Breast augmentation is typically performed by NYC plastic surgeon, Dr. Sherwyn, to enlarge small breasts, underdeveloped breasts or breasts that have decreased in size after a woman has had children. The procedure is accomplished by surgically inserting an implant behind each breast. Both the saline and silicone breast implants are available today for this purpose. These implants are silicone shells filled with saline, or salt water, or silicone gel, respectively.
Augmentation mammaplasty is often times oversimplified as a procedure. Rather, it entails a fair amount of planning which takes into consideration a multitude of factors including the person's height, weight, body habitus, chest wall measurements, their desired breast size and shape, and selected photographs of their desired breast size and shape. In those instances where a patient remains uncertain despite the aforementioned, this office provides “sizers” to assist the decision making process. A “sizer” is a sample implant that the patient may use beneath clothing to simulate the anticipated result. If equivocation remains, this same device can be sterilized for use during the procedure to determine the ideal size for the requested outcome. As always, communication between physician and patient is critical.
The physician must weigh and convey other, additional, considerations which include implant location (behind the breast tissue or behind the muscle), implant type (round or teardrop), implant surface (smooth or textured), incision placement (armpit, around the areola or beneath the breast). Each consideration should be individualized to each respective patient.
A modification of the traditional breast augmentation procedure is referred to as the dual plane technique, published extensively in the plastic surgery literature since 2001. The dual plane approach combines the techniques of augmentation both beneath the muscle superiorly, or above, and the gland inferiorly, or below, thereby permitting a more natural "take-off" and shape of the breast while simultaneously allowing for the existing breast envelope to be filled as it exists. The result is a more pleasing aesthetic appearance of the breast oftentimes avoiding the need for an uplift in women with a sagging, or overtly ptotic, breast.
These devices may be utilized for reconstructive purposes such as breast reconstruction following mastectomy, congenital malformations or anomalies, and even those women desiring both uplift and augmentation.
A breast lift, or mastopexy, is performed to return youthful shape and lift to breasts that have sagged as a result of weight loss, pregnancy, loss of the skin's natural elasticity or simply the effects of gravity.
The traditional technique for this procedure entails an incision that encircles the areola continues vertically down the breast and traces the inframammary fold. Once again, communication, planning and proper execution are critical to a successful outcome. Herein, the resultant breast shape and lines of closure should prove to be aesthetically pleasing and not a disappointment. This breast shape must be conical, rounded and not boxy or square. Tension on lines of closure has been shown to frustrate, even thwart, the best efforts to minimize the prominence of incisions. Tension must be avoided when utilizing this technique thereby allowing for resultant lines of closure which are finely linear and relatively inconspicuous.
In those instances of severe ptosis, or sagging, or procedures of greater complexity, the use of a technique referred to as "tailor-tack" helps to ensure accuracy. During this procedure, the operating room table is brought to a fully upright position wherein temporary sutures are placed to provide for the uplift much the same way that a tailor does when altering a garment. Should these temporary sutures prove satisfactory, they are delineated, the uplift is definitively performed and permanent sutures placed. The "tailor-tack" approach is somewhat time consuming and, as a result, not performed by many surgeons. However, none can dispute its accuracy.
There are several other techniques which have been used for purposes of breast lift inclusive of the superior crescent and circumareolar, or donut, mastopexy. These procedures have the appeal of a minimal incision approach. However, they often fall short and prove to be a disappointment. Each has been associated with distortion of the nipple-areolar complex, prominent scars, and loss of breast projection, particularly the latter.
A different approach to the breast lift is referred to as the vertical mammaplasty. This technique was modified by Madeline Lejour, M.D., a Belgian plastic surgeon, in 1989 and introduced to the United States at the national meeting of The American Society of Plastic Surgeons in 1991. The vertical mammaplasty, or Lejour technique as it is often referred, entails an incision around the areola with a vertical limb only. There is no incision beneath the breast mound, hence patient familiarity with and reference to this technique as the “lollipop” procedure. This distinguishing feature as well as the creation of a final breast shape that is consistently conical render this technique preferable to the traditional approach described above. Many plastic surgeons do not perform this procedure, however, as there is a relatively steep learning curve and a lack of familiarity with the nuances inherent in this technique could prove disastrous.
For purposes of breast lift, then, there is both the traditional technique as well as the vertical mammaplasty. Herein, the vertical mammaplasty maintains a clear advantage. In a breast lift, excess skin not volume is the focus of the procedure and the vertical mammaplasty, with its use of limited incisions while simultaneously fashioning a beautiful breast shape, reigns supreme.
The procedure can be performed alone or in combination with breast augmentation for added volume.