Breast Surgery
(Augmentation, Reduction Mammoplasty, Vertical Mammoplasty, Mastopexy)
Understanding breast surgery
The goal of breast surgery is to improve the size, shape and appearance of the breasts. Because a woman's body build is primarily determined by genetic and environmental influences, she may not be able to achieve the look she desires through diet and exercise alone. Today, surgical techniques allow a woman to alter the size and shape of her breasts through breast augmentation, breast reduction and/or breast lift. An important part of the preoperative consultation includes a determination of the desired breast size and shape. Although many different breast contours can be achieved, a decision must be made that coincides with total body size, shape and the existing breast tissue.
Some women with small or asymmetrical breasts choose to undergo breast augmentation. This procedure improves the contour of a woman's body by implanting specially designed saline-filled or silicone implants directly beneath breast tissue or the chest wall muscle. Incision placement varies depending on patient and surgeon preference. Many surgeons prefer to place the implants beneath the chest wall muscle. This placement usually results in softer and more natural looking breasts both standing and lying down. It also may decrease the possibility of unnaturally firm and painful breasts while also improving the reliability of mammograms.
Women with unusually large, sagging, or uneven breasts may be helped through breast reduction. This surgery reduces the dissatisfaction some women experience due to discomfort that results from the size of their breasts or the pressure of bra straps on their shoulders. Large breasts may also interfere with physical activities and make it difficult to find clothes that fit properly.
The typical breast reduction technique is performed by making an incision around the areola. The incision is extended downward to the base of the breast where it joins with a horizontal incision in the crease. The incision below the areola forms an upside-down T.
Another method of breast reduction is Vertical Mammoplasty. This procedure is performed by making an incision that circles the areola and extends down vertically to the base of the breast. The best candidates for this type of breast procedure are 1) women who have breast tissue that has fallen and desire that it be repositioned or 2) women with moderately large breasts that desire a breast reduction and lift. Known as the “lollipop” technique, this procedure allows the surgeon to achieve rounder, fuller breasts with a more desirable shape.
This procedure repositions or "lifts" breasts that sag as a result of pregnancy and nursing or a large weight gain followed by weight loss. These conditions cause the amount of breast tissue to decrease, leaving a skin envelope that is too large. The remaining breast tissue sags within the larger skin envelope. Breast lift raises and firms the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour. However, this procedure only restructures the skin. When more improvement of underlying tissue is indicated, a vertical mammoplasty should be recommended.
Understanding the procedure
Before the surgery, the breasts are carefully marked to indicate where incisions are to be made. The placement of these incisions depends upon the type of breast surgery that is being performed as well as the technique that will achieve the best result. Every effort is made to reduce the length of scars and to make them as inconspicuous as possible. Breast surgery is performed using general anesthesia as an outpatient procedure.
Understanding the recovery
Discomfort following surgery is generally minimal to moderate and is usually controlled with oral medications. Patients undergoing breast surgery may wear a special bra for several weeks and/or limit activities that interfere with the healing process. They should refrain from strenuous exercise for several days to avoid long-term complications. The internal stitches used to close the incisions dissolve in a few weeks.
Swelling and discoloration may occur but usually subside in a few weeks. Areas of numbness, firmness and tenderness around the incisions and under the skin are common. Normal feeling returns several weeks to months after surgery; however, the sensations of the breasts may never be quite the same particularly with large breast reductions. Scars from the incisions, although permanent, fade significantly with time; 18 to 36 months or longer may be required for this fading process to be completed, especially with breast reduction and breast lifting procedures.
