A medical student in his mid 20’s who has mild breast development on his left side in the 7th to 8th grade along with prominence of the nipple. He is mainly bothered by the prominence of the nipple in some clothing and with his shirt off. Because the breast development was mild and the issue that bothered him the most was prominence of the nipple, we decided to address this first. He is shown before and again, 6 weeks after nipple papule reduction in the office under local anesthesia. He is thrilled with his early result and is no longer bothered by the appearance of his chest with or without a shirt.
A woman in her early 20’s who wants fuller breasts but still natural in appearance. She is concerned about silent rupture and has elected for the Ideal structured saline implants.
She is petite at 5’3” and 109 lbs and wore a 32 A to B cup before surgery. She is shown before and again, 4 ½ months after bilateral partial sub-pectoral breast augmentation with the placement of the 300cc Ideal structure Saline implant filled to the 300cc total volume. The empty implant is 37 cc, and the back/inner lumen is filled to 188 cc and the front/outer lumen is filled to 75 cc to give the total volume of 300 cc.
A mother of 3 in her early 50’s who had liposuction of her breasts by another plastic surgeon 11 years before. She was a little better at first but her breasts have increased in size ane she is bothered with back and shoulder pain, a rash under the breasts in the warmer months, and difficulty exercising because of the size of her breasts. She currently wears a 36 JJ cup bra. She is 5’5” and 196 lbs and is shown before and again, 8 ½ months after a bilateral breast reduction with the removal of over 960 gms of tissue from her right breast and 690 gms of tissue from her left breast. An inferior pedicle/ Inverted T scar technique was used. Her symptoms have resolved, and she is thrilled with the new shape and size of her breasts.
Discussion: There was initially great enthusiasm about the idea of liposuction of the breasts. I have found however that there are very few patients that are a good candidate. It is difficult to predict how much of a breast is fatty tissue and can be removed with liposuction, because liposuction does not remove breast tissue. And the more youthful breasts that might benefit because they already have a better shape are denser and less fatty. The older breasts tend to be more fat but benefit from a mastopexy ( lift) at the same time to improve the shape. I actually see more discomfort and a longer recovery with liposuction of the breasts, and it is difficult to reduce someone more than a cup size or so. It is not unusual to see these patients coming back for a breast reduction, as we see here.
An RN and mother of one in her mid 30’s who described herself as a 34 DD cup and had difficulty doing jumping jacks and running and exercising even with multiple sports bras on because of the size and weight of her breasts. She had back and shoulder pain as well. Her case is made more complicated by her large areolas and only minor ptosis or drooping. We want to make her areola’s smaller and get around the outside with our breast reduction pattern and not leave excess areola behind. She is 5’ ½ “and 144 lbs and is shown before and again, 1 year after bilateral breast reduction with the removal of around 340 gms of tissue from each breast to bring her down to a C cup in size. She loves the new size of her breasts and no longer has back and shoulder pain or difficulty with exercise.
A woman in her early 60’s who wears a 40 DD bra who has lost more than 50 lbs with diet and exercise. She is bothered by irritation and grooving of her shoulders from her bra straps, difficulty exercising and rashes under the breasts in the summer months. She has skin rolls of the lateral chest ) “thorax”) and wished to have this contoured at the same time. (“lateral thoracoplasty”). She did not want to be too small after her surgery, and wanted her new breasts to be in proportion to her frame.
She is shown before and again, 4 ½ months after bilateral breast reduction with the removal of more than 600 gms of tissue from each breast. Internal autogenous suturing was done to improve the shape after her weight loss, as well as a lateral thoracoplasty. She is thrilled with her full C cup and new shape. Her pain and rashes are gone and she no longer has trouble exercising. Scars will typically continue to fade and improve over two years after surgery, but she is already thrilled with her appearance.
A woman in her early 50’s who wears a 36 DDD bra and is bothered by back pain, shoulder pain, difficulty exercising and postural problems. She is also bothered by axillary lipodystrophy- extra fat in the anterior axilla that makes it difficult for her to wear halter tops or dresses. She is 5’3” and 197 lbs and is shown before and again, just 4 months after bilateral breast reduction with the removal of more than 1300 gms of tissue from each breast as well as Power assisted liposuction of the anterior axilla using the S.A.F.E. technique. (Suction Aspiration Fat Equalization) Scars will typically continue to fade and improve for the first 2 years adfter surgery- she is already thrilled with her result and no longer has problems with back and shoulder pain or her posture. She looks forward to wearing summer dresses that show the top of her breasts and that she could never wear before.
A woman in her mid 60’s who wore a 38 GG cup bra and needed to wear a diaper beneath her breasts because of a rash. She also had grooving and irritation of her shoulders from the bra straps, as well as back pain, shoulder pain, and difficulty exercising because of the size of her breasts. Just before her surgery she was 5’3” and 171 lbs- She is shown again, 4 ½ months after the removal of more than 1000 gms of tissue from each breast and lateral thorax. The lateral chest was reduced at the same time to narrow the breasts and improve her overall shape. She has lost 6 lbs since her surgery because it is easier to exercise, and no longer has a rash, or pain in in shoulders and back.
Update: Our patient is now seen 8 months after surgery. The scars continue to fade and improve.
A woman in her early 20’s who describes herself as a 32 a-b cup and would like to be fuller but still relatively natural in appearance. She wanted the Ideal structured saline implant because she did not want to worry about silent rupture but wanted a more natural look and feel than the traditional saline implants. She is shown before and again, 3 months after bilateral partial sub=pectoral placement of the 300 cc Ideal implant filled to 300c, placed through an inframammary incision.
Discussion: She is very petite. When sized for a bra we are taught to measure around the chest just under the breast and add 3 inches- she measures 28” so a 31” bra would be her actual band size if they were made. The base width of her left breast is 11.2 cm. With the Ideal implant the edges are a little firmer and it is best to use an implant base width that is less than the actual breast base width. In a silicone gel implant it is possible to go slightly wider.
In addition, she has a mild pectus excavatum, a hollow in the sternal area that limits the medial placement of the implant. The base width of the 300cc ideal implant is 10.9, so it just fits within the base of her breast. The next larger size is 5 mm wider and would tend to stretch the breast more and appear unnatural. So, as is our usual practice, we want to use the largest implant that we can use that still looks relatively natural and won’t cause problems by overly stretching the breast.
An early ( 6 week) follow-up on a man in his early 30’s who first noted gynecomastia in his mid 20’s. He has had negative endocrinology testing and a negative testicular exam (testicular tumors can be one cause of gynecomastia). He is bothered by the appearance of his chest with his shirt off but also in fitted shirts and golf shirts. He wears extra shirts to camouflage his chest. He did take over the counter supplements for weight lifting, and that may have been the cause. He is 5’ 11” and 166 lbs and is shown just before and again, 6 weeks after Power Assisted liposuction of his chest using the S.A.F.E. technique ( S uction A spiration F at E qualization). After liposuction fluid is placed in the chest, then external ultrasound is applied to soften the fat. Then a cannula with fins is used first without suction to mechanically disrupt the fat. Then liposuction with a normal liposuction cannula is used. Any residual breast tissue that remains is excised through an incision around the areola- in his case about ½ ounce of tissue was excised from each side. Then the finned cannula is used again to smooth and equalize the remaining fat. Scars are at their thickest and reddest at the 6-week mark and he has been wearing paper tape to protect his incisions. We can see a little redness of the skin from the tape and from the scars, which will now fade over the next 6-12 months. The hands on head view shows the excellent contour that has been obtained and brings the gynecomastia into view before and shows the complete resolution after his surgery. He told me that he is so happy and relieved to have a normal appearing chest again. A tattoo on his arm has been blurred for his privacy. The photos are otherwise not retouched.
Update: Our patient is now seen 8 months after surgery. His contour remains excellent and his scars have continued to fade. He tells me that his only wish is that he had done this sooner. He is thrilled to be able to take his shirt off at the beach and look normal. And he is no longer bothered by the appearance of his chest in fitted shirts.
A man in his late 50’s who is bothered by enlargement of his nipples. He had nipple piercings when he was younger and the nipple papules grew. He had had the piercings out for years but was embarrassed by the prominence of his nipple papules in clothing, especially fitted shirts. He was also bothered by their appearance with his shirt off. He described his nipple papules as looking like “gumdrops”.
He wished to have a normal appearing nipple papule but not overly reduced either. His nipple is prominent in width and in height, and needs to be reduced in both dimensions. A nipple amputation technique, which removes the top of the nipple, would only reduce the height.
He is shown before and again, 6 weeks after bilateral nipple papule reduction using the Top Hat Flap technique under local anesthesia in the office. He is thrilled with his result and being able to wear fitted shirts again.