Breast Gallery

A woman in her early 50’s who is a 38 DD cup and has problems with back pain, shoulder pain, grooving and irritation of her shoulders from the bra straps as well as difficulty exercising. She does not like the droopy appearance of her breasts. She is 5’3” and 153 lbs and is shown before and again, 6 months after bilateral breast reduction with the removal of more than 350 gms of tissue from each breast. An inferior pedicle/ short inverted T scar procedure was used. She is thrilled with her new shape and size, and her symptoms have disappeared. We have had her using topical silicone for her scars, which will typically continue to fade and improve for another 18 months.

A man in his early 30’s who had gynecomastia surgery 10 years somewhere else before but is still bothered by prominence of his nipple papules in clothing. He works in the travel industry and is lucky to be able to spend a lot of time at the beach and in summer clothes. His left nipple bothers him more than the right nipple. The left nipple papule is 6 mm in diameter and 7 mm high. His right nipple papule is 5 mm in diameter and 5 mm high. After discussions we decided to proceed with bilateral nipple papule reduction utilizing the nipple amputation technique under local anesthesia in the office. He is shown before and again, 6 weeks after correction.

Discussion: He appears that he may still have mild gynecomastia but this is not present with the “hands on the head” view and may be due to mild skin laxity but not additional tissue thickness which means that further surgery of the chest would not be helpful. His nipples do appear prominent. “Normal” measurements for the nipple papule have not been reported but in a female are generally considered to be 8 by 8 mm. My experience in males is that they prefer a flatter nipple to prevent prominence in clothing. Our patient is thrilled with the normal appearance of his nipples and no longer has prominence of the nipples visible in a thin shirt.

A man in his early 30’s who had gynecomastia surgery 10 years somewhere else before but is still bothered by prominence of his nipple papules in clothing. He works in the travel industry and is lucky to be able to spend a lot of time at the beach and in summer clothes. His left nipple bothers him more than the right nipple. The left nipple papule is 6 mm in diameter and 7 mm high. His right nipple papule is 5 mm in diameter and 5 mm high. After discussions we decided to proceed with bilateral nipple papule reduction utilizing the nipple amputation technique under local anesthesia in the office. He is shown before and again, 6 weeks after correction.

Discussion: He appears that he may still have mild gynecomastia but this is not present with the “hands on the head” view and may be due to mild skin laxity but not additional tissue thickness which means that further surgery of the chest would not be helpful. His nipples do appear prominent. “Normal” measurements for the nipple papule have not been reported but in a female are generally considered to be 8 by 8 mm. My experience in males is that they prefer a flatter nipple to prevent prominence in clothing. Our patient is thrilled with the normal appearance of his nipples and no longer has prominence of the nipples visible in a thin shirt.

A woman who had a silent rupture of her right breast silicone implant 9 years after her original surgery. She originally had Allergan Natrelle style 15 smooth round 397 cc implants placed in a subpectoral position through an infra mammary incision. She has some mild ptosis of her left breast but not enough to warrant the scars of a mastopexy. She did well until 9 years later when she noticed a change in the feel of her right breast with more folds notices on the side. An MRI was ordered and showed a rupture of the implant.
She has elected to increase slightly in size and was changed to an Allergan 450 cc Inspira Soft Touch smooth round high profile implant on each side.
She is shown before her first surgery in her early 40’s 9 years ago and 6 months after, and then 9 years after surgery and again 4 months after replacing the implants on each side, now in her early 50’s. The higher profile has given her back a little more upper pole fullness.

A woman in her early 20’s who is a 32A cup and wished to be a full b or small c if possible. She is very thin at 5’7” and 101 lbs and a BMI of 16.06. Her case is also complicated by a pectus excavatum, which is a depressed hollow of the sternal area. In very thin patients I like to have them supplement their nutrition with an additional 80 gms of protein a day for a months before and after surgery. She had a nipple piercing when she first came in and I have recommended that she not replace this after surgery to decrease the risk of capsular contracture. There is bacteria in the nipple ducts, and any trauma can allow this bacteria to get into the blood stream and potentially travel to the implant, with the resultant biofilm potentially leading to a capsular contracture. The base width of her breast is 9.8 cm. The nipple to fold is 5 cm and increases on stretch to 6.5 cm. She is shown before and again, 4 months after bilateral subpectoral placement of Ideal Structured saline implants 210-235 cc filled to 235 cc. The empty implant volume is 30 cc. The back/inner lumen is filled to 120 cc and the front/outer lumen is filled to 85 cc to give the total of 235 cc. The breast fold was reinforced by anchoring it temporarily to the rib periosteum with long lasting but dissolving sutures to prevent “bottoming out” of the breast.
The dimensions of this implant are 9.7 cm but we add 0.3 cm because it is measured on a curved surface to give a base equivalent of 10 cm. The projection is 4.4 cm. The equivalent diameter is 0.2 cm larger than her native breast and can therefore give a slight implant look which she was ok with. She wanted the Ideal implant which is filled with saline and this is the smallest size that the company makes, but just fit. If she had wanted to be any fuller I would have recommended that she switch instead to a silicone gel implant which can allow a slightly fuller implant to be used.

She is thrilled with her fuller, but still natural appearance. Tattoos have been blurred for her privacy.

Update: She is now seen 9 months after surgery. The breasts have settled in appearance and appear even more natural.

A mother of 3 in her late 40’s who would like to have fuller breasts. She describes herself as a 34 B cup. She is 5’ 7” and 132 lbs. She was carefully sized in the office with her breast dimensions and wished the largest implant that would still appear natural. She is shown before and again, 3 months after bilateral partial subpectoral breast augmentation with a 5th generation cohesive silicone gel round high profile Sientra Opus implant placed through an inframammary incision.

An Asian woman in her early 20’s who wished to have fuller breasts. She described herself as a 32-34 A cup and wanted to be a C cup is possible but still natural in appearance.
She is shown before and again 1 year after breast augmentation with 5 th generation smooth round cohesive silicone gel implants placed below the pectoralis muscle through an infra mammary ( at the breast fold) incision. Implants used were Sientra Opus 255 ml moderate profile cohesive silicone gel implants. She is petite at 5’3” and 116 lbs. This was the largest implant that would fit the dimensions of her breast and still maintain a natural appearance, without an overly round “implant” look. Her inframammary fold was reinforced at the time of her surgery by anchoring it to the rib periosteum with long lasting but dissolving sutures to prevent “bottoming out” and dropping of the breast fold.

A woman in her early 40’s who is a 32 E cup bra and has problems with back pain, shoulder pain and difficulty exercising due to the size and weight of her breasts. She is shown before and again, 8 months after bilateral breast reduction with the removal of 200 gm from her left breast and 175 gms from her right breast. She is petite at 5’1” and this reduced her to a C cup. She is thrilled to be able to fit in her clothes and bathing suit now, and her symptoms have resolved.
Scars typically fade and improve for 2 years.

A college student in his early 20’s who first noticed female breast development at the age of 18. He was heavier, and reduced his weight by 50 lbs by stopping drinking soda, but the gynecomastia did not resolve. He wears compression shirts to hide the appearance of his chest in clothing and is uncomfortable with his shirt off. He is shown before and again, 4 ½ months after gynecomastia correction with power assisted/external ultrasound assisted liposuction using the S.A.F.E. technique ( Suction Aspiration Fat Equalization) combined with a direct excision of breast tissue from an incision around the lower border of his areola. He is thrilled to have a normal appearance.

An early ( 6 week) follow-up of a nurse and woman of color in her early 60’s. She described herself before surgery as wearing a 38 DD bra and had problems with upper back and shoulder pain, as well as grooving and irritation of her shoulders from her bra strap. She has required epidural injections by the pain clinic on multiple occasions but continues to have symptoms. She is 5’ 5” and 159 lbs, and did not want to be too small after her surgery. She is shown before and again, just 6 weeks after a bilateral breast reduction with a short T scar technique and the removal of 424 gms from her left breast and 397 gms from her right breast to reduce her to a full C cup. ( 454 gms in a pound) . Her back and shoulder pain is gone now and she is thrilled with her new shape and size. Scars are typically at their worst at 6 weeks and then will continue to fade and diminish over the next 2 years. She has just removed the Micropore tapes that we have her use for the first 6 weeks and we are having her start topical silicone which has been proven to help with scar maturation.

Update: Our patient is now seen 7 months after surgery. Her scars have faded nicely and she is thrilled with her new shape and size.