The patient to the left is a 27 year old african american female that was requesting a primary breast augmentation. During the consultation the patient explained her desire to enhance the size of her breast, but also stressed that she wanted to look as natural as possible. After setting her expectation we agreed to use high profile saline 350 cc implants and during the augmentation surgery I overfilled the left implant to 400 cc and the right to 390 cc.
The post op photo is 8 weeks out, and she is very pleased with her enhanced and natural look.
For more information regarding breast augmentation surgery or a consultation with Dr. Linder, give us a call at (310) 275-4513 or feel free to contact us via email.
These examples show patients who have had significant fluctuation in their weight associated with pregnancy, breastfeeding and massive weight loss. As a result, they have undergone augmentation with breast lifts or augmentation with tummy tucks and breast lifts. These patients are excellent examples how patients can regain their life and self-image by having tightening procedures of both the breast and abdominal areas to pre-pregnancy status. Patients often present after breastfeeding with significant fluctuation of skin laxity of the breast causing involutional upper pole loss of fullness and atrophy as well as severe skin laxity where the nipple may be greater than 3 cm below the fold, referred to as grade 3 ptosis. These patients will require a combination of implants (saline or silicone) placed under the muscle and a formal mastopexy concurrently with the complete scar of a Wise-pattern. The first example shows a patient who has undergone an augmentation mammoplasty procedure as well as a formal breast lift, a full abdominoplasty and sculpting of the muffin top hip areas.
The next patient shows specifically loss of upper pole fullness without skin laxity and abdominal wall laxity with rectus diastasis. Excellent candidate for straight saline augmentation in the dual plane technique and a full abdominoplasty with plication of midline rectus sheath. Both of these are excellent examples of when patients are placed under general anesthesia with a Board Certified Anesthesiologist and full medical clearance can undergo successfully, in an ambulatory facility, full body contouring and mommy makeover procedures without incident.
Patients who undergo both formal mastopexies as well as breast reduction procedures usually will have a reduction in the areolar size. In general, areolas are made between 3.8 and 4.4 cm in size. I prefer to make them approximately 4.2 cm or 42 mm.
We have what are referred to as cookie cutter patterns in the three sizes, 38, 42, 44 to 46 mm. I use 4.2 cm cookie cutter patterns on both my breast lifts and breast reduction procedures in the majority of cases. The areolar reduction is considered a part of a breast reduction or breast lift procedure if the areolar is enlarged. Areola enlargement can be seen as large as 8 to 10 cm on large women’s breasts who undergo large reduction mammoplasties or women who have had significant stretching of the breast tissue after breast feeding or postpartum. As a result, the areolar reduction can be made with skin removed in a circumferential fashion around the areola.
Areolar Reduction Techniques
Different techniques can be performed, including the round block or Benelli technique, which is simply an areolar reduction with skin removed circumferentially as in a donut mastopexy. This, however, has significant problems with stretching of the scars, widespread scars and pin cushioning which can look very, very poor. Scarring, in other words, can be very poor with the Benelli lift. As a result, I prefer not to use this approach whenever possible. A vertical mastopexy can be performed where skin is removed along the vertical plane and around the areola which will reduce the tension around the nipple areolar complex, bringing it below the 6 o’clock position of the areolar down along the vertical or midline plane of the breast. This helps to dissipate tension from the areolar scar and the results I have found to be much better in general.
Finally, a formal mastopexy using the inferior pedicle Wise-pattern technique can be performed in an anchor scar-like fashion, where the skin is removed again around the areola vertically and along the inframammary fold. This greatly reduces scarring, stretching and tension along the nipple areolar complex and has led to beautiful scarring around the nipple areolar complex.
In our practice we use Kelo-cote once the sutures are removed, usually on day 14 to 17. The Kelo-cote silicone gel spray or cream can be used twice a day for three to six months which greatly reduces scarring, spreading, hyperpigmentation and telangiectasias and blood vessels within the scar.
Today October 7th, 2016 we celebrated our 6th year Anniversary for Sharecare Advisory Board meeting in Atlanta, Georgia. It was great to spend time with all the board members.
The goal of the members is to provide guidance and input on matters of content, scope, and evolving issues of health education for Sharecare’s consumer and professional audiences.
The photo to the left was taken during the event, it was nice to have Dr. Sanjay Gupta an affiliate of CNN as a new board member.
What is a natural breast reduction? In my opinion, a natural breast reduction is breast reduction performed using native breast tissue, reducing the size of the breast by removing tissue centrally and along the medial and lateral aspects of the breast, repositioning the inferior pedicle without placement of an implant. In general, patients who desire to have combination breast reduction with augmentation will get more of a rounding shape to the upper pole of the breast and an excellent result as well. However, the more natural breast reduction is simply using native breast tissue.
A natural breast reduction in Dr. Linder’s practice is performed using the inferior pedicle Wise-pattern technique (Dr. Linder’s preferred technique). Tissue is removed from the superior portion of the inferior pedicle as well as from the medial and lateral aspects of the breasts. I like to remove more tissue laterally as well as liposuction the lateral breast to debulk the breast and narrow it while taking less tissue from the medial portion of the breast in order to increase cleavage and allow for a more natural parasternal angle.
Natural breast reduction surgery simply means using the natural tissue of the breast to recreate upper pole fullness. By keeping the inferior pedicle or the base of the pedicle bulky, 10 cm or more, we are able to allow for a more central increase fill volume of the breast by allowing more of the tissue that remains to be repositioned superiorly centrally which allows for almost the appearance of a breast enhancement without the use of an implant.
For more information regarding breast reduction or to set up a consultation with Dr. Linder call us at 310-275-4513 or contact us by email.