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Breast Procedures
Breast Augmentation
By inserting an implant behind each breast, Dr. Ebert is able to increase a woman's bustline by one or more bra cup sizes. Breast implants may give a small lift to the breasts but they cannot correct significant sagging of the breasts. A breast lift may be needed, alone or in conjunction with breast augmentation to correct sagging. The Best Candidates for Breast Augmentation Breast augmentation can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr. Ebert. The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you're physically healthy and realistic in your expectations, you may be a good candidate. All Surgery Carries Some Uncertainty and Risk Breast augmentation is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure. Surgical risks include bleeding, infection, poor healing and changes in sensation of the nipple or breast. Capsular contracture, implant leakage or deflation, visible wrinkles, asymmetry of the breasts, implant shifting or other possible complications will be discussed with you by Dr. Ebert. Planning Your Surgery In your initial consultation, Dr. Ebert will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. If your breasts are sagging, he may also recommend a breast lift. Be sure to discuss your expectations frankly with Dr. Ebert. He will be equally frank with you, describing your alternatives and the risks and limitations of each. Dr. Ebert will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. The Surgery The method of inserting and positioning your implant will depend on your anatomy and the desired breast size increase. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple), or in the armpit. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible. Working through the incision, Dr. Ebert lifts your breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). The implants are then centered beneath your nipples. Breast implants may be placed either under the breast or under the pectoralis muscle. Putting the implants behind your chest muscle may reduce the potential for capsular contracture. This placement may also interfere less with breast examination by mammogram than if the implant is placed directly behind the breast tissue. Placement behind the muscle may be more painful for a few days after surgery than placement directly under the breast tissue. Implants used may be either saline filled or silicone gel filled, textured or smooth. Dr. Ebert will discuss the pros and cons of all these alternatives before surgery to make sure you fully understand the reasons for and implications of the recommendations. Learn more about silicone breast implants Content courtesy of PlasticSurgery.org
Breast Lift Mastopexy can also reduce the size of the areola, the darker skin surrounding the nipple. If your breasts are small or have lost volume–for example, after pregnancy–breast implants inserted in conjunction with mastopexy can increase both their firmness and their size. The Best Candidates for Breast Lift The best candidates for mastopexy are healthy, emotionally-stable women who are realistic about what the surgery can accomplish. The best results are usually achieved in women with small, sagging breasts. Breasts of any size can be lifted, but the results may not last as long in heavy breasts. Many women seek mastopexy because pregnancy and nursing have left them with stretched skin and less volume in their breasts. However, if you're planning to have more children, it may be a good idea to postpone your breast lift. While there are no special risks that affect future pregnancies (for example, mastopexy usually doesn't interfere with breast-feeding), pregnancy is likely to stretch your breasts again and offset the results of the procedure. All Surgery Carries Some Uncertainty and Risk A breast lift is not a simple operation, but it's normally safe as performed by Dr. Ebert. Nevertheless, as with any surgery, there is always a possibility of complications or a reaction to the anesthesia. Bleeding and infection following a breast lift are uncommon, but they can cause scars to widen. You can reduce your risks by closely following your physician's advice both before and after surgery. Mastopexy does leave noticeable, permanent scars, although they'll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.) The procedure can also leave you with unevenly positioned nipples, or a permanent loss of feeling in your nipples or breasts. Planning Your Surgery In your initial consultation, it's important to discuss your expectations frankly with Dr. Ebert, and to listen to his opinion. Every patient–and every physician, as well–has a different view of what is a desirable size and shape for breasts. Dr. Ebert will examine your breasts and measure them while you're sitting or standing. He will discuss the variables that may affect the procedure--such as your age, the size and shape of your breasts, and the condition of your skin--and whether an implant is advisable. You should also discuss where the nipple and areola will be positioned; they'll be moved higher during the procedure, and should be approximately even with the crease beneath your breast. The Surgery The incision outlines the area from which breast skin will be removed and defines the new location for the nipple. When the excess skin has been removed, the nipple and areola are moved to the higher position. The skin surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around the areola, in a vertical line extending downwards from the nipple area, and sometimes along the lower crease of the breast. Some patients, especially those with relatively small breasts and minimal sagging, may be candidates for modified procedures requiring less extensive incisions. One such procedure is the "doughnut (or concentric) mastopexy," in which circular incisions are made around the areola, and a doughnut-shaped area of skin is removed. Content courtesy of PlasticSurgery.org
Breast Reduction Breast reduction, technically known as reduction mammaplasty, is designed for such women. The procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of him body. The Best Candidates for Breast Reduction Breast reduction is usually performed for physical relief rather than simply cosmetic improvement. Most women who have the surgery are troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort. In most cases, breast reduction isn't performed until a woman's breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort. The best candidates are those who are mature enough to fully understand the procedure and have realistic expectations about the results. Breast reduction is not recommended for women who intend to breast-feed. All Surgery Carries Some Uncertainty and Risk Breast reduction is not a simple operation, but it's normally safe. Nevertheless, as with any surgery, there is always a possibility of complications, including bleeding, infection, or reaction to the anesthesia. You can reduce your risks by closely following your physician's advice both before and after surgery. The procedure does leave noticeable, permanent scars, although they'll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.) The procedure can also leave you with slightly mismatched breasts or unevenly positioned nipples. Future breast-feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples. Planning Your Surgery In your initial consultation, it's important to discuss your expectations frankly with Dr. Ebert, and to listen to his opinion. Every patient-and every physician, as well-has a different view of what is a desirable size and shape for breasts. Dr. Ebert will describe the procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. He will discuss the variables that may affect the procedure-such as your age, the size and shape of your breasts, and the condition of your skin. The Surgery Techniques for breast reduction vary, but the most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. Dr. Ebert removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. He then brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast. Liposuction may be used to remove excess fat from the armpit area. Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. In some cases, techniques can be used that eliminate the horizontal part of the scar. And occasionally, when only fat needs to be removed, liposuction alone can be used to reduce breast size, leaving minimal scars. Content courtesy of PlasticSurgery.org
Breast Reconstruction But bear in mind, post-mastectomy breast reconstruction is not a simple procedure. There are often many options to consider as you and your doctor explore what's best for you. This information will give you a basic understanding of the procedure -- when it's appropriate, how it's done, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your surgeon if there is anything you don't understand about the procedure. The Best Candidates For Breast Reconstruction Most mastectomy patients are medically appropriate for reconstruction, many at the same time that the breast is removed. The best candidates, however, are women whose cancer, as far as can be determined, seems to have been eliminated by mastectomy. Still, there are legitimate reasons to wait. Many women aren't comfortable weighing all the options while they're struggling to cope with a diagnosis of cancer. Others simply don't want to have any more surgery than is absolutely necessary. Some patients may be advised by their surgeons to wait, particularly if the breast is being rebuilt in a more complicated procedure using flaps of skin and underlying tissue. Women with other health conditions, such as obesity, high blood pressure, or smoking, may also be advised to wait. In any case, being informed of your reconstruction options before surgery can help you prepare for a mastectomy with a more positive outlook for the future. All Surgery Carries Some Uncertainty and Risk Virtually any woman who must lose her breast to cancer can have it rebuilt through reconstructive surgery. But there are risks associated with any surgery and specific complications associated with this procedure. In general, the usual problems of surgery, such as bleeding, fluid collection, excessive scar tissue, or difficulties with anesthesia, can occur although they're relatively uncommon. And, as with any surgery, smokers should be advised that nicotine can delay healing, resulting in conspicuous scars and prolonged recovery. Occasionally, these complications are severe enough to require a second operation. If an implant is used, there is a remote possibility that an infection will develop, usually within the first two weeks following surgery. In some of these cases, the implant may need to be removed for several months until the infection clears. A new implant can later be inserted. The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of the implant. Reconstruction has no known effect on the recurrence of disease in the breast, nor does it generally interfere with chemotherapy or radiation treatment, should cancer recur. Your surgeon may recommend continuation of periodic mammograms on both the reconstructed and the remaining normal breast. If your reconstruction involves an implant, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast reconstructed with an implant. Women who postpone reconstruction may go through a period of emotional readjustment. Just as it took time to get used to the loss of a breast, a woman may feel anxious and confused as she begins to think of the reconstructed breast as her own. The Surgery While there are many options available in post-mastectomy reconstruction, you and your surgeon should discuss the one that's best for you. Skin expansion. The most common technique combines skin expansion and subsequent insertion of an implant. Following mastectomy, your surgeon will insert a balloon expander beneath your skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he or she will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has stretched enough, the expander may be removed in a second operation and a more permanent implant will be inserted. Some expanders are designed to be left in place as the final implant. The nipple and the dark skin surrounding it, called the areola, are reconstructed in a subsequent procedure. Some patients do not require preliminary tissue expansion before receiving an implant. For these women, the surgeon will proceed with inserting an implant as the first step. Flap reconstruction. An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks. In one type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of the skin, fat, and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself, without need for an implant. Another flap technique uses tissue that is surgically removed from the abdomen, thighs, or buttocks and then transplanted to the chest by reconnecting the blood vessels to new ones in that region. This procedure requires the skills of a plastic surgeon who is experienced in microvascular surgery as well. Regardless of whether the tissue is tunneled beneath the skin on a pedicle or transplanted to the chest as a microvascular flap, this type of surgery is more complex than skin expansion. Scars will be left at both the tissue donor site and at the reconstructed breast, and recovery will take longer than with an implant. On the other hand, when the breast is reconstructed entirely with your own tissue, the results are generally more natural and there are no concerns about a silicone implant. In some cases, you may have the added benefit of an improved abdominal contour. Follow-up procedures. Most breast reconstruction involves a series of procedures that occur over time. Usually, the initial reconstructive operation is the most complex. Follow-up surgery may be required to replace a tissue expander with an implant or to reconstruct the nipple and the areola. Many surgeons recommend an additional operation to enlarge, reduce, or lift the natural breast to match the reconstructed breast. But keep in mind, this procedure may leave scars on an otherwise normal breast and may not be covered by insurance. Content courtesy of PlasticSurgery.org
Breast Asymmetry The exact nature of the asymmetry is not always readily apparent. The patient usually realizes there is a different volume, or amount, of breast tissue. But what is often not so obvious is that this is usually accompanied by more skin on the larger side, possibly a larger diameter areola, a difference in the relative position of the nipple and areola, a difference in the location of the crease beneath the breast, and sometimes even a different configuration of the underlying rib cage. Not all of these facets of the asymmetry may be present and not all need be addressed to achieve an acceptable degree of symmetry. All Surgery Carries Some Uncertainty and Risk The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of the implant. As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood. A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted. Some women report that their nipples become oversensitive, under sensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients. Breast implants do not generally interfere with a woman's ability to breast feed, or present a health hazard during pregnancy to a woman or her baby. However, pregnancy and the associated changes to a woman's body may alter the results of any breast surgery, including surgery to place breast implants. Therefore, it is important to discuss the options of breast implant surgery with your plastic surgeon if you are interested in becoming pregnant and breast feeding in the future. The Surgery The method of inserting and positioning your implant will depend on your anatomy and your surgeon's recommendation. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple), or in the armpit. In addition, a saline implant may be placed through an incision at the navel. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible. Working through the incision, the surgeon will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue (submammary or subglandular placement) or may be placed beneath the pectoral muscle and on top of the chest wall (submuscular placement). Once the implant is positioned within this pocket, the incisions are closed with sutures, skin adhesive and/or surgical tape. A gauze bandage may be applied over your breasts to help with healing. The surgery usually takes one to two hours to complete. You'll want to discuss the pros and cons of these alternatives with your doctor before surgery to make sure you fully understand the implications of the procedure he or she recommends for you. Content courtesy of PlasticSurgery.org
Breast Implant Revision Deflation/Rupture Breast implants deflate when the saline solution leaks either through an unsealed or damaged valve or through a break in the implant shell. Implant deflation can occur immediately or slowly over a period of days and is noticed by loss of size or shape of your breast. Some breast implants deflate (or rupture) in the first few months after being implanted and some deflate after several years. Causes of deflation include damage by surgical instruments during surgery, overfilling or under filling of the breast implant with saline solution, capsular contracture, closed capsulotomy, stresses such as trauma or intense physical manipulation, excessive compression during mammographic imaging, umbilical incision placement, and unknown/unexplained reasons. You should also be aware that the breast implant may wear out over time and deflate/rupture. Deflated breast implants require additional surgery to remove and to possibly replace the breast implant. Capsular Contracture The scar tissue or capsule that normally forms around the breast implant may tighten and squeeze the breast implant and is called capsular contracture. Capsular contracture may be more common following infection, hematoma, and seroma. It is also more common with subglandular placement (behind the mammary gland and on top of the chest). Symptoms range from mild firmness and mild discomfort to severe pain, distorted shape, palpability of the breast implant, and/or movement of the breast implant. Additional surgery is needed in cases where pain and/or firmness is severe. This surgery ranges from removal of the breast implant capsule tissue to removal and possibly replacement of the breast implant itself. Capsular contracture may happen again after these additional surgeries. Pain Pain of varying intensity and duration may occur and persist following breast implant surgery. In addition, improper size, placement, surgical technique, or capsular contracture may result in pain associated with nerve entrapment or interference with muscle motion. You should tell your surgeon about severe pain. Additional Surgeries You should know that there is a high chance that you will need to have additional surgery at some point to replace or remove the breast implant. Also, problems such as deflation, capsular contracture, infection, shifting, and calcium deposits can require removal of the breast implants. Many women decide to have the breast implants replaced, but some women do not. If you choose not to, you may have cosmetically unacceptable dimpling and/or puckering of the breast following removal of the breast implant. Content courtesy of LookingYourBest.com
Male Breast Reduction For men who feel self-conscious about their appearance, breast-reduction surgery can help. The procedure removes fat and or glandular tissue from the breasts, and in extreme cases removes excess skin, resulting in a chest that is flatter, firmer, and better contoured. If you're considering surgery to correct gynecomastia, this brochure will give you a basic understanding of the procedure--when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't understand. The Best Candidates for Gynecomastia Correction Surgery to correct gynecomastia can be performed on healthy, emotionally stable men of any age. The best candidates for surgery have firm, elastic skin that will reshape to the body's new contours. Surgery may be discouraged for obese men, or for overweight men who have not first attempted to correct the problem with exercise or weight loss. Also, individuals who drink alcohol beverages in excess or smoke marijuana are usually not considered good candidates for surgery. These drugs, along with anabolic steroids, may cause gynecomastia. Therefore, patients are first directed to stop the use of these drugs to see if the breast fullness will diminish before surgery is considered an option. All Surgery Carries Some Uncertainty and Risk When male breast-reduction surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, as with any surgery, there are risks. These include infection, skin injury, excessive bleeding, adverse reaction to anesthesia, and excessive fluid loss or accumulation. The procedure may also result in noticeable scars, permanent pigment changes in the breast area, or slightly mismatched breasts or nipples. If asymmetry is significant, a second procedure may be performed to remove additional tissue. The temporary effects of breast reduction include loss of breast sensation or numbness, which may last up to a year. The Surgery If excess glandular tissue is the primary cause of the breast enlargement, it will be excised, or cut out, with a scalpel. The excision may be performed alone or in conjunction with liposuction. In a typical procedure, an incision is made in an inconspicuous location--either on the edge of the areola or in the under arm area. Working through the incision, the surgeon cuts away the excess glandular tissue, fat and skin from around the areola and from the sides and bottom of the breast. Major reductions that involve the removal of a significant amount of tissue and skin may require larger incisions that result in more conspicuous scars. If liposuction is used to remove excess fat, the cannula is usually inserted through the existing incisions. If your gynecomastia consists primarily of excessive fatty tissue, your surgeon will likely use liposuction to remove the excess fat. A small incision, less than a half-inch in length, is made around the edge of the areola--the dark skin that surrounds the nipple. Or, the incision may be placed in the underarm area. A slim hollow tube called a cannula which is attached to a vacuum pump, is then inserted into the incision. Using strong, deliberate strokes, the surgeon moves the cannula through the layers beneath the skin, breaking up the fat and suctioning it out. Patients may feel a vibration or some friction during the procedure, but generally no pain. In extreme cases where large amounts of fat or glandular tissue have been removed, skin may not adjust well to the new smaller breast contour. In these cases, excess skin may have to be removed to allow the removing skin to firmly re-adjust to the new breast contour. Sometimes, a small drain is inserted through a separate incision to draw off excess fluids. Once closed, the incisions are usually covered with a dressing. The chest may be wrapped to keep the skin firmly in place. Content courtesy of PlasticSurgery.org |
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