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Breast Surgery

BREAST LIFT

There are two categories of women with drooping breasts.

The first has overly large breasts which develop from the weight stretching out the skin. These ladies can suffer from pains in the neck, shoulders, and back. The second category has normal-sized or small breasts that have been stretched out after pregnancy, large weight loss, or the effect of gravity over the years. Both groups of women prefer firm, perky, and normal sized breasts.

The women with overly large breasts have a medical necessity to reduce the weight of the breasts so that they can be relieved of the pain in the neck, shoulders, and back.

In the surgical treatment of both classes of women excess skin around the nipple including the areola which is the brown area around the nipple, and the skin in the lower part of the breast need to be removed. This will result in a circular scar around the areola and either a vertical line in the underside of the breast or an additional horizontal line across the underside of the breast.

Some people form very fine scars and others, especially the darker complected, form scars that can be prominent. Surgeons have attempted to reduce the scars of surgery and there are some who do only liposuction to reduce the size of breasts. This is possible only in those who are not too large because with high volume liposuction of the breasts they will droop just like a balloon that has had its air removed.

In the case of breast lifts, it is possible to reduce the scar under the breast to just a vertical line in many cases. In those with only a moderate droop a doughnut of skin can be excised around the nipple and an implant placed under the breast to get excellent results without a need for excising skin under the breasts.

Breast surgery, as is true of all surgeries, have possible complications such as infection, bleeding, loss of sensation, or loss of skin postoperatively. The risk of complications is similar to the risks of accidents in driving a car.

These surgeries can be done in the doctor’s office but breast reduction is more often done in the hospital because there is insurance coverage. Most patients will be able to get around the day following surgery by wearing a good supporting bra. If the surgery is done in the hospital the patient may stay overnight or be discharged the same day depending on the extent of surgery done.

Be sure to ask your surgeon for preoperative and postoperative pictures of patients he has done and speak to some patients who have already had the surgery. For women who have had the surgery there are few who regret having had it done. For more information you can look up the American Society of Plastic Surgeons website on the Internet at www.plasticsurgery.org.

BREAST AUGMENTATION

The feminine shape of a woman is defined very significantly by the shape of the breasts.

That is why a mastectomy is such a feared consequence of breast cancer besides the obvious threat to life of the disease. In some women, the breast development is so poor that they might as well have had mastectomies. Then there are others who do not have adequate volume, or have lost volume after pregnancy, or have a significant size difference between the two breasts, or have breasts that are shaped wrong. No matter the reason, the woman who wants breast enlargement must choose the size that will please her rather than somebody else.

The first step in obtaining the surgery is to get a consultation from a well-trained surgeon such as one who is board-certified by the American Board of Plastic Surgery. The surgeon’s role is to cooperate with the patient in achieving the result that the patient desires rather than to impose his own personal taste on the patient. A surgeon can also advise the patient whether what she wants is achievable. There should be available preoperative and postoperative pictures of patients as well as referrals to those who have had the surgery that can talk to the patient.

The cost of breast enlargement in the Dayton area varies from $3800-$4500 and could be even higher if the surgery was done in the hospital. Most surgeries are done in the doctors’ offices because of the large savings to the patient. The surgery can be done with the patient totally asleep or well sedated by oral medication as well as IV medications and numbing of the chest.

The surgical procedure itself will take about an hour and a half to two hours. If there is a need for an additional lifting procedure it will take longer. More surgeons are putting the implants under the chest muscle than over the muscle under the breast. All implants for cosmetic purposes in the US have to be silicone rubber shells filled with salt water. Implants are placed through small incisions about an inch and a half under the breasts, through an incision on the edge of the areola, or an incision in the armpit. After the operation, the patient may go home with oral pain medications. How much pain a patient feels varies greatly between individuals.

There are surgeons who tell their patients to wear tight garments around their chests after surgery and to restrict their arm movements. Others like myself prefer their patients to have unrestricted movement in the chest and arms enough to allow loosening of the tight muscles and skin and the prevention of tightening of the space around the implant. The final shape will take 2-3 months or even more to be appreciated fully.

There are complications that can occur with all surgical procedures. With regard to breast enlargement, out of 100 implants that are placed in patients in a year, about 2-3 may leak. Should that happen, the salt water is absorbed without any side effects. The patient will notice that one breast becomes softer and does not fill up the bra as much. Implants used in the United States are guaranteed for life. Other rare complications include infection requiring the temporary removal of the implant. Rarely, there is bleeding after surgery, which requires re-exploration of the surgical site to stop the bleeding. Long term there is the possibility of contraction of the scar capsule that forms around the implant, which requires re-operation. Since no one has perfect symmetry of the breasts before surgery, there is high likelihood that the breasts will not be perfectly symmetrical after surgery. In addition, there can be areas of numbness of the skin of the breasts, which could be permanent. About half of the women who want to breast feed after breast enlargement will not be able to. Should there be unsatisfactory positioning of the implant, corrective surgery can be done about 6 months after the initial surgery.

There is a report available since December 1998 from the Scientific Panel appointed by the judge overseeing the class action lawsuit against silicone gel implant manufacturers, which gave a clean bill of health to silicone gel implants. We can be certain at this point in time that there is no relationship between silicone gel or silicone with saline implants causing any type of disease.

Women who have had breast enlargement have the same risks of breast diseases as other women who have never had breast surgery. Women should still examine their breasts once a month before their menstrual period to check for unusual lumps. They should also go for mammograms at age 40 and then every couple of years after that.

Over 90% of women are very satisfied after breast enlargement and have an improved self-image that leads to a higher quality of interpersonal relationships.