Breast & Reconstruction

Breast Augmentation is the enlargement of a woman's breasts by placement of saline or silicone prostheses. Women who undergo this procedure may achieve larger and more shapely breasts. Candidates for this procedure include:

Those who desire larger breasts
Women with a mild to moderate degree of breast sagging and smaller breasts who desire correction of their shape along with enlargement of their size.
This procedure is also helpful to women who have assymetery: congenital deformity of the breast where one breast that is noticeably smaller than the other.

The procedure is done on an outpatient basis. In our office, it is most commonly performed under a local anesthesia with intravenous sedation by a board certified anesthesiologist. The three most common sites for the small surgical incision required are in the fold at the bottom of the breast, around the areolae, or under the armpit. The only implants that are approved for all instances by the Food and Drug Administration in the United States are saline implants. Although all studies to date have demonstrated their safety, silicone implants are only available for limited and controlled situations. Thus, currently, a saline implant is the most commonly used implant in the United States. The implant is inserted in a surgically created pocket located between the breast tissue and the pectoralis muscle or under the muscle itself.

The patient goes home in a gentle compression dressing of gauze and ace bandages. She is able to remove the dressing after 48 hours, shower, and change into a sports bra. Initial discomfort is controlled with oral medication. Patients are generally seen the first and second weeks after the procedure. Light activities can be resumed as tolerated. Most patients return to work or school sometime at the end of the first week after the procedure. Aerobic activities can be resumed in about 3 weeks.

All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.

BREAST LIFT (MASTOPEXY)

Breast lift surgery, a mastopexy, is indicated for those woman whose breasts have fallen and lost their shape with the nipple position being close to or at the botton of the breast. The mastopexy procedure is often done in conjunction with breast augmentation. Most commonly, woman seek consulatation for a breast lift after child birth or weight loss. The procedure can result in a scar just around the nipple (periareolar mastopexy), around the nipple and extending vertically or laterally downwards, or less commonly, these days, in an anchor-shaped pattern. This procedure is most commonly done as an out-patient under a local anesthesia with iv sedation by a board certified anesthesiologist. The patient is placed in a gentle compression bandage which she can remove in two days and then change for a sports bra. Light activities can be resumed as tolerated. Most patients return to work or school sometime at the end of the first week after the procedure. Aerobic activities can be resumed in about 3 weeks.

The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.

BREAST REDUCTION

Breast reduction surgery is used to reduce the size and improve the shape of the woman's breast. It can correct such symptoms as breast, neck and shoulder pain, rash under the breasts, and back pain. Small breast reductions can be done as an out-patient under a local anesthesia with intravenous sedation. Most breast reductions, however, require a general anesthesia. The procedure involves 3 steps: a reduction in the volume of the breast tissue, a reposition of the nipple-areolar complex, and a reshaping of the breast skin. With modern techniques it is unusual to require the actual removal and replacement of the nipple. Traditionally, breast reduction surgery was performed using an anchor shaped incision. The last 10 -15 years has seen a rise in the popularity of procedures such as the "L-shaped" and vertical reduction which result in less visible scars on the breast. . Light activities can be resumed as tolerated. Most patients return to work or school sometime at the end of the first week after the procedure. Aerobic activities can be resumed in about 3 weeks.

BREAST RECONSTRUCTION

Breast reconstruction is performed after surgical mastectomy. The reconstruction of the breast can be accomplished using either a prosthesis, the patients own tissues, or a combination of the two procedures. Patients who elect reconstruction with a prosthesis usually require expansion of the overlying skin and muscle using a saline prosthesis known as a tissue expander. This is most commonly placed at the time of the mastectomy (immediate breast reconstruction). Several months later, under a local anesthesia with sedation or a general anesthesia, the tissue expander is removed and a permanent prosthesis (saline or silicone) is placed. This second procedure is most commonly performed on an outpatient basis.

Reconstruction of the breast with the patient's own tissues is called autologous reconstruction. The most popular donor site for the tissue for the reconstruction is the abdomen. Skin, fat, and muscle from the abdomen are transferred on their blood supply to form the reconstructed breast. This procedure is known as a TRAM flap. This stands for transverse rectus abdominis flap. This is a longer surgical procedure and has more complications and risks associated with it than does the prosthetic reconstruction of the breast.

Reconstruction of the nipple and areolar complex are done under a local anesthesia usually as an out-patient in the doctor's office. A breast augmentation, mastopexy, or reduction are often performed on the breast on the other side (contralateral breast). This is known as the symmetry procedure. The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk.

The specific risks and the suitability of these procedures for a given individual can be determined only after a personal consultation. Please Email us at info@rothausmd.com or call us at 212.737.0770 to schedule a consultation with Dr. Rothaus.

For additional information on Laser Aesthetic Procedures, go to www.lasersandplasticsurgery.com.