Breast Procedures, The Center for Plastic Surgery : Washington DC

Breast Augmentation

Breast Lift

Breast Reduction

Before and After Breast Surgery Images

BREAST AUGMENTATION

Women who have small breasts or whose breasts became smaller after pregnancy may be candidates for breast enlargement through a surgical procedure called breast augmentation. Breast augmentation has been performed safely for more than thirty years. Currently we are using saline filled implants for virtually all breast augmentation patients. During your initial consultation we will gladly discuss options available to you. You may view before and after photos of breast augmentation here at our web site, as well as during consultation.

In breast augmentation, the breasts are enlarged by surgically placing an implant behind the breast gland (right illustration) or, in some cases, behind the pectoralis muscle under the breast (left illustration).

The size and shape of the natural breast determine the best placement. At your initial consultation, we discuss placement recommendations with you. A nurse helps you select the size of the implant by placing trial implants in an elastic bra that you wear to see the changes in your appearance. Before breast augmentation, we require you to have a mammogram. Breast augmentation also may be combined with mastopexy to restore breast shape.

After surgery, a soft compressive dressing will be placed around your chest before you awaken from the anesthesia. One or two days later when this dressing is removed, we will give you a soft, elastic postoperative bra to wear continuously for three weeks, except when you bathe. You should avoid impact exercises and athletics for this time period.

A few patients may develop a breast "capsular contracture" which can cause unnatural firmness or alter the shape or position of the breast implant. This is not common but can usually be corrected.

Weight gain or loss, pregnancy and aging can cause changes in the tone and appearance of the skin and muscles of the body, just as they do in the face and neck. A variety of surgical procedures have been developed to improve the body contour.

BREAST LIFT (Mastopexy)

Mastopexy lifts and reshapes breasts. Weight loss, pregnancy and aging all can cause breasts to droop and lose their shape. Breast droop, called ptosis, can be corrected by mastopexy.

Mastopexy is a surgical procedure similar to breast reduction. Patients with breast ptosis have low nipple placement and excessive skin. These are two of the three anatomic problems also present in hypertrophic breasts. Mastopexy raises the nipple, removes excess skin and tightens the remaining skin.

Mastopexy can be combined with breast augmentation to restore breast shape, as shown in the illustration below.

Postoperative recovery from mastopexy is similar but quicker than recovery from reduction mammoplasty. Most patients may return to work or their other activities in three to seven days. Restrictions on bras and physical activity are the same as with breast reduction. The risks of this operation are similar to those in breast reduction. Both procedures leave similar scars, but those from mastopexy usually will be smaller.

BREAST REDUCTION (Reduction Mammoplasty)

Breast reduction not only improves the size but also the shape of overly large breasts. The condition of oversized breasts is called breast hypertrophy. Breast hypertrophy may develop at any time: at puberty, during teenage growth years, or after childbirth. The condition often causes problems such as back pain, bra strap pain and irritation of the skin under the breasts. Patients with very large breasts may have difficulty with physical activities such as tennis or jogging. They also may have problems dressing, particularly in today's popular athletic wear.

Patients as young as fourteen and as old as seventy have had successful breast reduction. In younger patients, the surgery may be performed once breast size has been stable for at least one year. When breast hypertrophy is significant, insurance may cover some or all of the costs of surgery. Proof of medical necessity usually can be determined through your request for preauthorization for the procedure.

Breast hypertrophy is characterized by three anatomic problems:

1. excessive glandular tissue;
2. excessive and/or loose skin over the gland; and
3. low placement of the nipple areolar complex.

Breast reduction surgery (reduction mammoplasty) corrects all three by reducing the size of the gland, repositioning the nipple and reshaping the breast.

Based on your age and breast size, the surgeon chooses one of several possible techniques to reposition the nipple. Then a portion of the glandular tissue is removed and the loose skin tightened to support and shape the reduced breast. The resulting scars are located around the nipple and in front of and under the breast, in the breast crease.

Reduction mammoplasty usually is performed on an outpatient basis or with a one night hospital stay. After surgery, a large, bulky dressing will be placed around your chest, and a small tube, called a drain, may be used to remove blood or fluid (serum) from the surgical area. The dressing will be changed and the drain removed two or three days after surgery. You will be given a soft postoperative bra to wear continuously for three weeks, except during bathing. You should not wear underwire bras or participate in impact exercises or athletics during this time. Patients usually return to work, school or other routines ten to fourteen days after surgery.

Complications from reduction mammoplasty are unusual. Occasionally, there may be a change in nipple sensation, but this is usually temporary. There have been rare instances of nipple damage.