My name is Dr. Elizabeth Harris. I’m a board certified plastic surgeon. Some of you may may be considering cosmetic surgery of the breast, and I’m going to be discussing different options available to you for this type of procedure. The current procedures include breast implants, also called breast augmentation, as well as a breast lift, also called the mastopexy, and breast reduction – and I’m going to discuss each of these.
Why do women want to have cosmetic surgery of the breast?
Frequently the reason is after children and after breastfeeding breasts begin to sag and have lost a lot of the volume that women used to have before that process was done. So there are different options available to a patient concerned about her appearance after breast feeeding, whether the breasts are too small, whether a woman’s breasts have begun to sag, as well as if they’re too large.
I’m going to start off talking about breast implants. Breast implants are performed with a board certified plastic surgeon, and the different options that a woman has include the size, the incision, as well as silicone versus saline – and I’m going to talk about each of these factors.
First and foremost, breast implantation surgery and breast surgery in general should be very natural. They should not look too large. They should not look as though they don’t belong on a woman’s body. And a good plastic surgeon should accomplish the goal of very natural aesthetic youthful results. And one of the important factors is choosing the size of the implant.
And again, choosing an implant size that is proportional to a woman’s body. Essentially if a woman’s breast fed and she’s lost the volume of her breasts, how do we choose a size. We just basically replace something that was present when she was younger. And that’s one of the factors that I discuss in great detail, and how I do that is by measuring the woman’s breasts, having her try on different size implants, and she looks at herself with different clothing in the mirror and allows herself to choose a size that she thinks will meet her needs.
And after that I’ll go through my qualification process in regard to how do I choose the size and i tell the patient exactly what type of implant I would use and what the volume would be so that the night before surgery she’s not lying in bed with her eyes wide open worried about whether her surgeon has thoroughly understood what she does want. So that type of decision making process should be done beforehand, again for patient satisfaction.
With silicone implants most commonly the incision is underneath the crease of the breast. And the silicone implant is, as I have in my hand, a prefilled implant and it has a very soft natural feel to it. But because it comes prefilled, we have to make the incision at the base of the breast to accommodate the size of the implant. And from that standpoint, a saline implant does not come prefilled, and so what we’re able to do is roll the implant up before placing it in the pocket and filling it once it’s in place. So we can use a saline incision of approximately one inch, whereas a silicone implant incision is sometimes two-and-a-half to three inches in length.
We have controversies in regard to the silicone implants that were at a height during the 1990s. Silicone implants now are able to be used freely for patients considering breast augmentation. They have a very soft nnatural feel and they are an excellent choice for breast augmentation procedures. From that standpoint, the silicone implants have gone under incredible scrutiny, and for them to be brought back on the market shows that they are very safe product.
The breast augmentation procedure is usually done as an outpatient, and the healing process usually involves the implant being inserted under the muscle, and these are the different placements that are possible.
This particular diagram reveals a subglandular or underneath the breast insertion. And this diagram shows a placement of the implant underneath the muscle, which is right here. Under the muscle gives you a little bit more of a natural coverage, reduces the risk of more severe scar tissue, and has I think a more softer teardrop shape appearance. The healing process involves approximately about six weeks for softening and settling of the implant, and after it’s completed you can do anything in regards to exercise and it’s associated with no loss of strength or changes of function of the upper body.
Breast Lift – Mastopexy
Another different procedure is the breast lift, also called the mastopexy, and this is for a patient who is happy with the size breasts that she has, but is unhappy about the sagging. Most commonly I see this after breastfeeding with women who have lowering of the implants, excuse me, lowering of the nipples. The nipple when it drops down to the lower poles of the breasts with sagging of breasts involves a tightening procedure.
The nipple is brought up to a higher, perkier position, the skin is tightened, and the loss of fullness superiorly may be corrected if the woman has enough breast tissue. Some women do not have enough tissue in the upper breast, and we can combine a small implant with the mastopexy surgery to tighten and give women a perkier, rounder, more youthful appearance.
But using the procedure that I use involves a lollipop shaped incision. That’s an incision around the nipple and leading down in a vertical line. Some other incisions involve an incision under the crease of the breast, and I do not do that procedure except for somebody who has had massive weight loss. So it is very possible to do a breast lifting procedure with limited scars, and with a very pretty soft contour.
Finally, the breast reduction surgery can also be done if a woman has breasts that are too large causing her back, neck, and shoulder problems. Reducing the breast, bringing the breast into an again, perkier position, rounding the breast so it has a very aesthetic youthful appearance is possible. And in my practice I’m able to do that, usually again with the lollipop shaped scar with an incision underneath the crease of the breast can be done in more serious larger breasted patients.
Some plastic surgeons do it with different techniques. My technique involves keeping the nipple intact so there is more chance of a more natural sensation as well as more natural contraction of the nipple. So in order to have the breast reduction procedure, I talk to a patient in detail and I ask them what type of size they would like and I show them photographs to better explain the procedure.
All of these procedures are performed in a hosptital operating room, usually as an outpatient. I also have a board certified anesthesiologist that does my anesthesia. Safety is always a big factor in choosing a plastic surgeon that considers safety as the primary choice is very very important. The plastic surgery process involves sometimes having to choose a plastic surgeon in your area and to contact the American Board of Plastic Surgery on their web site would be helpful.
My name is Dr. Elizabeth Harris. I practice in San Antonio, Texas. My web site is eharrismd.com, and my phone number is 210.545.4848.