Breast FAQs

Are there any advantages to a particular incision approach for breast surgery?
For breast augmentation, the surgeon may elect to place implants from either an under breast incision (inframammary), through the armpit (transaxillary), through the belly button (transumbilical), or through the border of the areola (periareolar). Depending upon surgeon experience, one or another site will be advised. While the transumbilical approach is clever and requires great skill, it may be more difficult when placing implants behind the muscle. This method may not be supported by some malpractice carries due to the higher incidence of litigation as a result of this approach. The implant manufacturers also are not as supportive of this method of insertion. Sensation is not affected by route of insertion. The incidence of implant shift may be increased with a transaxillary or transumbilical approach with inexperienced hands. For breast lift and reduction, a surgeon may use a T scar (anchor pattern), Vertical scar (lollipop pattern), or a Periareolar scar (purse string pattern). The least amount of scarring results from the latter method. This method is often difficult to master, and may be subject to slight spread or areolar widening in patients with thin elastic skin, and when the surgeon does not use a special blocking purse string suture. The latter method can be applied to more difficult cases of breast sag or excess enlargement, which is reflected in the work presented on this web site and through this Practice.
Will surgery to the breast affect breast feeding?
Any time there is significant manipulation to breast tissue, including breast lift with internal modification, breast reduction, implants inserted behind the breast tissue and above the muscle, or an incision is made around the areola, there is a chance that breast feeding may be affected. For implants inserted through a periareolar approach, about 15% of patients can expect to have some change in the ability to breast feed. When tissue is removed such as with a breast reduction, this incidence can be greatly increased. Choices as to operation and approach may be modified when breast feeding is a significant issue for patients.
Why are there changes in the breasts after pregnancy?
As pregnancy concludes and any breast feeding stops, the milk glands will dry up and shrink. Often the breast tissue loses volume which is termed involutional hypoplasia. For minimal sagging called mild ptosis, pseudoptosis, and glandular ptosis, this can be corrected by breast augmentation alone without a formal lift. When there is considerable sagging, then a breast lift with or without implants is suggested. It is felt that a pure periareolar purse string breast lift approach can be applied to all forms of breast sag when implants are used, and it can be applied to moderately severe forms of breast sag when implants are not used.
Inverted nipples can occur naturally and with major weight loss. The method of repair can be done under a local anesthetic in the office setting, or combined with a breast lift with or without implants, during a breast augmentation lift, or reduction. The literature abounds with methods all touting superiority over others when the basic principles of repair are the same. The shortened ductal bands are released to the point where the nipple rises up without tension, and the surgeon will either use sutures alone or in combination with local tissue to fix the new nipple platform so it remains above the surface of the areola. Sometimes a small plastic cup is sutured to the repaired nipple and kept in place for 7 to 10 days.
How long will a breast lift and reduction last, and how many years do implants last before they must be replaced?
The application of advanced methods of breast lift and reduction can immediately correct the forces of nature that have taken years to develop. Natural physiological changes in the female body and breasts will continue after surgery, and occasionally corrections may be necessary years later. The insertion of breast implants at the same time as a lift or reduction can provide some internal support that can help resist the ongoing forces of gravity and elasticity. Saline and silicone gel implants usually have 5 to 10 year warranties for breakage. For implant failure during the covered period, the manufacturer will replace the implant and provide for some reimbursement to cover costs of replacement. Fine or thick textured saline implants may have a higher incidence of deflation compared to smooth-surface saline implants. Combination saline and silicone gel implants may have a higher incidence of leakage. Textured-shell tear drop and anatomic implants may also be prone to earlier shell degradation when compared to smooth-shell saline implants. Implants with a postoperative fill system may also have a higher incidence of leakage compared to the standard workhorse implant system which is the smooth-surface round saline implant. Even the new silicone gel implants have an 8% overall incidence of shell degradation at 10 years.
What is the best place to make the pocket for the breast implant, over or under the muscle?
The incidence of rippling of the implant shell surface can be moderately increased when placing saline and even some styles of silicone implants over the muscle. All texture-surface implants can produce varying degrees of rippling seen and felt through the skin, when placed above the muscle. The under-muscle method may add to long term implant softness, cosmetically obscure any signs of the implant shell rippling, provide improved breast cancer surveillance, and be less prone for the rock-in-a-sock sag that can occur with over-muscle augmentations in patients of thin skin and slender frames.
What about revisions and complications?
With any operation on the human body, there are risks, and potential side affects. With proper patient selection, realistic goals, good technical performance by the physician, and standard postoperative care, one can expect to obtain a good outcome. Sometimes events may occur that are beyond the control of the patient and surgeon. A surgeon certified by the American Board of Plastic Surgery will have the training and experience to offer patients what is prudent and within the scope of his or her Practice, and be able to address the occasional problem and less than ideal result should it arise. With changing technologies and advancements, there may be a learning curve to the Art and Science of these developments which will determine what services are of most benefit insofar as long term effectiveness and overall safety.