Breast Procedures


Breast Enlargement
(Augmentation Mammoplasty)


To make the breast(s) larger, an implant is placed behind the breast, pushing it forward. This is most commonly done through an incision either below the breast, around the areola (darker area around the nipple) or in the armpit (axilla). Either salt water (saline) or silicone gel implants can be used.



Before After
This 5' 10" tall, 140 pound 43-year-old desired larger breasts. She did not fill the cups of her size 38B bra. She delayed seeking surgery until silicone gel implants were again made available for routine breast augmentation. She underwent breast augmentation with high-profile, round, textured silicone gel implants.

Before After
This slim 43-year-old requested breast enlargement so that she would fit into her clothing better. She was 5' 2" tall and weighed 107 pounds. She did not fill the cups of her 34A bra. She underwent a breast augmentation with shaped textured saline-filled implants.

Before After
This athletic 37 year-old requested breast enlargement because she had never developed much breast tissue and wanted to have breasts. She was 5' 6 1/2" tall and weighed 145 pounds. She wore a size 34A or AA bra. She underwent breast augmentation with shaped textured saline-filled implants placed behind the chest wall muscles.


Breast Implant Revision


When breast implants have been placed, either to enlarge the breasts or to reconstruct them after a mastectomy, it is sometimes necessary to perform an additional operation to address problems that have occurred. Sometimes the scar around the breast implant can tighten, changing the shape of the breast and causing discomfort. It is also possible that the breast implants can leak, requiring that they be replaced. Whenever possible going through the scar from the previous surgery, the old implant is removed and replaced with a new one. Modifications are made to the technique to try to decrease the likelihood that the problem will recur later.



Before After
This 42 year old underwent a breast augmentation 17 years ago with 200cc gel implants. Her left implant had ruptured. The shape of her breasts was uneven. Her breast augmentation was revised and her implants were replace with 360g Inamed Style 410 FX Cohesive Gel Silicone-Filled implants.

Before After
This 68 year old had breast implants place 20 years previously to enlarge her breasts. Her implants had been placed behind the breasts, but in front of the chest wall muscle. She developed severe contracture (tightening) of the capsules around her breasts, and an MRI indicated that her right implant had leaked.

She underwent removal of both breast implants with the capsules surrounding them and replacement with round, high-profile textured silicone gel implants positioned behind the chest wall muscles to decrease the likelihood that the contracture would recur.

Before After
This 50-year-old had a breast enlargement 25 years previously with her implants placed behind the breast and above the chest wall muscle. She subsequently developed tightness of both breasts, and six months previously she developed a lump in her right breast after having been hugged tightly.

At the time of surgery her right breast implant was found to have leaked, and both implants, as well as the loose silicone gel on the right side were removed. New pockets were created behind the chest wall muscle to decrease the likelihood of recurrence of the tightening of the capsule (scar) around the implants.

She had textured, shaped, cohesive gel implants placed. The implants chosen were larger than the ones that were removed to provide some lift to her breasts without any additional scars.

Before After
This 50-year-old had 3 previous surgeries starting 14 years previously to enlarge her breasts and treat complications. She was unhappy with the round appearance of her breasts, and the lack of fullness of the top of her breasts unless she wore a push-up bra.

She underwent a replacement of her implants with textured, shaped implants with her new implants placed behind the chest wall muscles. She also had a minor revision 8 months later to improve the position of her implants.

Breast Lift (Mastopexy)


When the breasts sag with age or after pregnancy they can be repositioned higher to look more youthful. This is often done in conjunction with placing implants behind the breasts to also make them larger. There are several different choices about where the scars will be placed, depending in part on how much the breasts must be lifted. When someone undergoes breast reconstruction after a mastectomy, a breast lift can be performed on the other breast to make the breasts more symmetrical.

Breast Reconstruction


After a mastectomy is performed because of breast cancer, the breast can be rebuilt. It is possible to use skin and fat from the abdomen. More commonly it is accomplished using implants. This is usually a two stage procedure. At the time the mastectomy is performed by a general surgeon, a temporary implant is placed by a plastic surgeon, which can be stretched by injecting fluid into it through the skin over the next few months. At a second operation a permanent implant, filled either with salt water (saline) or silicone gel, can be placed. If desired, the nipple can be reconstructed later.



Before After
This 47-year-old was scheduled to undergo a bilateral mastectomy after developing cancer of her left breast. She chose to have a staged breast reconstruction, with the first stage at the time of her mastectomies.

At the time of placement of her permanent implants, she had textured, shaped, cohesive-gel implants placed. She did not desire reconstruction of her nipples and areolae.

Before After
This 40 year old with cancer of the left breast was advised to have a bilateral mastectomy. She was initially seen after having a lumpectomy, so her pre-operative pictures show a bandage and drain in her left breast.

She chose to have a staged implant reconstruction. At the time of her mastectomies she had expander implants placed. They were then expanded during weekly office visits.

At the time of her second stage reconstruction, she chose to have textured, shaped, saline-filled implants. She did not wish to have nipple reconstruction.

Before After
This 37-year-old with cancer of the right breast was scheduled to undergo bilateral mastectomies. She chose to have staged implant reconstruction with the first stage performed at the time of her mastectomies.

After undergoing expansion of the tissues, at the time of placement of her permanent implants, she chose to have saline implants placed. Textured, shaped saline implants were used. She did not request nipple and areola reconstruction.

Before After
This 39-year-old with cancer of the left breast elected to undergo a staged implant reconstruction with the first stage at the time of her mastectomies.

Her preoperative photos were taken immediately after her original biopsy was done, which is why there is visible bruising. Her postoperative photos were taken early after her final surgery.

Textured, shaped, cohesive-gel implants were subsequently placed as her permanent implants. She declined nipple and areola reconstruction.

Before After
This 52-year-old developed cancer of the left breast, and chose to have a staged breast implant reconstruction beginning at the time of her mastectomy.

At the time of placement of her permanent implant, a textured, shaped, silicone gel implant was placed. She also had an enlargement of her opposite, right breast with a textured, round, moderate-profile silicone gel implant. She did not choose to have reconstruction of her nipple and areola.

Before After
This 52-year-old had undergone bilateral mastectomies 1 year previously and initially declined reconstruction. She found that she had problems with her external prosthesis, and came in to inquire about breast reconstruction.

She was 5'4" tall and weighed 185 pounds. She related that her breasts had been large. Her goal for reconstruction was to have smaller breasts, and she was not interested in having nipple reconstruction.

She underwent a staged breast reconstruction with initial placement of expander implants, which were expanded during weekly visits. Her second stage breast reconstruction was done using textured, shaped cohesive-gel implants.

Before After
This 67-year-old had a recurrent cancer of her left breast which required a left mastectomy. She underwent a staged reconstruction of the left breast with the final placement of a shaped textured silicone implant.

At the time the permanent implant was place on the left, she also had a mastopexy, or lift, of the right breast. She did not request nipple-areolar reconstruction.

Before After
This 50-year-old had undergone a lumpectomy and radiation of her left breast. She had a recurrence 7 years ago which required a mastectomy and at the time she had a staged implant reconstruction.

She developed cancer of the right breast and it was recommended that she have a mastectomy on this side also. She was also concerned about the abnormal appearance of her previously reconstructed left breast, which was shriveled up and positionned too high on her chest wall.

At the time of her mastectomy, she had first stage reconstruction of the right breast with placement of an expander implant. This was subsequently expanded.

For her second stage breast reconstruction, she had a textured, shaped, cohesive-gel implant placed on the right side.

The reconstruction of her left breast was revised. A latissimus dorsi musculocutaneous flap was moved from her back to provide extra tissue to cover a larger, and properly positionned implant. Because of the scarring from her previous radation therapy, the bottom of her left breast could not be stretched fully, so a slightly smaller textured, shaped, cohesive-gel implant was used on this side.

Although the bottom of her left breast is not as full as the right, the tops of her breasts are symmetrical. Even in the early postoperative pictures, one can see that she is able to wear clothing and bathing suits without problem, had no limit to her activities, and is extremely pleased.
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