1. Breast lift vs breast augmentation: How to tell which is needed?

A Breast Augmentation is done to enhance or enlarge the breast. A Breast Lift is performed to raise the breast back into the “normal” position. The procedures may be performed alone or in combination to not only lift, but enlarge the breast. If the breast has a normal position, with most of the breast tissue above the base/inframammary crease and if the nipple is not below the base, then a Breast Augmentation would be the best choice. If however, the breast skin has significant laxity and the nipple sits low on the breast, a Breast Lift is the correct option.

2. Can breast lift with implants provide symmetrical breasts?

A Breast Lift is designed to create symmetric breasts. If asymmetry exists prior to surgery, a breast lift alone or combined with an augmentation can very commonly create a very even and symmetrical breast shape.

3. What kind of breast lift leaves minimal scars?

The Breast Lift with the smallest scar is called a Concentric Mastopexy or Doughnut Lift. The procedure involves a surgical scar just around the areola or outer area of the nipple. However, most often the Breast Lift also has a small scar that extends vertically down from the nipple to the base of the breast or below the breast in the crease.

4. Can breast lift and breast augmentation procedures be performed on the same surgery?

Breast Lift and Breast Augmentation surgery are often performed together. Patients who require a Breast Lift will quite commonly have a significant loss of volume that makes the breasts appear “droopy”. Combining an implant with the lift, can create a very natural, fuller breast. In our experience, the combined procedure has a much longer lasting result than just a Breast Lift alone.

5. Is it possible to breastfeed after breast lift surgery?

We have numerous patients who have had Breast Lifts done prior to pregnancy and nursing. There have not been many issues. While no one is guaranteed that they have the ability to breast feed after pregnancy, Breast Lifts should minimally alter that option.

6. Should I wait until after pregnancy to get a breast lift?

While pregnancy does change the breast shape and size, it is a matter of the severity of the breast changes before pregnancy that should determine the timing of surgery. The best, longest lasting result would clearly occur when breast changes are minimized, i.e. pregnancy and weight changes. We have had many patients that would prefer the improvement over waiting until pregnancy. Make sure that all those issues are completely discussed with your Plastic Surgeon.

7. What questions should I ask my doctor before a breast lift?

Any question should be on the table when considering cosmetic breast surgery. Make sure your MD is board-certified by the American Board of Plastic Surgeons. Ask how many Breast Lift procedures the doctor has performed. Ask to see pre and post-operative photographs. Make sure you ask about risks, complications and physical limitations.

8. What is the recovery time from a breast lift surgery?

Recovery time after a Breast lift alone or combined with an Augmentation is in stages. The toughest part is the first 24-48 hours, when pain medication will be necessary. Patients will often take between 4-7 days off of work. Heavy lifting or strenuous exercise may be limited for 4-5 weeks. Most patients can resume driving after 2-3 days.

9. What is the difference between a crescent breast lift and a vertical lift?

A crescent lift includes a small semi-circular incision above the areola/colored are of the nipple. This may be performed in combination with a Breast Augmentation to reposition a nipple that is slightly low with minimal skin laxity. A Vertical Lift may include an incision all the way around the areola and a vertical incision to the  base of the breast. This procedure is done in patients with more severe skin laxity and droop of the breast and nipple. Both procedures are performed as outpatient operations at an accredited surgery center.

10. Can I combine breast lift and areola reduction in one surgery?

Very commonly areola reduction is included with the Breast Lift procedure. With pregnancy, nursing or weight changes, the areola can enlarge and expand as it drops in position. Often there is also asymmetry of the areola from one breast to the other. Correction of asymmetry and reduction of the enlarged size makes the final result that much more natural and appealing.

11. Will a breast lift without implants make breasts look smaller or larger?

A Breast Lift without implants will often  make the breasts appear slightly smaller. However, the improved position and shape should improve the appearance significantly such that the reduced size is not of any consequence. As described above, combining an implant with the Breast lift will often improve the final result and provide a longer lasting improvement.

Welcome to our blog.  Each week, I will try to find an interesting question that our patients ask us.  We’ll see if I can do this every week.  So here goes.

This week, I again was asked, “Do breast implants need to be replaced every ten years?  I’m not sure where the “ten year” time frame came from.  The manufacturers offer a ten-year warranty on the implants.  That warranty is free with silicone gel implants and costs $100 for saline-filled implants.  The warranty covers the cost of the implants, and reasonable anesthesia costs, surgeon’s fees and operating room charges.

But the simple answer is “No, breast implants do not need to be replaced every ten years.” They are not tires and don’t need to be rotated either. That being said I will quote verbatim from Allergan’s product information:

“No medical device can be considered to last forever, just as no natural body part necessarily lasts a lifetime. It is possible for any breast implant to leak, and that is true of both the saline and silicone gel filled breast implants. So assume that all implants will eventually wear out, because of the constant repetitive movements of the chest caused by breathing some 15,000 times a day. If every person with a pacemaker, breast implant, heart valve, knee joint etc lived to be 100, it is likely that all of these devices would need to be replaced at some point in their lifetime.

Implants do not have a date when they have to be routinely replaced. But little by little they do wear out. Based upon the best currently available information, many plastic surgeons tell patients to assume that the need for replacement at five-years would be about 1%, by ten years 5%, by fifteen years 25%.

It is not required to just routinely replace older, still intact implants because there is no known danger to you. But the FDA recommends frequent MRI testing for silicone gel implants.”

So there you have it, your implants may well last for your entire lifetime.  You may need to have them replaced. In the case of a ruptured implant, the removal and replacement surgery is usually much easier for you than the original implant surgery.  We just open the previous incision, take out the old implant and put a new one in the same pocket.  Some cases can be more complicated.

I have many patients who have had implants in for 30 years without a problem. I hope that answers this week’s question.

Remember: “it is better to ask some of the questions than to know all the answers” – James Thurber

 

Thanks for reading,

 

Dreyfuss Plastic Surgery Experts

A study published in Plastic and Reconstructive Surgery, based on patient input, revealed 6 aspects of breast surgery that made a profound impact on satisfaction and quality of life.

1. Breast Characteristics
Clearly the main goal of cosmetic breast surgery – participants of the study commented about improvements in breast shape and the clothing options that were now available to them as a result.  One patient with breast implants reports, “Some things are much more fun to put on, and the stuff that I used to wear looks way better–I am sure they looked good before, too–but I just fill in a bit more, look a bit more busty in them.”

2. Physical Well-Being
Breast reduction patients can get relief from back and neck pain, which often allows increased activity and better health.

3. Psychosocial Well-Being
Patients in the study shared the positive changes in self perception and experiences in social settings. Increased confidence and feeling as if you fit the perceived “norm” of the female body are said to be a common benefits of breast surgery.

4. Sexual Well Being
When people feel more attractive, they generally experience more sexual pleasure.  If breast implants or another surgery improve a woman’s perception of her self and her body, sexual well being can consequently improve.

5.  Surgeon-Patient Relationship
Women who experienced a good surgeon-patient relationship – with open, honest communication – expressed more satisfaction with breast surgery.  Patients who had an adverse relationship with the surgeon or staff reported being fearful, uncomfortable, and less satisfied.

6. Overall Satisfaction

Researchers also included the simple category of general satisfaction.  Would you undergo the surgery again?  One breast augmentation patient responds, “there is not one day that goes by that I am not so pleased that I did it.”

You can access a similar article by the same researchers for free at BioMed Central.

Mother breast feeding her baby girlOur patients frequently ask about breast feeding and breast augmentation.  Can the surgery disrupt the ability to breast feed?  Is it safe for my child?

In many cases, breast feeding is not disrupted by the presence of a breast implant. However, in some patients, often when an incision near the nipple was utilized, the patient’s ability to breast-feed does get disrupted.

How to minimize this risk

Utilizing a surgical incision that avoids manipulation of the nipple can decrease the risk of disrupted breast feeding.  Therefore, if this is a concern, you may want to investigate incision techniques such as the following:

  • Inframmary fold incision
  • Transaxillary incision
  • Transumbilical breast augmentation

Although breast feeding is not necessarily compromised by sub-glandular (above the muscle) breast implant placement, some surgeons maintain that sub-muscular placement reduces the risk as well.

Is it safe for the newborn?
If you’re especially concerned about infant safety, you may want to reference a study published in the June 1998 issue of Plastic and Reconstructive Surgery.  The study found no measurable risks to the infant, and found that women with silicone breast implants, and women without them, show comparable levels of silicone (silicon) in their breast milk.  It is not known what effect could occur if a small trace of silicone were to pass through to the infant.

Ask Your Surgeon
Feel free to speak with Dr. Dreyfuss, or your OB/GYN if you still have questions and concerns about this topic.  Whether you plan to become pregnant or not, it is best to understand all of the possible breast augmentation risks before proceeding with surgery.

stock_3Newly released ASPS statistics indicate that a significant change may be taking place in the cosmetic surgery industry;  the popularity of breast implants have surpassed liposuction for the first time.

Nationwide 2008 statistics collected by the American Society of Plastic Surgeons reveal that 355,671 breast augmentations were performed in 2008, while liposuction procedures numbered at a close 341,144.

In a recently issued press release, ASPS President Alan Gold is quoted as saying, “for the first time in the twelve years these statistics have been collected, liposuction is a runner up in popularity to breast augmentation. He goes on to predict that “this turnabout will generate discussions in the medical community and the public at large.”  Dr. Gold’s theory is that perhaps “changes in fashion, i.e. décolletage baring styles, might be a factor.”

10.2 million cosmetic procedures were performed in 2008 and 92 percent of them were had by women.  The top 5 procedures include:

  1. Breast Implants
  2. Liposuction
  3. Eyelid Surgery
  4. Rhinoplasty
  5. Tummy tuck

The top 5 non-surgical procedures were:

  1. Botox
  2. Laser Hair Removal
  3. Hyaluronic acid wrinkle fillers (Juvederm, Restylane)
  4. Chemical Peel
  5. Laser Skin Resurfacing

Although fat grafting to for breast augmentation is already being performed by a New York plastic surgeon, further study has been inspired by the recent work of a Japanese plastic surgeon, and a device to combine harvested fat with stem cells has been developed by San Diego company, Cytori Therapeutics Inc.

With the recent discovery that fat is rich in stem cells, the possibility of grafting it to different parts of the body is becoming a reality. Surgeons are rethinking the idea of fat transplantation for use in breast augmentation procedures. In this type of breast augmentation, stem cells are harvested from the patient’s own fat stores, so the controversial aspect commonly associated with stem cells is not relevant.

New York plastic surgeon Dr. Sydney Coleman, an international expert in fat grafting, claims he has been using fat in breast augmentations for years and once published his findings in Plastic and Reconstructive Surgery. A Japanese surgeon has reportedly been performing breast augmentation procedures using stem cell fortified fat from the patient’s body.

The reason this process hasn’t been established as a reliable option is the tendency for fat to die once it enters another part of the body. Fat can then calcify and turn hard. With stem cells, the theory is that a new blood vessels will form and bond with the reintroduced tissue, creating what might be considered a ‘natural implant.’

The Wall Street Journal reported that San Diego based Cytori Therapeutics Inc. has been marketing a device for combining fat with stem cells to other countries and has intentions to do so in the US. Cytori has begun working with plastic surgeons in Japan, Israel, Italy and France who are using its device, and has given Dr. Sydney Coleman a unit for testing.

The American Society for Aesthetic Plastic Surgery’s research arm is recruiting patients for a breast augmentation study at ClinicalTrials.gov.

Get ready for Summer!

Dr. Dreyfuss is pleased to announce two spring time specials now through June 13th, 2008.

For those women wishing to have a renewed self-image, Plastic Surgery Experts is offing a special on Breast Augmentation with saline filled implants for $4,995. (An additional charge of $850 will be applied for silicone breast implants). This discounted fee is all inclusive and cover’s surgeon’s fees, implants, On-Q pain relief system, all visits (pre-op and post-op), surgical bra, anesthesia and surgical center.

Plastic Surgery Experts is also offering a laser hair removal package, buy one area and get 2nd area at 1/2 price. (e.g. bikini and get armpits at 1/2 off)

These specials are good through June 13th, 2008. Contact Plastic Surgery Experts today from our website or call us at (815) 806-9400.

Plastic Surgery Experts serves the greater Chicago, IL area including, Frankfort, Hazel Crest, Homer Glen, Mokena, New Lenox, Orland Park, Palos Park, Tinley Park, Illinois and Munster, IN.

*Surgery can be scheduled after June 13th but will require a consultation and surgery date.