Breast Procedure

Breast Augmentation | Breast Lift | Breast Reduction
Breast Reconstruction

Breast Augmentation

Breast Augmentation is a surgical procedure to increase the size and/or alter the shape of a woman's breasts through the use of an artificial implant. Women may choose to have this operation either as a cosmetic technique to enhance body contour or as a reconstructive technique to balance different sized breasts or after breast cancer surgery. Whatever the specific purpose, women who undergo breast augmentation can expect larger, firmer, and more visually satisfying breasts.

The Surgery
The surgery begins with an incision, made either in the crease of the breast, the armpit, or the perimeter of the areola (the dark skin surrounding the nipple). The placement of the incision will vary according to body type and the specifics of each procedure. The surgeon enters through the incision and creates a pocket; either underneath the breast tissue or under the chest wall muscle. The implant is placed in either location, centered directly behind the nipple. Finally, the original incision is sutured.

Augmentation mammaplasty patient shown before surgery.	An incision is made either underneath the breast just above the crease, around the lower edge of the areola (the pigmented area surrounding the nipple) or in the armpit.
Cross section of the breast shows location of the implant, either in a pocket directly under the breast tissue or underneath the chest muscle.	The postoperative patient with fuller breasts.

After Surgery
Once the incisions have been closed and taped, the breasts are wrapped and supported by a gauze bandage. Patients are fitted with a surgical bra that provides support for up to several weeks. Fatigue, soreness, and discomfort are postoperative conditions that are greatly reduced through medication. Swelling gradually subsides and becomes undetectable in a month's time. Sutures dissolve on their own.

Health Concerns
As with any surgical procedure, complications, although rare, do exist. The biggest fear is a leak in the surgical implant. A leak would involve only a saline water solution. Capsular contraction (a tightening of the scar or capsule surrounding the implant, which rarely occurs in Dr. Lalla's practice) can occur following a breast augmentation procedure. If this happens, the surgeon either "scores" the scar tissue, or removes the implant and reinserts another. Other complications include excessive bleeding and infection in the area surrounding the implant. Scars may be evident for several months, but gradually fade. In some cases, the nipples may become hypersensitive or under sensitive for a period after the surgery. In rare instances, the breasts may produce milk for several days after the surgery. To maximize the success of surgery and minimize the risk of complication, always follow your doctor's instructions for surgical preparation and postoperative care.

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Breast Lift

Over time, the natural aging process can cause a woman's breasts to sag and lose their shape. A breast lift, or mastopexy, is a surgical procedure that reshapes and cosmetically rejuvenates a woman's breasts. After the procedure, women can expect firmer, more shapely and youthful looking breasts.

The Surgery
In the most common procedures, an incision periareolar (around the nipple), with extensions vertically or anchor shaped if needed are used. Working through this incision, the surgeon sculpts the excess skin and tissue and repositions the nipple to give the breast a new and youthful appearance. To finish the firming and shaping, the skin is pulled snugly around the new nipple and the surgeon stitches the incisions. A mastopexy can be performed using either a local or general anesthesia and is usually done on an outpatient basis.

Mastopexy patient shown before surgery with sagging breasts and low position of nipples.	Incisions following the breast's natural contour define the area of excision and the new location for the nipple. Skin in the shaded area is removed and the nipple moved higher.
Skin formerly located above and to the sides of the nipple is brought down and together to reshape the breast.	The postoperative patient shown with scars resulting from a commonly performed mastopexy technique. Scars are around the areola, extending vertically down the breast and horizontally along the crease underneath the breast.

After Surgery
Once the surgery is completed, the incisions are dressed in gauze and the breasts are wrapped in an elastic bandage. The next day, the bandage is replaced with a fitted surgical bra. Patients may be minimally bruised and swollen, although medication eases much of this discomfort. Patients can expect to have their stitches removed and return to work quickly, usually within one week.

Health Concerns
As with most cosmetic surgery, complications are rare, but include excessive bleeding, infections, and a reaction to the anesthesia. If you smoke, your surgeon will most likely ask that you stop at least two weeks prior to and following the operation. Other concerns include unevenly positioned nipples and a temporary or permanent loss of feeling in your breasts. To maximize the success of surgery and minimize the risk of complication, always follow your doctor's instructions for surgical preparation and postoperative care.

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Breast Reduction

Before and After Click To Enlarge

Breast reduction, or reduction mammoplasty, is designed for women who may experience medical problems due to uncomfortable heavy breasts. Problems may include back and neck pain, skin irritation, skeletal deformities, and breathing problems. Although the procedure is typically used to alleviate medical problems, it can also help women who feel self-conscious about the size of their breasts.

The Surgery
The most common procedure involves the surgeon making an anchor-shaped incision around the dark area of the nipple (areola). This incision is then extended downward, following the natural curve of the crease beneath the breast. The surgeon removes excess glandular tissue, fat, and skin, and adjusts the nipple to its new position. The skin from each side is pulled down and around the areola, thereby reshaping the breast. The surgeon then stitches the incision, always aiming for the least amount of scarring. In certain cases, the horizontal part of the scar can be eliminated. It should be noted that smoking prior to or following surgery increases the visibility of scarring. Stitches are usually removed in one to three week's time. A breast reduction may be an outpatient procedure. The procedure itself takes between two and four hours and is done under a general anesthetic.

Reduction mammaplasty patient shown before surgery with oversize, heavy breasts and shoulder indentations caused by tight bra straps.	Incisions are made in the breast to define the area of excision and the new location for the nipple. Breast tissue, fat and skin in the light shaded areas are then removed. Skin is removed from the darker shaded area, and the nipple is elevated.
Skin formerly located above the nipple is brought down and together to reshape the breast.	The postoperative patient shown with resultant scars around the areola, extending vertically down the breast and horizontally along the crease underneath the breast where, for the most part, the horizontal scar is hidden.

After Surgery
Once the surgery is complete, an elastic bandage or surgical bra wraps the breasts to provide comfort and support. The bandage is removed the next day while the surgical bra stays on until the bruising and swelling subsides (up to several weeks). Patients may experience minor pain in the days following the surgery, although this subsides in several days. Most women can return to work after one week to ten days.

Health Concerns
As with any surgical procedure, complications are rare, but can include bleeding, infection, and a reaction to the anesthesia. Some women temporarily lose feeling in their nipples, a condition that almost always fades over time. Patients may also experience some discomfort in the breast area. Occasionally, the surgery removes milk ducts leading to the nipples, impairing a woman's breast-feeding ability. To maximize the success of surgery and to minimize the risk of complication, always follow doctors' instructions for surgical preparation and postoperative care.

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Breast Reconstruction

For many women diagnosed with breast cancer, mastectomy, or breast removal, is an unfortunate and inescapable option. Women who have undergone this surgery can choose to have breast reconstruction. This procedure recreates the size and shape of the patient's natural breast and can renew a woman's sense of beauty and femininity.

The Surgery
One of the most common breast reconstruction techniques combines skin expansion with a breast implant (a silicone shell filled with a saline solution). In immediate reconstruction the expander is placed at the time of the mastectomy. In delayed reconstruction the surgeon makes an incision at the mastectomy site and inserts an expander under the chest muscle. The incision is then stitched. Over a period of weeks, the surgeon injects saline solution into the expander through a tiny valve that lies just below the skin's surface. Once the skin has stretched sufficiently, the doctor removes the expander and replaces it with a permanent implant. A final operation reconstructs the nipple and areola (the dark skin surrounding the nipple). In rare cases, no tissue expansion is required and the permanent implant can be inserted during the initial surgery.

Alternative Approach
Breast reconstruction can also be accomplished through a technique called flap reconstruction. In one approach, the surgeon creates a flap of back tissue (skin, fat, and latissimus muscle still attached to its blood supply) that serves as a pocket for an implant or as the chest mound itself. The surgeon may decide to create flap tissue from the abdomen (TRAM flap) and relocate it to the chest area. Breast reconstruction generally involves multiple procedures, and the initial procedure's performed under general anesthesia. The initial surgery is performed in a hospital, while follow up procedures are often outpatient based.

After Surgery
Following the surgery, patients experience some fatigue and soreness for several weeks. Postoperative conditions such as bruising, swelling, and discomfort are typically reduced through medication. Patients can expect to return home in two to five days.

Health Concerns
As with any surgical procedure, complications are rare, but include implant leaks, infection, fluid loss or gain, bleeding, and a reaction to the anesthesia. Fortunately, new advances in technology have minimized the impact of these potential post-surgical complications. For example, new implants are filled with saline water solution, so in the rare instance of a leak, only water is escaping from the implant. The most common complication is capsular contracture (a tightening of the scar or capsule surrounding the implant). If this should occur, the surgeon will either remove the scar tissue, or remove and replace the implant. If you smoke, your surgeon will probably ask that you quit at least two weeks prior to and following the treatment. To maximize the success of surgery and minimize the risk of complication, always follow your doctor's instructions for surgical preparation and postoperative care.

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