Breast Augmentation can be performed using a peri-areolar approach. This is very practical, especially if a lift is also required. It is my personal opinion that the major focus of breast augmentation should be the creation of a breast that retains the features of a full and natural breast. Augmentation to sizes greater than DD will eventually result in physical and anatomic issues of neck pain and back pain, as well as impede the ability to exercise effectively. Like the nose, there is also an ethnic context to breast augmentation. In addition, there is the physical context of the womans unique body shape and size that will frame the implants. However, the most critical this is for physician and patient to realize that breast augmentation is a FOUR DIMENSIONAL operation.
For those clients who do not wish to have a scar on the breast, or individuals who wish to have Silicone breast augmentation, or have a high risk of keloid scar formation, the TRANSAXILLARY approach should be considered. This is preferred to the transumbilical approach or the inframmary approach.
The TRANSAXILLARY approach is best suited to those patients who do NOT require a breast lift, .
Restoring the breast to aesthetic ideals requires repositioning the nipple areolar complex back to a more youthful and perky position. The most effective and ideal way to do this is by performing a Benelli Mastopexy. This is a circumareolar incision pattern that recreates the oval form of the areola, and can be used to move nipple to a different location. The nipple is NOT detached from the breast, so there is very little chance of losing sensation. In fact, MANY patients report increased sensitivity following this procedure. I believe that the mechnaism is that the nerves have been primed, and psychologically the patients are now more attentive to the area having had the operation.
Many women enjoy the fullness and firmness of their breast that accompanies pregnancy. Unfortunately, a lot of women soon discover after breastfeeding that their breast are not the size and shape that they once were. Ironically, the volume is gone, but all the excess skin remains like a loose fitting suit after loosing a lot of weight. Adding to the complexity of the situation is the fact that the breast are now drooping and require a lift to restore the Nipple Areola Complex to proper position as well as an inplant augmentation to restore the volume. Often, the Augmentation and the Lift are performed as TWO separate operation. However, they can both be performed at the SAME time if both physician and patient can agree to certain terms.
In cases where the distance required for the Nipple to travel exceeds 3cm, the best option is the use of the Lollipop (keyhole/vertical scar) Mastopexy. This leaves a scar pattern on the breast in a vertical orientation. The advantage of this technique is that it can be use to effectively create a very PERKY, well projected breast with excellent position of the nipple areola complex. Again, the nipple is NOT removed from the breast, it is repositioned within the breast, so there is minimal risk of interferance with sensation.
It is the recommendation of the manufacturers that all implants be removed and replaced at 10 years. This is simply due to the risk of rupture, a significant concern if the implants are silicone implants. Many women at the time of implant exchange should consider replacement with a slightly larger size to offset the volume increase created by the implant molding the anterior chest wall and thinning out the overlying muscle and fat layers. For women who are undergoing Implant exchange, it is essential to have the information regarding the SIZE and FILL VOLUME of the implants if they are SALINE,
Since breast surgeries are influenced by both technical issues as well as the effects of time and gravity, they sometimes require minor adjustments or "tweaks" to reach the aesthetic ideal. Even in the hands of the most talented surgeons, this is true. A great surgeon holds their work to a high ideal, and is willing to critically assess the outcome to become even better.
Tuberous breast are an anatomic anomaly in which the breast tissue is abnormal, and the shape of the breast is distorted and often constricted in growth. Often, one breast is more affected than the other, and the areolas are generally different in size and shape. Correcting these are very complex and require an understanding of the anatomy, as well as the behaviour of the breast over time in response to the presence of the implants.
All humans contain both male and female hormones in varying amounts. However, in some cases the males may be breast tissue that is very sensitive and responsive to the presence of estrogen, even if it is at normal levels. The male breast tissue may grow to large volumes, such as B or even C cup sizes, and may require a combination of liposuction and direct surgical excision to remove it and restore a more masculine profile to the male chest.
Not every surgeon truly understands the architecture, anatomy, physiology, and mechanics required for breast surgery. In addition, even fewer grasp the significant impact of time and gravity compounding the physical impact of the implant presence in the body. Yet all these variables must be understood completely in their nuances if the surgeon is expected to restore the anatomy to normal or exceed the patient's expectations.