Breast Lifting – Droopy versus Perky

“The Fountain of Youth” – Dr Chris Porter’s inside view of cosmetic surgery where he aims to help you to make the best possible informed choice and achieve your cosmetic surgery goals.

Following my blog last week on breast reduction surgery I have had some comments asking about breast lifting. Breast lifting (also known as mastopexy) is a procedure to correct the changes of nipple position and breast shape that occur with time and recreate a youthful appearing breast. Theses changes can occur with aging, weight loss, pregnancy and following breast feeding. Generally the nipple descends and the breast mound droops (breast ptosis) as the breast skin loses elasticity. A good way to think of this is the breast skin acting like a bra supporting the breast gland. Just like an old bra that has lost its elastic nature the breast skin also fails allowing the gland and nipple to head south.

There are two main options to correct breast droop, either tighten the skin or expand the breast gland volume using an implant. This second option known is as augmentation-mastopexy and I will discuss in a separate blog as it is worthy of discussion alone. Mastopexy is a term that describes the goal of breast and nipple lifting which improves the breast shape but maintains the current breast size. There are however a number of surgical procedures to attain this goal, the choice of surgical procedure should be individually tailored to the patient’s breast shape, skin characteristics and desires. The most important issue is how drooped the breasts are, generally the more droopy the breast the more surgery is required and results in more scarring. Scarring can be limited from around the nipple alone, to around the nipple and a short scar on the lower portion of the breast, to a scar that includes the nipple, lower breast and in the fold itself. Only after consultation with a Plastic Surgeon will you know what the best option is for you. Minimal scarring is desirable but the overall goal of a youthful breast should not be compromised to keep the scar short. A longer scar on a youthful breast is better aesthetically than a shorter scar on a droopy breast.

It is worth remembering that once the breast has been lifted and returned to its youthful appearance then the changes can again occur slowly with time. Plastic surgery can turn the clock back but once the procedure is performed the clock will start ticking again. Having said this, a good quality and well chosen mastopexy should gain many years of satisfaction for the patient.

If you have any specific requests regarding cosmetic surgery topics that you would like discussed on this blog, please feel free to email me: chris@breast-body.co.nz

Advertisements

Breast Reduction – Do Not Wait to Improve Your Quality of Life

“The Fountain of Youth” – Dr Chris Porter’s inside view of cosmetic surgery where he aims to help you to make the best possible informed choice and achieve your cosmetic surgery goals.

Breast reduction surgery is one of the most common procedures I perform and becoming more popular over a wide range of patient ages. Historically referrals from family doctors was poor as the potential surgical gains from the symptoms of large breasts were poorly understood. Patients with large breasts (also known as mammary hypertrophy or mammary hyperplasia) suffer from a constellation of symptoms and concerns. Physically patients can experience neck and/or back pain, breast pain, rashes under the breasts, bra shoulder strap grooves, and may need to wear their bra to bed for support. Exercise is often difficult or impossible due to the breast mass being poorly supported or due to tight fitting swimming or gym gear. Patients also suffer socially due to the attention their chest gets when wearing fitted clothing, consequently they tend to wear loose clothing several sizes larger than their lower body and slump their shoulders forward to hide their breast size. Emotionally the prolonged psychological weight of having large breasts can be as bad as the physical symptoms. The key things are knowing that if you have large breasts your symptoms are typical, you are not alone and surgery is a very good option to consider. What you should expect to gain from breast reduction surgery are breasts that are smaller (shorter, narrower and less full), lighter, perkier and generally more youthful. You will also gain a new self-confidence and be able to wear normal bras, shirts, dresses, swimming and gym gear. Exercise will be achievable and your neck, back and breast pain should improve as will your posture. You will appear proportionate to your friends and family as well as appearing slighter in frame as your heavy upper body has been treated.

Patients who present for breast reduction surgery generally come in two age brackets, those that are 18-30 years before having a family and those 35+ years following a family. A small age difference I know but there are a couple of issues that patients need to be aware of. Like all plastic surgery procedures the post-operative result of breast reduction can be affected by a number of life factors from the day of surgery onwards. Pregnancy and breast feeding can affect the breast size, shape and gland density. So, in theory the result of breast reduction can be affected by pregnancy and breast feeding. However, I believe the overall the gains of having a breast reduction before having a family are immense and exceed any potential pregnancy changes. The second group of patients are post family and typically have been thinking about having a breast reduction for many years, almost universally my patients in this group comment following surgery that they wish they gone and had their breasts reduced years ago.

Surgery can be performed as a day procedure, or with a single night in hospital, as the post operative pain is usually quite mild. Recovery is faster than most patients expect and a commonly I need to tell patients to slow down their activities in the early days after surgery. I would expect that most patients are back to work or study and driving by 1 week after surgery.  The sense of physical and emotional improvement is immense making breast reduction one of the most satisfying plastic surgery procedures for patients and plastic surgeons alike.

If you have any specific requests regarding cosmetic surgery topics that you would like discussed on this blog, please feel free to email me: chris@breast-body.co.nz

ALCL – Facts that Breast Augmentation Patients Need to Know

“The Fountain of Youth” – Dr Chris Porter’s inside view of cosmetic surgery where he aims to help you to make the best possible informed choice and achieve your cosmetic surgery goals.

Anaplastic large cell lymphoma (ALCL) has been identified as occurring in a small number of patients with breast implants. ALCL is a rare type of non-Hodgkin’s lymphoma and is not a cancer of breast tissue. The US FDA is investigating this possible association and “believes that there is a low but increased risk of developing ALCL adjacent to the breast implant”. Approximately 60 cases have been identified throughout the world, which represents a fraction of the 5-10 million women who have received breast implants. It is estimated that the risk of ALCL for breast augmentation patients is between 1 in 250,000 and 1 in 1 million. Breast implants have been proven not to increase the risk of breast cancer; breast cancer can affect up to 1 in 7 women in developed countries. There is no association between ALCL and any particular breast implant brand, shell or whether the implant has saline or silicone fill.

Of the known cases of ALCL in patients with breast implants there are some warning signs that patients should be aware of. If a breast lump is detected or if one of the breasts becomes larger or tighter than the other then it is recommended that breast augmentation patients are reviewed by a Plastic Surgeon. An MRI scan may be ordered to assess the implant integrity and adjacent breast tissue for any abnormal lumps. If a seroma (a fluid collection around the implant) is suspected then an ultrasound scan can be used for documentation or used to aspirate any seroma fluid which can then be sent to the laboratory to test for the presence of ALCL cells. If  ALCL is suspected or confirmed with these investigations then implant removal with capsulectomy is recommended. The breast capsule is then sent to the laboratory for further testing.

There is, however, a slightly silver lining to this warning – ALCL developing around breast implants is a clinically indolent disease with a favorable prognosis that is quite distinct and different from systemic anaplastic lymphoma kinase–negative ALCL. Although some women underwent irradiation and/or chemotherapy after breast implant removal and capsulectomy for ALCL, more recent reports suggest that outcome and survival may be equivalent with only implant and implant capsule removal.

Prospective breast augmentation patients need to be aware of ALCL and discuss this with their Plastic Surgeon, patients need to be reassured that the risk is of developing ALCL is extremely low and that ALCL behaves in an indolent manner.

If you have any specific requests regarding cosmetic surgery topics that you would like discussed on this blog, please feel free to email me: chris@breast-body.co.nz

Body Contouring Surgery after Massive Weight Loss

“The Fountain of Youth” – Dr Chris Porter’s inside view of cosmetic surgery where he aims to help you to make the best possible informed choice and achieve your cosmetic surgery goals.

Surgery to cause weight loss has become increasingly popular recently, such as gastric banding or bypass surgery, as have TV reality shows which prove that similar weight loss can be achieved by dedicated diet control combined with exercise. Weight loss surgery is known as bariatric surgery and in the US alone in excess of 250,000 patients are having these procedures every year to help manage their obesity and related health issues, such as diabetes and hypertension. The number of bariatric procedures performed in NZ are similarly increasing every year. Initially in NZ these procedures were performed purely in private and paid for by patients without health insurance funding, now a limited number of selected patients are offered bariatric surgery throughout the public health system and there can be a part payment provided by health insurers for private surgery.

I am grateful to have had the opportunity to operate with some of the pioneers of body contouring surgery in Los Angeles when I worked at the University of Southern California in 2005/2006. The techniques we used then created a core of great surgical options but are better understood now have also been modified to tailor and finesse individual patient needs.

Weight loss, either through surgery or diet and exercise, improves general health in a number of ways, increases life expectancy and most importantly quality of life. The flip side of the coin is that patients who undergo major weight loss are often left with excess loose skin that creates undesirable folds and contours. This appearance is psychologically and physically a let down after all the effort patients have put into improving their health. Body contouring surgery can help to create the body shape they set out to achieve.

Excess skin occurs commonly around the abdomen, buttocks, thighs, breasts and arms, it can also occur around the back, face and neck. Depending on the degree of weight loss, skin quality, patient health and desires a number of body contouring surgical options are available. Procedures often performed by Plastic Surgeons following massive weight loss include abdominoplasties (tummy tucks), lower body lifts, belt lipectomies, thigh lifts, arm lifts, breast reductions, breast lifts with or without breast implants, face lifts and neck lifts. Some of these procedures can be performed under the same anaesthetic but often procedures need to be staged with a rest period of 3 months or more between stages. There is no rule as to which procedures are performed first, the key is matching the patient’s goals with their health and anatomy to maximize outcomes. Prior to body contouring surgery patients need to have achieved their weight goal and been stable for at least 6 months, be physically fit, be under the care of a dietitian, and be psychologically sound and motivated. This last point is usually not an issue as patients are typically very motivated and realize they are only half way along their journey when they present for body contouring. I have found with my body contouring patients they are hugely appreciative and pleased with their outcomes, truly life changing and inspirational.

If you have any specific requests regarding cosmetic surgery topics that you would like discussed on this blog, please feel free to email me: chris@breast-body.co.nz