An 18 yo woman of color with severe macromastia and breast asymmetry. She describes herself as a 38G cup and has problems with grooving and irritation of the shoulders, back pain, shoulder pain, difficulty exercising and intertrigo. She is shown before and again, 5 months after bilateral breast reduction with an inferior pedicle Inverted T scar technique with the removal of 1538 gms from her right breast and 961 gms from her left breast to reduce her to a full Cup. Scars will typically fade and improve over the next two years. She is thrilled with her result. She no longer has symptoms due to the size of her breast and is able to exercise now. She is confident now, and showed me photos of her being able to wear beautiful dresses now from a recent trip to a bridal shop that she could never have been comfortable in before.
A 17 year old woman with severe breast asymmetry. She is larger than a DD on her right and a full C cup on her left. She has had problems with right shoulder and back pain due to the size of her breasts. She had first developed breasts at the age of 13 and has not had any changes in size over the past year.
She is shown before and again, 7 ½ month after a J breast lift on her left side and a short T scar technique on her right. Gortex Round block sutures were used to prevent spreading of the areola. 40 gms of tissue were removed from her left and 252 gms from her right. Her symptoms have resolved and she is thrilled to have breast which match. Scars typically get thicker and redder for 6 weeks and then fade and improve over the next 2 years or longer. She is using topical silicone to help with the scar maturation.
A mother of 2 in her early 50’s who wears a 34 DD and has problems with grooving and irritation of her shoulders from the bra as well as back pain, neck strain and difficulty exercising due to the size of her breasts. She also feels that the size of her breasts draws too much unwanted attention and she hunches her shoulders to hide them. She is petite at 4’10” and 127 lbs. She is shown before and again, 7 months after a bilateral breast reduction with the removal of 391 grams from her right breast an 386 grams from her left breast ( 454 grams = 1 pound). An irritated mole was removed from her cleavage area for her at the same time. Scars will typically continue to fade and improve for 2 years after a breast reduction. She is already thrilled with her new breasts. Her symptoms have resolved, she no longer feels that the breasts are too large for her frame. She is learning to stand up straight again and like many patients, her “only regret is that she didn’t do this sooner”.
An 18 yo with bilateral macromastia since the 5 th grade who was wearing a 32 Double D bra . She needed wto wear 2-3 bras just to support her breasts and had problems with back pain, shoulder pain, irritation of the shoulders from her bra straps, difficulty exercising and problens with her posture. She is petite at 5’1” and 112 lbs and had very large areola, which made it difficult to perform a traditional Inverted T scar technique. In her case we elected to perform a short scar technique, known as a S hort P eri ariolar I nferio r Pedicle (SPAIR) technique. This incorporates a permanent Gortex suture around the areola to decrease it’s diameter along wth a “J” shaped incision. The blood supply to the nipple is from an inferior pedicle. She had the removal of 271 grams from her left breast and 336 grams from her right breast to reduce her to a 32 “C” cup, more in keeping with her frame. She is shown before and again, nearly 2 ½ years after surgery. Her symptoms have resolved. Her scars have faded. And she is thrilled with the new shape and size of her breasts.
A mother of one in her early 30’s who is bothered by a deflated appearance of her breasts after breast feeding. She describes herself as a 36 B but wanted to be a full C. She is 5’4” and 158 lbs and is shown before and again, 4 ½ months after bilateral subglandular breast augmentation with Ideal Structured Saline implants filled to 410 cc.
Discussion: She has pseudoptosis with her nipples being located just at to above her breast fold. Caliper pinch of her breasts shows a thickness of 4.5 cm. A subglandular placement was chosen because she has enough breast tissue thickness to hide the implant and a subpectoral placement puts her more at risk for a “waterfall effect” with her somewhat loose breast falling off of the breast mound. With a subglandular placement, the implant drops with the breast, avoiding the potential for a waterfall effect. She has the Ideal 370-410 cc implant. The empty implant volume is 56 cc and the inner lumen is filled to 214 cc. The outer lumen is filled to 145 cc to give a total implant volume of 410 cc. This higher fill volume is similar in profile to a high profile silicone implant and gives a little more fill to the upper breast. She is pleased with the soft feel of the Ideal Implants which are nearly as soft to the touch as silicone implants. She is also happy to not have to worry about silent rupture.
A man with recurrent gynecomastia. He first presented at age 38 when he was 5’7 1/4 and 169 lbs. and had gynecomastia treatment by myself with external ultrasound assisted, power assisted liposuction combined with the direct excision of breast tissue through a periareolar (around the lower areola) incision with the specimen of breast tissue weighing 63 gms on the left and 70 gms on the right. He did well after surgery, with a good result at 5 months.
He returned to see me two years later.
He continued to smoke Marijuana (which can lead to gynecomastia) and also gained 15 lbs. and developed recurrence of gynecomastia, with new development of some firm breast tissue in the lateral lower breasts. This was a little surprising and not common in my experience, especially with direct excision of the breast tissue under the areola at the initial surgery. We returned to the operating room and performed liposuction again, along with the direct excision of 49 gms of breast tissue from the right and 40 gms of breast tissue from the left. The new breast tissue was located more laterally and inferiorly in the breast this time.
He again did well. He is seen again, 5 years after this second procedure. He reports having one treatment of cool sculpting to his upper chest for a little more refinement. He has lost one pound since his second surgery, but has been spending more time at the gym. His case illustrates a few points. Recurrence of gynecomastia is uncommon, but can happen, and may be impacted by gaining weight and significant marijuana usage. I have other patients who have continued to use marijuana without recurrence of their gynecomastia, so a recurrence like this has been uncommon in my experience. Weight gain after surgery can certainly contribute as well.
An Asian woman in her early 20’s who wished to have fuller breasts. She described herself as a 32-34 A cup and wanted to be a C cup is possible but still natural in appearance.
She is shown before and again, 6 weeks after breast augmentation with 5 th generation smooth round cohesive silicone gel implants placed below the pectoralis muscle through an infra mammary ( at the breast fold) incision. Implants used were Sientra Opus 255 ml moderate profile cohesive silicone gel implants. She is petite at 5’3” and 116 lbs. This was the largest implant that would fit the dimensions of her breast and still maintain a natural appearance, without an overly round “implant” look. Her inframammary fold was reinforced at the time of her surgery by anchoring it to the rib periosteum with long lasting but dissolving sutures to prevent “bottoming out” and dropping of the breast fold.
A woman in her early 50’s who describes herself as a 38DDD cup and has had problems with back pain, grooving and irritation of her shoulders, a rash under the breasts in the warmer months, postural difficulties and problems with exercising due to the size of her breasts. She is over her ideal body weight at 5’ tall and 193 lbs but has had difficulty loosing weight. She is shone before and again, just 4 ½ months after a bilateral short T scar inferior pedicle breast reduction with the removal of more than 600 gms from her right breast and more than 500 gms from her left breast to bring her down to a full C cup. Her symptoms have resolved and she is thrilled with her new shape and size. Scars will typically continue to fade and improve over the next 2 years.
A man in his mid 30’s who has had gynecomastia since middle school. He describes developing breasts at 11-212. He was smoking marijuana at that time, and continues to smoke marijuana on a regular basis. Marijuana use has been associated with gynecomastia development in some studies.
He is bothered by the appearance of his chest with his shirt off and also in fitted shirts. He has worn compression garments to hide the appearance of his chest.
He is shown before and again, just 6 weeks after bilateral gynecomastia treatment with A modified S.A.F.E. technique combined with a direct excision of breast tissue through an incision around the areola. External ultrasound is used to soften the fat before the finned cannula is used to mechanically disrupt the fat. Then liposuction is performed through an incision behind the pectoralis muscle and beneath the areolar. Remaining breast tissue is excised through the periareolar incision and then the fatty layer is mechanically smoothed with the finned cannula.
Scars are at their thickest and reddest at 6 weeks and will now begin to fade and improve over the next 1-2 years. He is already thrilled with his improvement and is looking forward to going the beach this summer and wearing fitted shirts
Update: Our patient is now seen 4 ½ months after surgery. Scars have continued to soften and fade.
A mother of 2 in her early 30’s who was a 34 DD cup before surgery and had problems with her posture due to the weight of her breasts. She was having increasing problems standing up straight, as well as back pain, shoulder pain, a rash under her breasts in the summer months, and grooving and irritation of her shoulders from her bra straps. She is shown before and again, 7 months after breast reduction with the removal of more than 400 gms of tissue from each breast, bringing her down to a 34 C cup. Scars will typically continue to fade and improve over the next 18 months. She is already thrilled with her new shape and size, and her symptoms have all resolved.