Breast Procedures

Breast Procedures

Breast Procedures 2018-06-15T11:05:39+00:00

Breast Procedures

The UPMC Aesthetic Plastic Surgery Center physicians are experts in cosmetic surgical breast procedures such as breast augmentation, breast lifts, breast reconstruction, and breast reduction. Our surgeons use state-of-the-art techniques and procedures to reconstruct breasts after cancer surgery.

We offer a variety of services, including:

Overview

Breast augmentation is a surgical procedure that enlarges and uplifts the breasts, and is typically performed on women who have small breasts, or sagging breasts due to pregnancy, significant weight loss, or genetics.

The procedure involves the use of a synthetic implant containing either silicone gel or saline, and the implant is placed beneath the breast’s tissue or muscle. The implant is placed into the breast using a small scar around the nipple areola complex, in the armpit, or under the breast. Sometimes longer incisions are necessary if a breast lift is performed at the same time.

Who Is a Candidate?
Typical candidates are women between the ages of 18 and 60 who want their breasts to have a fuller appearance. The operation usually is considered an aesthetic enhancement or cosmetic procedure. In certain rare instances, the procedure can be performed on a young patient to treat breast asymmetry or to correct breast developmental deformities. Silicone gel implants can only be placed in women over the age of 22.

Before the Procedure
Your plastic surgeon will perform a comprehensive evaluation of your breasts, including a detailed history of any personal or family breast problems, pregnancy, and weight loss or gain.

Your breast health, including the most recent mammogram for women over 35, will be thoroughly evaluated.

Some of the specific instructions you’ll receive about preparing for surgery include:

  • Smoking cessation
  • Medications to avoid
  • When to take your prescribed medications
  • Proper washing techniques
  • Restrictions regarding eating and drinking the night before surgery

Procedure Details
You and your surgeon will discuss your concerns about your current breast shape, and your goals regarding the breast augmentation procedure. Prior to the consultation, you should think carefully about your goals because various augmentation techniques often are combined. Incisions can be made around the nipple and under the armpits, as well as under the breasts.

You and your doctor will discuss:

  • The location of the implant (either above or below the pectoralis muscle)
  • The implant size
  • Type (silicone gel or saline filled)
  • Any potential short-term or long-term problems following surgery

The approximate location of the incisions and scars will be outlined directly on your skin with a medical skin marker or on a diagram.

Finally, your surgeon will perform a careful evaluation of your overall health as well as issues that could cause complications, such as:

  • Your blood pressure
  • Bleeding tendencies or blood clotting disorders
  • History of adverse scar formation after previous surgeries

Where Will the Surgery Be Performed?

A breast augmentation is usually done in a hospital as outpatient surgery, and you must be driven to and from the hospital by a friend or family member.

Type of Anesthesia
Your doctor will recommend the best type of anesthesia for you. General anesthesia or local anesthesia with intravenous sedation can be used.

Immediate Postoperative Recovery
In most cases, patients experience pain for 24 to 72 hours. Some swelling usually occurs in the breast tissue but it resolves within a month of surgery.

Short-term Recovery
Most patients can go out in public within two to four days. In an effort to maintain the softest possible state for the implant, you will have to perform an external breast massage designed to move the implant in its pocket. Vigorous physical activity cannot be resumed until four weeks after surgery. This includes:

  • Running
  • Jumping
  • Bouncing
  • Heaving lifting
  • Aerobics cannot be resumed until four weeks after surgery

Risks

This is considered major surgery, so you should think carefully about your specific expectations and communicate your goals to your plastic surgeon. In addition to the risks associated with anesthesia, complications can include:

  • Bleeding
  • Infection
  • Scarring issues
  • Postoperative breast asymmetry

Complications with the implant can include:

  • The implant’s failure
  • Infection
  • Issues related to the patient’s reaction to the implant

Overall, breast implants are safe and do not pose a health risk. They are not permanent, however, and you will most likely need additional surgery on your breasts in the future. Not every person is a candidate for this procedure, and your risks may be greater or different than those of other patients. Your plastic surgeon will review all potential risks and complications with your prior to surgery.

Anticipated Results
Breast augmentation usually produces a rejuvenated, more youthful, fuller, and attractive breast appearance.

Overview

A breast lift (or mastoplexy), is a surgical procedure performed on women who have sagging breasts due to pregnancy, significant weight loss, or genetics. The procedure involves:

  • Elevating the breast tissue to a higher position on the chest wall
  • Repositioning the nipple-areolar area
  • Tightening the skin

The procedure can involve the use of a breast implant to increase the volume of the breast. When there is mild sagging to the breasts, an implant alone can produce a rejuvenated appearance with only a minimal skin incision. Any incision, however, will result in permanent scars. The procedure can restore a more youthful-looking shape to the breast.

Who is a Candidate?
Most patients are between 30 and 60 years of age and want to make aesthetic enhancements to their breasts. The procedure can be performed as part of a post-mastectomy breast reconstruction procedure to achieve better symmetry with the reconstructed opposite breast.

Before the Procedure
Your plastic surgeon will perform a comprehensive evaluation of your breasts including a detailed history of any personal or family breast problems, as well as a review of your mammograms.

Some of the specific instructions you’ll receive about preparing for surgery include:

  • Smoking cessation
  • Medications to avoid
  • When to take your prescribed medications
  • Proper washing techniques
  • Restrictions regarding eating and drinking the night before surgery

Procedure Details
You and your surgeon will discuss your concerns about your current breast shape, and your goals regarding the breast uplift procedure. Prior to the consultation, you should think carefully about your goals, such as your satisfaction levels with the volume of your breasts and whether you want to increase or decrease the volume.

Breast lift procedures can be performed in a variety of ways with different types of incisions. The approximate location of the incisions and scars will be outlined directly on your skin with a medical skin marker or on a diagram. For a small uplift, short incisions just around the nipple areola may be necessary. Sometimes they extend down the breast like a lollipop. The more the breasts sag, the more likely you will need longer incisions.

Your surgeon will perform a careful evaluation of your overall health as well as issues that could cause complications, such as:

  • Your blood pressure
  • Bleeding tendencies
  • Blood clotting disorders
  • History of adverse scar formation after previous surgeries

If you are having breast implants, your doctor will talk to you in great detail about the different types of implants, their proven safety record, and how long you can expect them to last.

Where Will the Procedure Be Performed?
A breast lift usually is done in a hospital as outpatient surgery and you must be driven to and from the hospital by a friend or family member.

Type of Anesthesia
Your doctor will recommend the best type of anesthesia for you, but local anesthesia along with intravenous sedation or general anesthesia can be used.

Immediate Postoperative Recovery
In most cases, patients will experience pain in the breast area for the first 24-48 hours. Some swelling of the breast tissues always occur, but it is usually gone within a month following surgery.

Short-term Recovery
Most patients will be able to go out in public one or two days after surgery. Showering is permitted within the first several days. Vigorous physical activity is limited for four weeks following surgery.

Risks
A breast lift will enhance the appearance of your breasts but is considered major surgery. You should think carefully about your specific expectations and communicate your goals to your plastic surgeon. How much volume your breasts maintain over time will depend on the type of procedure, your weight stability, and overall good health.

You may notice breast asymmetry following the surgery but that is normal, primarily because most women’s breasts are asymmetrical before surgery. Asymmetries that exist before surgery often will remain after surgery, although the overall look of the breasts is significantly enhanced.

In addition to the risks associated with anesthesia, loss of sensation to the nipple occurs in a small number of cases, and scars are common. Not every person is a candidate for this procedure, and your risks may be greater or different than those of other patients. Your plastic surgeon will review all potential risks and complications with you prior to the surgery.

Anticipated Results
A breast lift usually produces a rejuvenated, more youthful and attractive breast shape and overall breast appearance.

Overview

Being diagnosed with breast cancer or having a genetic predisposition to breast cancer can be physically and emotionally traumatic. The removal of a breast (mastectomy) often adds to the psychological trauma. Breast reconstruction following the surgical removal of a breast can help a woman cope with this stress and regain a sense of normalcy.

The breast reconstruction specialists at UPMC’s Department of Plastic and Reconstructive Surgery use state-of-the-art techniques that can create a natural-looking breast and help patients regain a positive body image.

When patients are diagnosed with breast cancer and want immediate breast reconstruction, UPMC plastic surgeons work as part of a multidisciplinary team that includes:

  • Surgical oncologists
  • Radiation therapists
  • Oncology physicians and nurses

Breast reconstructions can be done as an autologous tissue reconstruction, which uses the patient’s own tissues to reconstruct a new breast mound, with a breast implant, or a combination of the two.

Who is a Candidate?
If you already had a mastectomy, or are anticipating a mastectomy, you may be a candidate for breast reconstruction. In general, age is not a limiting factor. If you are healthy enough to undergo a surgical operation, you are most likely a candidate for one of the breast reconstruction techniques outlined below.

Before the Procedure
Your plastic surgeon will speak with you about your goals, take an in-depth history of your cancer diagnosis, and perform a detailed physical examination to help you arrive at a decision about which breast reconstruction method is best for your particular situation.

Some of the specific instructions you’ll receive about preparing for surgery include:

  • Smoking cessation
  • Medications to avoid
  • When to take your prescribed medications
  • Proper washing techniques
  • Restrictions regarding eating and drinking the night before surgery

Procedure Details

Autologous (flap) reconstruction

An autologous, or flap reconstruction, technique uses your own tissues to recreate a breast after a mastectomy. Autologous reconstructions can appear more natural than implant reconstructions, and tend to be more durable, thereby possibly avoiding additional operations.

  • Transverse rectus abdominus myocutaneous (TRAM) flap – The surgeon relocates a flap of skin, fat, blood vessels, and muscle from your abdomen to the breast area. This procedure also can be done as a free flap in which blood vessels are reconnected to vessels in the chest.
  • Deep inferior epigastric perforator (DIEP) flap – The surgeon removes only your skin and fat, and spares the abdominal wall muscles, which results in a shorter recovery time and less abdominal muscle weakness. If your anatomy is appropriate, the surgeon may opt to perform this procedure instead of the more conservative TRAM flap procedure.
  • Other microvascular reconstructive options include variations of these flap procedures — SIEA, SGAP, TUG, and Reuben.

Prosthetic implant reconstruction

The use of saline or silicone implants can be an excellent option for breast reconstruction. If you do not require radiation therapy, and lack sufficient autologous tissue in your lower abdomen to create adequate breast volume, you may be a good candidate for this type of reconstruction.

Following a mastectomy, surgeons insert a skin expander beneath your skin and chest muscle. Over the course of several weeks, surgeons adjust the expander and eventually perform a second operation to insert the implant and reconstruct the surrounding skin and areola. If you do not require a tissue expansion, you can receive a breast implant immediately following the mastectomy. Breast implant technology has improved greatly over the past decade, and good reconstructions are achieved in most patients.

Partial breast reconstruction/oncoplastic breast reconstruction

Many women with breast cancer are able to be treated with breast conservation therapy (BCT), in which the tumor is removed via segmental mastectomy (lumpectomy) followed by radiation therapy. Although many patients heal well with acceptable cosmetic results, some develop abnormal breast contours, shapes, or asymmetries. Prior to the surgery, potential cosmetic problems from BCT can be anticipated in some women, especially if the tumor is larger, if the breasts are small to moderately sized, or if the area of tissue removal is in a cosmetically sensitive location.

Partial breast reconstruction can be helpful in many women who have unsatisfactory results after BCT. In this approach, a variety of techniques are used to improve shape, contour, and size discrepancies between the breasts.

Oncoplastic breast reconstruction refers to the use of multiple techniques being done simultaneously with the segmental mastectomy, so that reconstruction can be done immediately.

Where Will the Surgery Be Performed?
The surgery is performed in a hospital, and the length of stay depends on the type of procedure that is performed. You must be driven to and from the hospital by a friend or family member.

Type of Anesthesia
Primary breast reconstruction is performed under general anesthesia. Smaller second stage and touch-up procedures may often be performed under sedation or with local anesthetic alone.

Immediate Postoperative Recovery
Patients who have implant-based breast reconstruction and patients having oncoplastic reconstruction usually stay one night in the hospital. Autologous breast reconstruction patients typically stay in the hospital three or four days after surgery. All patients are out of bed the day after surgery, and walking in the halls within a few days.

Short-term Recovery
In most cases, patients who have implant-based breast reconstruction and patients having oncoplastic reconstruction return to normal activities (walking, stairs, grocery shopping, and driving) within a week after surgery. They may return to work about two weeks after surgery.

Autologous breast reconstruction patients also return to normal activities quickly, within a week or two after surgery. They generally return to work after four weeks.

Most patients will have restrictions on lifting for a period of time, and they can drive when they are no longer taking pain medications. Showering is permitted after two to three days, but may take longer if drains remain in place. Vigorous physical activity is limited for several weeks following surgery.

Risks
All surgical procedures carry risks. In addition to risks associated with anesthesia, the risks vary greatly between the different procedures but all procedures are considered major surgery. Not every person is a candidate for breast reconstruction, and your risks may be greater or different than those of other patients. Your plastic surgeon will review all potential risks and complications with you prior to surgery.

Anticipated Results
The main goal of breast reconstruction is to create breast symmetry while wearing clothing. Many patients are able wear clothing more comfortably following surgery, including bathing suits. Your plastic surgeon will discuss the different techniques available, and help you decide which one fits your instrongidual needs and lifestyle.

Overview

Overly large male chests can cause emotional issues and poor self-esteem for men.

Gynecomastia repair, or a male breast reduction, is a surgical procedure that removes excess chest tissue through incisions made on the chest. In addition to the reduction, the procedure also uplifts the nipples and can reduce their size to one that is in proportion with your body, thereby alleviating the discomfort associated with overly large breasts.

After massive weight loss, gynecomastia repair can eliminate a lot of the extra skin on the chest extending out to the sides of the chest as well.

Who is a Candidate?

Gyencomastia repair is a highly instrongidualized procedure. It can be a good option for you if you are physically healthy, but are bothered by the feeling that your breasts are too large.

Chest reduction can help you comfortably resume your normal activities of daily living, but you must be willing to accept permanent scars on the chest.

Before the Procedure

The success and safety of your procedure depends on your complete honesty during your initial consultation with the plastic surgeon. You’ll be asked a number of questions about your:

  • Health
  • Lifestyle, including your reasons and expectations for the surgery
  • Desired outcome

You’ll be asked about certain medications such as testosterone, marijuana, and other drugs that may cause gynecomastia as a side effect. Most cases are idiopathic, meaning there is no understood cause of the enlarged breasts in men.

You will have to provide a detailed history of your medical condition(s), drug allergies, and use of current medications. A physical exam will check for masses in the chest, and possibly in the testicles.

Notify your doctor of any previous surgeries or family history of breast cancer, and provide the results of any mammograms or previous biopsies. As part of the preparation, your surgeon will examine your breasts and may take detailed measurements and photographs of their:

  • Size
  • Shape
  • Skin quality
  • Placement of nipples and areolas

Some of the specific instructions you’ll receive about preparing for surgery include:

  • Smoking cessation
  • Medications to avoid
  • When to take your prescribed medications
  • Proper washing techniques
  • Restrictions regarding eating and drinking the night before surgery

Procedure Details

Gyencomastia repair usually is performed through incisions made on the breasts under the nipple with surgical removal of the breast’s excess glandular tissue, associated excess fat tissue, and excess skin. In some cases, liposuction may be used in conjunction with the surgery to remove excess fat.

In rare cases where the large breast size is primarily due to fatty tissue and excess skin is not a factor, liposuction alone may be used for gynecomastia reduction. For men with large breasts, the nipples may need to be completely relocated while being preserved on some tissue on the chest. For men with lots of loose skin, the nipples may need to be removed and sewn back on as a skin graft. Larger reductions may require a scar across the entire chest.

The surgical technique used will be determined by your:

  • Breast anatomy
  • Composition
  • Amount of reduction desired
  • Surgeon’s preferences

Several incision options are available, and your surgeon will discuss each in detail with you. Incision lines are permanent but will fade and significantly improve over time.

Where Will the Surgery Be Performed?

Breast reduction surgery usually is done in a hospital as outpatient surgery and you must be driven to and from the hospital by a friend or family member. Some patients may spend the night in the hospital.

Type of Anesthesia

Your doctor will recommend the best type of anesthesia for you, but local anesthesia along with intravenous sedation or general anesthesia can be used.

Immediate Postoperative Recovery

This is considered major surgery and following your physician’s instructions are important to the procedure’s success. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.

Short-term Recovery

When the procedure is complete, dressings or bandages will be applied to the incisions, and an elastic bandage will be worn to minimize swelling and support the chest as it heals. You will be given specific instructions about caring for the surgical site and which medications to take or apply directly on the breasts to aid with healing and reduce the risk of infection.

Risks

In addition to the risks associated with anesthesia, other risks can include scarring, infection, and changes in nipple or breast sensation, which may be temporary or permanent.

From a cosmetic standpoint there may be breast contour and shape irregularities, and there may be a need for future surgical revisions. The decision to have breast reduction surgery is extremely personal and you’ll have to weigh your goals against the potential risks and complications.

Not every person is a candidate for this procedure, and your risks may be greater or different than those of other patients. Your plastic surgeon will review all potential risks and complications with you prior to the surgery.

Anticipated Results

The results of gynecomastia surgery will be long lasting. Your new chest size should help relieve the physical and emotional limitations you may have experienced prior to the chest reduction. Your chest generally will have a better shape and more proportional with your physique. Over the course of time, your chest may slightly change due to aging, weight fluctuations, and gravity.

Overview

Overly large breasts can cause health and emotional problems for some women. In addition to self-image and emotional issues, women may experience physical pain and discomfort, and the weight of excess breast tissue can impair their abilities to complete normal daily activities.

A breast reduction, also known as reduction mammaplasty, is a surgical procedure that removes excess breast tissue through incisions made on the breasts. In addition to the reduction, the procedure also uplifts the breasts to give you a size that’s in proportion with your body, thereby alleviating the discomfort associated with overly large breasts.
Who is a Candidate?
Breast reduction is a highly instrongidualized procedure. It can be a good option for you if you are physically healthy, but are bothered by the feeling that your breasts are too large. Breast reduction also can be a good option if you are experiencing:

  • Back pain
  • Neck pain
  • Shoulder pain
  • Have indentations from your bra straps across your collar bone
  • Have rashes underneath your breasts

Breast reduction can help you comfortably resume your normal activities of daily living, but you must be willing to accept permanent scars on the breasts.
Before the Procedure
The success and safety of your breast reduction procedure depends on your complete honesty during your initial consultation with the plastic surgeon. You’ll be asked a number of questions about

  • Your health
  • Desires
  • Lifestyle, including your reasons and expectations for the surgery, and desired outcome

You will have to provide a detailed medical history including:

  • Medical condition(s)
  • Drug allergies
  • Use of current medications

Notify your doctor of any previous surgeries or family history of breast cancer, and provide the results of any mammograms or previous biopsies. As part of the preparation, your surgeon will:

  • Examine your breasts
  • May take detailed measurements of their:
    • Size
    • Shape
    • Skin quality
    • Placement of nipples and areolas
    • Take photographs for your medical record

In addition, women 35 years of age or older will need to have a baseline mammogram if you have not had one in the past.

Some of the specific instructions you’ll receive about preparing for surgery include:

  • Smoking cessation
  • Medications to avoid
  • When to take your prescribed medications
  • Proper washing techniques
  • Restrictions regarding eating and drinking the night before surgery

Procedure Details
Breast reduction usually is performed through incisions made on the breasts with surgical removal of the breast’s:

  • Excess glandular tissue
  • Associated excess fat tissue
  • Excess skin

In some cases, liposuction may be used in conjunction with the surgery to remove excess fat. In rare cases where the large breast size is primarily due to fatty tissue and excess skin is not a factor, liposuction alone may be used for breast reduction. For women with very large breasts, the nipples may need to be taken off and sewn back on as skin grafts.

There are several factors that help to determine the surgical technique used for your breast reduction, including:

  • Breast anatomy
  • Composition
  • Amount of reduction desired
  • Your surgeon’s preferences

Several incision options are available, and your surgeon will discuss each in detail with you. Incision lines are permanent but will fade and significantly improve over time, and usually are hidden beneath a swimsuit or bra.
Where Will the Surgery Be Performed?
Breast reduction surgery usually is done in a hospital as outpatient surgery and you must be driven to and from the hospital by a friend or family member. Some patients may be required to spend a night in the hospital.
Type of Anesthesia
Your doctor will recommend the best type of anesthesia for you, but local anesthesia along with intravenous sedation or general anesthesia can be used.
Immediate Postoperative Recovery
This is considered major surgery and following your physician’s instructions are important to the procedure’s success. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.
Short-term Recovery
When the procedure is complete, dressings or bandages will be applied to the incisions, and an elastic bandage or support bra may be worn to minimize swelling and support the breasts as they heal. You will be given specific instructions about caring for the surgical site and which medications to take or apply directly on the breasts to aid with healing and reduce the risk of infection.
Risks
In addition to the risks associated with anesthesia, other risks can include scarring, infection, and changes in nipple or breast sensation, which may be temporary or permanent.

From a cosmetic standpoint there may be breast contour and shape irregularities, and there may be a need for future surgical revisions. The decision to have breast reduction surgery is extremely personal and you’ll have to weigh your goals against the potential risks and complications. When breasts are made smaller, other areas, such as the abdomen, may appear larger.

Not every person is a candidate for this procedure, and your risks may be greater or different than those of other patients. Your plastic surgeon will review all potential risks and complications with you prior to the surgery.
Anticipated Results
The results of breast reduction surgery will be long lasting. Your new breast size should help relieve the pain and physical limitations you had experienced prior to the breast reduction. Your breasts generally will have a better shape, are uplifted, and are more proportional with your physique. Over the course of time, your breasts may slightly change due to aging, weight fluctuations, hormonal factors, and gravity.

Overview

The injection of fat is used to treat various types of plastic surgical conditions.

It can be used to add volume to:

  • Lips
  • Cheeks
  • Breasts

It is sometimes used in conjunction with breast reconstruction operations to aid in symmetry and to make implants feel softer. Fat can also be used in the foot as a natural cushion to help reduce pain, ulcers, and callouses.

Who is a Candidate?

Adults over age 20 are candidates for this form of rejuvenation.

Before the Procedure

Your plastic surgeon will perform a detailed analysis of the area you desire to have treated. You should speak with your prescribing physician regarding the use of blood thinners. These medications can cause bruising and swelling.

Procedure Details

In the office or in the operating room, the part of your body receiving the fat injections will be numbed with topical agents and/or an injection of a local anesthesia. General anesthesia may be used for larger procedures or procedures combined with other operations.

Fat will be removed from another area (such as the belly or thighs) by liposuction, and then transferred to the desired area (such as the face, breast, or foot).

Where Will the Procedure Be Performed?

The procedure may be done in the plastic surgeon’s office, or in a hospital operating room.

Type of Anesthesia

Topical anesthesia can be used or your plastic surgeon may wish to inject a nerve blocking agent to numb a specific area of your body. For larger cases, general anesthesia may be necessary.

Immediate Recovery

Compression garments may be necessary on the liposuction area. Compression is sometimes required on the area where the grafts are placed. For fat grafting to the foot, special pads may need to be placed in a comfortable shoe to prevent too much pressure after the injections.

Risks

The risks of the procedure are minimal and can include:

  • Bruising
  • Bleeding
  • Infection
  • Asymmetry

Not every person is a candidate for this procedure, and your risks may be greater or different than those of other patients. Your plastic surgeon will review all potential risks and complications with you prior to the procedure.

Sometimes only 50-80% of the fat that is injected may “take”, requiring more procedures to get to the desired result.

Anticipated Results

Fat injections usually result in an improvement and enhancement in the area(s) that are treated.

There may be:

  • A softening or elimination of a crease
  • Filled wrinkles or areas of the face
  • Enhanced lips or breasts
  • Increased the padding of the foot