Breast Gallery

A woman in her late 40’s with macromastia. She was a 46 E cup and had problems with back pain, neck pain, shoulder pain, and difficulty exercising. Her case is complicated by being a current smoker and having been a smoker since the age of 18. Smoking interferes with healing because it has damaged the microcirculation and blood supply to the skin. She would be more at risk for necrosis of the nipple with a traditional technique. In her case I chose a free nipple graft technique- the nipple is completely removed and replaced like a skin graft. It will be “scabby” for 6 weeks but then heals and gives a good result. She is shown before and again, 17 months after her surgery. 5 lbs of breast tissue were removed at the time of her surgery. She is thrilled that her symptoms have gone away, and also pleased by her new shape and size.

A woman in her late 30’s who is bothered by an embarrassing prominence of her nipples in clothing. She is shown before and again, 7 weeks after bilateral nipple papule reduction in the office under local anesthesia using a modified, Top Hat Flap method. This allows the reduction of both the nipple height and width, while preserving the core of the nipple and nipple sensation.

A mother of one in her late 40’s who is bothered by a drooping appearance of her breasts as well as the size. She describes herself as a D cup and wished to be a C. She is shown before and again, 14 months after a mastopexy with the removal of around 200 gms of tissue from each breast to bring her down to a C cup, using a superior/medial pedicle and an short T scar technique.

A 33 yo engineer who is bothered by a female appearing chest since his 20’s. Despite some recent weight loss, he is still bothered by the appearance of his chest in fitted shirts and with his shirt off. He wears extra shirts to camouflage the appearance, He is shown just before and again, 4 months after External ultrasound assisted, Power assisted liposuction using the S.A.F.E. technique (Suction Aspiration and Fat equalization) combined with a direct excision of breast tissue through a peri-areolar incision. He is thrilled with his early result, and is no longer bothered by the appearance of his chest with his shirts on or off.

A woman in her mid 40’s who had saline breast implants at the age of 28 to increase the size of her breasts and help to correct some asymmetry. Since her surgery she has had 2 children and her body has changed. She notes that both breasts are larger and more asymmetric as her left breast has increased proportionally more in size. She wished to be smaller in size. She was not sure if she wanted to have a breast lift at the same time as removal of her breast implants. This is a question that comes up and there is a novel solution for patients with saline implants-they can be drained in the office under local anesthesia a month or more before surgery. This allows the breasts to recover and gives the patient a better idea as to whether she wants to proceed with a breast lift, or simply remove the deflated shell of the implants later in the operating room. In her case, she was satisfied with the appearance of her breasts after they had recovered from the deflation and decided to proceed with implant removal only. She can always return later for a mastopexy (breast lift) if she changes her mind.

An medical professional and mother of 1 who describes herself a s a 32 A cub. She was a C cup with her pregnancy and wanted to be a C cup again if possible. She did mind a slight implant look if needed to achieve her goals as long as she did not look overly unnatural. She has a mild pectus excavatum ( a depression of the sternum) She is shown before and again, 6 weeks after bilateral partial subpectoral breast augmentation with the placement of 350 cc high profile textured silicone gel implants using the milder texture.

Surgical planning: The width of her breast were 12.1cm on the right and 12.6 cm on her left. The nipple to inframammary fold distance on stretch is 8cm on her right and 7cm on her left. There is a mild laxity of her tissues from her previous pregnancy. The 350 cc high profile implant has a base width of 11.7 cm and this was the largest implant that would “fit” without requiring us to lower her inframammary fold and risk a double bubble or collapse of the fold and bottoming out. Texture was chosen to prevent medial migration of her implants over time into her pectus excavatum. Texture can be controversial because of it’s association with the rare condition of BIA-ALCL but seems to be less of a problem with the milder textures. It also is felt to be related to biofilm formation and we used the typical measures during surgery to avoid this: nipple shields/insertion sleeves ( “Keller funnel” ) as well as antibiotic irrigation. I also recommend that my breast implant patients take oral antibiotics just before dental cleaning or procedures to decrease the risk of bacteria from the mouth going through the blood stream and settling on the implant after surgery. In her case, after discussion she felt that the possible tradeoffs of texture were worth the benefits of better stability of the implants over time.

A mother of 4 who is bothered by a deflated appearance of her breasts after pregnancy and wants a full but still natural look. She describes herself as a 36B and would like to be a full C cup. Her right nipple is 0.5 cm below her breast fold and her left nipple is 1.5 cm below her breast fold. “second degree ptosis” or drooping. She would not be able to be treated well with breast implants alone, and chose a breast lift with implants. She wished to try and maintain some fullness of her upper breasts. After reviewing the options and careful sizing in the office based on her measurements, she elected for a 450 cc high profile round textured surface implant, placed in a dual plane position. The high profile implant helps to fill her upper breast- it may not be an appropriate choice for a woman who has never had children because it might stretch a tight breast too much- in her case her breast is “loose” after children. We would like to fill but not overly stretch the breast. The high profile is a good fit here.
The use of texture is a more complicated decision. Smooth implants tend to shift to the sides and bottom out more with time. This is especially a problem when we are performing a breast lift with implants, because the breasts have already shown us that they are not as elastic. I tell my patients that its not just the tailor, but the fabric that impacts the result. Texture may help to decrease this tendency to shift. Texture has been associated with the rare condition of BIA-ALCL, at type of lymphoma that is found only around textured implants and is associated with biofilm, a kind of bacterial contamination. BIA-ALCL is possible but extremely rare, and very treatable when properly diagnosed. It may be more of a risk with the more aggressively textured implants, so when we choose texture I prefer the less aggressively textured surface. In her case balancing the tradeoffs she has chosen to use texture. She is now shown nearly 1 ½ years after her surgery. The mastopexy scars continue to fade for up to two years. Her implants have been stable. A ”dual plane” position allows the edge of the pectoralis muscle to rise up to the lower edge of the areola after it is released, so that the implant is below the muscle in the upper breast , and below the breast in the lower breast. IF an implant is entirely below the muscle the implant stays in position and the breast can drop off- a “waterfall” effect. When the implant is above the muscle it will drop with the breast, but there is a higher risk of a capsular contracture, it is a little more difficult to perform a mammogram, and the breasts may stretch more and not age as well. So the dual plane is a blend of the two. She is thrilled with her fuller but still natural appearance. And we have been fortunate that despite decreased elasticity her breast surgery result has stayed fairly stable with time.

A mother of 4 in her late 50’s who wears a 36D bra and is bothered by back and shoulder pain as well as feeling that her breasts are two big for her frame. She also has some fat deposition in her anterior axillary area. She is shown before and again, 4 ½ months after a superior medial pedicle breast reduction along with S.A.F.E. ( Suction Aspiration and fat equalization) liposuction of the axillary fat deposits (“axillary lipodystrophy”). We can expect her scars to continue to fade and improve for the next 20 months, but she is already thrilled with her new shape and size.

A woman in her early 70’s who describes herself as a 36 DD cup and has been having increasing problems with neck, back and shoulder pain. She is shown before and again, 9 months after a bilateral breast reduction with an inferior pedicle/ Wise Pattern Inverted T scar) technique. Internal plication sutures were used to give better shape to the breasts. She is thrilled with her new shape and size, and her symptoms have resolved.