Breast reduction is performed by Dr. Sherwyn in his New York City (NYC) office to correct large, sagging breasts. Oversized breasts interfere with normal function and physical activity by causing back pain, postural problems, deformities of the back and shoulders, skin rashes under the breasts and breast pain. Though classified as a reconstructive procedure, breast reduction surgery has an important aesthetic component improving the shape of the breasts and enhancing one's overall appearance by making the breasts more proportional to the rest of the body.
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, final breast size should be anticipated prior to the procedure. Moreover, 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.
A different approach to this procedure 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. This distinguishing feature as well as the creation of a final breast shape which is consistently conical make 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. In addition, this approach is limited with respect to the distance the nipple-areola complex may be elevated as well as the amount of breast tissue that can safely be removed at procedure which typically translates to one cup size.
Breast Uplift And Augmentation
Those persons who lose volume and tone postpartum or consequent to weight loss may desire breast enlargement as well as a lift.
The breast uplift-augmentation is a deceptively difficult procedure which effectively combines two independent and, oftentimes, competing variables, one to enlarge a breast and the other to lift and thus tighten the overlying skin envelope. This may mitigate the final size the breast may achieve so that the lift does not compromise the closure or the resultant breast aesthetic. The virtual unknown that can occur during the course of this procedure requires both surgeon and patient to understand that there must be a degree of latitude given to the surgeon intraoperatively in order to accomplish both procedures simultaneously. This might translate to the use of a smaller implant than anticipated or a breast that is not as elevated as planned. On occasion, with complex revisions of prior work, capsule removal and/or pocket modification may eliminate the need to perform a lift altogether. On rare occasions, a staged approach is recommended in order to successfully perform both procedures while satisfying the patient's ultimate goal. This must be communicated with the patient prior to procedure and thoroughly discussed lest disappointment ensue.
As is true of most aesthetic procedures, accuracy is critical. Herein, the use of a technique referred to as "tailor-tack" helps to ensure such accuracy. During this procedure, the augmentation is traditionally performed first. The operating room table is then 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. The breast mound is thereby brought into harmony with the underlying implant. Should these temporary sutures prove satisfactory, they are delineated, the uplift is definitely 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.