Radiant Life – RLM Success Files features breast augmentation by Dr. Joseph A. Mele.
As seen in Radiant Life Magazine. (Click to enlarge.)
Radiant Life® Magazine is The Aesthetic Wellness Magazine, and is dedicated to innovations in cosmetic plastic surgery. The current issue of Radiant Life® features an article by Lindsay Haakenson on the latest innovations in Breast Augmentation entitled Breast Surgery 2.0.
Radiant Life Magazine approached me with a short deadline and the need for an example of modern breast augmentation. My staff contacted a few of our many satisfied patients. Jennifer was the first to respond, and she immediately agreed to both an interview with Radiant Life Magazine and the use of her pictures, and for that she gets my sincere thanks. This is a true testimonial* to how worthwhile breast augmentation surgery has been for her. Thanks goes out to my other happy patients who also graciously responded, and to Lindsay Haakenson for including me.
Jennifer first came into the office for a consultation after noticing her breast volume had decreased after pregnancy. She was interested in restoring what mother nature had both given and then taken away. She expressed a desire to maintain proportions with her body, and wanted a natural look that would be attractive, without being distracting.
The excerpt to the right is from the Breast Surgery 2.0. At the top are her breast augmentation before and after pictures. Before submuscular (subpectoral) breast augmentation, her breasts where asymmetrical, small, had a relatively low set nipple and a constricted base. The distance between the nipple and the inframammary fold was short, and the remaining breast tissue was firm. She had a mild form of what is sometimes referred to as a tubular breast.
The simplest way to correct a tubular breast is with a subglandular breast augmentation. Often a periareolar mastopexy is performed to lift and reshape a protruding nipple/areolar complex at the same time. Okay, that may not sound so simple, and in Jennifer’s case, the easiest way was not necessarily the best way.
Every patient requires careful thought and consideration. In Jennifer’s case, the tubular deformity was mild, and a periareolar breast lift was not needed. The lack of breast tissue higher on the chest meant that the upper pole of the implant was more likely to be seen. A saline implant was placed behind the muscle to help soften the upper pole of the implant, and to give a more teardrop shape. A periareolar incision was used, and this, as is usual, healed very well.
For a more pronounced tubular breast deformity, this approach may not work. Unlike the approach using a periareolar lift, it will not correct a bulging areola that is often seen in concert with the narrow constricted breast base. If you are considering breast augmentation, it is important to seek a qualified and experienced, board certified plastic surgeon, so that the safest and most predictable plan can be constructed.
I want to thank Jennifer for volunteering to share her results with you. The best part of my job is helping my patients. I am thrilled that Jennifer is happy with the results of her breast augmentation.
* As per the latest American Society of Plastic Surgeons Code of Ethics this is a true testimonial. I have not reimbursed my patient in any way for her kind words, and I have not paid Radiant Life Magazine to be included in this article. To read the entire Radiant Life Magazine article, click here. You need to be able to view pdf files in order to display the contents properly. To download the latest version of Adobe Reader for free click here.
Whether you are considering breast enhancement, or already have breast implants, this video discusses the most frequent reasons why corrective surgery is needed and includes before and after pictures and live viewer questions.
This is part two of two from an episode of KRON 4′s Body Beautiful with Vicki Liviakis that aired last month. This video discusses breast augmentation revision surgery, including before and after pictures and viewer questions.
Specific examples are shown. The first patient (shown below) had breast augmentation in her twenties. Years later, she had children and was not happy with the changes in her breast resulting from pregnancy and breast feeding. Before and after breast augmentation revision surgery pictures are shown. In her case a breast implant exchange and breast lift and were performed to adjust for lost volume and improve the shape of the sagging breasts.
A different patient had breast implant bottoming out. In her case the implants had fallen below the inframammary fold leaving the nipples high and flattening out the normal curve beneath the breast. Corrective beast augmentation surgery included breast implant implant exchange to adjust the volume, and the inframammary fold was reconstructed internally to raise the implant and form a distinct curve beneath the breast.
The caller in this video had a question about ruptured silicone gel implants that were placed in the 1970′s. If any breast implant has ruptured, it needs to be removed. Most frequently, a ruptured breast implant is replaced at the same operation. Silicone gel implants in particular should be removed sooner than later. A ruptured silicone gel implant, over time, can cause increased scarring and hardening of the breasts, as the body tries to wall off the free gel. If not treated promptly, this type of scarring can lead to further problems than may not be correctable.
Silicone gel filled implants placed before 1985 seem to have a higher deflation rate than the new silicone breast implants. In fact, the outer shell of silicone breast implants has changed twice since the 70′s. The first change, in the mid 80′s, was to decrease the rupture rate. The second change, in the mid 90′s, was to reduce gel bleed (the ability of the silicone gel to leak through outer shell without a rupture). Both US FDA approved breast implant manufactures, Allergan and Mentor, offer lifetime replacement of their implants should they fail, and often provide financial support should this occur within ten years of your breast augmentation procedure. For details of the Mentor and Allergan (Natrelle) Breast Implant Warranties click on the manufactures names. It is best to get the information direct from the manufacturer; however, the Mentor site has been going through some changes, perhaps with the merger with Johnson & Johnson, so if you can’t link there, JustBreastImplants.com also has information on breast implant warranties.
Breast Augmentation is currently the most frequently performed cosmetic plastic surgery procedure. Whether you are considering breast enhancement, or already have breast implants, this video discusses the most frequent reasons why corrective surgery is needed.
Breast augmentation revision surgery is sometimes necessary even in the best of hands. Revision surgery can range from simple, like changing breast implants after deflation or changing sizes, to more complicated, like when treating breast ptosis (sagging) or capsular contracture. The best way to reduce your risk of needing breast revision surgery is to choose a qualified Board Certified Plastic Surgeon.
If you need breast revision surgery, choosing a well trained Board Certified Plastic Surgeon with a broad experience in breast enhancement surgery is the best way to get a satisfying result. By choosing a Board Certified Plastic Surgeon who specializes on cosmetic surgery, you get a doctor who is well trained and well rehearsed in a wide range of treatment options.
Breast implant revision in San Francisco is no different than in other areas of the United States. Sometimes the results of the breast augmentation where just not what was expected. Other times, the result were great and either the breasts change, the implants change or the desires change. When these situations arise, breast augmentation revision surgery could be your best option to get back into the shape you want.
This is part one of two from an episode of KRON 4′s Body Beautiful with Vicki Liviakis that aired last month. This video discusses breast augmentation revision surgery. Part two will include more discussion, before and after pictures and viewer questions.
The best way to be certain your plastic surgeon is appropriately trained to perform breast augmentation surgery is to make sure that he or she is a Board Certified Plastic Surgeon. By choosing a Plastic Surgeon who is a member of the American Society of Plastic Surgeons (ASPS), you can be certain that their credentials have been verified. ASPS members are held to higher standards in ethical care of patients and continuing medical education requirements. ASPS standards are above and beyond those required by State licensing boards and hospital credentialing committees.
A small percentage of ASPS members are also members of the American Society for Aesthetic Plastic Surgery (ASAPS). ASAPS members are ASPS members who specialize in the cosmetic side of Plastic Surgery. ASAPS members must meet the standards of ASPS, apply independently for membership to ASAPS and demonstrate a commitment to cosmetic plastic surgery both in education and in patient care.
ASPS is the largest plastic surgery specialty organization in the world. Founded in 1931, the society is composed of board-certified plastic surgeons who perform cosmetic and reconstructive surgery. ASAPS is the leading organization of board-certified plastic surgeons specializing in cosmetic surgery of the face and body, and I am proud to be an active member of both.
Next time I will talk more about the reasons for breast augmentation revision surgery and how a qualified Plastic Surgeon can help.
Walnut Creek Plastic Surgeon (San Francisco Bay Area, East Bay) Joseph A. Mele, III, MD, FACS, will be appearing on KRON channel 4′s, Body Beautiful this Monday, September 14, 2009, at 11:00 AM.
KRON4′s Body Beautiful, is a weekly news show hosted by News Anchor Vivki Liviakis. It originates right here in San Francisco and is know through out the Bay Area for its coverage of the lastest trends in cosmetic plastic surgery.
This week’s topic will be breast augmentation, specifically breast implant revision surgery. Information about breast augmentation and the most common reasons for breast implant revision will be presented. Topics will include, choosing the best breast implant size, breast implant deflation, capsular contracture, dealing with breast asymmetry, and how to decrease your risk of needing breast augmentation revision surgery.
If you have questions that you would like me to answer on air, please send them via the contact form on this page. Please do mention that you would like me to answer your question on Body Beautiful, otherwise all inquiries are kept confidential. Alternatively, you can send your questions directly to KRON4 via the Body Beautiful web page. You can also phone into the studio while we are on the air, and get your questions answered live.
Previous shows discussing breast augmentation, tummy tucks, liposuction, eyelids surgery and many other cosmetic plastic surgery procedures can be found on my website in the DrMele.com Video Gallery
A unique aspect of Body Beautiful is it live broadcast live. Broadcasting live allows for more a more dynamic and interactive presentation. A segment of the show will be dedicated to viewer questions. So be sure to call in.
Breast augmentation has become the most frequently performed cosmetic plastic surgery procedure. As a result, breast augmentation revision has also increased. This topic has been discussed previously under breast asymmetry and capuslar contracture. There are many reasons for breast implant revision surgery San Francisco; they can be divided into three main groups.
Breast implant size – Perhaps the most common reason for breast implant revision surgery. The breast implant and pocket may both be fine, but there is a desire to change the size of the breast augmentation. By far, the most common change is to place larger breast implants, but reducing breast implant size and correcting asymmetry for size also are included in this category.
Breast implant leak – Failure of the implant, and loss of the filling volume is another common reason for breast implant revision. Saline filled breast implants rapidly lose volume and it is clear that there is a problem. Silicone gel filled breast implants may require an MRI to determine if there is a leak. Regardless of the type of implant, if there is a leak, it needs to be replaced.
Pocket problems – The pocket around the implant is normally lined with a thin soft scar. When the scar becomes too thick or too tight this is called capsular contracture. In its advanced stages, capsular contracture can lead to a firm, tight, immobile breast, which in severe cases becomes painful. On the other hand, if the scar is too soft and loose, the implants can move too much. This can lead to implants that are bottoming out (too low) or the implants may fall to the side when laying down (like natural large breast do).
Here is another example of breast augmentation revision surgery bay area. This patient presented to my Walnut Creek plastic surgery office. Overall, she was happy that she had breast implants, but she had several aspects that she wanted improved.
Her bra would ride up onto the lower pole of her breast with exercise.
Her implants had bottomed out.
Her breast implants were asymmetric (more bottoming on the right).
Her implants were a little small still.
Her nipples were too prominent, noticed more after her primary breast augmentation.
Her nipples were asymmetric.
The following procedures were discussed:
Capsulorrhaphy – literally means capsule tightening. The lower pole of the capsule is closed to lift the implant higher on the chest. Capsulorrhaphy is also performed to move implants out of the armpits. Larger implants and weaker soft tissues increase the risk of implant malposition, and recurrence of the problem.
Creation of an New Inframammary Fold (IMF) – This is a difficult procedure to get right, and it is worth finding a Board Certified Plastic Surgeon who has experience with this type of correction. The IMF is purposefully formed slightly higher than the desired result as there is almost always some stretching again after surgery. This procedure and capsulorrhaphy can both improve asymmetry. A defined IMF is important to keep the bra in the correct position and to allow the bra to support the breast properly.
Breast Implant Exchange – Whenever breast augmentation revision is performed, it is worth considering whether to replace the implants. Implant volumes are most commonly increased during breast revision surgery. Sometimes the volumes are reduced and sometimes the volumes are adjusted to help compensate for asymmetry. The implants can also be exchanged between saline and silicone gel. As is often the case, a slightly larger implant was desired. Larger implants can increase the risk of bottoming out. Smaller implants will increase the reliability of the capsulorrhaphy and IMF repairs. Smaller implants are lighter, and less weight means a better chance for long term correction.
Nipple Reduction – Generous nipples can be reduced in size. The scar lies in the crease at the base of the nipple and is very difficult to see.
Periareaolar Breast Lift – The periareolar scar can be used to move the nipple/areaolar complex (nipple and the dark skin around it) in any direction. As with a breast lift, the scar goes around the areola. In this case, the right nipple is significantly higher than the left; however, since the patient was not really bothered by her nipple position, it was not fixed.
Breast Augmentation Revision with Nipple Reduction - Before (left) and After (right)
The previous implants were removed, a capsulorraphy was performed, additional work was done internally to form a new IMF, and new implants where placed via a periareolar scar (from 4 to 8 o’clock). The volume was increased from 300 to 350 cc’s using saline filled implants. In addition, the nipples were reduced with an incision that runs around its base. The nipple is still high on the right, and could be improved by further raising the breast implants. However, for the sake of the left breast, it is better to keep the implants in their current position. While this leaves the right nipple high, it avoids creating a low (sagging looking) nipple on the left.
Notice the improvement of the angle at the bottom of the breasts. It is no surprise that the bra was ridding up onto the breasts before surgery. After recreation of the IMF, it is higher, smooth and well defined.
Breast asymmetry is more the rule than the exception, and there are many ways in which breasts can be uneven. Size, shape and location all come into play. Asymmetry may effect the entire breast mound (see previous post) or just the nipples. Normally, the differences are small; however, as the magnitude of breast asymmetry increases, so does the desire for correction.
In my San Francisco Bay Area (Walnut Creek) cosmetic plastic surgery practice, I measure the differences between the breasts both subjectively and objectively every day. Small differences frequently go unnoticed. Often, asymmetry is first noted in the consultation for breast augmentation. When the difference is obvious, however, breast asymmetry can be the driving force toward seeking consultation with a Board Certified Plastic Surgeon.
This post is focussed primarily on areola asymmetry (the darker skin around the nipple) and nipple asymmetry (the raised part in the middle). Look for a post on breast asymmetry (the breast mound itself), including breast implant asymmetry, in the very near future.
One of the most common nipple asymmetries is caused by inversion (retraction) of the nipples. Inverted nipples can occur on one or both sides. Inverted nipples and even bifid (split or duplicated) nipples can be treated with minor surgery.
Before correction the nipple and part of the areola are hidden.
Inverted nipples are caused by short mammary ducts that pull the nipple inside the breast tissue. In the most pronounced forms even the areola maybe hidden. The scar for inverted nipple correction is normally hidden in the fold beneath the nipple. Since correction involves releasing the tight ducts, correction may interfere with the ability to breast feed, and this should be discussed with your plastic surgeon prior to surgery.
After correction the relatively large nipple can now be seen.
The size and shape of the nipple can also be adjusted.
Close-up of breast showing appearance of nipple enlargement after pregnancy.
Overly large nipples can be reduced in length and girth. In general, it is easier to reduce a large nipple than to enlarge a small one. Nipple reconstruction is performed after a mastectomy when the nipple is absent. With nipple reconstruction, especially when the breast has received radiation, the most difficult aspect is creating and maintaining nipple projection.
Close-up of breast showing appearance of nipple after nipple reduction.
There are times when the nipples are normally formed, but their location on the breast is asymmetric or they are just too low. Modest changes in nipple location can be improved with a periareolar approach. Several centimeters of motion can be safely accomplished with this method. The same periareolar technique can also be used for areolar reduction or to correct the overly full areola, as seen with a tubular breast deformity.
Larger asymmetries may require surgery similar to a breast lift. Formal breast lifts allow the larger movement of the nipples, and reshaping of the entire breast mound. See the previous San Francisco Plastic Surgery Blog posting by clicking here Breast Mound Asymmetry San Francisco: Breast Mound, Breast Implants. There are many types of lifts, and each has its own pros and cons. The art of Plastic Surgery is choosing the best approach for each individual San Francisco breast asymmetry patient. This will be the topic of a future posting.
There are many ways in which breasts can be uneven. Size, shape and location are the most common. There can be asymmetry of the nipples as discussed in Breast Asymmetry San Francisco: Inverted Nipples and Asymmetry, or asymmetry of the breast mounds themselves discussed here. If the differences are small, everything appears normal; however, as the magnitude of asymmetry increases, so does the desire for correction.
There are times when the nipples are normally formed, but their location on the breast is asymmetric or low. This post will discuss breast mound asymmetry, including breast implant asymmetry and nipple location.
Modest changes in nipple location can be improved with a periareolar approach. In these cases an incision is made around the areola and differing amounts of skin are removed to move the nipple and areola in the desired direction. Several centimeters of motion can be safely accomplished with this method.
The same periareolar technique can also be used for areolar reduction. When the areola is too large, it be reduced to better match the proportions of the breast. The periareolar technique can also correct the overly full areola, as seen with a tubular breast deformity.
Larger asymmetries, require greater movement of nipple areola, and are accomplished with surgery similar to a breast lift.
Before breast augmentation and formal breast lift. Note the asymmetries. On left side (patient's right) both the breast mound and the nipple areola complex are larger and lower.
Formal breast lifts are also know as inferior pedicle breast lifts, inverted-T breast breast lifts or anchor scar breast lifts. This is the most versatile of the breast lift and allows for the largest movement of the areola and nipples, as well as reshaping of the entire breast mound. Larger corrections are possible with preservation nipple sensation and circulation.
After breast augmentation and an "inverted-T" breast lift. The periareolar and vertical components of the scar can be seen. The horizontal scar is hidden in the inframammary fold.
There are many types of breast lifts and each has its pro’s and con’s. The art of Plastic Surgery is choosing the best approach for each individual San Francisco breast asymmetry patient. I call this, using the smallest hammer necessary to get the job done. While bigger lifts leave a longer scar, choosing too small a lift still leaves a scar but it does not correct the original problem.
Breast revision surgery has become an important part of my walnut creek plastic surgery practice. Today’s post is a case presentation of breast augmentation revision surgery for a woman who developed capsular contracture.
The patient presented after a previous breast augmentation. She was naturally flat and two Mentor moderate profile 525 cc saline filled implants accounted for the majority of her breast mound. She had developed firmness in her right breast after a flu-like illness and the right breast became progressively smaller, higher, and firmer, but was not painful (Baker’s class III*). She was primarily concerned about restoring her symmetry; as is often the case however, she also desired a little more volume.
The picture on the left shows the breasts before surgery. The right breast mound with capsular contracture is tight, high, laterally displaced when compared with the right breast mound. Her right nipple is also lower.
An open capsulotomy was performed on the right breast for capsular contracture. Utilizing the previous periareolar incisions, the right capsular contracture was released and both implants were exchanged for Allergan Natrelle style-15 752 cc silicone gel implants. The right implant was lowered to a more symmetrical position. This and the capsular release allowed some upward migration of the nipple without having to do a lift and without adding any new scars.
San Francisco breast augmentation patients who are dissatisfied with their appearance due to capsular contracture will want to consider breast augmentation revision surgery. It can be performed on an outpatient basis and recovery is often simpler than the origin breast augmentation. Capsular contracture can recur after revision surgery, but the chances of this are not increased by the fact that it has happened before.
