Breast surgery is one of the commonest aesthetic surgery performed around the world. This surgery typically can be divided into:
Primary breast surgery.
i. Breast Augmentation. This is primarily a volume enhancing procedure using an implant or Liposuction with fat transfer to make the breast bigger.
ii. Breast 3D Re-shaping – this includes either a Breast Reduction which is a procedure to decrease the actual size of the bust or remodeling of an empty droopy breast aiming to maintain as much breast volume as possible. This is called an Uplift/Mastopexy.
iii. Mastopexy/Augmentation. This is a two-part procedure where volume is first added to the bust, usually in the form of breast implants, and then the second part is to reshape the breast over the implant to create a fuller, bigger, pert bust.
iv. Minor breast procedures include inverted nipple correction, bifid nipples, and areolar reduction procedures, which can all be performed under local anaesthetic.
It is important for patients to understand that all paired structures in the body have some form of asymmetry including the breast. These differences can include some of the following:
1. Chest wall/rib cage shape – this will determine the way your breast projects i.e. directly forwards, outwards or rarely inwards.
2. Breast volume – slight variation between sides is completely normal.
3. Nipple position on the breast, its height (traditionally measured from the notch between the collar bones to the nipple), the nipple distance from the midline and from the fold under the breast.
4. Height of the fold under the breast
An augmentation’s aim is to enhance the appearance, size and contour of a woman’s breasts. Women consider breast augmentation for different reasons. Some women feel their breasts are too small in relation to their body contour. It is not uncommon for women to desire augmentation after volume loss associated with pregnancy, breastfeeding and weight loss for example. Others desire to correct an asymmetry in breast size.
Breast Hypoplasia/underdevelopment is a complex 3D correction and has to address in various degrees: skin shortage, the volume of breast tissue, and nipple areolar complex shape. Often patients may require a number of procedures throughout their lifetime, including volume replacement (augmentation) usually first, then secondary treatments include uplift (reshaping), fat transfer and areolar surgery.
Large, heavy, pendulous breasts can be uncomfortable and have a significant mental/physical and emotional affect on women, of any age. Breast reduction is also known as reduction mammoplasty.
The reduction procedure reduces breast volume, re-shapes and lifts the breast while for the vast majority of patients preserving breast sensation and function. The size of the areolar will also be made smaller if needed to give a more aesthetic result.
Breast reduction surgery has the highest patients satisfaction in aesthetic surgery despite the scars.
A Mastopexy may be the ideal procedure for patients who have a reasonable breast volume, but the position/shape of the bust is not ideal following for example weight loss, pregnancy and breastfeeding.
This operation involves maintaining as much volume as needed, lifting the breast and re-shaping the breast mound and placing the breast tissue in a higher, in a pert position on the chest wall. The size of the areolar will also be adjusted smaller if needed to give a more aesthetic result.
This procedure is used to firstly replace lost volume to the breast using a Breast implant. Then performing the Mastopexy, which involves maintaining as much volume as needed, lifting the breast and re-shaping the breast mound and placing the breast tissue in a higher, in a pert position on the chest wall. The size of the areolar will also be adjusted smaller if needed to give a more aesthetic result.
A wonderful way of using nature’s excess from an area that you do not like such as the lower tummy or thighs. The excess fat once harvested, is washed and filtered and then re-injected back into the areas of the breast that is needed. The aim of this surgery is to increase the volume or balance natural asymmetry
It is very important to note that:
1.This Lipo-sculpture technique results in a maximal 1/2 to one cup size increase only.
2. It is NOT a technique that provides any true “lift” to the breast.
Male breast surgery, which is planned to address one or of all of the following: excess fat (liposuction) excess breast glandular tissue (open excision and removal) and excision of skin excess if needed.
These three simpler breast procedures are performed under local anaesthetic as a day case procedure.
Inverted nipple correction – either due to a developmental (born with it) or follow on from an infective process resulting in an imbalance between the length of the breast ducts or the strength of the muscle that lifts the nipple upwards. The surgical technique can have immediate, significant and long-term result in the space of 15-20 minutes, but unfortunately the breast ducts need to be cut so breast feeding is not possible post op.
Congenital nipple shape asymmetry – due to the way the breast buds develop in the womb, occasionally the shape of the nipple is not as uniform, or symmetrical compared to the opposite side. This can be reshaped to closer match the opposite side.
Areolar reduction surgery performed in various situations such as asymmetry of areolar size with similar breast volumes, or as part of breast reshaping in conditions of tubular breast or breast hypoplasia. It is not a technique to be used to attempt to lift the breast.
Revision Breast Surgery
Revision Breast surgery.
In my practice, this is a growing and complex subset of patients. The surgery involves two aspects firstly addressing the volume by removing the old implants/scar tissue, and replacing with new. Secondly, to decide what needs to be done with the soft tissues this may include a reduction/ uplift/ liposuction and fat transfer or even the use of an Artificial Dermal Matrix (ADM)
Revision surgery is always more complicated and I recommend two full consultations to fully discuss the options before making a decision on which type of surgery is best for you.
The factors to consider include:
1. The shape of the chest wall
2. Placement of implant i.e. above or below the muscle
3. The implant capsule – scarring that occurs around the implant
4. Type of implant
5. Changes of the breast tissue since previous augmentation i.e. thinning of the breast tissue and or drop of the breast tissue off the implant.
6. Trying to compromise by using bigger volumes and not having an Uplift, may result in a visible implant (to touch and feel), increased risks of rippling.
The surgical options are below:
This surgery is more complicated than the original surgery and usually involves the removal of the old implants and the surrounding scar tissue called a capsule. Once a new “clean” field has been created a new implant can be inserted into this pocket.
If over time the volume and shape is not ideal, patients may request removal and replacement of the breast implants followed by the reshaping of the loose breast tissue onto the implant i.e. an Uplift.
This is, unfortunately, a growing section of my practice where decisions made in the primary or previous surgeries have left significant volume and tissue issues.
In these situations often staged surgery is planned using the full range of Aesthetic Plastic Surgery reconstruction options in addition to those techniques described above, other options may use liposuction with fat transfer, and/or the use of Artificial Dermal Matrix (ADM) to support and thicken the soft tissues of the breast.