Mastoplexy for Tubular Breasts

This young woman had very asymmetric breasts. The right was droopier and both had a problem called herniation of the nipples. Both areolae were much too large for the breasts. She did not want bigger breasts, just a nicer proportion and better symmetry. A breast lift (mastoplexy) was done using an incision around the areolae. She is shown before and 6 months after surgery.

Breast Augmentation 12

Front, before

Front, after

This young lady described her breasts as “fried eggs” after two children. She desired larger breasts with more superior fullness. She was 5’4” and weighed 114lbs. Augmentation was done using Mentor round, smooth saline implants placed under the muscle through a 1-inch incision under each breast. The final implant size was 375 cc. After, she was a D cup with very soft breasts with normal sensitivity. She is happy but would have liked more fullness superiorly. This is difficult, if not impossible to achieve in most patients without making them so large that they will look “strange”. Too much superior fullness is unattractive as it is not natural.

Augmentation

Before (1)	Before (2)
After (3)	After (4)

Breast Augmentation with Lift

1 & 2. 18 year old girl with severe breast asymmetry and almost no development of the right breast. In 1998 she had bilateral breast augmentation using submuscular, round, textured McGhan saline implants, 390 cc on the right and 290 cc on the right. She also had a breast lift on the left using an incision around the areola. She did well with this but came in several years later because of sagging of both breasts and firmness from contracture of the scar around the implants.

3 & 4. Patient seen in October 2001, 6 months after revision. Both old implants removed, the internal scar tissue was released, and new implants inserted. These were Mentor round, smooth, saline, 600 cc on the right and 325 cc on the left. Both breasts are very soft and natural feeling. The patient was married two months earlier.

Breast Augmentation 2

Before (1)

After (2)

1. 25 year old patient desiring breast augmentation. She wears a “small B” cup bra. She is 5 feet 8 inches tall and weighs 141 pounds. The left breast was a bit smaller than the right.

2. 6 months after breast augmentation using Mentor round, smooth, saline implants in submuscular pockets. Implant size: right 450 cc, left 500 cc. Postoperative bra size is a 34D cup. Both are exceptionally soft. The scars are 1 inch long and under the breasts. They are very faint.
 

Breast Augmentation 3

Before (1)

After (2)

1. 49 year old woman desiring breast augmentation. Patient wears an “A” cup.

2. 6 months after augmentation with 380 cc Mentor round, smooth, saline implants placed under the pectoralis muscle. Bra size is now a “C” cup.
 

Breast Augmentation 4

Before (1)

After (2)

1. 23 year old girl seeking breast augmentation. She felt self conscious about wearing bathing suits and not filling her clothes out adequately. She is 5 feet, 4 inches tall and weighs 110 pounds. Her bra size is a 34-36 “padded” B.

2. Here she is 6 months after breast augmentation with Mentor smooth, round, saline implants in submuscular pockets through a small incision under the breasts. Her implant size is 380 cc on the right and 360 on the left to compensate for a slight asymmetry. Post operative bra size, sized at Victoria’s Secret, is a 36 D. Both breasts are very soft. She has retained normal sensitivity.
 

Breast Augmentation 6

Before (1)

After (2)

1. 21 year old girl desired breast augmentation. She was a 34 C cup before her one pregnancy but after that pregnancy, and breast feeding, she dropped to a 34 B cup. She liked her D cup size while she was breast feeding.

2. She is shown after breast augmentation with Mentor round, smooth saline implants placed above the muscles. The implants are 350 cc. She now wears a 34 C/D cup bra. Breasts are very slightly firm but with a very pleasing shape and an overall excellent result with which she is pleased.

 

Breast Augmentation (7) complicated by capsular contracture

Before (1)	After (2)
After (3)

1. 35 year old lady desiring breast augmentation. She experienced loss of volume in her breasts after her pregnancies and now wears a 34 B cup bra. She would like to be a full C cup if possible. She was felt to be a good candidate for augmentation.

2.She is shown 6 months after augmentation with McGhan anatomically shaped, texture saline implants in pockets above the muscle. She has experienced contraction of the implant pocket, called capsular contracture. This causes the breasts to feel very firm and alters the shape of the breasts. In her case, the breasts area much too round and the implants have shifted apart producing too wide a space between the breasts. This will require surgery to correct. Capsular contracture requiring surgical correction occurs in less than 5% of breast augmentations.

3. Here she is 3 months after revision. Her old implants were removed, the contracted capsule was released and new implants inserted. These are Mentor round, smooth saline 380 cc implants. The difference in the appearance of her breasts is obvious and they are very soft.
 

Breast augmentation (8) in patient needing a lift

Before (1)

After (2)

1. 33 year old lady came desiring more fullness and correction of sagging in her breasts. She stated that her breasts have always sagged, even before her pregnancy. She wears a 34 B cup bra and would like to be at least a C cup. I discussed her options with her and recommended a combined breast augmentation with a breast lift (mastopexy). She did not want to have the lift done at this time because of the additional scars it would leave. She was willing to accept the limitations of an augmentation in situation such as hers.

2. Here she is 7 years after breast augmentation using McGhan round, textured saline implants, 350 cc volume. Because of her sagging, the implants were placed in pockets above the muscle (if she had undergone a simultaneous lift, placing the implants under the muscle would have been an option). She now wears a 34 D cup and is very happy with that size. She is still pleased with the result and not ready to consider a breast lift.


 

Breast Augmentation 9

Before (1)	After (2)
Before (3)	After (4)

1. 32 year old girl seeking breast augmentation. She wears a B cup and would like to be a C, or even a small D cup. She had one pregnancy and this caused slight sagging and some volume loss in her breasts. Because the sagging is mild, she is a good candidate for an augmentation alone.

2. She is shown 6 months after her breast augmentation using Mentor round, smooth, saline implants placed under the muscle. The implant volumes are 450 cc. She has gone from a 34 B to a 34 D cup in her bra size. She retained all sensitivity in her breasts.

3. Here she is seen on an angled view to better show the degree of sagging. As long as the nipples are above the lower crease of the breast, augmentation is a good option to fill them out.

4. Angled view, 6 months after surgery.
 

Breast Augmentation 10

Before (1)

After (2)

1. 24 year old girl presented requesting breast augmentation. She felt she was too small and did not fit well into her clothes or bathing suits. This was a 25th birthday present to herself. Her preoperative bra size is a 34 A to 32 B. She is 5 feet 7 inches tall and slim.

2. She is shown 6 months after augmentation with Mentor anatomically shaped, textured implants placed through a 1 inch incision under the breasts. Implant volume is 350 cc. She now wears a 34 C cup bra. She is now over 2 years out from the surgery and the result remains soft and natural.
 

Breast augmentation 11

Before (1)

After (2)

1. 38 year old lady came in for breast augmentation. She lost volume in her breasts after her pregnancies and losing over 20 pounds. She wears a 34 B cup but does not fill that out.

2. She is seen 6 months after having augmentation with Mentor round, smooth, saline implants 475 cc, placed above the muscle. Bra size is now a D cup.
 

Breast Reduction 1

Before (1)

After (2)

1. 53 year old woman with extremely pendulous breasts and severe back, neck and shoulder pain. This patient also had chronic skin irritation under her breasts.

2. Same patient 6 months after breast reduction using a nipple graft technique. Each breast was reduced by about 3 ½ pounds. Bra size decreased from EE/EEE to a C/D cup. All symptoms resolved.
 

Breast Reduction 2

Before (1)

After (2)

1. 59 year old lady with back, neck, and shoulder pain. She also has arthritis in her back. Breast cup size is 34DDD. She has had a breast biopsy in the left breast which left this breast smaller than the right.

2. 6 months after a bilateral breast reduction. The right was reduced by 847 grams (30 ounces) and the left by 384 grams (13.5 ounces). She now wears a 36 B cup bra. All her symptoms have been eliminated.
 

Breast Reduction (3) and Abdominoplasty

Before (1)	After (2)
Before (3)	After (4)

1. 64 year old woman presented to discuss breast reduction and an abdominoplasty (tummy tuck) as well. She has a history of fibromyalgia and was also concerned about the effect of surgery on her body’s electrical meridians which might be interrupted by the incisions. She decided to have the breast reduction first (these procedures can sometimes be combined into one operation).

2. Results 9 months after removal of 667 grams from the left breast and 595 grams from the right, she went from a 38DDD cup down to a C/D cup. Despite the patient’s misgivings, the surgery had no effect on her meridians. She is also 4 months after an abdominoplasty which removed 2100 grams of skin and fat from the abdomen.

3. Side view before her tummy tuck.

4. Side view 7 months after the tummy tuck.

 

Breast Reduction 4

Before (1)

After (2)

1. While most breast reductions are done for medical necessity, they can be done for cosmetic purposes. This 19 year old girl came in unhappy with her large, heavy breasts and wanted them smaller and lifted. She did not need enough reduction to qualify for insurance coverage.

2. She is shown after a breast reduction in which 212 grams (about 7 ½ ounces) were removed from the left breast and 240 grams (8 ½ ounces) from the right. She went from a 32 D/DD bra to a 32 C. This photo was taken 6 months after surgery. The scars are still very red and reactive but will fade away completely with a bit more time. Younger patients take longer to mature their scars than older patients.
 

Breast Lift (Mastoplexy): Removal of old breast implants with mastopexy

Before (1)

After (2)

1. This 65 year old woman had breast augmentation done 39 years ago with saline implants. She came in because she thought they might be leaking as she noted her breasts getting smaller (leakage of saline implants requires exchange or removal, but the leaking itself is harmless). She had considered having them removed but was concerned about her size without them and how much sagging she would have. After discussing all of her options, she elected to have them removed and a breast lift (mastopexy) done.

2. She is shown 6 months after removal of her implants, which were not leaking, and a breast lift. She is wearing a 34 B cup bra and is thrilled with the overall appearance of her breasts.
 

Breast Reconstruction 1

Before (1)

After (2)

1. 61 year old patient underwent a right modified radical mastectomy in 1976 and a left mastectomy in 1996 for breast cancer. After the second procedure, the patient sought reconstruction. She is seen marked for surgery. The large, spindle-shaped area of skin and fat on the lower abdomen, marked “14 x 44 (cm)” will be divided in half and each half used to build one breast.


2. Patient is shown one year and nine months after reconstruction of both breasts with TRAM (using abdominal muscle, skin, and fat) flaps and nipple/areola reconstruction with nipple flaps and medical tattooing. Bra cup size is a D.
 

Breast Reconstruction (2) with TRAM

Before (1)

After (2)

1. This 47 year old lady had a left modified radical mastectomy for breast cancer and underwent reconstruction with an implant elsewhere. She had postoperative radiation therapy and this caused the tissue around her implant to scar and contract, producing a small, hard breast mound which felt and looked nothing like her natural breast. Radiation therapy can be very damaging to normal tissues and usually implant reconstruction does not work well in such patients.

2. Here she is 1 year and 9 months after removal of her breast implant and a new breast reconstruction using skin and fat from her abdomen (this is called a TRAM flap for Transverse Rectus Abdominis Myocutaneous flap) followed by reconstruction of the nipple area with a small flap and tattooing of the color. This flap allows the surgeon to remove a lot of the radiation damaged tissue and replace it with healthy, pliable abdominal tissue. This new breast, though not perfect, is just as soft and natural as her right breast and should remain so forever.

 

Right Breast Reconstruction (3) with implant, left mastopexy

Before (1)

After (2)

1. This 71 year old woman was referred for possible immediate breast reconstruction. She had a biopsy of a lump in the right breast showing cancer and a mastectomy was recommended. She wanted reconstruction at the same time. At the time her breast was removed, a tissue expander was placed and inflated in the office over a period of 6 months and then was replaced with a permanent Mentor round, smooth saline implant with a volume of 650 cc. Because of sagging of the left breast, a small lift was done through an incision around the areola. Here she is seen with the inflated expander, before the implant and lift surgery were done.

2. Here she is 9 months after completion of her reconstruction, including nipple/areola reconstruction. Her result has remained stable over 4 years and she has only required a bit of additional tattooing of the areola on the left due to fading.

 

Breast Reconstruction 4

Front, before

Front, after

Poland’s Syndrome Reconstruction

This patient has a severe expression of Poland’s Syndrome, in which the breast and underlying pectoralis major muscle are absent. She had undergone two previous attempts at reconstruction elsewhere, without success, due to infection. She is shown before and after reconstruction. The right breast was lifted and the left breast reconstructed using a tissue expander, followed by insertion of a permanent implant. The nipple/areola complex was reconstructed using skin from the right areola and a small flap to simulate the nipple. The implant is a Mentor adjustable saline implant with a volume of 730 cc. She wears a D cup bra and fills both cups very evenly. This patient takes a long time to settle her scars, which remain very red for a long time.
 

Breast Reduction (5)

Front, before	Front, after
Oblique, before	Oblique, after

This patient was a 36 DD cup bra size and suffered from chronic pain in her back, neck, and shoulder, and rashes under her breasts. After a reduction of 490 grams on the left and 480 grams on the right (about 1lb per breast). Afterwards, she is a 36 C cup and all of her symptoms resolved.

Breast Reconstruction (5)

Front, before

Front, after

This young woman had cancer of the right breast. She underwent a right mastectomy and reconstruction with immediate placement of a tissue expander. This was later replaced with a permanent implant and she underwent nipple/areola reconstruction using a nipple sharing technique with medical tattooing of the areola. Since the left nipple was generous, reducing it improved the left breast and provided nipple tissue for the right (the Robin Hood principle of plastic surgery). She also had breast augmentation on the left. Her implants are McGhan textured, anatomically-shaped, saline implants; 390 cc on the right and 230 cc on the left. She is shown just after her breast biopsy and after the completed reconstruction.

Bilateral Breast Reconstruction 6

Before

After

1. (Before) - This young (41) lady presented with an extremely difficult situation for breast reconstruction. She had a left mastectomy for breast cancer and a right mastectomy for prevention of future cancer because of her cancer type. She also had radiation thereapy to the left side (note the darkened skin). Her slim figure made it impossible to build two breasts with her own tissue. The left breast was reconstructed with an abdominal (TRAM) flap with later tissue expansion and an implant, and her right with tissue expansion and an implant. I first saw her in July 2002. She underwent a total of 5 procedures; 3 to build the two breasts mounds, and 2 to reconstruct the nipples and areolae.

2. (after) - She is shown in May 2005. While symmetry is not perfect, she has a good match, the breasts are soft, and she can wear any clothes she wishes without a prosthesis.

Breast Augmentation with Abdominoplasty

Before

After

1. (Before) - This 34 year old lady wanted fuller, larger breasts. She was a 36 B cup and feels this is too small for her size. She was also unhappy with her bulging abdomen with loose skin from two pregnancies. Although overweight, this was stable and she had no plans to lose weight.

2. (After) - She is shown 6 months after a breast augmentation using Mentor round, smooth saline implants placed under the muscle through a 1 inch incision under the breasts. Her implant size is 500 cc and she is a C/D cup, depending on the bra. Breasts are very soft. She also had abdominoplasty with removal of just over 1.5 lb of skin and fat and tightening of the muscles.

Breast Augmentation 13

Before 1	After 1
Before 2	After 2

1. (Before) - This 29 year old patient desired fuller, larger breast. She wears a padded B cup bra.

2. (After) - She is shown 6 months after her surgery. Augmentation was with mentor round, smooth saline implants placed under the muscle througha 1 inch incision beneath the breasts. The implant volume is 400cc. She wears either a 36 C or 34 D cup bra. The breasts are soft and feel entirely natural. This is an exceptional result, the kind surgeons love to show off. using baseball terms, it is the equivalent of a grand slam homerun. There are innumerable tangible and intangible facors that contribute to each patient's result. Although nearly all results are going to range from good to excellent, once in a while we get a nearly perfect result, as in this case.

3. (Before) - An angled view of this patient.

4. (After) - Angled view showing the superb breast shape.

Breast Reconstruction 7

Before 1	After 1
After 2	After 3

1. (Before) - This case spans nearly 13 years, going back to 1992 when this 35 year old patient was first diagnosed with cancer of th left breast. She is shown before her mastectomy, marked for removal fo the nipple/areola and biopsy site. Reconstruction was planned using a flap of skin and muscle from the back (latissimus dorsi muscle) with a small, textured saline implant.

2. (After) - She is shown after her reconstruction. The skin from the back was never a perfect match with the breast skin.

3. (After) - This shot, taken in 2001, shows the scar on the back from where the flap was taken. That year she had a leaking saline implant replaced. Textured saline implants are more prone to this problem.

4. (After) - In 2002, she underwent a planned preventative mastectomy on the right with immediate reconstruction using an abdominal flap (TRAM flap). Cancer was found in this breast and she underwent an immediate mastectomy, without reconstruction. After a course of chemotherapy and readiation, she came back to finish the reconstruction on the right. This photograph shows her after the completed reconstruction. The left breast has held up beautifully with only the one implant exchange for a leaking implant, and a single repigmentation of the areola. So far, she continues to be free of cancer.

Breast Reduction 6

	After 1
After 2	Before 2
After 3	After 4

1. (Before) - This 53 year old lady had very large (38 D/DD) breasts and her problems included back and shoulder pain, tingling down her arms, and rashes under her breasts. Her insurance company approved the surgery.

2. (After) - She is shown about 6 months after a breast reduction. Approximately 1 pound of tissue was removed from each breast. Even at 6 months, her scars are very reactive. All of her symptoms resolved completely.

3. (After) - She came in for an unrelated issue 4 years later. Her exam at this time demonstrates just how much scars can improve with time. She remains symptom free.

4. (Before) - An oblique view demonstrates better the shape of the breasts

3. (After) - This shows the nice shape of the reduced breasts.

3. (After) - The breast have settled further but still maintain a very nice, attractive shape, with excellent scars. She now weighs about 7 bounds less than when she had her surgery.

Left Breast Reconstruction with TRAM Flap

Before 1

After 1

1. (Before) - This 65 year old lady presented in Jauary 2004 with a very difficult situation for reconstruction. She had a cancer of the left reast 11.5 years earlier, treated with a lumpectomy and radiation. Now she had a new cancer of the left breast. A total mastectomy was planned and she desired reconstruction at the same time. Challenges were the radiation changes to left breast (note the darker skin color), making her a poor candidate for implants, and the abdominal scar, which would create difficulties in using the abdominal tissue.

2. (After) - She is shown in June 2005 after having a total left mastectomy, immediate reconstruction with abdominal (TRAM) flap, using both rectus muscles because of the scar, a reduction of the right breast, and nipple/areola reconstruction using a small flap and tattooing. You can see the old abdominal scar in the upper, outer part of the flap on the left breast. Given her very difficult clinical situation, I would consider this an excellent result except for the somewhat thickened scars which will hopefully soften and fad with time.