In the Media

PLASTIC SURGERY UPDATE:

BREAST ENHANCEMENT

The appearance of a woman's breasts is often intimately tied to her sense of femininity, yet many women find themselves dissatisfied with what nature has dealt them. For some, it is their breast size, while for others, it is their position or shape. Fortunately, these issues can be addressed.

Breast surgery and enhancement is diverse and complex. Results can vary, and no one standard fits or applies to all women. Small breasts can be enhanced or augmented. Large breasts can be reduced, sagging breasts can be lifted, and sometimes what's required is all of the above.

One of the first questions I ask a prospective patient is "What is your fantasy?" It should be their fantasy, as it is their body and their decision. My role is to assess whether their fantasy is realistic and to inform them of what the risks and limitations may be. Breast augmentation involves multiple choices. Size is obviously important, but patients should realize that there are limitations based on their anatomy, such as chest width and size of their existing breast tissue. Fortunately, many sizes and shapes of implants are available to choose from. Placement is important, as it can be subglandular or submuscular. My personal preference in most cases is submuscular because they tend to stay softer with less scar tissue and have a more natural look. There is also less wrinkling in the long-term. The additional discomfort with this approach can be mitigated with the use of a pain pump. The approach can either be periareola, inframammary, or axillary. The decision as to which approach depends on the type of implants and size, as well as the patient's individual anatomy.

Most patients' breasts are not even to begin with. Usually this is not significant, but if it is, then adjustments in implant size need to be taken into account, as well as placement. We will be starting a clinical trial with a new implant that has the ability to be modified once it is inserted by injecting saline into the gel to increase the size and adjust for any asymmetries. Candidates will be limited to the first 10 patients.

Breast reductions usually involve repositioning the nipple areola complex, reducing the excess breast tissue, and removing the excess skin. Obviously, the scarring involved is more extensive but usually very acceptable. Insurance will often pay for this for non-cosmetic reasons. Sagging breasts can often be corrected with an implant alone. The critical factor is the position of the nipple areola complex. If it is truly too low, then it will have to be repositioned with an incision around the nipple and down the breast and sometimes underneath as well. Often, an implant is also inserted for additional improvement and to maintain superior fullness.

As one can see, the options are varied. I often find it helpful during the consultation if a patient brings in a photograph. This saves time and helps ensure that we're both on the same wavelength.