Breast Procedures

 

Breast Augmentation using Fat Grafting

Women have always wanted to move fat from their waist or thighs to their breasts. Now it is possible! In 2007, Dr. Saboeiro and Dr. Coleman published a paper in the journal Plastic and Reconstructive Surgery discussing breast enlargement using a woman's own fat. Using the technique of LipoStructure®, fat can be used for breast augmentation and reshaping of the breast to create a long-lasting and natural result. Fat can be used as an alternative to breast implants for augmentation, to "fine tune" breast reconstruction, and to disguise the edges or rippling of existing silicone gel and saline implants.

Fat grafting involves suctioning a significant amount of fat from the body, refining the fat, and placing the refined fat into the breasts. The suctioning is done gently by hand, removing fat from areas such as the abdomen, thighs, love handles, back, etc. This is done through small incisions that are generally hidden in natural skin creases. The fat is then refined and separated using a centrifuge. The refined fat is then carefully and meticulously placed into the breasts using tiny incisions that are again hidden in a natural skin crease.

This procedure takes considerably longer than placing breast implants, typically four to five hours. However, some of the advantages of fat grafting to the breasts include the following:

• Fat is a completely natural substance
• Harvesting, or suctioning of the fat, can enhance your body shape
• The breast can be sculpted and shaped, as well as enlarged
• Only tiny incisions are necessary, reducing the possibility of scarring

Who is a candidate?

• Healthy women with sufficient excess body fat
• Women considering breast implants
• Women with visible saline or silicone breast implants
• Women who have had or require breast reconstruction after breast cancer surgery

Prior to the procedure, a mammogram to exclude breast disease must be performed. There is no evidence that fat grafting to the breast is less safe than any other cosmetic or reconstructive breast procedure. Since it is a somewhat new procedure, we caution that fat grafting to the breast should only be performed by a board certified plastic surgeon experienced in fat grafting.

 

Breast Augmentation using Silicone or Saline Implants

Breast augmentation is a surgical procedure performed to enlarge a woman’s breasts for a number of reasons:

• To enhance the body contour of a woman who feels that her breast size is too small.
• To correct a loss of breast volume after pregnancy.
• To balance breast size, when there is a significant difference between one breast and the other.
• As a reconstructive technique for various conditions, including breast cancer.

There are several things to consider when considering a breast augmentation with implants: the size of the implant, the location of the incision, the position of the implant, and the implant type.

Dr. Saboeiro will examine you and take some measurements during the consultation. She will then work with you using these measurements, and by having you try on different sized implants to determine the best size for you. It is also helpful if you bring photos of what you consider the ideal breast size and shape, so that she has an idea of your preference. If your natural breast size is very asymmetric (different from one side to the other), she may recommend using two different sized implants to help correct the asymmetry.

The incision placement will then be discussed. Incisions are made to keep scars as inconspicuous as possible. They are usually placed under the breast in the natural crease or around the lower part of the areola (pigmented portion of the nipple). Dr. Saboeiro’s preference is to place the incision in the crease, but she will work with you if you feel strongly about the placement.

Once we decide on the surgical approach, we need to determine if we are going to place the implants above the chest muscle or beneath the chest muscle. Dr. Saboeiro’s preference it to place the implant beneath the chest muscle whenever possible, as this provides more tissue to cover the implant, making it look more natural. It is slightly more uncomfortable immediately following the surgery, but well worth it in the long run. If you have significant asymmetry of the position of the nipples or significantly sagging breasts, you may also need a mastopexy, or breast lift, at the same time that the implants are placed. Additional scars are needed for to lift the breasts (see section under Mastopexy below) and can be discussed at the time of your consultation. If you are only slightly droopy and do not want additional scars, the implant can be placed above the muscle. This helps to fill out the extra breast skin, but does not really provide a true lift.

Lastly, we need to determine what type of implant to use. The new, FDA-approved silicone gel-filled implants that are now on the market underwent extensive testing prior to their release and are considered completely safe. They offer a more natural feeling breast augmentation when compared to the feel of saline, which is like water. The new silicone gel-filled implants do not leak like the older versions, as the gel inside is much thicker. With saline implants, if there is a hole in the shell of the implant, the saline will leak out and the implant will deflate. It will be obvious that something has happened. With silicone gel-filled implants, however, the only way to tell if there is a hole is to perform an MRI. Because of this “silent rupture”, it is recommended to have an MRI every few years if you have silicone implants in place. Dr. Saboeiro likes the new silicone gel-filled implants very much, but if you still have concerns about silicone, she will be happy to place saline implants instead. With either type of implant, you can expect a beautiful result.

 

Breast Implant Exchange or Removal

Over time, your breast implants may need to be exchanged for new ones. Reasons for this may include deflation of saline implants, rupture of silicone implants, or encapsulation (scar tissue causing hardening or distortion of the shape) of the implants. If any of these issues occurs, a procedure is required to remove the old implants, possibly remove some of the scar tissue, and place new implants. In addition, there may come a time that you no longer desire the implants. In this case, the implants can be removed, but the contour of the breast may or may not be acceptable to you and additional measures may be necessary. If you do not like the look of your implants, it is possible that they may be “disguised” by placing some of your own fat around them (See Breast Augmentation using Fat Grafing).

 

Breast Lift (Mastopexy)

Breast lift surgery is designed to raise and reshape sagging breasts due to pregnancy, nursing, weight change, aging, and gravity. If you have not yet finished having children, you may want to consider waiting, as your breast shape may change again after the surgery with subsequent pregnancies. This operation can also reduce the size of the areola, the darker skin around the nipple. If your breasts are small or have lost volume, breast implants inserted at the same time as the breast lift can increase both firmness and size. Breasts of any size can be lifted, but the results generally do not last as long in women with large breasts.

Incisions must be made to lift the breasts. The number of incisions necessary depends on the severity of the sagging. If there is a very minimal amount of sagging or nipple asymmetry, a small crescent (half-moon) incision can be made above the areola, which will be hidden at the edge of the areola. If there is more sagging, the incision may need to extend around the areola, but again would be essentially hidden at the edge. More severe sagging would require an incision around the areola, as well as an incision vertically down from the lower edge of the areola to the crease. Very severe sagging may require all of the above incisions, as well as an incision in the breast crease (anchor-shaped incisions). The extent of post-operative scarring will be discussed during your consultation with Dr. Saboeiro.

 

Breast Reduction (Reduction Mammaplasty)

Breast reduction surgery is a procedure designed to reduce the size and weight of a woman’s breasts. Women who have large breasts often suffer from problems such as back, neck, and shoulder pain, as well as skin irritation beneath the breasts. Breast reduction surgery is performed to help alleviate these symptoms. There are a variety of techniques used to reduce and reshape the breast. In young women, if the breasts are not too large or too saggy, liposuction may be an option. In larger breasts, however, there is usually too much extra skin, and therefore some of the skin will need to be removed and the nipple will need to be repositioned upward. This usually involves an incision around the nipple, another vertically from the lower edge of the areola to the crease under the breast, and in the breast crease. Most women who have this procedure feel an immediate relief from the discomfort in their back, neck and shoulders and are pleased with their decision to undergo surgery.