A 17 yo high school student who was 16 at the time of her surgery. She had consults with and interviewed multiple plastic surgeons before deciding who she wanted to perform her breast reduction. I am, of course, delighted that she chose our office. She was a 30 G cup and had problems with back pain, shoulder pain, irritation of her shoulders from her bra as well as difficulty exercising. She was active in gymnastics until she had her breast development at the age of 13, but was not able to do gymnastics since because of the size of her breasts. As an aside, 30 is a difficult band size to find and she was able to obtain these at Lula Bell in Hanover, Massachusetts. She wished to be a full C after her reduction. She is petite at 5’2” and 127 lbs and is shown just before her surgery at the age of 16 and again, now 10 months after her surgery. She had a short T scar, superior pedicle breast reduction with the removal of 596 gms of tissue from each breast. (454 gms make a pound). She is thrilled with her new shape and size. Her symptoms are gone. She was proud to show me the difference between her size 6 prom dress, which she called a “granny dress” before her surgery, and this year’s prom dress which is a size 2, and looks like it she belongs on the red carpet in a Hollywood premiere.
A 17 yo woman with 36DD-DDD breasts that have large since she was 13. She has not had any further breast development since she was 15. She has back pain, and also feels that her breasts are out of proportion to her body and draw undue attention. In addition she does not like the drooping appearance of her breasts. She is petite at 5’2” and 136 lbs .
She is shown before and again, 8 months after a superior pedicle breast reduction with a short T scar pattern and the removal of 250 gms of tissue from each side. Scars continue to fade and improve for 2 years or longer. She was meticulous in wearing a postoperative support bra and using the topical silicone that we recommended, as well as “resting her breasts” as instructed for 6 weeks after surgery. She loves her new shape and size, but is even happier to no longer have back pain. And the exciting news is that recent studies confirm that breast reduction via the inferior, medial or superior pedicle does not decrease the ability to breast feed later. And her clothes fit better now. She happily reports that she was able to go from a size 8 dress before her surgery to a size 4 for the most recent school dance! She is thrilled to be able to start her college without back pain or drooping breasts.
A 22 yo woman with breast asymmetry and macromastia who wears a 34 DDD cup bra and has problems with back pain, neck pain, grooving and irritation of the shoulders from her bra strap, difficulty with her posture especially in her job as hair stylist and also difficulty exercising due to the size of her breasts. She needs to wear extra sports bras to exercise. She is petite at 5 ‘ 3 ½ and 125 lbs. She is shown before and again, just 4 months after an inferior pedicle short T scar breast reduction with internal plication sutures to support her breast. 477 gms of tissue were removed form her right and 289 gms from her left ( 454 gms = 1 pound) to bring her down to a C cup. Although scars will continue to fade and improve over the next 2 years, she is already thrilled with her new shape and size. Her symptoms are gone, and she loves being able to exercise without extra bras.
A breast reduction in a mother of 2 in her early 40’s who describes herself as a 36 G cup and has problems with back and shoulder pain. At 5’2” and 170 lbs she is over her ideal body weight and does not want her breast to be too small after surgery. In addition, her nipples are pointing to the outside of her breasts and need to be brought back to the midline. She is shown before and again, 1 ½ years after removing more than 2 lbs of breast tissue from each breast to reduce her to a full C cup. Her scars are fading nicely and her symptoms have resolved. She is thrilled to have normal sized breasts.
A woman in her mid 30’s who is bothered by prominence of her nipples. She wanted them to be smaller and less prominent in clothing but still natural in appearance. There is no standard measurement for a hypertrophic nipple but a “normal” nipple is sometimes suggested to be 1 cm wide by 1 cm in projection and in a women I typically aim for a correction to reduce the nipple to 8 mm wide by 8 mm high, as we have done here. Our patient is shown before and again, 6 weeks after a “top hat flap” nipple papule reduction performed under local anesthesia in the office. Her nipple sensation remains intact and she is thrilled with the correction.
A long term follow-up on a woman now in her later 30’s. This helps answer the question of “what will happen to my breast if I get pregnant after breast augmentation” She was initially seen in her late 20’s and described herself as a 32 AA cup and wanted to be a B or C cup if possible, but still natural in appearance. She is petite at 5 feet tall and 101 lbs. She elected for a smooth round silicone gel implant placed in a partial subpectoral position through an inframammary incision. A 250 cc high profile implant was used. This was the largest implant that I felt would still fit her tissues without looking overly round. She is shown just before and again, 10 months after surgery She has since had a child, and is shown again, 7 1/2 years after surgery. Although the breast typically gets larger with pregnancy and then smaller after, she has not developed significant drooping or stretching of her tissues and has maintained an excellent result. This is partly because she does not have as much native breast tissue to change with pregnancy, and partly because she did not have an implant that was too large for her tissues and could therefore lead to more problems with stretch.
A man in his early 30’s who developed gynecomastia at puberty. He does not have a history of significant marijuana use or anabolic steroid use, both of which can cause gynecomastia. Studies report that as many as 30% of young boys will develop some growth of the breasts at puberty. In most cases this goes away on its own by 18 months. If it has not resolved by that time it typically is not going to go away on its own.
He is bothered by the appearance of his chest in fitted shirts and with his shirt off.
He is shown before and again, 6 weeks after Power-Assisted liposuction using a modified S.A.F.E. technique combined with direct excision of breast tissue though an incision around the lower part of the areola. In the S.A.F.E. technique ( the letters stand for S uction A spiration and F at E qualization) the procedure is typically performed under general anesthesia. Wetting solution, sometimes called “tumescent” solution is injected under the skin. This is a dilute solution containing some local anesthetic and epinephrine. Then I perform external ultrasound to soften the fat. Then a cannula with fins called a “Becker” cannula is used without suction to mechanically disrupt the fat. I prefer the Microaire power system that vibrates this cannula rapidly back and forth. This loosens up the fat cells that remain viable however. Then the “aspiration” or liposuction is performed using an incision under the arm as well as the incision around the areola. After excising any remaining breast tissue under the areola, the fat is “equalized” or smoothed by using the finned cannula again to smooth the remaining fat layer around. In this manner the most aggressive liposuction can be performed without as much of a risk of leaving dimples or irregularities. A compression vest is worn for 6 weeks.
Scars are at the pinkest and reddest at 6 weeks and then begin to fade and improve over the next 2 years. The peri-areolar scars are nearly imperceptible even at this time. The lateral access scars are typically the most visible early on, and I try and place these behind the border of the pectoralis muscle so they are not as noticeable. He will now wear topical silicone on the small access scars for the next 3-6 months. He is ready to go to the beach now at 6 weeks. Sunblock is recommended for the first 12 months because any scar that is exposed to the sun while it is still pink can turn brown. He is thrilled to finally have a normal chest.
An athletic man in his early 70’s who had been troubled for years by prominent nipples that showed through his shirts. He did not want an extremely flat nipple papule as is the request of some men, but wanted to have normal prominence of the nipple papule with his shirt off, but correction of the excessive prominence. He is shown before and again, 3 months after nipple papule reduction in the office.
A mother of 2 in her early 40’s who is a 38 G cup and is bothered by back pain, shoulder pain, grooving and irritation of her shoulders from the bra straps, chronic rash under the breasts which has been treated by the dermatologist without success. She is 5’* and 194 lbs and is shown before and again, 10 months after bilateral breast reduction with the removal of 855 gms from her right breast / 889 gms from her left breast to take her down to a C cup. ( There are 454 gms in a pound) Her symptoms have resolved and she is thrilled with her new shape and size.