Breast Surgery
Everyone is different. And every body is different—including breast size and shape. Whether you are looking for breast reduction or augmentation, lift or reconstruction, WellSpan Plastic and Reconstructive Surgery works with you to help reach your personal goals to achieve your desired breast appearance.
Our professional team will meet with you in an environmental respectful of your needs and take the time to carefully discuss your personal expectations and desired results.
Our breast procedures are individually designed to help you achieve your own ideal shape and size of your breasts. Using the latest surgical techniques, our procedures include reconstructive surgery for women looking to recover from the impacts of pregnancy, enhancement of naturally smaller breasts and reduction of larger breasts causing discomfort. In addition, we lovingly work with breast cancer survivors to help rebuild the shape and look of their breasts.
Everyone is different. WellSpan Plastic and Reconstructive Surgery works with you to provide the highest quality care for natural-looking results that are uniquely you.
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Breast Augmentation
Breast augmentation or enhancement is one of the most popular cosmetic procedures in the United States. There are many reasons women come to see us to discuss breast surgery – a desire to have larger breasts and cleavage, to return to their pre-pregnancy shape, or to achieve a more balanced and youthful body shape. For many of these women, breast size and shape is an important factor in feeling healthy, confident, and attractive.
Saline vs Silicone Implants
The two types of breast implants currently used in the United States consist of a silicone shell with either a saline (salt water) or silicone fill. Both implant types are safe and have their respective advantages. It is important to discuss with our surgeons what your cosmetic goals are, as they may affect the choice of implant used.
The main advantages of silicone are that it tends to produce less rippling and has a more natural look and feel than saline. Having said that, saline implants used in the correct patient and situation can achieve a result essentially indistinguishable from that of a silicone implant.
There are pros and cons of each type of implant. Patients should take into consideration that saline implants are generally less expensive and require a slightly smaller incision as compared to silicone implants. Saline implant leaks are also easier to detect, as the body will absorb the fluid and lead to noticeable implant deflation.
On the other hand, silicone implant leaks are much less noticeable – therefore, the FDA recommends an MRI 3 years after silicone breast augmentation and then every 2 years thereafter for surveillance. The main side effect of an implant leak is capsular contracture (a hardening of the scar tissue surrounding any implant or foreign body, which can lead to pain or distortion and may require implant removal or revision).
Under vs Over the Muscle
Breast implants can be placed above (subglandular) or below (subpectoral) the chest’s pectoralis muscle. The pectoralis is the large muscle seen in body builders, on top of which sits the breast tissue. In general, our surgeons will place the implants below the muscle, as she feels that this provides for a more natural look than when the implant is placed only beneath the breast tissue.
Other advantages to subpectoral implant placement include decreased risk of capsular contracture and less interference with mammograms. A possible disadvantage of subpectoral placement is increased pain in the immediate post-operative period due to the stretching and cutting of muscle required to position the implant. Subglandular breast implant placement is typically reserved for those women with a moderate amount of existing breast tissue and female body-builders. During your consultation, our surgeons will help you to decide which option is best suited in your situation.
Incision Location
The available locations for incision placement are: in the lower breast fold (inframammary), along the outer edge of the areola (periareolar), in the arm pit (transaxillary), and through the belly button (transumbilical).
The inframmamary incision is by far the most common approach used. It is hidden in the fold underneath the breast, not being visible in the sitting or standing position, and offers ideal visibility for the procedure.
A periareolar approach is ideal for patients who have a medium to large-sized areolar diameter. The scar is usually difficult to detect as it is concealed by the color and texture difference between the areola and surrounding breast skin.
The transaxillary and transumbilical approaches are less seldom used in breast augmentation. These incisions are smaller and located away from the breast tissue. As a result, there are more difficulties in creating a more precisely defined pocket for the breast implant, which may lead to a less natural and less than ideal result. Furthermore, these two approaches are generally limited to the use of saline breast implants.
Implant Size
Many women come to our surgeons seeking a change in their breast to a specific cup size. The problem is that cup size is not standardized in the clothing industry – one company’s cup size is usually not the same as that of another company. Cup size also changes depending on the chest or band size (for example, the volume in a 32C is smaller than the volume in a 40C bra).
Our surgeons will work with you to decide what implant size will best help you to achieve your desired look. This will depend on a variety of factors, including the amount of existing breast tissue, your body frame, any difference between the two breasts, and breast droop. We find that the most accurate way to choose implant size is to try on sizing implants during your consultation. We recommend that you bring in a form-fitting top as well as a sports bra to try on with the sizers.
Other Considerations
Breast implants not only come in a variety of sizes, but also shapes, textures, and projection profiles. There are many decisions to make during the breast augmentation process and this can be overwhelming. Our surgeons will educate you and help you to understand how each of these decisions can affect the surgical result. Working together, the best implant and technique will be chosen to help you achieve the desired look to enhance your attractiveness and confidence.
Complications
Breast augmentation surgery is usually done under general anesthesia and takes about 2 hours from the start of anesthesia to entering the recovery room. Although every patient is different, it is advisable to take at least 1 week off before returning to work and to refrain from strenuous exercise for 4-6 weeks. Patients need to consider the risks of the procedure prior to undergoing such an operation. Some considerations are discussed here:
General Surgical Risks
Every surgery carries risks of bleeding, infection, and complications of anesthesia. Although these risks are relatively low in breast augmentation surgery, they are important to consider. Bleeding can require return to the operating room or blood transfusion. A superficial infection may be treatable with antibiotics, but deeper infections closer to the implant itself may require implant removal. Infections have even been reported to occur years after breast augmentation surgery. As with any surgical case involving anesthesia, patients are more susceptible to pneumonia, heart attacks, blood clots, and other problems in the recovery period.
Implant Leak
Breast implants have come a long way from when they were first introduced in the 1960s. The latest generation of implants carries roughly a 1% risk of leak per year. Leak of saline implants will be immediately noticeable, whereas the leak of silicone implants is more inconspicuous. Implant leak may possibly lead to the development of capsular contracture.
Capsular Contracture
A film of scar tissue will form around any foreign body or implant in the human body. Capsular contracture occurs when this film of scar tissue thickens and hardens, which in the case of breast augmentation can lead to pain, implant distortion, and firmness of the breasts. The exact cause of capsular contracture is unknown, but is thought to be related to bacterial contamination, implant leakage, or bleeding around the implant. Depending on the severity of the capsular contracture, the answer to the problem may require implant removal or surgical revision of the breast augmentation.
Cosmetic Issues
According to a study published in the May 2013 issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons, 98% of women undergoing breast augmentation surgery reported that the results met or exceeded their expectations. Breast augmentation is a long-lasting result whose cosmetic outcome depends partly on the size, shape, and contour of the breasts before surgery. It is important to remember that no two breasts are alike and that there is no way to fully counteract gravity and the natural aging process. Our surgeons will discuss the realistic expectations and goals of breast augmentation with you during your consultation.
Nipple Sensitivity
Changes in sensation of the nipple are not uncommon after breast surgery. Most women will report increased sensitivity that resolves or improves after several weeks. Permanent numbness or decreased sensation, although rare, has also been reported.
Breast Feeding after Breast Augmentation
In general, breast feeding after breast augmentation is unaffected. However, there have been some reports of decreased milk production or inability to lactate (usually associated with decreased nipple sensitivity). It is important to note that there is an increased chance of eventually requiring a breast lift or breast augmentation revision in those women who have significant enlargement of their breasts during pregnancy and lactation.
Mammography after Breast Augmentation
Studies have shown that mammography can be more difficult to read in patients who have breast implants. Special views are required and these women are more likely to require a subsequent study such as an ultrasound or MRI.
Learn more about Breast Augmentation with Saline Implants (video)
Learn more about Breast Augmentation with Silicone Implants (video)
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Breast Lift
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 breast feeding, 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.
Learn more about Breast Lift (video)
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Breast Reconstruction
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 area 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.
Breast Reconstruction with Implant
Almost one half of the patients who decide to undergo breast reconstruction choose the implant procedure. Breast implants are used for both reconstruction and breast augmentation procedures. The main advantage of the implant reconstruction is the relative ease of the operation and rapid recovery. There is no need for surgery on other body parts which may be required when an autologous method is selected (TRAM, DIEP Flap). The breast implants have been shown to be very safe medical devices, however, they have a limited life expectancy. Patients with an implant reconstruction may require further procedures in years to come to exchange the implant or perform other adjustments.
Transverse Rectus Abdominis Myocutaneous (TRAM) flap is the most common autologous procedure for breast reconstruction. Autologous means using the patient’s own tissue for reconstruction. This avoids the use of prosthetic (implant) material. The main advantage of this procedure is that the lower abdominal tissue is used for the breast reconstruction and not an implant. The “new” breast has a more natural feel and look compared to am implant redconstruction. The abdomen is closed by pulling the remaining skin tight which creates a flat and more attractive abdomen similar to a tummy tuck procedure.
The main disadvantage of a traditional TRAM procedure is that one or both rectus muscles (six-pack muscles) have to be sacrificed. Therefore the abdominal wall will be weaker. This has been the main reason why DIEP and muscle sparing free TRAM flap procedures have been developed and have gained in popularity over the recent years.
Deep Inferior Epigastric Perforator (DIEP) flap is a modification of the classic TRAM flap. DIEP flap utilizes the skin and fatty tissue from the lower abdomen to recreate a new breast mound. The blood vessels responsible for perfusion of this tissue are freed from within the rectus muscle (the six-pack muscle) in front of the abdomen without sacrificing the muscle. These vessels are reconnected to recipient vessels on the chest to re-establish blood supply to the tissue. Microsurgical techniques are used to reconnect the vessels. The donor site on the abdomen is closed similar to a tummy tuck procedure. Dr. Soltanian routinely performs DIEP flap reconstructions. He was the first surgeon in the region to perform this procedure.
Learn more about Breast Reconstruction (video)
The Women's Health and Cancer Rights Act of 1998 (WHCRA) is a federal law that provides protections to patients who choose to have breast reconstruction in connection with a mastectomy. Learn More.
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Breast Reduction
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.
Learn more about Breast Reduction (video)
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Male Breast Reduction (Gynecomastia)
Overdevelopment of male breasts is a condition known as gynecomastia. Gynecomastia can affect men of all ages and most commonly is the result of genetics, hormonal changes, certain drugs or medications, and weight gain. Gynecomastia affects approximately one out of two men at some time in their lives.
This condition is characterized by excess breast fat and glandular tissue and can be present in one (unilateral) or both (bilateral) breasts. Gynecomastia can cause emotional distress and selfconsciousness and many men refrain from certain activities in order to hide their condition.
While losing weight may reduce the size of male breasts, because of the presence of excess glandular tissue, weight loss alone will rarely result in satisfactory breast reduction. Gynecomastia surgery or reduction mammoplasty is an effective and long-lasting way to reduce breast size, repair nipple and areola abnormalities, and improve chest contours.
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