Breast

Breast Surgery

The art and science of breast augmentation and enhancement has improved considerably over the past several years. Now with the Natrelle® Collection women have beautiful and safe options for breast augmentation never before possible. The Natrelle® Collection is the result of 25 years of experience with the science and aesthetics of breast augmentation and enhancement and represents the very best in breast augmentation and enhancement technology.

 

Breast Enhancement

Enlargement/Augmentation, Reduction, and Other Breast Procedures:

What is breast enhancement? Cosmetic surgery of the breast can help patients achieve a sense of confidence and desired proportions – whether that be from an augmentation or enhancement with an implant, a breast reduction, a breast lift, or a combination of the above.

Breast Augmentation
Breast Reduction
Breast Lift
Breast Reconstruction

Breast Augmentation
(Breast Enhancement, Augmentation Mammaplasty, Breast Enlargement)

Breast augmentation enhances breast shape and size, corrects a loss of volume after pregnancy, improves symmetry, and will give the breasts a small lift.

dr-fisher-breast

breast-augmentation-before-and-afterDeciding What’s Best For You

Your own decisions will increase your satisfaction with breast augmentation and other enhancement procedures. Dr. Orna Fisher is a highly trained Plastic Surgeon which specializes in Breast Surgery.  Your surgeon will help decide on several important choices such as:  to use silicone “gel” implants or saline implants, to place the implant in front of or behind the muscle, the incision site, and the size. You will have the opportunity to examine the different types of implants and talk with staff who have had both silicone and saline implants.   Saline implants behind the muscle gives a natural look, helps reduce the risk of implant hardening, has little risk with deflation, and minimizes interference with breast examinations and mammography. Silicone implants are the most widely used implants and are made by Allergan and Mentor both of which we have extensive experience with.   The gel implants used are the newest generation of “cohesive gel” implants. The media has liked the term “gummy bear” implant. The true gummy bear is an even more cohesive gel implant, the style 410, which is more recently available in the  US. These are a shaped implant, and may feel firmer. The current generation available here is the third generation of cohesive gel, which is softer. As for how to choose, the look of saline and gel is similar.

There are three different incisional approaches that can be used: in the axilla (armpit,) periareolar (a small incision at the junction of the areola and breast skin), or inframammary (underneath the breast where an underwire goes.) Again there are pros and cons to each, which will be reviewed during  your consultation.  It’s always a good idea for you to have a ballpark idea of cup size, but trying on sizing implants is the most accurate way to find the appropriate volume for you.

Personal Consultation

During your consultation in Dr. Fisher will meet with you personally. The choices in breast enhancement can be confusing. Dr Fisher is a strong believer in education, and will try to help you understand the pros and cons of gel versus saline implants, subglandular versus subpectoral placement, sizing, incision choices, and implant styles (low, medium, and high profile implants, shaped and anatomic implants versus round implants.) During your exam, any differences between your breasts will be noted and discussed with you, the patient. Most women are asymmetric. Frequently the breasts have different sizes or positions. Nipples are at different heights. The rib cage may be asymmetric. It is important during breast enhancement that we see these asymmetries and try to soften them and make you more symmetric. There are breast shapes which require special techniques, particularly the tubular breast and constricted breast. During this initial exam, you may try on implant sizers to help visualize the results and size, so bring a form-fitting top. Photos of breasts you consider attractive are useful as well.

The cosmetic breast augmentation surgery is between 1-1 ½ hours. Recovery time is one to two weeks.

Breast Reduction (Reduction Mammaplasty)

Breast reduction procedure,  LIFTS and REDUCES the size of the breasts. It is ideal for women whose breasts are too large. Common reasons include feeling self-conscious, back pain, neck pain, shoulder notching (where the bra straps have caused an indentation on your shoulder), breast sagging, difficulty with exercise, and difficulty finding bras and clothing. It is one of the highest patient satisfaction surgeries I perform.

Frequently, the areola size is reduced. Many women notice following the procedure their postures are better, their neck and back pains subside, and they feel more confident about their bodies. There is no typical patient, except that the breasts should be fully developed. Occasionally, when a young woman has serious physical discomfort, a breast reduction can be done in the mid-teens, with the caveat that a second reduction may be needed subsequently.

During your consultation, a detailed examination is performed with  review of a number of before and after examples. At that visit we discuss the types of reduction: vertical breast reduction, periareolar reduction, liposuction, and inferior pedicle/wise pattern reduction.

Types of Breast Reduction

Vertical reduction, “short scar” technique:

The vertical breast reduction is a newer  technique and the most common procedure performed. It  allows the breast to be fully reshaped and enhances  projection from the chest wall.   Many patients comment they have never been so round and perky. Those internal breast sutures help take tension off the skin, which helps breast reductions maintain their shape and have better scars than other techniques. It also minimizes the scar, with a “lollipop” scar instead of the traditional anchor scar, so there is no scar under the breast.

Inferior pedicle/wise pattern, “anchor scar”:

This is still a popular breast reduction technique and has been the workhorse of breast reduction surgery for thirty years. For extremely large reductions, this is  may be the best procedure.  It is important to have good skin tone, and the scar is substantially larger, with an “anchor” pattern.

Periareolar reduction:

This scar is just around the areola. It is good for a very small reduction/lift.

Liposuction:

Is good to reduce the volume of the breast in fatty breasts. Most young women have dense breast tissue, so liposuction is more difficult. For those with sagging skin, this procedure does not tighten and lift the breast well.

Breast reduction surgery is between 2-3  hours under general anesthesia. Recovery time is two weeks.  All these procedures are performed at our facility in Palo Alto.  Insurance will sometimes cover the surgery depending on your height, weight, and approximate volume to be removed. Women who have not had children should note breast reduction may interfere with breast feeding ability.

Breast Lift (Mastopexy)

As we age, gravity, pregnancy, and nursing all take their toll on the elasticity and shape of the breast. You may notice your breasts becoming pendulous, the breast substance lacks firmness, your nipples point downward, or your breast hangs below the crease. A breast lift will raise and reshape the breast.

Mastopexies vary widely. An analysis is done of your breast shape, skin elasticity, and breast volume. For some, just a lift is needed. For others who have lost volume or have small breasts, breast enlargement can be performed in conjunction with the mastopexy to give the desired volume and shape. There are different kinds of lifts, with different locations and amount of scar.  During your breast lift consultation your surgeon will review your goals and the possible ways of achieving them.

The surgery lasts about three hours. Recovery time is two weeks.

Breast Reconstruction( Breast Cancer)

Breast cancer affects one of every eight women. Ages range from 30s to the 80s. When you find a lump or have an abnormal mammogram, you need to see your doctor immediately. Plastic surgeons become involved when you have been diagnosed with cancer and are going to have a mastectomy, a total removal of the breast tissue.

Breast reconstruction is done to restore the breast lost to cancer. It is one of the most rewarding breast enhancement surgical procedures available today. With modern refinements, we can create breasts that come close in form and appearance to matching a natural breast. Sometimes the shock and the number of necessary decisions are overwhelming when a woman is diagnosed with breast cancer. Reconstruction can be done immediately, at the time of mastectomy, or it can be delayed. Reconstruction can be done with an implant/expander or with your body’s own tissue.

Some women choose to have breast reconstruction, others do not. The choice is a personal one. When you meet with a plastic surgeon, we can help you identify what decision is best for you. I have assisted many patients in determining whether undergoing breast augmentation is the right choice for them. We can meet in the comfort of my Palo Alto office and discuss all the options available to you.

There are two fundamental types of reconstruction and one developing technique which uses fat grafts from your own body. First is tissue expander/implant reconstruction. When you have a mastectomy, the nipple, areola, and some breast skin is removed. This tightens the breast envelope. As the skin flaps are thin, an expander is placed underneath the pectoral muscle to slowly stretch the skin. The expander is inflated through multiple office visits, using a simple, painless 15-minute procedure. This breast enhancement technique will gradually stretch out the skin to accommodate an implant. The implant is placed at a second surgery.

The second type of reconstruction is called the ‘autologous’ reconstruction. The most common procedure done in this group is the TRAM flap. A TRAM flap uses your body’s own fat and skin from the abdomen to reconstruct the breast. It has the additional benefit of giving an abdominoplasty. The surgery and recovery time are longer than the expander/implant reconstruction. In an appropriate patient, it is a great breast enlargement surgery.

A third type of reconstruction (is also autologous)  involves the use of fat grafts to the breast and is used in conjunction with an external tissue expander known as the BRAVA device.  Adult fat grafts contain some of your body’s own stem cells which when purified and mixed with platelet rich plasma can survive and add volume to the expanded chest wall.  This technique is evolving and works well for smaller breast.

A ‘symmetry’ procedure can also be done to help the breasts look alike. This may involve a breast lift, breast enlargement, or a combination of these breast augmentation procedures during surgery. This is covered by insurance. Nipple and areola reconstruction can also be done. This occurs months after your initial reconstruction. The nipple is reconstructed by using a local skin flap. The areola is reconstructed using a skin graft or tattoo. Examples of both can be reviewed.

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