BREAST

A common method of lifting the breasts involves three incisions: One incision courses around the areolar complex. A second incision runs vertically from the bottom edge of the areolar complex to the crease underneath the breast. A third incision traverses horizontally beneath the breast, following the natural curve of the breast crease. Different patterns of incisions can be used depending on individual conditions. After Dr. Minoli has removed excess breast skin, the nipple and its areolar complex are shifted to a higher position. The areolar complex, which in a sagging breast may have been stretched, can be reduced in size. A region of breast skin which is originally located above the nipple (before surgery) is loosened during surgery, then rotated downward and inward…as the central components of the nipple and its areolar complex are simultaneously moved upward: This combination of maneuvers help to reshape the breast.

The nipples and areolar complexes remain attached to underlying mounds of tissue, and this usually allows for the preservation of sensation and the ability to breast feed (although this cannot be guaranteed.). Liposuction may be used to improve the adjacent contours.

There are many variations to the design of the incisions for breast lift surgery. The size and shape of your breasts, the size of your areolar complexes, and the extent of breast sag are factors that will help Dr. Minoli determine the best technique for you. In some instances, it may be possible to avoid the horizontal incision beneath the breast. Sometimes a technique may be used which limits incisions to the circular rim of the areola alone. Dr. Minoli will discuss the particular methods that may be right for reshaping your breasts. These considerations are based on individual factors and upon realistic goals that you and he set.

(**** If you and Dr. Minoli have decided that it is desirable to simultaneously lift and enlarge your breasts, you will need breast implants and your consultation will proceed accordingly. ****)

One or more of the following conditions may indicate that you are a good candidate for breast lifting (mastopexy) surgery:

• Your breasts are pendulous, but of satisfactory size.
• Your breasts lack substance or firmness.
• Your nipples and areolar complexes point downward and are even below your breast crease (inframammary fold).
• Your breasts have developed differently so that one breast is firm and well-positioned while the other is not (possibly due to heredity).
• Your breasts are different in size & shape (possibly due to heredity).

A common method of reducing the breasts involves three incisions: One incision courses around the areolar complex. A second incision runs vertically from the bottom edge of the areolar complex to the crease underneath the breast. A third incision traverses horizontally beneath the breast, following the natural curve of the breast crease. As previously exhibited, different patterns of incisions can be used depending on individual conditions.

After Dr. Minoli has removed excess breast gland, fat & skin, the nipple and its areolar complex are shifted to a higher position. The areolar complex, which in large breasts usually has been stretched, can be reduced in size. A region of breast skin which is originally located above the nipple (before surgery) is loosened during surgery, then rotated downward and inward … as the central components of the nipple and its areolar complex are simultaneously moved upward: This combination of maneuvers help to reshape and reduce the breast.

The nipples and areolar complexes remain attached to underlying mounds of tissue, and this usually allows for the preservation of sensation and the ability to breast feed (although this cannot be guaranteed.). Liposuction may be used to improve the adjacent contours.

Breast lifting, breast reduction or combined breast lift/augmentation surgery is typically a cosmetic procedure and, as such, is not covered by most insurance companies. However, under certain circumstances of overly enlarged breasts and accompanying symptoms insurance coverage may be available. Many factors determine your eligibility for coverage, including the specific terms of your insurance policy. A letter of predetermination may be required by your insurance company prior to surgery. Dr. Minoli & his staff will discuss these matters with you.

The subject of risks and potential complications of surgery is best discussed on a personal basis between you and Dr. Minoli & his staff. Fortunately, significant complications from breast lifting, breast reduction or combined breast lift/augmentation surgery are uncommon – this takes into consideration thousands of procedures worldwide. As benefits are considered, so too are specific risks: These include the possibility of bleeding, infection, bruising, prolonged discoloration, swelling, numbness, reactions to anesthesia, contour irregularities, fluid collections, tissue loss, need for further surgery, and unsatisfactory overall results.

Further considerations which pertain to breast lifting, breast reduction or combined breast lift/augmentation surgery include the following:

• When a breast implant is inserted, a scar capsule forms around it as part of the natural healing process. The capsule may sometimes tighten and compress the implant, causing the breast to feel firmer than normal. Capsular contracture can occur to varying degrees. If it is severe, it can cause discomfort or changes in breast shape. In such cases, more surgery may be needed to modify or remove scar tissue, or perhaps remove or replace the implant itself.
• Breast implants are not “lifetime devices” and cannot be expected to last forever. If a saline-filled implant breaks, its contents are harmlessly absorbed by the body. Breast changes are usually noticeable. Implant rupture can occur as a result of trauma to the chest, but more commonly it occurs spontaneously with no apparent cause. Surgery is required in order to replace the ruptured implant; but this surgery is typically straightforward.
• If you are at an age when routine mammograms should be conducted, it will be important for you to select a radiologist who has experience & skill in taking x-rays of augmented breasts. Additional mammogram views of your breasts will be required. In some instances Dr. Minoli may recommend other imaging exams such as ultrasound or magnetic resonance imaging (MRI).
• Some women with breast implants have reported the co-existing presence of connective-tissue disorders or autoimmune-related diseases. Women without implants also have these disorders. Several large studies provide reassurance that women with breast implants do not have any unusual or increased risk of contracting connective-tissue disorders or autoimmune-related diseases.
• Permanent changes in sensation (or loss of sensation) within the nipples or breasts can occur.
• In the unlikely event of injury to the nipple-areolar complex, small skin grafts or skin flaps can be used for a satisfactory reconstruction.

Minor irregularities can sometimes arise (e.g., in certain instances – when incisions have not healed in an ideal way, when contour irregularities arise in the healing process, when the breasts are not perfectly symmetrical, or when nipple height varies somewhat from side to side), but office-based postoperative treatments are usually available to help minimize these problems if they occur. You can help to lessen certain risks by following the professional advice given by Dr. Minoli and his staff.

We want your surgical experience to be as easy and comfortable as possible. If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin, certain anti-inflammatory drugs, and an array of supplements (e.g., fish oil, flaxseed oil, garlic supplements, green tea & Vitamin E) can cause increased bleeding, so you should avoid taking these medications & supplements well in advance of surgery.

In certain instances, Dr. Minoli may recommend that you have a baseline mammogram before your surgery and another mammographic examination some months after surgery: This will help to detect typical postoperative changes in your breast tissue.

Breast lifting, breast reduction or combined breast lift/augmentation surgery is performed on an outpatient basis. Even though surgery is performed on an outpatient basis, you will need someone to drive you home after surgery and stay with you that first postoperative night. (Dr. Minoli & his staff will will help guide you during your formal preoperative counseling session.)

Your breast lifting, breast reduction or combined breast lift/augmentation surgery may be performed in a hospital or a free-standing ambulatory facility. Medications are administered for your comfort during the surgical procedure. Dr. Minoli and your anesthesiologist will determine with you what type of anesthesia will be used – intravenous sedation, or general anesthesia. For your safety during the operation, various monitors are used to check your blood pressure, pulse and circulating oxygen.

When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. If you do experience discomfort, this can be controlled by medication which you may continue taking in the days following surgery. Surgical dressings & bandages will be placed over the treatment area. After a few hours of recovery room monitoring, your likely will be permitted to go home. (On request, some patients stay overnight in hospital or in a postoperative-care facility. Dr. Minoli & his staff would help guide you in these preparations.)

You will be returning to Dr. Minoli’s office at regular intervals so that your postoperative progress can be properly evaluated. During the first few postoperative days your breasts may be tender, but this usually subsides later in the 1st week or so.

In the early stages of recovery (the first 2 or 3 days especially) you may need personal assistance. Washings must be done in a gentle manner during this early period; and in fact, specific instructions are given to each patient.

The day after surgery, you will be encouraged to get out of bed for short walks to promote blood circulation. Straining, bending and lifting must be avoided, since these activities may cause increased swelling or even bleeding. You may be instructed to sleep on your back with a pillow under your knees.

In some instances, small temporary drain tubes may be placed in the breasts under the bandages. These drains can help prevent the accumulation of postsurgical fluids in the breasts: They are usually removed the first day after surgery; but a full shower or bath is not permissible until the drains are gone.

As the 1st postoperative week progresses so does one’s sense of independence. External sutures are usually removed in about 7 to 10 days. Drains and their associated sutures are typically removed within the 1st week. Bruising and swelling, common during the first few postoperative days, subside during the 2nd week. By the 2nd week driving privileges will likely resume.

Special notes: Dr. Minoli recommends that breast-implant patients take antibiotics at the time of dental procedures to indirectly protect their breast implants from oral germs: So you may need our assistance in such an event. Following surgery, you will still be able to perform breast self-examination. The surgery itself will NOT increase your risk of developing breast cancer. Of course, we continue to recommend that you schedule routine mammograms appropriate for your age.

It is important to realize that the amount of time it takes for recovery varies greatly among individuals. Straining, bending and lifting should be avoided during the early postoperative period. Depending on the extent of your breast surgery and your general physical condition, you may be able to return to non-strenuous work anywhere from 1 to 3 weeks after surgery. Any sexual activity should be avoided for a minimum of 3 weeks. And vigorous activities, especially extended arm movements, should be restricted for at least 3 weeks.

In many instances, you can resume most of your normal activities, including some form form of mild exercise, after a few weeks. You may continue to experience mild periodic discomfort and swelling during this time, but such feelings are normal. Severe pain should be reported. In general, the timing of your recovery depends largely on the extent of your surgery and your individual healing capacity.

Bruising & swelling, common during the 1st week, begin to subside noticeably during the 2nd week. In a broader sense: It takes about 6 weeks after surgery to pass social scrutiny … & 6 months or more before residual lumps & bumps soften & dissipate. Incisions will initially be red or pink in color: They will remain this way for many months following surgery – and may even appear to worsen before they fade. There may also be numbness in some areas; it may take months before feeling returns. Of course, Dr. Minoli will help guide you through these milestones.

You should be up and gently about during the first few days following surgery; but without strain. Your dressings will be removed in the days following surgery so that Dr. Minoli can examine the treated areas. You will be advised to wear a supportive post-surgical bra. Stitches will be removed in 5 to 10 days, depending on their nature. If present, drains and their associated sutures are typically removed within the 1st week. A full shower or bath is usually permissible on the 2nd or 3rd postoperative day.

It is important to realize that recovery time varies greatly among individuals. Please remember that your relationship with our staff does not end when you leave the operating room. Since the healing process is gradual, you should expect to wait up to 1 year to see the final results of your breast surgery. You are likely, however, to begin enjoying the initial stages of your new appearance within a few weeks after surgery. If you have any questions or concerns during your recovery, or need additional information at a later time, please contact us.

The results of your breast surgery may be dramatic or subtle, depending on how you looked before surgery as well as the specific goals that you and Dr. Minoli establish. Since the healing process is gradual, you should expect to wait at least several weeks before being able to appreciate your “new look.” Modest changes may continue to occur over several months to a year.

When healing is accomplished, breast lifting, breast reduction or combined breast lift/augmentation surgery will have re-positioned your breasts and enhanced their shape. You may find it easier to wear certain clothing styles. It may take some time to adjust to your new body image, but you are likely to feel a boost in self-confidence as you progress in your healing. Still, it is important to remember that various healing factors may prolong the final result. Fluid retention and prolonged swelling are typical in the months following surgery. The healing process is gradual, so you should expect to wait a while before fully enjoying the outcome. Nevertheless, the results of your surgery should be long-lasting. Unless you gain or lose a significant amount of weight or become pregnant, your new breast shape should remain fairly constant.

However, aging, gravity & weight-fluctuation can take their toll; and they will eventually alter the size and shape of virtually every woman’s breasts. Furthermore, implants are not your own flesh-and-blood. ~25% of women undergo another breast surgery years later. If, after a period of years, you again become dissatisfied with the appearance of your breasts, you may choose to undergo a second breast procedure to restore their more youthful contour and appearance.

Scars will fade over time; but no matter what, incisions create scars – and scars are permanent. Most incisions heal nicely; but some scars are more noticeable. Fortunately, breast lifting, breast reduction & combined breast lift/augmentation surgery scars are usually concealed by natural body creases or actual clothing. Occasionally, a touch-up revision may be desired to improve a contour or a scar. The additional treatment can usually be performed under local anesthesia in Dr. Minoli’s office. You will return to Dr. Minoli’s office for follow-up care at prescribed intervals, at which time your progress will be evaluated. This postoperative period typically spans the first year following surgery, and certainly beyond if needed. Please remember that the relationship with Dr. Minoli and his staff does not end when you leave the operating room, but continues. If you have questions or concerns during recovery Dr. Minoli and his staff will be available to respond.

(Dear reader, please note: Aging, gravity & weight-fluctuation can take their toll. If your breasts change even after surgery, secondary procedures are still available.)