Breast Reduction – Patient 229
A nurse in her early to mid 20’s who described herself as a 34 D cup and had problems with back pain and difficulty exercising due to the size of her breasts. She was not able to obtain insurance coverage for her procedure because the amount of tissue to be removed to reduce her to a C cup did not meet insurance criteria for her carrier. She proceeded as a cosmetic breast reduction and is shown before and again, 15 months after bilateral breast reduction with the removal of just over 200 grams of tissue from each breast to reduce her to a C cup. Despite gaining 13 lbs, her breasts remain in a c cup range and her symptoms have resolved and not recurred.
Breast Augmentation – Patient 335
A mother of 3 in her early 60’s who is bothered by a deflated appearance of her breasts after children. She is 5’ 4” and 116 lbs and is shown before and again, 6 weeks after subglandular placement of Sientra 415 cc high profile smooth round high strength cohesive silicone gel implants.
Discussion: Although I would more typically recommend a subpectoral placement of the implants ( below the muscle) which may have a lower risk of capsular contracture, She has some early ptosis or drooping of the breasts. A subpectoral placement in her case would place her at a higher risk of a “waterfall deformity” with the breasts falling off of the implant mound. With a subglandular placement, the implants settle with the breasts and gives a more natural appearance.
Breast Augmentation – Patient 334
An Asian mother of 2 in her later 40’s who is bothered by a deflated appearance of her breasts after pregnancy. She wanted to be fuller but still natural in appearance. She is shown before and again, 6 weeks after bilateral partial subpectoral placement of Sientra round smooth cohesive silicone gel implants.
Discussion: She has truncal asymmetry and her right breast is positioned higher on her chest, before and after surgery. This is a “foundation” problem and is not changed with implants. She is 5’ 3 ½” and 109 pounds and selected Sientra 255 High Profile implants. This helps to fill the deflation of the upper breast but because it is not wider than the base of her existing breast it does not give an “implant” look.
Breast Reduction – Patient 228
An early ( 4 month) follow-up on a woman in her early 50’s with bilateral macromastia and axillary lipodystrophy ( fat “bulges” in the upper breast/armpit area)
She describes herself as a 40 DDD cup and had problems with shoulder pain which did not resolve with massage and physical therapy as well as grooving and irritation of her shoulders from the bra straps. She also had back pain and neck pain. She is 5 feet tall and 160 lbs and is shown before and again 4 months after bilateral breast reduction along with liposuction of the axillary lipodystrophy. She had more than 800 grams of tissue removed from each breast ( 454 grams = 1 pound). She is thrilled with her new shape and size, and all of her symptoms have resolved. Scars are typically redder and thicker for 6 weeks and then fade and improve over the next 2 years.
Breast Reduction – Patient 227
A woman in her later 50’s who describes herself as a 38 DDD and has had problems with grooving and irritation of her shoulders, back pain, shoulder pain, and a rash under the breasts.
She is 5’ 3” and 139 lbs and is shown before and again, 6 months after bilateral breast reduction with the removal of 475 grams of tissue ( 454 grams = one pound) from each breast. She is thrilled with her new shape and size and her symptoms have resolved. Scars will typically continue to fade for the next 18 months or longer.
Nipple Reduction – Patient 133
A woman in her early 30’s who is bothered by prominence of her nipples in and out of clothing. She does not have irritation. She also has some mild retraction of the nipple ducts. Her nipple papules are wide and the breast is cone shaped, making it difficult to perform a top hat flap. The top hat flap would not reduce the nipple papule diameter enough, and because the nipple is sitting on top of the cone of her breast, would not reduce the prominence enough. She elected for a nipple amputation technique and is shown 6 weeks after surgery. She is thrilled to have a correction of the prominence. The continued mild nipple retraction which is due to shortening of the nipple ducts is not bothering her at this time.
Breast Reduction – Patient 226
A mother of 2 in her late 50’s who describes herself as a 38 DDD cup bra and has had problems with grooving and irritation of her shoulders from her bra strap, back pain, shoulder pain, rash under the breasts and difficulty exercising . She is shown before and again, 6 months after breast reduction. He symptoms have resolved and she is thrilled with the new shape and size of her breasts.
Breast Reduction – Patient 225
A woman in her early 50’s who describes herself as a 36 F and has problems with chronic rashes under her breasts, neck pain, back pain, shoulder pain and difficulty exercising. She is shown before and again, nearly 6 months after bilateral breast reduction. Her symptoms have resolved and she is thrilled with her new shape and size.
Gynecomastia – Patient 164
An early ( 6 week) result for a man in his late 20’s with gynecomastia since the age of 17, most likely from weight lifting supplements. He is shown before and again, just 6 weeks after treatment with a combination of power assisted liposuction using the S.A.F.E. technique, combined with a direct excision of breast tissue through a peri-areloar incision
Scars are typically at their thickest and reddest at 6 weeks and will now soften and fade over the next 2 years. Tattoos have been blurred for his privacy
Gynecomastia – Patient 163
A man in his late 30’s with gynecomastia since puberty. He was heavier as a child and had a maximum weight of 250 lb. He took some anabolic prohormones in his early 20’s and developed some tenderness and increasing fullness of his breasts. He has reduced his weight to 190 lbs but continues to have female appearing breasts which are prominent in fitted shirts and also bother him with his shirt off. He wears extra shirts to try and camouflage the appearance.
He is shown before and again, 6 months after surgery with power assisted liposuction using the S.A.F.E. technique combined with direct excision of breast tissue through a periareolar incision.
Although he continues to have mild skin laxity from decreased skin elasticity following his weight loss, his appearance is greatly improved. The only reliable way to tighten loose skin would be to place a visible scar on his chest which would not be worth the tradeoff.