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There is probably no body part that defines femininity more than breasts. When breasts are proportional and full they symbolize youth and vitality. However, when they fail to meet these criteria problems ensue.
Breasts that are too large can be painful and restricting when it comes to activities. Breasts that are too small may make a woman feel less feminine. Breasts that sag may make many women feel older and less attractive. And certainly breast development in men can be psychologically devastating.
Fortunately this is a well studied area and there are many safe and sound options for breast rejuvenation, balance and proportion.
Breast Reduction
Almost all women want beautiful breasts. When they are too large they may feel like burdens rather than beauty. The procedures (reduction mammaplasty) have become sophisticated to the point that incisions can be reduced and recovery hastened. No longer are women mandated to have the large anchor shaped incisions of the Wise Pattern. Many surgeries can utilize a smaller vertical (lollipop) (LeJour) technique which heals faster and looks better. A personal consultation will determine which technique will be best suited for you.
No matter how large the breasts, the surgeries can be safely performed as short stays. Some may go home the same day and some will stay for less than 24 hours in the hospital. Again at consultation this will be determined.
A typical surgery is approximately 3 hours under general anesthesia. Drains are rarely used. The stitches are all under the skin and do not need to be removed. A surgical bra serves as the dressing over small steri-strip bandages. Pain is in fact minimal and easily controlled with oral medication. Breast reduction patients recover rapidly and may resume most routine activities within 2 weeks. Sports and physically demanding jobs require 3-4 weeks healing time.
Insurance companies have varying policies on which patients can receive reimbursement. Usually there needs to be documentation of any related situations such as back pain, grooving from bra straps, and irritations or rashes beneath the breasts. A defined amount of breast tissue to be removed must meet the individual company’s criteria. Our office will help you get a predetermination of benefits.
Breast Augmentation
Small breasts can be as distressing as breasts that are too big and breasts that sag. For those women whose breasts are normal but small, an augmentation mammaplasty can be very “fulfilling”
An in depth consultation is very important since implants are involved. Patients must understand the need for proper surveillance to maintain good breast health and to check on the integrity of the implants at periodic intervals for life.
A great deal of time is spent in selecting the size and shape implant that will provide best fit. Implants can be saline filled or silicone gel. Gel implants are now made of a more cohesive material and FDA approved for cosmetic use.
Augmentations are performed as out patients in our surgical facility under general anesthesia. The incisions are usually around the areola or in the breast fold beneath. Rarely is the axillary or arm pit incision used; and the TUBA (trans- umbilical breast augmentation) is not utilized. Dr Lukash believes that since implants may require changing over a patient’s lifetime the incisions should be near the implants. The implants are most often placed beneath the chest (sub pectoral) muscle. In some cases they are placed in the retromammary position, above the muscle.
At the time of surgery, a long lasting local anesthetic is used to provide post operative comfort and ease the transition home. The incisions are of the size necessary to place the implant.
Recovery is rapid and the patients are very comfortable within hours and can resume most activities within days. Heavy physical activity is restricted for 3 weeks. “I encourage my patients to swim. Swimming has been shown, in my experience, to keep the implants soft.”
Breast Lift
A breast lift (mastopexy) is a very rewarding procedure for those women who have ample breast volume but have lost their shape. Sagging breasts can be easily repositioned and “tightened up” to reintroduce youth and vitality. Areolae that have stretched out can be reduced to normal size. The degree of sagging (ptosis) determines the extent of the incisions. The can range from a small crescent around the areola to a vertical lollipop incision to the full Wise anchor pattern. The nipple remains on the breast tissue and retains its sensitivity.
The procedure ranges between 1-2 hours and is usually under general anesthesia as an outpatient in our surgical facility. As with breast reduction the bandages are steri strips and the dressing is a surgical bra. Recovery is rapid. There are no drains and no stitches to be removed. Patients may resume activities in about 1 week.
There are situations in which not only are the breasts sagging but they are also deficient in substance. In these conditions an implant would be considered as part of the rejuvenation. (see breast augmentation)
Male Breast Reduction (Gynecomastia)
For a male, this is a psychologically damaging situation. Men have chests – women have breasts. Men or boys afflicted with gynecomastia will benefit from surgery to correct this.
It is important to determine if there is a known and reversible cause prior to considering surgery. An in depth consultation will help in this process as well as possible consults with endocrinologists to check for hormonal imbalances. If the cause is defined and not deemed reversible, surgery is the treatment of choice. There are options ranging from liposuction to glandular excision to combinations of both. Incisions are small and placed within the areola.
Correction of gynecomastia is ambulatory and takes between 1-2 hours, either under general anesthesia or local with sedation. There are seldom drains and the dressing is a compression vest. After a few days patients wear the “Under Armour” spandex shirts to help with healing.
Breast Reconstruction
Reconstruction of the breast after a mastectomy due to cancer or other disease is quite possible with today's surgical procedures. Congress has enacted mandatory insurance coverage for breast reconstruction. Using the newest medical techniques, a plastic surgeon is often able to create a breast that is similar in form and appearance to that of the natural breast. A consultation will provide you with information on the many available options for post-mastectomy breast reconstruction.
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