 2-3 weeks. Moderate exercise such as walking or stationary biking is allowed after the first week. Vigorous exercise such as jogging or aerobics may be resumed at 3-4 weeks. You will most likely be able to return to work within a few days, but you will need to avoid any strenuous activity for at least a couple of weeks.

During recovery, the breasts will be somewhat swollen. Within a few weeks, the actual shape and size will be evident. You may notice some asymmetry; however most breasts are naturally somewhat asymmetrical.

Possible Complications
Delayed wound healing may occur in persons with diabetes, history of radiation, autoimmune disease or smokers. Other complications include capsular contracture, bleeding, infection, or irregularity of the skin. It is important to have a thorough medical evaluation beforehand to address these potential risks. You also need to know that even a small hole in an implant can cause the saline to leak out, resulting in a "flat” implant and necessitating surgical replacement. This is completely avoidable, however, by taking proper precautions.

About silicone gel implants: The FDA placed a hold on silicone implants in 1992 to further investigate their safety and effectiveness. They have since been replaced by saline (salt water) implants. There has been much discussion about the possibility of silicone and in particular silicone gel, being related to autoimmune disease. However, a large study of women with and without breast implants conducted at the Mayo Clinic showed that autoimmune disease occurred with the same frequency in both groups. It is not known what causes autoimmune diseases, seen in middle-age women.

Conclusion
Augmentation mammoplasty is a safe procedure that has produced pleasing and satisfying results for many women. Those who are psychologically stable and have realistic expectations benefit the most. A preliminary consultation can help you determine whether breast augmentation is right for you.

BACK TO TOP

---

Liposuction

• Liposuction is a very common, popular procedure. It is designed for the permanent removal of fatty tissue, commonly refersred to as “cellulite.” It is an elective procedure that allows the plastic surgeon to remove undesirable, subcutaneous fat in isolated areas that do not respond to diet and exercise. These areas include the hips, thighs, abdomen, knees, ankles, face and neck.

  Liposuction is most successful in people with good skin tone who have fatty deposits. It is not a treatment for obesity. If weight gain occurs following liposuction, the fat will be deposited in areas that have not been treated. The procedure can be repeated, if necessary. To maintain the safety of the procedure, there is a limit on how much can be done at one time.

  A variety of factors can affect the results: Physical condition, genetic makeup, diet, exercise, smoking, alcohol intake, and skin elasticity.

  Body contours made irregular by fat can be improved by this procedure; it cannot correct contours that are irregular for other reasons, such as muscle weakness or hernia. However, combined with other procedures, liposuction can correct these other deformities with good results.

  The Procedure
  Liposuction is done under general anesthesia on an outpatient basis in a hospital or surgical center. The surgeon makes small (less than 1/2 inch), discreet incisions in the areas to be treated. A cannula is inserted in a small incision and attached to a suction machine. The procedure may take an hour or more, depending on how many areas are involved.

  Recovery
  Recovery from liposuction is relatively easy. Expect a fair amount of swelling and bruising in the following two weeks. You will wear special garments provided to apply pressure, minimize swelling and provide support while healing. These garments also assist in retraction of the skin. Stitches will be removed in a week to 10 days.

  Results are recognizable almost immediately and will continue to improve as swelling subsides. The day after surgery you should be up and walking around. Increase your activity daily until full activity is resumed at 2-4 weeks. You will be ready to return to office work in 3-5 days and more active employment at 10-14 days. Avoid the sun until all bruising has subsided. A sunscreen should be used routinely; it is easy to get sunburned during recovery because of decreased sensation.

  The results of liposuction are permanent. If you were to gain a large amount of weight you might note rippling in the treated areas, depending on your skin elasticity.

  Possible Complications: As with any surgical procedure, complications can occur. Cosmetic complications include contour irregularities, skin discoloration, asymmetry, scar tissue, tape burns, collection of blood or fluid under the skin. Uncommon complications include loss of sensation, skin breakdown, fat embolism serious infection or shock. Bleeding does occur during liposuction. There is a limit to the amount of fat that can be safely removed in a given procedure.

  Following liposuction, the scar will go through a maturation process—during the first 8-12 weeks they may be red and possibly raised. The scars will mature over 6-2 months and become pale, flat and soft. You may experience numbness, burning, tingling around the incision site. These symptoms are almost always temporary.

  Please let us know if you are prone to keloid scars.

  BACK TO TOP

  ---

  
  

  Abdominoplasty or Tummy Tuck

  
  A flat and well-toned abdomen is something many of us strive for through exercise and weight control. Sometimes these methods cannot achieve our goals.

  Even individuals of otherwise normal body weight and proportion can develop an abdomen that protrudes or is loose and sagging. The most common causes of this include:

  * Pregnancy
  * Aging
  * Significant fluctuations in weight
  * Heredity
  * Prior surgery

  Also known as abdominoplasty, a tummy tuck removes excess fat and skin, and in most cases restores weakened or separated muscles creating an abdominal profile that is smoother and firmer.
  What it won’t do:

  A tummy tuck is not a substitute for weight loss or an appropriate exercise program.

  Although the results of a tummy tuck are technically permanent, the positive outcome can be greatly diminished by significant fluctuations in your weight. For this reason, individuals who are planning substantial weight loss or women who may be considering future pregnancies may be advised to postpone a tummy tuck.

  Also, a tummy tuck cannot correct stretch marks, although these may be removed or somewhat improved if they are located on the areas of excess skin that will be excised, generally those treated areas below the belly button.
  Is it right for me?

  Tummy tuck surgery is a highly individualized procedure and you should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.

  Abdominoplasty is a good option for you if:

  * You are physically healthy and at a stable weight
  * You have realistic expectations
  * You are a non-smoker
  * You are bothered by the feeling that your tummy is too large

  The success and safety of your tummy tuck procedure depends very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle.
  Be prepared to discuss:

  * Why you want the surgery, your expectations and desired outcome
  * Medical conditions, drug allergies and medical treatments
  * Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
  * Previous surgeries

  Your surgeon may also:

  * Evaluate your general health status and any pre-existing health conditions or risk factors
  * Take photographs for your medical record
  * Discuss your options and recommend a course of treatment

  Prior to surgery, you may be asked to:

  * Get lab testing or a medical evaluation
  * Take certain medications or adjust your current medications
  * Stop smoking well in advance of surgery
  * Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding

  Special instructions you receive will cover:

  * What to do on the day of surgery
  * The use of anesthesia during your tummy tuck
  * Post-operative care and follow-up
  * Discuss likely outcomes of the tummy tuck and any risks or potential complications

  BACK TO TOP

  ---

  
  

  Mommy Makeover

  Mommy Makeovers Counter the Physical Effects of Pregnancy

  On average, most women gain 25 to 35 pounds during pregnancy. This weight is stored as fatty tissue in the breasts, abdomen, flanks (love-handles), hips, lower back, buttocks and thighs. The breasts also grow due to weight gain and to prepare for nursing. But don't despair, a mommy makeover can help you look your best again.

  As the baby grows, so does the abdomen. This may result in a weakening and separation of the abdominal muscles, and stretching of the abdominal skin. This stretching may cause a breakage of the skin collagen, also known as stretch marks. These unsightly marks are purple-red in color and concentrated around the belly button and lower abdomen.

  These effects often become even more apparent after childbirth and nursing. A mommy makeover can help reverse these effects.

  Many new moms do lose the excess weight – eventually. Unfortunately, the weight loss is not proportional to the amount of fatty tissue in a given area. That means for some, more weight may be lost from the breasts or buttocks than the abdomen and waist.

  The result? Smaller breasts despite fullness of the waist and abdomen. In these cases, a mommy makeover may be in order.

  Once a woman finishes breastfeeding, the breasts deflate even further and begin to sag. The weak abdominal muscles and the excess abdominal fat appear as fullness and bulging of the belly. Many new moms may still look pregnant even as their child is taking his or her first steps. Once again, a mommy makeover can help.
  What is a Mommy Makeover?

  A mommy makeover is performed using a unique combination of plastic surgery procedures designed to counteract the physical effects of childbearing, and restore and enhance your body.

  The mommy makeover trend is becoming so pervasive that there is even a children's book – My Beautiful Mommy – by Florida plastic surgeon Michael Salzhauer that helps moms explain the procedures to their children.

  In general, a mommy makeover may include:

  * Breast augmentation
  * Breast lift
  * Tummy tuck (abdominoplasty)
  * Buttock lift
  * Liposuction

  Mommy makeovers can include any or all of these body contouring procedures depending on your wishes and needs.

  For example, some women need breast augmentation to correct severely deflated “pancake” breasts, while others may need breast implants in combination with a breast lift. Still, some women may actually desire a breast reduction with a lift.

  In the abdominal area, many women need a full abdominoplasty with tightening of the muscle layer as well as removal of the excess skin and fat, while some may need a mini-abdominoplasty.

  Some women may also benefit from liposuction to sculpt the back, hips and thighs; and smooth out their contours.

  Finally, an increasing number of women have also been requesting a buttock lift as part of their mommy makeover. The length of the surgery varies based on the amount and type of procedures performed. Some surgeons may perform a mommy makeover as two or more separate operations.

  BACK TO TOP