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Many consider breasts to be an important part of a woman's attractiveness and sexuality. Whether it is due to heredity, pregnancy, aging, or cancer, many women are dissatisfied with their breast size and or shape. A Board Certified Plastic Surgeon is the only medical professional who has been specifically trained in a formal residency / fellowship setting to treat aesthetic breast problems. During a consult with Dr. Wigod, you will have a full medical history taken, be examined with a chaperone in attendance, have your concerns fully discussed, and then be presented with a plan for your treatment.
Breast Augmentation (Augmentation Mammaplasty)
Breast Augmentation
Breast enlargement, or augmentation mammoplasty, enhances the body contour of a woman who is unhappy with her small breast size. Other purposes of this procedure include correction of breast volume loss after pregnancy, balancing breast size difference, or as a reconstructive technique following breast cancer surgery.
Breast augmentation is one of the most frequently performed cosmetic surgery procedures in the U.S. and one of Dr. Wigod's most popular services. Breast augmentation can give women with small, deflated, or unevenly sized breasts a fuller, firmer, better-proportioned look through the placement of saline or silicone implants beneath the breast. Patients undergo breast augmentation for many different medical and aesthetic reasons, including balancing breast size, compensating for reduced breast mass after pregnancy or surgery, and correcting congenital breast problems.
Fully Customized Breast Enhancement
Dr. Wigod knows that every woman has a unique body shape and goals for improvement. Accordingly, Dr. Wigod and his staff take time during consultations to learn what each patient hopes to gain from breast augmentation surgery and to decide which implant type and implant placement is best. In this way, each patient enjoys a completely customized treatment plan designed for her specific goals.
Most women think in cup sizes, but Plastic Surgeons think in cc's (milliliters). In general, approximately 150 to 200cc's equals one cup size. Ultimately, the final cup size is not as important as choosing the best implant to optimize the beauty of your breast. Implant makers have tables of implants which vary in the number of cc's, base diameter, and projection (profile). The main factor is your chest width. The larger the chest width, the larger the implant which can be appropriately placed. Selecting an implant base diameter about .5 cm above or .5 to 1 cm below your measurement is usually acceptable. Next, a low (rare), moderate (most common), or high profile implant type is selected. As the profile becomes higher, the implant becomes larger and rounder. Some women want as little rounding (fullness) in the upper breast while some want as much as possible. Examples of different sizes and projections are shown to demonstrate the difference. There is no right or wrong answer, only what is anatomically appropriate and what you like best. Once Dr. Wigod has narrowed down the options to a few implants, you and a nurse will use breast sizers to finalize the exact implant you need to best achieve the look you desire. You will be advised against choosing implants which are too large for your breast tissue to support as they may cause difficult to treat problems in the future.
Breast Implants: Saline or Silicone Gel, Round or Shaped, Smooth or Textured?
A breast implant is composed of an outer silicone rubber shell filled with saline or silicone gel. Both implant types are considered safe for implantation, but each offers its own advantages and disadvantages. After reviewing these points in detail, Dr. Wigod will help you decide which type is right for you. The FDA has allowed silicone gel implant use only after exhaustive studies were performed by independent scientists looking for a connection between silicone gel and systemic health problems. No link has ever been demonstrated.
The implant outer surface is usually smooth and the shape round. While shaped implants are available, Dr. Wigod (as well as the vast majority of Plastic Surgeons) is not convinced that their purported benefits (a more "natural" shape) outweigh their problems. Studies have shown that properly filled and placed round implants mimic the natural breast as well as shaped implants when the patient is upright. When the patient is flat, the round implant spreads like a natural breast while the shaped implant maintains unnatural upper pole fullness. Shaped implants may rotate and require re-operation to correctly orient them. To help minimize the chances or rotation, shaped implants are textured, but this makes them thicker and easier to feel through the skin. Finally, the cost of a shaped implant is double the cost of a round one.
The Procedure: Incision Location, Above or Below Muscle?
Augmentation mammoplasty is done as an outpatient and usually under general anesthesia. An implant (prosthesis) must be placed through an incision. The incision can be made under the breast (inframammary) or around the nipple (peri-areolar). Dr. Wigod will help you determine which approach would best for you. Dr. Wigod does not offer the under arm approach for several reasons. First, scars may be visible while wearing tank tops or bathing suits. Second, accurate placement may be more difficult from such a remote approach. Third, nerves supplying sensation to the breast and to the upper inner arm may be damaged. Fourth, a re-operation for almost any purpose would have to be done through another incision. Umbilical (belly-button) placement is also not offered because accurate placement is difficult and reoperation impossible.
Dr. Wigod places almost all implants below the pectoralis muscle. When the implant is placed sub muscularly under the breast, there is a lower chance of contracture (contraction of the tissue capsule surrounding the implant), and mammography is more reliable. There is also less risk of visible or palpable implant edges. For women with larger or more ptotic (droopy) breast, Dr. Wigod offers a bi-planar approach in which the lower breast is effectively spread over the implant while still maintaining upper muscular coverage.
Complementary Procedures
Breast augmentation can achieve dramatic and beautiful results on its own as well as in conjunction with other cosmetic surgery or non-invasive procedures. Dr. Wigod sometimes recommends combining breast augmentation with other procedures such as a breast lift for more satisfying results.
Post Operative Information
You must have someone drive you home and stay with you for 24 hours after surgery. You will experience some pain the first day or two that is controlled with pain pills. Some tightness in the breast area is also normal as your body adjusts to the implants. You will most likely be able to return to work within a few days, but may feel easily fatigued.
Your breasts may be dressed with tape (to define your inframammary fold), a soft bra, an elastic strap called a bandeau (to prevent movement of the implants), and an ACE wrap. The dressing should not be removed until you return for your first post-op visit. You may then start light massage exercises (light pressure in all directions once or twice a day) and continue to use the bandeau as instructed. For the weeks following your operation, an underwire or soft bra may be recommended, depending on your individual breast. Long term support is advised to help maintain implant placement.
Moderate exercise such as walking or stationary biking is allowed after the first week. Vigorous exercise such as jogging or aerobics may be resumed at 4 weeks. Heavy lifting or exercises using your upper body should be avoided for 6 weeks. An effective sports bra is particularly important.
Your breasts will feel swollen for 2 to 4 weeks. Gradually they will "settle" until they look and feel more a part of your body. Within a few weeks, the actual shape and size will be evident. You may notice some asymmetry. This should not be unexpected as studies show approximately 90% of women have significant breast asymmetries both before and after operation. Some women have changes in their nipple sensation which usually resolves. Your breasts will continue to change with time as implants do not stop the natural aging process. You may require surgery in the future such as implant exchange or mastopexy (breast lift). Dr. Wigod will maintain your records and be available to help with any problems.
Complications include, but are not limited to, implant deflation, capsular contracture, bleeding, infection, skin rippling and contour problems.
Read more about breast surgery from the American Society of Plastic Surgery
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Breast Lift (Mastopexy)
Breast lift surgery, or mastopexy, restores a more youthful appearance to a woman's breasts. Over the years breasts can lose their shape and firmness due to pregnancy, nursing, weight loss, and normal aging. The resulting loss of skin elasticity causes breasts to become ptotic (droopy). Mastopexy can raise and reshape breasts as well as reduce the size of enlarged areola (the darker skin around the nipple). Mastopexy will reverse and slow the effects of aging and gravity, but not stop these inevitable processes.
The Procedure
Though not a simple operation, mastopexy is normally safe when performed by a qualified plastic surgeon. Breast lifts may be performed under general anesthesia versus local anesthesia with sedation, depending on the extent of the operation. The surgery may take between 1 1/2 to 3 1/2 hours. Markings are made on the breast before the operation. A common approach makes incision along natural contours of the breast where excess skin will be removed. The nipple and areola are then repositioned. The skin is then closed around the areola in a circle. Depending on the amount of lift needed, the remainder of the breast is then closed in a straight line extending to the breast fold or in an inverted "T" with the closure continued in the fold of the breast. Advanced techniques are used to to maintain good blood flow and drainage to the nipple / areola complex and skin flaps while also maximizing fullness.
Post Operative Information
After surgery, your stitches will be covered with gauze and an elastic binder or surgical bra will hold your breasts in place. Your breasts will be bruised and swollen, and you may experience some mild to moderate discomfort for a few days. In the recovery stage, it is important to wear support at all times. You may shower 48 hours post op, but should not submerge you wounds in a bath until the sutures are removed. During the first 3 weeks after the operation, you should wear a tube top or loose sports bra. During the second 3 weeks, you may wear a regular soft bra without underwire. After 6 weeks, you may wear an underwire bra for short periods and progress to longer periods over the next month. Many women return to work and normal daily activities within a week. You should let your pain level guide your activity, but avoid vigorous exercise for at least 3 weeks. Your sutures will be removed at approximately 2 weeks post op.
Some noticeable, permanent scarring is expected, but easily covered by your bra or bathing suit. The scars may be red and uneven for a few months, but usually fade and become less obvious. As with other lifting type operations, mastopexy is a trade off of concealable scars for improved contour. After a few months, once the final result is seen, few women would ever trade back for their pre-operative appearance. You may notice some asymmetry. This should not be unexpected as studies show approximately 90% of women have significant breast asymmetries both before and after operation. Your breasts will continue to change with time as mastopexy cannot stop the natural aging process.
Complications are not common, but do occur. The operation disrupts the breasts' natural blood supply and drainage, so there may be skin and nipple healing difficulties. Nipple sensation may also be temporarily or permanently decreased. Smoking increases the risks of these problems. Other complications include, but are not limited to bleeding and infection. The ability to breast feed is often preserved, but cannot be guaranteed.
Click here for more information on Breast Lift »
Augmentation Mastopexy
Breast augmentation and mastopexy are two commonly combined procedures. Some women have breasts which have too much ptosis (droop) to be filled by just an implant. They need to have their skin tightened up around the implant in order to raise the nipple to the proper level as well as prevent a "rock in a sock" breast shape. Other women have significant ptosis and will obviously need a mastopexy, but also want an implant added to give fullness to the upper part of the breast. This fullness can only be provided by an implant and cannot by achieved by lifting alone. As with all lifting operation, there is a trade off of scar for contour.
The Procedure
Markings are drawn on the breast similarly to a straightforward mastopexy. The breast implant is then inserted and the skin is tailored around the new breast volume. The procedure lasts approximately 2-4 hours. Augmentation Mastopexy is a technically challenging operation as all the difficulties of each procedure are combined and multiplied in one. While Dr. Wigod has excellent experience with this powerful operation, he only offers it to appropriately selected and counseled patients.
Post Operative Information
The post operative course is more similar to breast augmentation than to mastopexy. The list of potential problems and complications is combined. Please see the Augmentation and Mastopexy sections for details.
Gynecomastia
Men may have breast enlargement secondary to breast gland hypertrophy (growth) versus weight gain. Gland hypertrophy (gynecomastia) often occurs in puberty, and then resolves on its own. If it does not, a medical work up may be necessary to rule out a more serious underlying medical condition causing the problem. Insurance plans do not cover treatment of gynecomastia in adults, but may rarely in teens. Apart from possible related medical issues, breast enlargement may cause the male patient to feel subconscious about his appearance. Treatment is aimed towards reducing the breast size while minimizing scarring.
The Procedure
Some gynecomastia patients may be treated by liposuction only. Small incisions are made around the nipple and in the armpit to allow access for the suction cannulas (tubes). Tissue is then removed centrally and feathered out to the edges of the chest. If there is a particularly large amount of breast tissue underneath the nipple, or if there is an excessive amount of skin, larger excisions for surgical removal may be necessary. The chest is then wrapped in a compression garment.
Post Operative Information
The compression garment is like a vest and should be worn for several months after the operation for best results. Sutures are usually removed one week after operation and activity should be limited for 2 weeks.
The chest may feel hard or uneven at first, but this will improve with time. The chest is naturally asymmetric and asymmetries often persist after the operation. Sometimes, a limited amount of improvement is accepted to avoid making larger incisions. These incisions are better hidden on a woman's breast, but tend to make a man's chest appear more feminine. Accordingly, these incisions are not made unless absolutely unavoidable. In large breasts, liposuction may be performed first and then skin excision at a later date in an effort to reduce scar length.
Complications include, but are not limited to, infection, bleeding, seroma, nipple loss or insensitivity, and recurrence. Most men are very happy with their choice to have surgery and feel more comfortable with their bodies both with and without their shirts on.
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After graduating medical school, Dr. Wigod completed eight years of formal General Surgery Residency and Plastic Surgery Fellowship training. His 16 years of higher education allows him to perform both Cosmetic and Reconstructive Plastic Surgery and to treat the whole patient without being limited to one body part or technique. Broad surgical training, large volume practice experience, and continuing education assist Dr. Wigod in his efforts to provide optimal care for his patients. Dr. Wigod has experience in all aspects of Plastic Surgery, but now specializes in Cosmetic Surgery of the Breast, Body and Face, as well as Breast Cancer Reconstruction.
