AYPSC - Cosmetic Breast Surgery Procedures at a Glance
Southern California purse string breast lift, breast reduction, breast augmentation, breast revision, and breast reconstruction surgery in Long Beach California offered by experienced, double board certified top cosmetic and plastic surgeon, Dr.Donn Hickman - a Southern California specialist in cosmetic plastic surgery serving Los Angeles, Long Beach, and Orange County since 1984.

This section offers a general overview of cosmetic breast surgery procedures and explores cosmetic surgical offerings, many of these procedures may also fulfill true medical needs. You should understand that the circumstances and experience of every individual will be unique. In addition, please note that all surgery carries some uncertainty and risk, including the possibility of infection, bleeding, blood clots, and adverse reactions to the anesthesia. If you're considering cosmetic plastic surgery, please contact us for more in-depth information on these procedures.

  • Breast size is important to many women for a variety of reasons. If you are dissatisfied with your breast size, augmentation surgery is a choice to consider. Breast augmentation can:
    * Increase fullness and projection of your breasts * Improve the balance of your figure * Enhance your self-image and self confidence

    Also known as augmentation mammaplasty, the procedure involves using implants to fulfill your desire for fuller breasts or to restore breast volume lost after weight reduction or pregnancy. Implants also may be used to reconstruct a breast after mastectomy or injury.

    Procedural steps: Common incision locations include the breast crease, in the underarm, or around the areola (pigmented skin surrounding the nipple).

    Placement of implants beneath the chest wall muscle or directly behind breast tissue using pre-filled implants or implants filled during surgery creates desired volume.

    Generally performed as an outpatient procedure under local anesthesia with sedation; general anesthesia may be recommended.

    Your results: Immediate. Swelling should subside in 2-4 weeks. Incision lines will continue to flatten and fade for up to 1 year.

    Implants may need to be replaced: It’s important to know that breast implants are not designed to last a lifetime. You should plan for an annual examination by your plastic surgeon to see if the implants need to be replaced.

    [ Detailed Procedural info. | B&A Gallery ]

  • Also known as mastopexy, a breast lift raises and firms the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour. Sometimes the areola becomes enlarged over time, and a breast lift will reduce this as well.

    Procedural steps: Excess skin is surgically removed to raise the nipple and tighten the breast tissue. Incision patterns vary, depending on degree of excess skin and amount of lifting required as well as patient and surgeon preference.

    Your results: Swelling should subside in 2-4 weeks. Breast shape may take 1-3 months to fully refine. Incision lines will continue to flatten and fade for up to 1 year.

    [ Detailed Procedural info. | B&A Gallery ]

  • Enlarged male breasts, also known as gynecomastia, can cause emotional discomfort and impair your self confidence. Gynecomastia is characterized by:
    * Excess localized fat
    * Excess glandular tissue development
    * A combination of both excess fat and glandular tissue
    * Gynecomastia may present unilaterally (one breast) or bilaterally (both breasts)

    Gynecomastia can be surgically treated by removing excess fat, glandular tissue and/or skin. The result is a better proportioned, more masculine-contoured upper body and the freedom and self confidence to lead an active life.

    Procedural steps: Surgical removal of excess tissue is performed by excision and/or liposuction. This procedure can include areola reduction.

    Your results: Initial swelling should dissipate in 2-4 weeks. Final results may appear in 2-4 months. Incision lines will continue to fade for up to 1 year. Significant weight gain can reverse results.

    [ Detailed Procedural info. | B&A Gallery ]

  • if you are considering a breast reduction it is important to understand the various presentations of heavy enlarged (hypertrophic) breasts which confront the Plastic Surgeon who is recommending various TECHNICAL OPTIONS. The changes in the female breast that lead to significant and excessive enlargement can be due to genetic and developmental events and can include adolescent hormonal surges, medication, childbirth, general advancing age, and marked weight gain. When the size of the breasts become unwieldy, leading to symptoms such as breast pain, under-breast rashes, nerve tingling, shoulder, neck, and back pain, the Plastic Surgeon is sought to assist the patient in a relief of these issues by volume reduction surgery, which at the same time attempts to restore a more appealing shape to the reduced breasts. This site is devoted to a look at minimal scar breast reduction, with special reference to the periareolar scar approach which can be applied to a wide array of breast shapes and sizes of a of a mild to moderate degree.

    For excessive breast size termed gigantomastia, it may be necessary to utilize other methods which include the Vertical Mammoplasty, Wise or Free Hand T Scar Mammoplasty, or Reduction Mammoplasty where the Nipple is Removed and Replaced as a Graft (Free Nipple Graft). When the patient has thin elastic skin and fatty-type breasts, the surgery can be more challenging and subject the breasts once again, to the forces of nature and to the series of physiological changes that naturally occur over the course of a woman's life. To this end the plastic surgeon must carefully explain to the patient what is to be expected in terms of shape, and degree of scar placement to achieve the desired results.

    Historically, the performance of a breast reduction for symptoms has been a benefit offered by most insurance companies, however, in recent years many patients are excluded from coverage on the basis of insufficient weight of breasts to be considered for surgical removal. Various charts and graphs have been developed to help surgeons, patients, and insurance carriers understand what constitutes breast reduction for medically necessary reasons. Often a patient of smaller stature and slender frame may have moderate sized breasts that require only 300 to 400 grams of breast tissue to be removed in order to improve symptoms. A patient who is tall and has a heavy frame may require reductions of 500 grams to 1500 grams per breast to provide significant relief. Patients who may require 150 to 450 grams of reduction at any body size may experience marked improvement in breast weight and symptoms, but are excluded by most insurance companies.

    With an increasing number of patients presenting to our Practice who may have been denied coverage and do not meet the stringent insurance benefit requirements, these patients became candidates for minimal scar reduction techniques which would be aptly suited for the smaller breast hypertrophies. The use of reduced scar methods for both breast lift and reduction is not new, and fundamental techniques were developed over 30 years ago, but only now are becoming popular as plastic surgeons gain familiarity with the more exacting technical demands of these procedures With further experience, the plastic surgeon becomes more adept in applying a reduced scar approach to a wider range of patient candidates for breast reductions less than 600 grams per breast. Ongoing work in the field continues to find the single best method for every patient, but it is best to select the best method for each individual patient. The periareolar method leaves a simple circle around each areola for each breast. The early appearance of the breasts operated with this method is often temporarily compressed and flattened with some pleating around the areolae. In time this improves dramatically. Even with minimal scar approaches, a certain percentage of patients will develop more than minimal scarring around the areolae. Revisions can still be performed to honor the circular pattern and not lead to placement of other scars to provide corrections when indicate.

    [ Detailed Procedural info. | B&A Gallery ]

  • On occasion following breast augmentation some women can develop scar tissue or implant shifting that presents as stiffness, asymmetry, and sagging of the nipple and areola, despite having a good early result from the primary surgeon. There is a chance that these problems may require secondary surgery. Each patient may have a different sense of the personal impact of these changes, and can request: (1) a change of implants with some treatment of the implant pockets, (2) a change of implants and a breast lift to address any sagging that has occurred over the years, (3) complete bilateral implant removal with a breast lift alone to restore shape, or (4) removal of implants and no additional surgery. Breast augmentation is a highly successful procedure, but does involve some maintenance which in part relates to: (1) the durability of the prostheses that are artificial man-made devices subject to stresses and fatigue as with any structural material, and (2) the numerous physiologic changes occurring in a woman's body as she matures, including weight fluctuations, childbirth, breast feeding, hormonal changes, and natural aging. When patients return to their primary Plastic Surgeon or seek consultation elsewhere and have concerns over internal scarring and shape issues from their Breast Augmentation, it is important for the patient and consulting surgeon to identify how the surgery was originally performed, and the style and volume of implants that were used in the original surgery. Records of the original surgery may be requested to insure that subtle details are not overlooked, when they may impact the secondary surgical intervention.

    A breast lift may be necessary in the correction of secondary breast augmentation problems, and since most patients prefer to have their existing implants replaced at the same time, the thought of any new scars may be disquieting. The common approach to secondary breast augmentation requiring a major lift involves a Lollipop or T pattern scar. For lesser degrees of breast sag in the presence of existing implants, many surgeons are incorporating a crescent skin excision, or donut skin excision to provide some skin tightening. By themselves these procedures are used when the nipple needs no more that 1-2 cm of elevation to bring things into better alignment. As the nipple elevation needs to be raised 3-4 cm, some surgeons may perform a more periareolar skin removal and insert a permanent blocking suture to keep the areola from stretching.

    When the nipple needs to be raised more than 4 cm, most surgeons recommend a vertical breast lift (Lollipop scar) which leaves a vertical breast scar beneath the areola, or a standard Wise lift leaving an anchor type scar (T scar) down and across the under surface of the breast. Even when a surgeon performs some measures to suspend the breast by creating an internal bra, practically all surgeons use a vertical or T scar for the skin repair component of a lift or reduction. A laser or standard scalpel may be used to create the skin brassiere to tuck inside the breast, but patients are concerned about the amount of scar that is present on the skin, especially when they originally underwent breast augmentation with no other than a tiny skin scar. The idea that to lift the breasts requires the surgeon to add scars to the skin may not be acceptable to all patients.

    This Practice has been applying the periareolar purse string breast lift for use in all patients requiring secondary surgery for breast augmentation where a breast lift is required. The nipples can be raised 4 to 9 cm with this method, and it has been used since 1992. While some stretch of the areolae may occur with any purse string periareolar approach, the overall patient satisfaction has been excellent since no other scars were used to lift the breasts. For patients requiring nipple elevation of 1 to 3 cm, this Practice performs a modified Breast Augmentation alone, where no lifting scars, crescent, scars, or donut scars are used. This procedure has been termed a dual-plane breast augmentation or partial over and partial under breast augmentation and can be used in cases of mild ptosis, glandular ptosis, pseudoptosis, and selected cases of moderate ptosis. (SEE BREAST LIFT; CLASSIFICATION OF PTOSIS)

    Historically, the surgical treatment for problems related to silicone gel implants has been a benefit offered by some insurance companies, however, in recent years many patients are excluded from coverage for any breast implant-related issues. In selected cases some insurance Payers may permit bilateral implant removal of old silicone gel implants alone, but will decline to offer benefits for any treatment of scar tissue or necessary breast lifting. A number of patients present to our Practice who may have been denied coverage for problems related to breast implants and do not meet the stringent insurance benefit requirements. The use of reduced scar methods for both breast lift and reduction is not new, and fundamental techniques were developed over 30 years ago, but only now are they becoming popular as plastic surgeons gain familiarity with the more exacting technical demands of these procedures. For the prospective patient who returns for secondary breast implant surgery, it may be comforting to know that a breast lift performed simultaneously, may be accomplished with a purse string circular areolar skin approach with no other scarring.

    [ Detailed Procedural info. | B&A Gallery ]

  • Plastic Surgeons are called upon to perform breast reconstruction in situations of:
    1. Severe alterations of breast shape including marked asymmetry.
    2. When there are major alterations of shape as a result of previous breast surgery.
    3. Restorative surgery as a result of cancer treatment including mastectomy and radiation change.
    4. Planned mastectomy in patients at extreme risk of developing breast cancer by virtue of a strong family history of early breast cancer and when multiple breast tumors place a patient in a fearful state.

    Some of the reconstructive types of breast procedures are covered in the Revisionary Surgery Section, and in the Breast Augmentation Section, but for the most part this section covers the most challenging problems encountered by the Plastic Surgeon. Ordinarily, a patient's insurance may covered all or part of the services covered for reconstruction. In recent times with restriction of medical benefits particularly in patients who have silicone gel implants, the patient must seek help outside the bounds of third party reimbursement. A planned approach to these types of breast problems must take into account the financial burden that may be born by the patient, and the usual multiple staged operations that may be standard such as for mastectomy reconstruction. A single-stage focused strategy may be necessary in order to treat these patients and deliver the best possible Plastic Surgical care in one operation.

    In patients of record who may experience early or late complications of breast implants and breast lift, the surgeon usually provides services of corrective surgery at a reduced surgeon's fee. Sometimes the services may be covered by insurance for the hospital and anesthesia services. The most common problems in this category include wound healing problems that may occur rarely in augmentation with lift surgeries. Infection can lead to implant removal and surgical treatment of the inflamed tissues that can lead to consequences of poor healing, scarring, and asymmetry.

    When there are problems such as leaking implants or saline implant deflation, the manufacturer will usually replace the implant at no charge, and within a set period of time, will help with finances for the replacement costs themselves. Each manufacturer has extended warranty programs at a modest cost to help defray costs of implant replacement if there is implant failure.

    For patients who are advised to have a prophylactic removal of one or both breasts due to a strong family history of cancer, and frequent surgeries to remove breast tumors and lumps, the decision to remove normal and non-cancerous breast tissue requires careful counseling with the patient and the family. The results of reconstruction for prophylactic or protective mastectomy may not be as pleasing as with primary breast restorative surgeries including augmentation, lift, and reduction. The reduction in psychological stress, worry, and fear are less in women who have high risk breasts treated by mastectomy, but the aesthetic satisfaction with the results of breast reconstruction in this situation may fall below expectations.

    Minimally invasive mastectomy and skin-sparing mastectomy for precancerous breasts and those with cancer have been available in selected cases since the early 1990s. A careful combined strategy by general surgeon and plastic surgeon in the right patient can provide a proper cancer operation for disease and a proper reconstruction with more residual skin left behind. The type of reconstruction in cases of breast cancer will depend on tumor cell type, stage of disease, patient general health, and skill plus experience of the surgical staff. Often the changes in a woman's body that can occur with cancer treatment may influence the results of even a well performed reconstructive breast surgery. These surgeries require a particularly close relationship of the patient, general surgeon, oncologist, and plastic surgeon. Early detection of breast cancer is the single-most important factor that can influence the success of a planned mastectomy with reconstruction, as it may provide for skin and breast sparing procedures that can improve the chances of a better reconstructive result.

    [ Detailed Procedural info. | B&A Gallery ]

  • This is a full list of most popular surgery procedures performed in our office. If you have any questions, please feel free to contact us.
    Abdominoplasty Advanced Areolar Breast Lift and Reduction Asian Blepharoplasty Natural
    Blepharoplasty Body Contouring Body Lifts
    Botox Breast Augmentation Breast Implant Natural
    Breast Reduction Brow Lift Brow Suture Suspension
    Buttocks Implants Calves, Ankles, Knees Calf Liposuction
    Chemical Peel Advanced Cheek Implants Cheek Suspension
    Chin Augmentation Cosmetic Plastic Surgery Corrective Plastic Surgery
    Ear Cosmetic Surgery Eyelid Cosmetic Surgery Face Lift
    Feather Lift Forehead Lift Gynecomastia
    Hairline Lowering Hairline Advancement Implants
    Lip Enlargement Lipo Filling Liposuction
    Liposculpture Lift with Suture Brow Liposuction Ankle Calf Knee
    Microliposuction Microliposculpture Minimal Scar Breast Lift and Reduction
    Mini Face Lift Mini Neck Lift Neck Lift
    Neck Tightening Neck Liposuction Nose Cosmetic Surgery
    Nose New Concepts Nose Shaping Nasal Surgery for Breathing
    Otoplasty Natural Periareolar Breast Lift Periareolar Breast Reduction
    Reconstructive Plastic Surgery Restylane Rhinoplasty from Inside
    Sclerotherapy Veins Structural Fat Grafting Structural Fat Transfer
  • "Much of the information in this section is provided by the Plastic Surgery Information Service of the American Society of Plastic Surgeons."

  • Presented course "Chemical Peels" to RNs/ Skin Care Professionals,Newport Beach, CA February 25, 2010 Science, Selection, and Depth Issues - 2 March 2010 9:48
  • Article: Periareolar Purse String Breast Lift (Goes Method) in publication: J.of Plas,Rec.Aesth, Surg, 14 yr. experience; (4-9 cm elevation) - 24 December 2009 6:12
  • Our article on periareolar breast lift should be the first North American series on this minimal scar method for challenging breast cases.. - 1 December 2009 10:08
  • Article accepted for publication in the Journal of Plastic Reconstructive and Aesthetic Plastic Surgery: Brazilian periareolar breast lift - 1 December 2009 10:07
  • THE CROTON OIL PEEL Practice has been performing the peel in variations for over 25 years, and - 20 November 2009 6:59
  • The results can be seen in the BEFORE AND AFTER SECTION ON SKIN RESURFACING PHOTOS. - 20 November 2009 6:45
  • The pendulum may be swinging back to peels as a key element in skin resurfacing equalling and perhaps surpassing the laser. - 17 November 2009 7:03
  • The peel can be adjusted for skin type, the patient's desired end result, - 14 November 2009 11:40
  • and is planned to encompass a consumer's schedule and time budgeted for skin improvement. - 14 November 2009 11:40
  • CROTON OIL PEELS with phenol are making a comeback - 10 November 2009 7:55
See Dr. Hickman's Expert Answers on Realself
Aesthetically You Plastic Surgery Centre
Southern California Specialist In Cosmetic Plastic Surgery Serving Los Angeles, Long Beach, and Orange County
Offering Cosmetic Plastic Surgery By Experienced, Double Board Certified Top Cosmetic and Plastic Surgeon, Dr.Donn Hickman

Aesthetically You Plastic Surgery Centre - Long Beach Office
920 East Wardlow Road, Long Beach, CA. 90807
PHONE: (562) 988-0365   FAX: (562) 427-4086

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