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3-D Animations of Breast Procedures

Transcripts

Breast Augmentation-Saline Implants

Introduction

Breast augmentation, or augmentation mammoplasty, is one of the most common plastic surgery procedures performed today. Over time, factors such as age, genetics, pregnancy, weight changes, and gravity can cause the size and shape of the breast to change. Women who are dissatisfied with the size of their breasts or have experienced changes in breast appearance can achieve fuller, shapelier breasts with breast augmentation. During this process, breast implants are placed inside a pocket behind existing breast tissue. Breast augmentation can increase or balance breast size, restore breast volume, or restore the breast shape after partial or total loss. It is important to realize that breast augmentation cannot correct significantly sagging or drooping breasts. In these instances, a breast lift is often necessary, which may be performed in conjunction with this procedure.

Implant Options

A variety of breast implant options exist. Breast implants differ by shape, texture, and profile. Breast implants may be round or contoured, and may have a smooth or textured surface. The breast implant profile may be standard, moderate, or high. Breast implants also vary by size or volume. One of the main decisions involved in breast augmentation is whether to use silicone or saline implants. Both silicone and saline implants are available in similar shapes, sizes, and textures but they differ in composition filling the implant. Silicone implants are made of a silicone rubber shell filled with a silicone gel that feels very similar to natural breast tissue. Saline implants are made of a silicone rubber shell and are filled with sterile salt water, or saline solution. This animation provides details about saline implants and the various insertion and positioning options. After determining whether you want saline or silicone, your surgeon will help you choose the proper style and size of breast implant based on your lifestyle, body contours, and existing amount of breast tissue to achieve the cup size and appearance you desire.

Anatomy

As you may know, certain factors such as age and pregnancy can affect the elasticity of your skin and breast tissue, which results in changes to shape and appearance. Your breasts consist primarily of fatty (adipose) and glandular tissues which determine the size and shape. Firmness and lift are generally influenced by how well ligaments connected to the chest wall support your breasts. The fatty tissue and ligaments surround the milk-producing glandular tissue (lobules) and milk ducts. Breasts also contain nourishing blood vessels and lymph vessels that help the body fight off infection. There are tiny muscle fibers in the nipples, but otherwise, the breasts are non-muscular. However, they lie atop two layers of muscles, the pectoralis major and pectoralis minor, which separate the breasts from the chest wall.

Preparation

Breast augmentation procedures typically last approximately one to two hours. Before the start of your procedure, your surgeon may draw guidelines including any necessary markings for incisions or implant placement. Prior to the start of surgery, an anesthetic will be administered. Depending on the surgeon’s preferences and the nature of the procedure, a local anesthetic usually in combination with intravenous sedation or general anesthesia will be used. There are four primary options for inserting saline implants into the breast. They can be inserted through incisions in the areola, armpit, under-breast crease, or belly button, where the resulting scars are minimized or hidden. In what is known as the periareolar incision, a single small incision is usually placed along the perimeter of each areola, where the scars will follow a natural line. The transaxillary incision approach uses a small incision in the natural fold of the armpits; therefore there will be no scars on the breasts. In what is known as the inframammary incision, a small incision is placed along the crease of the lower portion of each breast, concealing the scars in the natural breast folds. A transumbilical, or TUBA, approach uses a small incision in the rim of the bellybutton.

Procedure

Your surgeon will create an incision to gain access behind the breast. Although the incision will be made as inconspicuously as possible, its length and appearance may vary depending on the type and size of the implant, your body contours, and the surgeon’s preference. Your surgeon will separate the breast tissue in order to reach the area of the breast in which the pocket will be formed and carefully create the pocket. A pocket for a dual-plane (partial submuscular) insertion is shown here. If the transaxillary or TUBA approach is chosen for your procedure, your surgeon may use an endoscope, which is a thin tube with a camera and light on the end, to create the path from the armpit or belly button incision to the breast area.

Implant Placement

Saline implants are usually inserted into the breast empty. A tube attached to a valve on the breast implant allows your surgeon to use a syringe to fill it with saline after it has been inserted into the pocket. Once the implants are filled, your surgeon will visually inspect your breasts to ensure that they are symmetric. Your surgeon may add additional saline solution to one or both breast implants, adjust the pocket, or the position of the breast implant itself to ensure that the desired look is achieved. Once satisfied, your surgeon will remove the tube used to deliver the saline solution, sealing the implants. For the TUBA procedure, once the path from the belly button to the breast area is created, a tissue expander may be inserted before the breast implant. The tissue expander is temporarily inflated with saline or air, which stretches the pocket area to the correct size to accommodate the implant. The tissue expander is then emptied, removed, and replaced with the implant. Tissue expanders may also be used with other incision types, such as transaxillary, when recommended by your surgeon. The incisions are commonly closed using sutures in the breast tissue, and sutures, skin adhesive or surgical tape may be used to close the skin.

Recovery

Most breast augmentation procedures are done in outpatient surgery facilities, meaning you should be ready to go home the same day, usually within two to four hours. Before you leave, your doctor may fit you with a compression dressing or bra and prescribe medication to manage your pain for the first few days and as needed. It is a good idea to allow yourself several days to recover before resuming your daily activities. Be sure to follow your surgeon’s recovery plan, including activity and lifting restrictions, to avoid complications. If non-dissolving sutures were used, they will generally be removed in one to two weeks. The majority of the swelling will likely subside within a few days. However, some swelling may persist for several weeks. Risks and Results Consult your surgeon regarding how implants may affect breastfeeding and mammograms; risks such as rupture or capsular contracture, in which scar tissue may compress or distort an implant; and options for future revision since implants are not intended to last a lifetime. Although you will be able to notice your fuller breasts immediately after surgery, final results emerge only after the implants have settled and the swelling has subsided completely. The scars from your incisions will typically fade to thin, slightly discolored lines over several months. It is important to realize that your breasts will continue to change shape over time. However, the results from breast augmentation are typically long-lasting, which means that your breasts will maintain the fuller, shapelier appearance that you desire for years to come.

Breast Lift

Introduction

Changes to the breasts can be dissatisfying and make a woman feel as if she is losing her femininity and youthfulness. Over time, factors such as age, genetics, pregnancy, and breastfeeding, and weight and hormonal fluctuations can change the appearance of the breasts. Breasts that were once firm and shapely may begin to sag giving them a loose or heavy appearance. A breast lift, or mastopexy, can help restore a firmer, shapelier breast, which will improve body contours and give the breasts a perky, youthful appearance.

Breast Anatomy

It’s important to understand the structure of the breast in order to understand why breast shape changes over time. Your breasts are made up of primarily fatty (adipose) and glandular tissues which determine the size and shape. Firmness and lift are influenced by how well ligaments connected to the chest wall support your breasts. The fatty tissue and ligaments surround the milk-producing glandular tissue (lobules) and milk ducts. Breasts also contain blood vessels and lymph vessels that help the body fight off infection. The pectoralis muscles lie underneath the breasts, separating them from the chest wall. The breast does not contain muscle tissue, except for tiny muscle fibers in the nipple. The circular, darker region around the nipple is called the areola, and the nipple and areola region together form the nipple areola complex.

What Causes Breasts to Change Shape?

While many factors contribute to sagging of the breasts, the aging process and the effects of gravity play a primary role in breast changes. Over time, the skin around the breast loses its elasticity due to a gradual breakdown of the skin’s support network.Additionally, the suspensory ligaments that attach the breast to the chest wall weaken and stretch in response to gravity.Changes in the breasts during pregnancy and breastfeeding also play a part in the development of sagging breasts. Breast enlargement during pregnancy and breastfeeding causes the skin to stretch. Following pregnancy, the breasts reduce in size and the skin that was once stretched becomes loose and sags.Lastly, fluctuations in your weight and hormones can cause your breasts to change in appearance.In combination, these factors can cause the breast to sag and the areolae to enlarge and point downward.

Breast Ptosis and Surgical Technique

During a breast lift procedure, excess skin is removed, the breast tissue is reshaped, and the remaining skin is tightened.Additionally, large areolae may be reduced in size and moved to face forward. As a result, the overall shape of the breasts is improved as they are lifted to a new, upright position.Your physician will assess the degree of sagging, or ptosis, of your breasts to determine the type of breast lift procedure that is best for you. There are generally three degrees sagging, which are classified as minor, moderate, and severe. These classifications are determined by the position of the areola. There are four basic breast lift techniques known as the crescent, circumareolar, vertical, and anchor technique, used to correct various degrees of sagging. The crescent, or periareolar, technique involves a crescent or half-moon shaped incision made around the top of the areola. This technique is a minimally invasive procedure that achieves a small degree of lift. This technique is appropriate for individuals with small breasts or minor breast sagging.The circumareolar, or doughnut, technique involves a circular incision made around the areola. This technique is a minimally invasive procedure that achieves a small degree of lift and can be used to reduce areola size. This technique is appropriate for individuals with small breasts or minor breast sagging.The vertical, or lollipop, technique involves a v-shaped incision that extends around the top of the areola and down the midline of the breast. This technique is more invasive and it achieves a large degree of lift. This type of incision is appropriate for individuals with larger breasts and moderate to severe breast sagging.The anchor, or inverted T, technique involves an anchor-shaped incision that extends around the top of the areola and across the lower portion of the breast. This technique is the most invasive and it achieves the greatest amount of lift. This technique is appropriate for individuals with large breasts and severe breast sagging. This animation will explain the anchor technique, which is one of the most common breast lift techniques performed today.

Surgery Preparation

Breast lift procedures typically last one to two hours depending on the complexity of the procedure and whether an additional procedure, such as breast augmentation, is performed at the same time. Your surgeon will draw incision guidelines on your breasts. If the size of the areola is being reduced, the incision guidelines will show this change.Before surgery, an anesthetic will be administered. Your surgeon will determine whether local anesthesia with IV sedation or general anesthesia will be used.

Procedure

The physician carefully makes incisions along the pre-marked lines. The upper incision extends above the border of the areola.This area marks the new upper edge of the areola. The area below the areola will be pulled together and tightened, lifting the breast.Using a variety of surgical instruments, the physician lifts the skin and separates it from the tissues below. While the breast skin is removed, the areola/nipple complex is left intact.Some doctors may choose to use internal sutures within the glandular tissue or a mesh product to give the breast additional support.Once the excess skin has been removed, the new skin edges are brought together and temporarily held in place with surgical staples or clamps and the nipple/areola complex is slid into its new, higher position, revealing the basic shape of the new breast.The physician will close the incision by placing internal, dissolvable sutures around the new border of the areola and along the skin edges. Some physicians choose to place external sutures along the incision as well. Before closing the incision completely, the physician may place a surgical drain inside each breast. Lastly, surgical tape or bandages are applied to protect the incision sites as you heal.

Recovery

Breast lift procedures are typically done in outpatient surgery facilities, meaning you should be ready to go home the same day, usually within one to two hours following surgery. Before you leave, your doctor may fit you with a compression dressing or bra to help reduce swelling by preventing fluid buildup, as well as provide comfort and support as you heal. You may also be prescribed medication to manage your pain for the first few days and as needed. It is a good idea to allow yourself several days to recover before resuming your daily activities. Be sure to follow your surgeon’s recovery plan, including activity and lifting restrictions, to avoid complications and allow your body time to heal. If surgical drains are present, they, along with any bandages, will likely be removed within the first week following surgery, while any non-dissolvable stitches may stay in place for seven to ten days. Dissolvable sutures will be absorbed by the body in about four to eight weeks. You may experience some minor pain, bruising, and swelling, as well as numbness around the areola, all of which should decrease in several weeks.

Results

You will notice a dramatic difference in the shape and position of your breasts immediately following your procedure. You may continue to notice a change in the appearance of your breasts as swelling decreases. It may take up to one year before the final results from your procedure are apparent. Although you will have permanent scars following a breast lift, the scars may slowly fade to thin, white lines with time. It is important to realize that if you become pregnant after having a breast lift, the effects of pregnancy and breastfeeding may affect the results and cause your breasts to sag and change shape. A breast lift cannot stop the aging process, but it can improve the position of your breasts and create the shapelier appearance that you desire for years to come.

Breast Lift with Implants

Introduction

For those women who would like to increase the size of their breasts as well as restore a more upright, youthful position, a breast augmentation in combination with a breast lift, or mastopexy, can improve body contours and revitalize breast appearance. This animation will highlight the causes of sagging breasts, the breast augmentation with breast lift procedure, and what to expect after surgery. Breast Anatomy It’s important to understand the structure of the breast in order to understand why breast shape changes over time. Your breasts are made up of primarily fatty and glandular tissues which determine the size and shape. Firmness and lift are influenced by how well ligaments connected to the chest wall support your breasts. The fatty tissue and ligaments surround the milk-producing glandular tissue and milk ducts. Breasts also contain blood vessels and lymph vessels that help the body fight off infection. The pectoralis muscles lie underneath the breasts, separating them from the chest wall. The breast does not contain muscle tissue, except for tiny muscle fibers in the nipple. The circular, darker region around the nipple is called the areola, and the nipple and areola region together form the nipple areola complex.

What Causes Breasts to Change Shape?

While many factors contribute to sagging of the breasts, the aging process and the effects of gravity play a primary role in breast changes. Over time, the skin around the breast loses its elasticity due to a gradual breakdown of the skin’s support network.Additionally, the suspensory ligaments that attach the breast to the chest wall weaken and stretch in response to gravity.Changes in the breasts during pregnancy and breastfeeding also play a part in the development of sagging breasts. Breast enlargement during pregnancy and breastfeeding causes the skin to stretch. Following pregnancy, the breasts reduce in size and the skin that was once stretched becomes loose and sags.Lastly, fluctuations in your weight and hormones can cause your breasts to change in appearance.In combination, these factors can cause the breast to sag and point downward.

How a Breast Lift with Implants Works

During a breast augmentation procedure, breast implants are placed inside a pocket behind existing breast tissue. However, this procedure alone may not correct sagging breasts.During a breast lift procedure, excess skin is removed, the breast tissue is reshaped, and the remaining skin is tightened. As a result, the overall shape of the breasts is improved, and they are lifted to a new, more upright, youthful position. A breast augmentation in combination with a breast lift results in total breast rejuvenation by increasing the size of the breast while restoring a firmer, more youthful appearance.

Surgery Preparation

A breast augmentation in combination with a lift may last approximately two to four hours, depending on the complexity of the procedure and the surgical technique that is used.Your surgeon will draw incision guidelines on your breasts.Prior to the start of your procedure, an anesthetic will be administered. Your surgeon will most likely administer general anesthesia which causes you to sleep during the procedure.

Breast Augmentation Procedure

To begin the procedure, the surgeon will make a skin incision. The incision length, placement, and appearance may vary depending on the type and size of implant, your body contours, and the surgeon’s preference. If you are interested in learning about the different breast augmentation techniques, please view our breast augmentation animation.Your surgeon will separate the breast tissue in order to reach the area of the breast in which a pocket will be formed and carefully create the pocket where the breast implant will be placed.Breast implants can be placed in two general locations, known as either subglandular or submuscular placement. This animation depicts subglandular placement in which the breast implant is placed in a pocket formed beneath the breast tissue, but above the pectoralis muscle. You should discuss the benefits of the different implant placement options in more detail with your surgeon.There are two types of breast implants known as saline and silicone implants. This animation demonstrates the placement of silicone implants. Your surgeon will insert the implants into the pocket using fingers or a touchless device and will inspect your breasts to ensure they are symmetric. Adjustments may be made to the pocket and the position of the breast implant itself to ensure that the desired look is achieved.

Breast Lift Procedure

Once the breast implants are in place, the surgeon will begin the breast lift procedure. This animation demonstrates the vertical technique. If you are interested in learning about the different breast lift techniques, please view our breast lift animation.An incision is made along the pre-marked lines. The area that extends above the areola marks the new upper perimeter of the areola. The v-shaped area below the areola will be pulled together and tightened, lifting the breast.Using a variety of surgical instruments, the surgeon lifts the skin and separates it from the underlying tissues below. While the breast skin is removed, the areola/nipple complex is left intact. Some doctors may choose to use internal sutures within the glandular tissue or a mesh product to give the breast additional support. Once the excess skin has been removed, the new skin edges are brought together and temporarily held in place with surgical staple or clamps and the nipple/areola complex is slid into its new, higher position, revealing the basic shape of the new breast. The surgeon will close the incision by placing internal, dissolvable sutures around the new border of the areola and along the skin edges. Some surgeons choose to place external sutures along the incision as well. Before closing the incision completely, a surgical drain may be placed inside each breast. Lastly, surgical tape or bandages are applied to protect the incision sites as you heal.

Recovery

Breast lift procedures typically are done in outpatient surgery facilities, meaning you should be ready to go home the same day, usually within one to two hours following surgery. Before you leave, your doctor may fit you with a compression dressing or bra to help reduce swelling by preventing fluid buildup, as well as provide comfort and support as you heal. You may also be prescribed medication to manage your pain for the first few days and as needed. It is a good idea to allow yourself several days to recover before resuming your daily activities. Be sure to follow your surgeon’s recovery plan, including activity and lifting restrictions, to avoid complications and allow your body time to heal.If surgical drains are present, they, along with any bandages, will likely be removed within the first week following surgery, while any non-dissolvable stitches may stay in place for seven to ten days.Dissolvable sutures will be absorbed by the body in about four to eight weeks.You may experience some minor pain, bruising, and swelling, as well as numbness around the areola, all of which should decrease in several weeks.

Risks and Results

Consult your surgeon regarding how implants may affect breastfeeding and mammograms; risks such as rupture or capsular contracture, in which scar tissue may compress and distort an implant; and options for future revision since implants are not intended to last a lifetime.

You will notice a difference in the size, shape, and position of your breasts immediately following your procedure. You may continue to notice a change in the appearance of your breasts as swelling decreases. It may take up to one year before the final results from your procedure are apparent. The scars from your incisions will typically fade to thin, slightly discolored lines over several months. It is important to realize that your breasts will continue to change
shape over time. A breast lift with implants cannot stop the aging process, but it can restore the fuller, shapelier appearance that you desire for years to come.

Breast Reconstruction

Introduction

Women who have lost one or both breasts to cancer may desire to have their breasts reconstructed. Reconstruction may be done at the same time as the breast is removed via mastectomy (immediate reconstruction) or at a later time (delayed reconstruction), and is often covered by insurance. A variety of reconstruction options exist and can restore breasts to near normal shape, size, and appearance. Some options involve using a flap of your own tissue, called an autologous flap, which is taken from your abdomen, back, buttocks, or other areas to reconstruct your missing breast. Other options involve using a breast implant, which is an elastic silicone sac filled with sterile saline solution or silicone gel. Sometimes autologous flaps and implants are used together. The type of reconstruction you choose will depend on your body type, lifestyle factors, procedure risks and benefits, and personal preferences. Your plastic surgeon will help you decide which procedure is best for you.

Anatomy

The breast is composed of mammary glands and milk ducts surrounded by fatty tissue, which provides shape, and ligaments and connective tissue, which provide support. The pectoralis muscles lie underneath the breasts, separating them from your ribs. The breast does not contain muscle tissue, except for tiny muscle fibers in the nipple. The circular, darker region around the nipple is called the areola. Blood is supplied to the breast by a network of blood vessels, providing cells with oxygen and nutrients and removing wastes. Lymph, a fluid which helps fight infection and eliminate waste material, circulates through the breast and the rest of the body through a series of lymph vessels and lymph nodes. During a mastectomy, all fatty tissue, connective tissue, and glands are removed. Depending on findings and the extent of the cancer, lymph nodes in the armpit area may also be removed. Although there are skin-sparing and nipple-sparing mastectomy options, the nipple and areola are also commonly removed to minimize the risk of recurring cancer.

Preparation

A general surgeon and plastic surgeon will often work together to coordinate your care. Prior to your surgery, the surgeons will draw guidelines for your particular procedure, including any necessary markings for incisions, tissue flaps, or implant placement. General anesthesia will be administered, in which you are asleep and will not feel pain. Breast reconstruction procedures typically last anywhere from two to eight hours depending on which procedure is chosen and whether one or both breasts are reconstructed.

Options for Breast Reconstruction with Flaps

Options for reconstruction with autologous flaps can be done with what are known as either pedicle flaps or free flaps. Pedicle flaps remain attached to their original blood supply, whereas free flaps are completely detached from one area of the body and reconnected to tiny blood vessels in another area. The surgeon uses a microscope to visualize vessels from the harvested flap and attach them to vessels in the breast area, a technique known as microsurgery. Although weakness at the flap harvest site may be less of an issue because muscles are usually left intact, the microsurgery procedures are considered to be more complicated because vessels need to be carefully reattached to ensure adequate blood circulation and prevent loss of the flap. A table with some of the more common types of flaps, whether or not they are pedicle flaps, and factors to consider when making a decision is shown. The next parts of this animation will provide overviews of several of the more common reconstruction options.

TRAM Flaps

One type of flap harvested from the lower abdomen is the TRAM (transverse rectus abdominis muscle) flap. A TRAM flap may be performed as either a pedicle or a free flap procedure. An oval section of skin, fat, and muscle tissue may be taken from the abdomen. In the pedicle flap version, muscle tissue and blood vessels remain attached to provide blood to the flap. Depending on whether one or both breasts are being reconstructed, one or both halves of the flap will be used accordingly. The flap is tunneled under the skin to the chest area, creating the new breast mound. Although a TRAM pedicle flap has similarities with other flaps using abdominal tissue, it is a shorter surgery that avoids the complications of microsurgery. However, a disadvantage of the TRAM pedicle flap is that it is more likely to disrupt the muscle tissue, which can result in loss of abdominal strength. In the free flap version, skin and fatty tissue are detached from the abdomen. Microsurgery is used to attach blood vessels in the chest to the newly placed flap. The free flap version may allow the surgeon to spare most, if not all, of the abdominal muscle.

DIEP & SIEP Free Flaps

Two similar types of flaps from the abdominal region are named for the vessels that nourish them. A DIEP (deep inferior epigastric perforator) flap uses tissue that has as its primary blood supply the deep inferior epigastric artery and vein. A SIEP (superficial inferior epigastric perforator) flap has as its primary blood supply the superficial inferior epigastric artery. In both a DIEP and SIEP free flap procedure, an oval incision is made in the abdomen, and skin and fat tissue are excised. Similar to a TRAM free flap, the surgeon uses microsurgery to attach vessels to their new blood supply.

Gluteal Free Flaps

Two types of flaps that are obtained from the buttock region are also named for the vessels that nourish them. An SGAP (superior gluteal artery perforator) free flap uses skin and fat tissue that has as its primary blood supply the superior gluteal artery and vein. An IGAP (inferior gluteal artery perforator) free flap uses tissue that has as its primary blood supply the inferior gluteal artery and vein. The oval-shaped tissue flap for an SGAP is taken from the upper buttock, whereas tissue for an IGAP is taken from the lower buttock. Microsurgery is used in this procedure as well, allowing blood vessels from the chest to be attached to those in the flap.

Latissimus Dorsi Pedicle Flap

A Lat (Latissimus Dorsi) Pedicle Flap uses tissues from your upper back to form a new breast mound. The Lat flap procedure is named for the large latissimus dorsi muscle, located below the shoulder blade and under the armpit. The procedure involves moving muscle, skin, and fat from this area around to the front of the chest to reshape the missing breast tissue. The muscle remains attached to the armpit area and blood vessels are left attached and intact to provide blood to the flap.

Options for Reconstruction with Implants

As you realize, breast reconstruction has many options. Implants may be used alone or in combination with a flap procedure to recreate the missing breast mound. If a skin-sparing mastectomy is performed, wherein much of the breast skin is preserved, an implant alone may be used to reconstruct the breast immediately. As soon as the general surgeon has completed the mastectomy, the plastic surgeon will insert the implant under the pectoralis muscle to hold it in place. If the mastectomy leaves the skin on the chest flat and tight, a two-stage implant process may be used. During the first stage, a temporary tissue expander is positioned and slightly expanded with a small amount of sterile salt water, called saline solution. The tissue expander is gradually enlarged over a period of several weeks by injecting a small amount of saline at regular visits. When the tissue expands to the desired size for your new breast, the second stage of the procedure replaces the expander with a permanent saline-filled or silicone gel-filled breast implant. In some instances, the tissue expander is left in place to serve as the implant and the second stage of the procedure is not necessary. Cancer treatment with radiation may reduce the likelihood of a successful implant procedure and should be discussed with your surgeon.

New Techniques and Additional Support

While popular breast reconstruction procedures have been highlighted, surgeons are actively exploring and testing new techniques to improve outcomes. Sometimes breast reconstruction procedures benefit from additional support for growth and healing. Surgeons may use a synthetic mesh or products created from donated human or animal skin for this purpose. Products made from donated skin, known generically as acellular dermal matrix, have had the cells removed, which prevents the body from rejecting the material and prevents the transmission of diseases. Synthetic mesh and acellular dermal matrix products may accommodate the size and weight of implants or flaps, repair and support abdominal tissues after the flap relocation, and facilitate surrounding tissues nourishing the new breast tissue during healing.

Procedure

Regardless of which type of reconstruction option is chosen, an incision is made in the chest, either from an immediate mastectomy procedure or along the scar of a previous mastectomy. A pocket-like opening is formed to hold the flap, expander, or implant. If a pedicle flap procedure is done, a tunnel is created under the skin from the harvest site to the chest, and the tissue flap is gently pushed through the tunnel up to the breast area. Once the flap is in place on the chest and properly attached to its blood supply, drain tubes are typically placed near the harvest site to prevent fluid buildup. For free flaps and reconstruction with implants or expanders, drain tubes may also be placed in the reconstructed breast tissue to collect fluid during healing. Once the flap, expander, or implant is positioned, incisions are closed with sutures, skin adhesive, or surgical tape.

Recovery

Depending on your type of reconstruction, you may remain hospitalized for up to a week or more. You will most likely experience bruising and swelling after surgery, which may subside within a few days, or persist for several weeks to a couple of months. It is important to note that since nerves are cut in the course of the surgery, your reconstructed breast typically does not retain normal sensitivity. Drain tubes are usually removed a few days after your surgery and if your surgeon has used non- dissolving sutures, they will typically be removed in a week or two. Scars from the incisions will fade considerably over time, but typically do not completely disappear. Your doctor will give you detailed instructions for your recovery period, including lifting and activity restrictions, and whether you need to wear a support garment to provide stability during healing.

Revisions

While your initial reconstruction procedure creates the breast mound, you have the option to undergo subsequent procedures to give your breasts a more natural appearance. These may include revising the reconstructed breast or the opposite breast to achieve a more symmetrical appearance, and procedures to create a nipple and areola. A nipple can be formed using existing breast skin and tissue. Sometimes skin can be taken from elsewhere on the body and used to create the areola. After healing, areolar pigmentation may be achieved by tattooing the reconstructed nipple and the surrounding area. You are now familiar with some of the wide variety of options for breast reconstruction. New approaches are being considered as well, and the popularity of current procedures may change as techniques evolve. Your surgeon will help you evaluate the options to determine which procedure is best for your particular body and lifestyle.

Breast Reduction

Introduction

Breasts that are excessively large in proportion to body size are a frequent cause of back and neck pain as well as shoulder irritation from bra straps. Additionally, sleep and participation in certain activities may be affected, and the likelihood of rashes and infections in the folds underneath the breasts increases. Fortunately, an operation known as breast reduction or reduction mammoplasty achieves good results in alleviating these problems. A reduction removes extra breast tissue, reshapes the breasts, and lifts them to a more upright and youthful position; additionally, uneven breasts can be made more even. Although an improved appearance is often a benefit of the operation, breast reduction is reconstructive in nature, and the goal of this procedure is to alleviate symptoms.

Breast Anatomy

Your breasts are made up of primarily fatty and glandular tissues which determine their size and shape. The fatty tissue and ligaments surround the milk-producing glandular tissue (lobules) and milk ducts. Breasts also contain blood vessels and lymph vessels that help the body fight off infection. The pectoralis muscles lie underneath the breasts, separating them from the chest wall. The breast does not contain muscle tissue, except for tiny muscle fibers in the nipple. The circular, darker region around the nipple is called the areola, and the nipple and areola region together form the nipple areola complex.

Surgical Technique Variations

Reduction techniques vary depending on breast size and shape, the amount of tissue to remove, and other factors such as scarring or the need for future breastfeeding. Common procedures include an anchor incision, a vertical incision, a free nipple graft, and liposuction.

The anchor or inverted T technique extends around the top of the areola, downward, and across the lower portion of the breast.

The vertical incision technique extends around the top of the areola with a v-shaped incision down the midline of the breast.

The free nipple graft removes the nipple and areola and replaces it higher on the breast after removing tissue.

Liposuction can also be used alone or in combination with another technique to remove excess fat from the breasts in certain candidates.

This animation will explain the common anchor technique, in which the nipple and areola remain attached and are moved upwards to a new position after underlying breast tissue is removed. Your surgeon may use other techniques depending on your specific conditions.

Surgery Preparation

During an initial consultation, your surgeon will measure the size
and shape of your breasts and evaluate surgical options,
determine your desired nipple placement, and preplan the
procedure.

The breast reduction procedure typically lasts from two to three
hours. Prior to the procedure, your surgeon will draw incision
guidelines on your breasts.

Before surgery, you will be placed under anesthesia. Your surgeon
will determine whether to use local anesthesia with IV sedation or
general anesthesia.

Procedure

Incisions are made along the pre-marked lines and excess skin is removed. Next, portions of underlying fat and glandular tissue are removed. The nipples and areolae, which remain attached to their original blood and nerve supplies, are raised to their new positions. Next, the skin beneath the areolae is brought together and closed with dissolvable internal sutures to reshape the new smaller breasts. Some surgeons choose to place external sutures along the incision as well. Before closing the incision completely, a surgical drain may be placed in each breast to allow fluids to escape as you heal. Surgical tape or bandages will be placed on the breasts, and typically you will be wrapped in an elastic bandage or placed in a compression garment or bra, which helps to maintain your breast shape while you heal.

Recovery and Results

Typically, breast reduction procedures are performed in an outpatient center and you should be able to go home the same day. Swelling and discoloration after the procedure are normal and will subside over time. If surgical drains are present, they, along with any bandages will likely be removed after a day or two. External sutures are removed after one to two weeks, and you may be instructed to wear the compression garment, avoid sleeping on your stomach and avoid excessive exertion or heavy lifting for a month or more. You may be prescribed medication to manage your pain for the first few days and as needed. Scarring along the lower centers and creases of the breasts is normal, but your scars will fade considerably over time. Patients typically experience high satisfaction with reduced back, shoulder, and neck pain, an improved ability to participate in physical activities, and a new appearance with smaller, shapelier breasts.

Fat Transfer

Introduction

For those who would like to decrease unwanted fat in specific body areas while restoring or adding volume to other areas of the body, a fat transfer can improve body contours and revitalize overall appearance. This animation will highlight the fat transfer procedure including how fat is removed from certain areas of the body using liposuction, the process of transferring fat into a targeted location, and what to expect after surgery.

How a Fat Transfer Works

Over time, the contours of the body change due to the effects of aging, gravity, and weight and hormonal fluctuations. Additionally, unwanted fat may accumulate in areas such as the abdomen, back, buttocks, and thighs. A fat transfer procedure works by removing unwanted, excess fat through liposuction and injecting it into areas of the body where rejuvenation is desired. The face, breasts, and buttocks are three common areas that can be revitalized using fat injections. Signs of aging in the face and neck occur for many reasons, such as heredity, skin type, sun exposure, and lifestyle choices. Several areas of the face can be treated with a fat transfer including the cheeks, forehead, nose, chin, under-eye area, jawline, temples, and lips. A fat transfer, sometimes performed in combination with a face lift, can reduce the appearance of wrinkles, frown lines, or depressions while revitalizing the contours of the face. Women who are dissatisfied with the size of their breasts or have experienced changes in breast appearance can achieve fuller, shapelier breasts with a fat transfer breast augmentation. A fat transfer breast augmentation results in only a small increase in the breast size, but offers natural-looking results. Weight loss, aging, and heredity may cause you to be unhappy with the size and shape of your buttocks. A buttock augmentation using fat transfer can help add volume and create a more youthful, shapelier appearance. This animation will highlight a fat transfer procedure used for buttock augmentation, also known as a Brazilian Butt Lift.

Preparation

A buttock augmentation by fat transfer may last approximately one to four hours, depending on the complexity of the procedure and whether an additional procedure is performed at the same time. Your surgeon will carefully mark the areas where fat will be removed, and the areas where fat will be injected. These markings will be used as guidelines during the procedure. Fat transfer may be performed under local anesthesia where only the surrounding area is numb. Alternatively, for procedures involving large or multiple areas of the body, you may be asleep under general anesthesia. A special medicated fluid called tumescent fluid is injected into the areas that will be treated with liposuction. This fluid expands the tissues, to make it easier to remove fat cells, numbs the treatment area, and minimizes bleeding. Once a large volume of tumescent fluid is injected into the treatment area, you will rest for several minutes while the area becomes completely numb.

Procedure

Your surgeon will begin the procedure by using liposuction to harvest your fat. Excess fat is removed from areas of the body including the jowls, back, abdomen, thighs, and buttocks. Most body fat is located on top of muscle tissue, just beneath the skin. Liposuction works by surgically removing excess fat with a suction device, resulting in improved contours in the desired area. Depending on the location of the procedure, your surgeon will make short incisions along natural creases of your body in order to easily conceal scars. Your surgeon will insert a small tube-like device, called a cannula. Using a forward and backward motion, small tunnels are created in the fat layer, removing the fat with a gentle suction. The tunnels will collapse over the next few weeks, resulting in new contours in the specific treatment areas. For more information on the liposuction procedure, please view our liposuction animation. Next, the undamaged fat cells that were removed are isolated, cleansed, and prepared to be injected into the buttocks. Some surgeons may prepare the fat with stem cells before injection. Then, your surgeon will use a cannula to inject the fat cells into your buttocks. Using a forward and backward motion, fat is slowly added in multiple areas until the desired volume is achieved. The incisions may be closed with sutures or may be left open. Surgical drains may be inserted in order to help prevent fluid buildup. Lastly, absorbent pads are applied to protect the incision sites as you heal.

Recovery

Most fat transfer procedures are completed in outpatient surgery facilities; you should be ready to go home the same day, usually within two to four hours. You will likely need to wear a compression garment for a few weeks to provide support, minimize swelling, and help the skin conform to the new contours of the body. You may also be prescribed medication to manage your pain for the first few days and as needed as you heal. It is a good idea to allow yourself several days to recover before resuming your daily activities. Pain and bruising after the procedure are normal, and typically will fade within a couple weeks. Swelling also may occur and should subside within several months. If surgical drains are present, they along with any bandages will likely be removed within the first week following surgery, while any non-dissolvable stitches may stay in place for seven to ten days. Be sure to follow your surgeon’s recovery plan, including sitting and sleeping position restrictions, in order to avoid complications and allow your body time to heal.

Risks and Results

Consult your surgeon regarding risks such as cysts, infection, small mineral deposits called microcalcifications, and death of fat cells. You also may need to discuss options for future fat transfers as it may take more than one procedure to achieve your desired look. While you will most likely notice an improvement immediately after the procedure, final results will not be apparent until one year after surgery. You should have initial satisfaction with the size and shape of the buttocks after surgery, however much of this is due to swelling and the results may diminish over time. Although fat cells are removed permanently during the procedure, it is important to realize that fat transfer does not prevent growth of remaining fatty tissue. Additionally, fat cells injected into the buttocks may disperse from the injected area. Your results may also change if you gain or lose weight. With realistic expectations and proper maintenance, you may enjoy the results of your fat transfer procedure for several years.