A very early followup in a college student with unilateral (one sided) gynecomastia. He is shown before and again, 5 1/2 weeks after a combination of external assisted, power assisted liposuction of the right chest/breast combined with direct excision. Scars typically thicken for 6 weeks and then start to soften and lighten over the next two years. He already has an excellent contour and correction, no longer having a “feminine” appearing breast. No skin excision was necessary.
An 18 yo college student with idiopathic gynecomastia (idiopathic means that the cause is unknown). He is shown 5 weeks after a combination of direct excision and mechanically assisted/ external ultrasound assisted liposuction. The imprint from the silicone pads that we have recommended that he wear to help with scarring is seen in the after photos. He already has an excellent contour, and the scars should continue to fade over the next 6 months.
A man in his late 20’s is troubled by prominent breasts (gynecomastia) as well as prominent nipple papules. This really bothered him at the beach, and also when wearing shirts. As in many of my cases here in Boston, he has had this since puberty. He denies significant marijuana use or anabolic steroids, which have both been known to cause gynecomastia (male breast development). In his case we would list the cause as “idiopathic”, which is a fancy word for “the cause is not known”. As much as 30% of young males can have some breast development at the time of puberty, but in the majority of these men, it resolves spontaneously. If it has not gone away by 18 months, however, it is probably not going to go away without surgery. At first glance, his gynecomastia and nipple prominence may not seem too noticeable, but an oblique (3/4) view and side view tell the story. He is shown before, and again, 6 weeks after a combination of a nipple papule reduction with a “top hat flap”, combined with external ultrasound assisted liposuction of his chest and a direct excision of a small button of breast tissue through an incision around his areola. The keloids in the middle of his chest are preexisting from acne scars, and were treated at the time of his surgery with the injection of Kenalog, a type of steroid that can soften and flatten scars. His tattoos are blurred for his privacy, the photos are otherwise unretouched.
A 27 yo man with gynecomastia (male breast development) secondary to marijuana use is shown before and again 6 months after bilateral gynecomastia correction with a combination of liposuction and direct excision. He is pleased with the correction of his gynecomastia, giving him back a normal male chest after his surgery. He now feels comfortable in a golf shirt or at the beach. His tattoos are blurred for his privacy, the photos are otherwise unretouched.
A 14 boy with gynecomastia (feminine breast development) of idiopathic (unknown) cause is shown before and 4 months after surgery with a combination of liposuction and direct excision. The small scars in the upper chest and at the lower edge of the areola are barely visible at 4 months, but will continue to diminish over the next 18 months. He already feels comfortable going without his shirt in gym class.
A mother of 3 in her mid 40’w who was 21 years after saline breast augmentation when she developed a sudden deflation of her right breast implant. She did not have her records,so we had to make an educated guess and have a range of implants available in the operating room. Her left implant was weighed upon removal and was determined to be filled to 392cc. She did not have a history of capsular contracture (firmness of the breast due to tightening of the scar tissue around the implant, often felt to be from “biofilm”) so I felt comfortable with immediately replacing her implants. She elected for silicone gel implants, and was replaced with 375 cc cohesive round silicone gel high profile implants, which are similar in dimensions to her current implants. She is shown before and again, 8 months after surgery. She is especially pleased with the more natural feel of the implants, compared to her prior saline implants. I was able to use her original infra mammary incision. She had an abdominoplasty at the same time. Of course the breasts are “sisters and not twins” with her right nipple being higher than her left before and after surgery.
An Asian professional in her early 40’s. Mother of one. Now shown 14 months after bilateral partial sub pectoral breast augmentation with 375 cc round smooth silicone gel moderate profile plus implants placed through an inframammary (breast fold) incision in a partial sub pectoral (below the muscle) location. She is 5’4″ and 118 lbs.
An Asian professional in her early 40’s. Mother of one. Initially shown 14 months after bilateral partial sub pectoral breast augmentation with 375 cc round smooth silicone gel moderate profile plus implants placed through an inframammary (breast fold) incision in a partial sub pectoral (below the muscle) location. She is 5’4″ and 118 lbs. It is said that 90+% of women after breast augmentation wish that they had “gone larger” but that is not always the case. Some women wish to downsize. This woman initially selected the 375 cc implant after discussions and sizing in the office. She was ok with the look in clothing, but always felt a little self-concious in a bathing suit. Then her liftestyle changed and she began to spend more time at the gym. The tight gym clothes accentuated her breasts to the point that she felt that they were too full. She decided after 2 1/2 years to return to the operating room and down-size to a 275 cc moderate profile plus round smooth silicone gel implant. Her original incision at the breast fold was used, and I tightened her lower pocket by performing an excision of the breast capsule in the lower portion and anchoring it to the periosteum (covering) of her rib (this is called a capsulorrhaphy). The “pocket” that the implant was in would be too large for the new implant otherwise. She is now seen 7 1/2 months since this second procedure. Her breasts are fuller than before her initial surgery but now seem absolutely natural to her in her workout clothes and in a bathing suit. It is a cautionary tale, that even with careful discussion of the tradeoffs and sizing in the office, not everyone “wishes that they had gone larger”
A woman in her mid 30’s who describes herself as a 32 DDD. She had breast implants and a breast lift in Texas in 2011 with 375 cc silicone implants. She feels that she is too large, and does not like the superior fullness in her upper breasts from the implants. Her nipples are properly positioned at 21 1/2 cm from the sternal notch, but she has an increased distance from the nipple to the breast fold. There is always a worry about the blood supply to the nipple when a patient has had previous surgery in this area, so not having to move the nipples is a relief. She had an inverted T mastopexy using her previous scars,, along with removal of her implants. She is shown again, 2 months after surgery. She had enough breast volume remaining to be pleased with her “C”cup breast after surgery. Her scars have also been improved slightly, and will continue to fade over the next 2 years. The imprints on her skin are from the silicone pads that we are having her wear after the surgery to improve her scars.
Our patient is seen again, now 5 months after surgery. Her scars continue to fade with the silicone pads, and the breasts are “settling in” to their new shape.
A mother of 3 in her mid 40’s who developed a sudden implant deflation on her right side, 21 years after having saline implants. She did not have her original records. Her left intact implant was weighed at the time of removal, 392 gms. They were both replaced with 375 cc smooth round high profile cohesive silicone gel implants. She had an extended abdominoplasty along with repair of an umbilical hernia. Seri Surgical scaffold was used to reinforce the umbilical hernia repair at the time of surgery. EXPAREL was used at the end of surgery to decrease postoperative pain. She is shown before and again, 4 months after surgery. There is typically still some swelling in the lower abdomen for the first 6 months, so she may decrease a little more in the lower abdomen. She reports that she is down from a 10 to a 6 dress size. The oblique view demonstrates the periumibilical hollow and champagne groove sculpted in the fat at the time of surgery.