WHAT'S NEW

The patient is a woman who had lumpectomy and radiation on the left for breast cancer treatment.  She did not desire an implant, muscle flap surgery, or completion mastectomy.  After discussion with the patient’s oncology team, the patient elected to undergo serial fat grafting of the left breast with right breast matching mastopexy.  After 3 fat grafting sessions, the breast was soft enough to allow nipple relocation.  While this reconstruction was not traditional, fat grafting only in a radiated breast is considered well accepted practice and the patient is happy with her result.

The patient is a woman who is dissatisfied with her brow position and the laxity in her neck.  She has minimal jowls and has tight skin overlying her face.  She is best served with an anterior hairline brow lift to ease her central tense look and a platysmaplasty via an incision hidden beneath her chin to redrape her neck skin and musculature.  With later aging, she plans a facelift to address her jowl and eventual greater skin laxity.

anterior pre op

anterior post op

lateral pre op

lateral post op

The patient is a young woman who has breast augmentation.  Large implants are chosen to maximize her size as well as distribute her dense breast tissue.  The patient is happy with her resulting cleavage, but this is secondary more to her chest structure than to the implant size.  Implants may be only be properly placed as far medially as the insertion of the pectorais muscle into the sternum will allow.  If these insertions are released or tear, symmastia (where the implants touch in the center and have no definition) can occur.  This is a very difficult problem to improve upon.  A relatively narrow sternum, level chest shape, pre existing soft tissue with inframammary folds curving towards the midline, and a larger implant all contribute to cleavage.  Women without these factors will not develop cleavage (without the aid of a good bra), no matter how large the implant.

Pre anterior view

Post anterior view

Pre oblique view

Post oblique view

The patient is a slender woman with minimal redundant chest skin and poor skeletal and inframammary fold support for a breast implant.  She requests a high profile silicone gel implant for maximal size on her narrow diameter chest.  A textured implant is chosen to minimize device movement and the inframammary fold is reinforced at surgery with deeply placed, long lasting absorbable sutures.  Post operatively, she has appropriate stretch of the nipple to fold distance and maintains a well defined inframammary fold for an aesthetic result.

Pre op anterior view

Post op anterior view

Pre op oblique view

Post op oblique view

The patient is a woman with a mastectomy on the left and ptotic (droopy) breast on the right who presents for a Trans Rectus Abdominus Muscle Flap and Mastopexy (breast lift).  The ultimate goal is symmetry in the setting of a native breast on one side and mastectomy flaps on the other.  The TRAM, while a large operation, supplies natural feeling fat from the abdomen to the breast location and gives a permanent result without the potential downsides of an implant.  Not all patients are candidates, nor do all want the additional risks associated with a TRAM.