Breast Gallery

A man in his mid 20’s who is bothered by the prominence of his nipples in fitted shirts.  He has mild gynecomastia and this calls attention to it.  Although he could consider gynecomastia surgery, he preferred to start with bilateral nipple reduction in the office with a free nipple amputation technique.  He is shown before and again, 6 weeks after this procedure.  He is pleased with his result and now feels comfortable in fitted shirts.  He can choose to have the gynecomastia treated at a later time if the female breast development becomes more bothersome to him.

An Asian mother of 2 in her later 40’s who described herself as a 32 A cup and wanted to have a fuller but still natural look.  She has some asymmetry with her right breast being higher and slightly more lateral on her chest wall  She does not want an “implant” look.  She is shown before and again, 4 ½ months after bilateral partial sub-pectoral placement of round smooth highly cohesive silicone gel Sientra 255 High profile implants through an inframammary incision.

Discussion: The Sientra 255 HP implant is 10.8 cm at the base.  The measured base width of her breasts was each 10.6 cm and the IMF to nipple distance on the stretch was 7.5 cm.  A larger implant would have been significantly wider than her breast and would have been more likely to give her an overly round “implant” look, which she wanted to avoid.  She is thrilled with her fuller but still natural appearance.

A woman in her early 50’s described herself as a 40DDD cup and had difficulty exercising as well as grooving and irritation of her shoulders from her bra straps,  back pain, and a rash under her breasts in the warmer months.  She also has “axillary lipodystrophy”, a fatty prominence in the anterior axilla that shows in an evening dresses and bathing suits.  She is shown before and again, 7 months after bilateral breast reduction with the removal of more than 800 grams of tissue from each breast as well as liposuction of the axillary lipodystrophy.  She is thrilled with her new appearance, and her symptoms have resolved.  

A woman in her later 20’s with bilateral macromastia.  She described herself as a 36 H bra and had problems with neck pain, back pain, shoulder pain, irritation, and grooving of her shoulders from her bra straps.  She is shown before and again, 7 months after breast reduction with the removal of almost 600 grams from her right breast and more than 800 grams from her left breast to reduce her to a C cup.  (454 grams = 1 pound).  She is thrilled with her new shape and size, and her symptoms have all resolved.  A tattoo has been blurred for her privacy.

• A woman in her mid 50’s who is z 48DD and has problems with irritation of her shoulders from her bra as well as neck, back, and shoulder pain from the weight of her breasts.  She also gets a rash under her breasts in the warmer months.  She is over her ideal body weight at 5’3” and 206 lbs but has trouble losing weight because of difficulty exercising. 

  She is shown before and again, 8 months after bilateral breast reduction with the removal of more than 1000 grams from her left breast and more than 800 grams from her right breast to reduce her to a C cup.   ( 454 grams = 1 pound)

  Her symptoms have all resolved and she is thrilled with the new shape and size of her breast.  Scars will typically continue to fade and improve for another year or longer. 

A man in his middle 30’s who had had gynecomastia (development of female-appearing breasts) since he was 13.  He wears Spanx under his shirts to camouflage the appearance of his chest and is bothered by his appearance in most fitted shirts and with his shirt off.  He is shown before and again, 6 weeks after bilateral gynecomastia surgery using the S.A.F.E. technique (  Separation  Aspiration Fat Equalization) utilizing power-assisted liposuction combined with direct excision of breast tissue through an incision around the areola.  A finned  “Becker” cannula is used to breast up the fat mechanically, followed by liposuction, then the excision, then smoothing of the fat with the finned cannula again.  In my hands, this has given the most consistent results.  At 6 weeks he is already thrilled with his improvement and ready to resume normal activity.  A mole was removed from his right shoulder at the same time. 

A woman in her late 50s with bilateral macromastia described herself as a 38F cup bra.  She had problems with neck pain, shoulder pain, grooving and irritation of her shoulders from her bra strap, and back pain.  Her case is complicated by smoking a ½ pack of cigarettes a day.  Smoking damages the blood supply and can cause the nipple to turn black and necrose (die) with traditional techniques.  She was not able to stop smoking so we performed a free nipple graft technique, where the nipple is removed completely and replaced as a full-thickness graft. In a case like this, I like to use some of the breast tissue to add volume back to the upper part of the breasts.  The nipple typically will look like a scab for the first two months but then generally heals in well.  She is shown just before surgery and again, 3 months after her procedure.  More than 600 grams of tissue were removed from each breast.  9 454 grams= 1 pound)  Her symptoms have resolved and she loves her new shape and size. 

A medical professional in her early 40’s who is bothered by the shape of her right breast, as well as breast asymmetry (a  difference in the two breasts) and drooping (breast ptosis)  She also feels that her breast are too large for her frame and wanted them to be a little smaller.  She is shown before and again, one year after bilateral mastopexy reduction.  Scars typically are pinker for 6 weeks and then soften and fade over the next two years.  She is thrilled with the new shape and size of her breasts.

A medical professional in her late 20’s who describes herself as a 36 B cup.  She describes herself as a “tomboy” and “athletic body” in high school and college.  She has been attending a lot of weddings and does not feel “feminine” and would like to have breasts that are fuller but still natural in appearance.  She is shown before and again, just 6 weeks after the placement of Ideal Structured Saline Implants in a partial sub-pectoral ( “under the muscle” position through an infra-mammary ( at the breast fold) incision.

Discussion:

She  is petite at 5’ 1 ½” and 126 lbs.  She viewed photos in the office and wanted an absolutely natural appearance without any implant roundness or superior bulging ( “superior pole convexity)  He nipple to fold distance on stretch is 7 ½ cm and her breast base width is 11.4 cm.  With the Ideal implant, which is curved to fit on the curved surface of the chest wall and not flat as with most  other implants, we typically add 3 mm to the base so an 11.1 cm base or less will “fit” but not be wider than her existing breast and not give an overly round or “implant” look So the Ideal implant 270-305 is 10.6 cm( remember to add 3 mm for an equivalent diameter of 10.9 cm0  at the base when filled to 305.  She could have considered the next size up which is 300-340 and 10.8 cm at the base ( equivalent of 11.2 cm) but this was much too large to her in the office during a sizing appointment.  So We used the 270-305.  The back lumen or chamber  is filled to 165 ml and the front or outer lumen is filled to 105 ml and with the empty implant volume of 35 ml gives a total implant volume of 305 ml

At 6 weeks she is already thrilled with her result- we can expect the breasts  to continue to soften in appearance as the tissues stretch to accommodate the implant over the next few months and appear even more natural.