Breast Gallery

A woman in her late 20s with 36 G cup breasts and problems with back pain and shoulder pain. She has seen a chiropractor for the past year without success.  She loves to run but has so much difficulty due to the weight of her breasts that she had to give it up.  She has lost 40 lbs without improvement in her symptoms.  She also has some “axillary lipodystrophy,” which is some bulging of the fat at the tail of the breast/ front of the armpit area.  She is shown before and again, nearly 8 months after bilateral breast reduction with the removal of 665 grams of tissue from her right breast and 753 grams of tissue from her left.  (454 grams = 1 pound). We performed liposuction of the axillary lipodystrophy at the same time.  She has lost an additional 15 lbs since her surgery.  Her symptoms have all resolved, and she loves the new shape and size of her breasts!

A man in his early 20s with right unilateral gynecomastia.  He first noticed this at puberty, but it became more noticeable when he was 20.  He is a bodybuilder.  This bothers him in shirts and with his shirt off.  He is shown before and again, 4 ½ months after right gynecomastia excision with power-assisted liposuction.

A mother of 2 in her mid to later 70s who is bothered by drooping of her breasts as well as neck pain, back pain, shoulder pain, and grooving and irritation of her shoulders from the bra straps of her 34D cup bra.  She has problems with her posture as well as difficulty exercising due to the size of her breasts.  She is shown before and again, 6 ½ months after breast reduction with the removal of 333 grams of breast tissue from each side.

Discussion:  The quality of results with plastic surgery is not just the “tailor”, it’s the quality of the “fabric” that we are working with.  She has the typical skin elasticity of someone of her age, which can limit the result we might obtain.   An inverted T scar, inferior pedicle breast reduction was performed, with internal dermal reinforcement of the inferior pedicle to add more structure and decrease recurrent drooping.  The good news of being in the 70’s is that scars fade faster, and at 6 1/2 months her scars are fully mature- similar to someone in their 30’s might be after a year or longer.  She has an excellent result, and her symptoms related to the weight of her breasts have all resolved.

A woman in her late 50s who was referred by another patient.  She was a 40DD and had problems with back pain, neck, and shoulder pain.  She has L4-5 Disc problems, which are exacerbated by the weight of her breasts.  She was waiting to get approval for Tirzepatide ( Zepbound) and wanted to lose 25-30 lbs.  She was so uncomfortable that she proceeded with breast reduction, with the removal of 624 grams from her right breast and 499 grams from her left breast (454 grams = one pound), and we left her with an ample C so that she would still be proportional if she lost weight.  She then started the Tirzepatide and has lost 30 lbs at the time of her visit today, 4 ½ months after surgery.  Her symptoms have all resolved, and she is thrilled with her new shape and size, which is still proportional despite her weight loss.

A woman in her mid-40s with deflation of her right breast implant. She is shown before and again, 6 weeks after bilateral saline implant replacement.

Discussion:  She has had bilateral partial subpectoral placement of saline breast implants 23 years before by another physician, who has since retired.  She did well and was happy with her size and shape, but noticed a month before seeing me that her right breast started to get smaller.  We were able to obtain her old operative report from the surgery center where she had had her original procedure.  It mentioned the final fill volume of 375 but was inconsistent with the description of the implant size, mentioning 300 on one size “ filled to 375, which is within the desired limits of the implant. and 310 on the other  Mentor does not make a 300 cc high-profile saline implant. We were able to contact the manufacturer, Mentor, to open a warranty claim, and they had her in their database and were able to confirm that she had a Mentor 350-3310 on each side, which is a 310-round smooth high-profile saline implant that can be filled to 375.  So our detective work paid off.  She liked her original size and shape, even though it looked perhaps a little implant-like, with the implant pushing the limits of size that could be accommodated by her breast.  We kept the same size when I replaced her implants, and a capsulotomy was performed on her right to release the breast capsule, which had tightened around the deflated implant, and an inferior capsulotomy on her left to allow the implant to sit a little lower. At 6 weeks, she is doing great. We have just removed her steri-strips, and the discerning eye may notice a little tape residue under the breasts.

A college student in his early 20s with left gynecomastia that developed when he was 13.  He is bothered by the appearance of his chest in fitted shirts and with his shirt off.  This is a typical presentation for idiopathic gynecomastia.  He is shown before and again, 3 months after surgery, with a combination of power-assisted liposuction and a direct excision of breast tissue through an incision along the lower areola.  He now has a normal appearing chest and is thrilled to be comfortable now with his shirt off and in fitted shirts.

A man in his late 20s who is bothered by prominent nipples, both in shirts and with his shirt off.  He had gynecomastia surgery elsewhere 6 years before for gynecomastia that had developed in his 20s.  He continues to be bothered by the prominence of his chest and does have some residual gynecomastia with his “hands on head view” that is accentuated by his nipple projection. He also has a keloid on his left breast that was noticed after his surgery.  This itches and is painful.  He does not want more surgery for his gynecomastia, but wanted a simpler procedure so that his chest is not as noticeable in fitted shirts.  I performed a nipple amputation technique as well as a Kenalog injection into his scar. At 6 weeks, he is thrilled with the contour, the itching of the scar has resolved, and the scar is somewhat improved. An additional Kenalog injection was performed, and I will have him use topical silicone. He is now happy with the appearance of his chest in and out of shirts.

A woman in her early 50s who has had problems with back pain, shoulder pain, neck pain, grooving and irritation of her shoulder from her bra straps, and difficulty with her posture.  She is wearing a DDD cup bra.  She is shown before and again, 6 months after bilateral breast reduction using a superior pedicle technique with the removal of 660 grams from each breast. (454 grams is equal to one pound).  Her symptoms have resolved, and she is thrilled with her new shape and size. She is 5’4” and 182 lbs, and wanted her new breasts to be proportional.

A 4-month follow-up on a man in his mid-20s with gynecomastia since the age of 11.  It has not changed since.  He unfortunately had testicular cancer the year before and was treated successfully with orchiectomy and chemotherapy.  His last dose of chemo had been 10 months before.  He remained bothered by the female appearance of his chest, with his shirt off and in fitted shirts.  He is shown just before and again, 4 months after treatment with power-assisted liposuction combined with a direct excision of breast tissue through a lower periareolar incision. He is thrilled with his result, and his scars are fading well.  The scar on his right upper chest is from his chemotherapy port placement and subsequent removal.

A 6-year follow-up on a woman in her late 50s who was a 36 DD and had problems with grooving and irritation of her shoulders from the bra straps, back pain, rash under the breasts, and difficulty exercising.  She was a size 6 in pants and a size 10-14 in tops and felt that her breasts were out of proportion.  She is an avid runner and wishes to have a smaller C-cup breast. She also had some mild bulging of the fat pads in the armpit area/ upper breast (axillary lipodystrophy) and had liposuction of those areas at the same time. She is 5′ 7 1/2” and 145 lbs.  She is shown just before and again, 6 years after, 381 grams from her right breast and 421 grams from her left breast. (454 grams=one pound)

She is thrilled with her new shape and size, no longer needs to wear special bras to run, and states that “this is the best thing that she has ever done.”