Breast Gallery

A man in his early 30’s who was bothered by a feminine appearance of his breasts in fitted shirts and with his shirt off. His breast development started after he graduated from college. He does not have a history of anabolic steroid or marijuana use. Because of the unusual presentation ( most cases of idiopathic gynecomastia present at puberty) he had a full workup and testicular exam by an endocrinologist which was negative.
He is show before and again, 7 weeks after bilateral chest liposuction using power assisted liposuction combined with external ultrasound assist and direct excision of breast tissue through a peri-areolar incision. Fluid is first placed under the skin, then ultrasound is applied externally to soften the tissues. Fat is then broken up mechanically with a finned liposuction cannula, and then liposuction is performed. The firm breast tissue is exised through a “half moon” incision at the lower border of the areola and then the fat is equalized and smoothed with the finned cannula again.
He is left handed, and his left pectoralis chest muscles are larger. But he has an excellent early contour after his surgery. Swelling typically will continue to diminish for 6 months and scars continue to improve for up to 2 years. The small lateral incisions that are used for cross tunneling are placed behind the lateral border of the pectoralis muscle to camouflage them better. His areola diameter has decreased after removal of the breast tissue.

A woman in her late 30’s who is bothered by back pain, shoulder pain, and a rash under her breasts in the summer months. She is a 38 DDD cup. She is slightly over her ideal body weight at 5’8 ¼” and 200 lbs but was unable to lose further weight because of difficulty exercising due to the size of her breasts. She is shown before and again, 1 year after bilateral reduction-mastopexy with the removal of more than 450 gms from her left breast and 580 grams from her right breast to bring her down to a C cup.
She no longer has back and should pain or rashes under her breast and is thrilled with her new shape and size.

An 18 yo college student whose breasts never developed. She chose to have breast augmentation after high school graduation and before going off to college. After reviewing the pros and cons of silicone gel vs saline implants, she elected for the off label use of silicone gel implants. She is shown before and again, 2 years after bilateral partial subpectoral placement of smooth round moderate profile plus silicone gel implants placed through an inframammary incision. She is 5’6” and 152 lbs, and is thrilled to have a natural and proportional appearance.

A petite 24 yo who describes herself as a 34 A cup and wanted to be fuller but still natural in appearance. She is 5 ‘ ¼ “ and 112 lbs. Based on careful measurements, including the width of her breast and the nipple to breast fold distance on gentle stretch the largest implant that could be used is a 250 CC implant without giving her an overly unnatural look. She is shown before and again, 10 weeks after a bilateral partial subpectoral placement of smooth round silicone gel 250 cc moderate profile plus implants through an inframammary ( at the breast fold) incision. The breasts will continue to soften in appearance over the next few months as the breast tissues gently stretch to accommodate her implants and will appear even more natural with time.

A petite mother of 2 in her mid 40’s who describes herself as a 32-34 A. She would like to be able to fill our her clothes and bathing suits without padding, but wishes to have a natural look.

She is shown before and again, 4 months after partial subpectoral placement of 250 cc round smooth moderate profile plus silicone gel implants, placed through an infra mammary ( at the breast fold) incision. She is 5’3” and 106 lbs. Based on her measurements, this is the largest implant that can be used without an implant “look” which we would see if the implant is significantly wider than the width of her breast. Her nipple to fold distance on stretch is 7 cm on the right and 7.5 cm on the left. Formulas suggest that an implant base of 11 cm would be perfect on her right and she could go as wide as 11.5 cm base width on her left, without getting significant and unnatural appearing fullness in the upper breast. Her chosen implant has a base width of 11.3 cm. So using her measurements and wishes, we are able to arrive at just the right implant size for her tissues and her wishes. For more information on breast implant sizing, please see our video (link here)

A mother of 2 in her late 30’s who had a breast reduction/lift in her early 20’s, reducing her to a C cup. She subsequently got married, had 2 children, and her breasts have “deflated”. Her breasts decreased to a 34 A cup, and she was bothered by looseness of the skins on the side of the breast as well. She is shown before and again 1 year after bilateral breast augmentation.. She is 5’6” and 129 lbs and had 350 cc high profile round silicone gel (mentor) textured implant placed in a dual plane position, utilizing a portion of her original breast reduction scar for access. Texture was chosen to decrease risk of lateral shift and dropping of the implants which would be more common given her decreased skin elasticity.

A 19 yo student who is shown before and again 18 months after a breast reduction using the short periareolar inferior pedicle reduction (SPAIR) technique. Her case is challenging because her areola is large and the typical “Wise” or anchor pattern would not allow us to get around the outside of her areolar without removing too much skin. The SPAIR technique I a perfect choice for her case, with the benefit of a shorter scar as well. This technique works best for smaller reductions in patients with excellent skin elasticity, because there is some “gathering” of the skin that has too be able to have enough elasticity to smooth out with time. She had 350 gm of tissue removed from her right and 200 from her left to correct her asymmetry.

A mother of 3 in her mid 30’s who is bothered by a deflated appearance of her breasts. Her nipples are each located 1 cm below her breast fold, which is the definition of ptosis or drooping of the breasts. When the nipple is below the breast fold it is generally best to add a mastopexy (breast lift). She is shown before and again, 11 months after augmentatioin mastopexy. 350 cc High profile round textured implants were placed in a “dual plane” location. An inverted T mastopexy was performed.
Explanation of choices made: I prefer round implants for breast augmentation-a recent study showed that trained plastic surgeons cannot tell the difference in photographs between properly sized round and shaped implants. And shaped implants can flip or turn. So round is our choice. When breasts are “loose” there is a tendency for the implants to drop more or slide to the side (lateral shift) with time. Texture may help to stabilize the result. So Texture was chosen. There can be problems with late seroma formation and pseudocapsule formation with more aggressive textures, so I prefer the less aggressive textures for my breast augmentation patients. It is important to “fill “ the breast but not overly stretch the breast. In a tight breast I prefer a moderate profile implant, but breasts that are looser after children (or weight loss) may need more volume to fill the upper breast. So a high profile implant was chosen here.
Implants can go above or below the muscle- below the muscle has the benefits of less capsular contracture, easier to do a mammogram, the breasts “age” better. But in a loose breast the breast can drop off the mound (“waterfall effect” and look unnatural. Implants can go above the muscle, so that they will drop with the breast. But they tend to stretch the breast more, make it more difficult to do a mammogram, have a higher risk of capsular contracture and less “padding” over the cleavage portion of the implant. A dual plane allows the edge of the pectoralis muscle to come up, so that the implant sits below the muscle in the upper breast , and sits below the breast in the lower breast- so that was chosen here.
Mastopexy skin patterns achieve different results. Because the nipple to breast fold distance on stretch was 10 cm in her case, a vertical mastopexy would not work as well and a horizontal component of skin is excised at the breast fold to shorten the distance- this gives an inverted T scar, sometimes called a “WISE” pattern after a physician who described it. Scars will typically continue to fade for another year, but she is already thrilled with her result.

Update: Our patient is now seen 4 ½ years after her surgery. Her scars have faded nicely. Her implants are still soft and have not shifted down or to the sides as we may have expected to see with smooth implants. A good demonstration of how the thoughtful use of a micro-textured breast implant still makes sense in patients who are more at risk of implant shifting in patients who understand the pros and cons of micro-texture.