Breast Procedures

Mesa AZ | Gilbert | Scottsdale | Breast Augmentation

Breast Reconstruction

Breast reconstruction is performed on women who have lost one or both breasts to mastectomy, or who lack breasts due to congenital or developmental abnormalities. The goal of breast reconstruction is to create a breast and nipple that resemble the natural breast as closely as possible in shape, size and position. A long as a woman is healthy, age is not a factor in whether she is a good candidate for breast reconstruction. However, women with health problems such as obesity and high blood pressure, and those who smoke, are advised to wait rather than have breast reconstruction immediately following mastectomy.

Types of Breast Reconstruction

Breast reconstruction is performed in several steps, and there are essentially two types. Which one is used depends on whether there is enough tissue on the wall of the chest to cover/hold an implant. Whichever type is used, a woman’s breast surgeon and plastic surgeon should work as a team during reconstruction.

Implant/Tissue-Expansion Breast Reconstruction

Implant/tissue-expansion breast reconstruction involves inserting an implant in the chest after the skin has been stretched enough by an expander to contain it. First, the surgeon inserts a balloon expander beneath the skin and chest muscle where the reconstructed breast will be built. Then, during the next few weeks or months, a saline solution is injected through a tiny valve beneath the skin into the expander. As the expander fills with saline, it stretches the skin and creates a pocket for the implant. The expander is left in place to serve as the implant or replaced with a another one, which can be made of saline or silicone gel. A final procedure reconstructs the areola and nipple. Some patients do not require tissue expansion, which can take up to a year to complete, and begin reconstruction with insertion of the implant.

Autologous-Tissue Breast Reconstruction

Autologous-tissue breast reconstruction is used if there is not enough tissue left post-mastectomy to create a new breast using tissue expansion, or a woman does not want implants. During autologous-tissue breast reconstruction, a breast is created using skin, fat and, sometimes, muscle from other parts of the body. The abdomen, back, buttocks or thighs are all donor sites. The donor tissue, which is called a “flap,” is either surgically removed and reattached (free flap) to the chest, or left connected to its original blood supply and “tunneled” through the body to the chest (pedicle flap). There are a number of different flap techniques; which one is used depends on the individual patient. Factors taken into consideration include how much extra tissue is available for transfer; the width and flexibility of blood vessels; and how large the breast(s) needs to be.

Implants may or may not be used with autologous-tissue breast reconstruction. Constructing a nipple and areola is performed in a separate surgery.

It is essential that a patient have reasonable expectations about the results reconstruction provides.


Mesa AZ | Gilbert | Scottsdale | Breast Augmentation

Breast Augmentation (Augmentation Mammaplasty)

Augmentation mammaplasty (breast enlargement) is performed to increase breast size and/or fix breast asymmetry. Candidates include women who want larger breasts, and those who want to restore the breast volume often lost as a result of pregnancy or significant weight loss. Breasts can be enlarged with implants or by fat transplantation. Augmentation mammaplasty is not a substitute for mastopexy, which is a procedure to “lift” breasts that sag significantly.

Augmentation Mammaplasty with Implants

Silicone and saline are the two implant types most commonly used in augmentation mammaplasty. Silicone implants feel more like natural breasts than saline ones. However, if a saline implant ruptures, the saline is naturally absorbed by the body, whereas if a silicone implant has an extracapsular rupture (a rupture to the outer capsule), silicone filler leaks into the body, possibly resulting in inflammatory nodules or enlarged lymph glands.

Implants are placed behind each breast, underneath either breast tissue or the chest-wall muscle. The procedure lasts 1 to 2 hours, and is typically performed with general anesthesia, although local anesthesia combined with a sedative may be used. Incisions are made in inconspicuous places (in the armpit, in the crease on the underside of the breast, or around the areola) to minimize scar visibility. The breast is then lifted, creating a pocket into which the implant is inserted.

Advantages of implant placement behind the chest-wall muscle include a possible reduced risk of capsular contracture (hardening of scar tissue around implant), and less interference during mammograms. Disadvantages include the possible need for drainage tubes, and a longer recovery period. Advantages of implant placement beneath breast tissue include that the breasts move more naturally as the patient uses her chest muscles, and that slight breast sagging is corrected.

Other types of implants include “gummy bear,” round, smooth and textured.

Augmentation Mammaplasty with Fat Transplantation

Augmentation mammaplasty with fat transplantation (fat transfer) uses liposuction to harvest excess fat from other parts of the body; the fat is then injected into the breasts. Augmentation mammaplasty is appropriate for women who are not looking for a dramatic increase in breast size, and want breasts that look and feel as natural as possible.

For a number of weeks prior to augmentation mammaplasty, tissue expanders may be placed below the muscles of the chest wall to expand the breasts, and increase the amount of fat they can hold. When the tissue has expanded enough, augmentation using fat transfer can begin. First, fat is removed using liposuction, in which a cannula (a thin, hollow tube) is inserted through small incisions, and then moved back and forth to loosen excess fat, which is suctioned out using a vacuum or a cannula-attached syringe. The harvested fat cells are then purified. In the second procedure, which takes place on the same day, the fat is injected into the breast through small incisions. The procedure takes approximately 4 to 5 hours.


Breast Lift (Mastopexy)

Mesa AZ | Gilbert | Scottsdale | Breast liftMastopexy (breast lift) is a surgical procedure for lifting and reshaping sagging breasts. Aging, pregnancy, weight loss and gravity can all cause breasts to sag. By trimming excess skin and tightening supporting tissue, breasts can be made to sit higher on the chest and be firmer to the touch.

In addition, the nipple and areola can be repositioned or resized to further enhance breast appearance. Because mastopexy does not change breast size, it is often combined with breast augmentation or reduction.

The Mastopexy Procedure

Mastopexy is performed on an outpatient basis under general anesthesia, and usually takes 1 to 3 hours. Depending on the size and shape of the breasts, as well as the degree of sagging and amount of excess skin, one of the following types of incisions is often used:

  • Two rings, one larger than the other, around the areola
  • A keyhole shape, around the areola and down to the breast crease
  • An anchor shape, beginning in the breast crease, and extending up to and around the areola

The first type of incision (above) is used for small breasts and leaves the least amount of scarring; the third type is used for breasts with significant sagging.

After the incisions are made, breast tissue is removed and reshaped to achieve the desired breast contour. The nipple and areola are usually moved higher on the breast or resized. Excess skin is trimmed to create a tighter, more defined appearance. Incisions are closed with stitches.


Mesa AZ | Gilbert | Scottsdale | breast reduction

Breast Reduction

Women who are unhappy about having large breasts and/or want to treat symptoms such as back pain, breathing problems and poor posture, may benefit from reduction mammaplasty (breast reduction), during which fat, glandular tissue and skin are removed from the breasts. The resultant smaller breasts increase patient comfort, and look more in proportion to the rest of the body. Ideal candidates for reduction mammaplasty are women with oversized breasts that are causing medical problems, low self-esteem, and/or physical or social discomfort. Women who are pregnant or breastfeeding cannot undergo reduction mammaplasty.

The Reduction Mammaplasty Procedure

Reduction mammaplasty is performed under general anesthesia. Depending on the technique used and the individual case, it takes from 2 to 5 hours to perform. One of the following incisions is often used:

  • Two rings, one larger than the other, around the areola
  • A keyhole shape, around the areola and down to the breast crease
  • An anchor shape, beginning in the breast crease, and extending up to and around the areola

Liposuction alone is sometimes used to reduce breast size. One advantage is that it leaves little-to-no scarring. However, because liposuction removes only fatty tissue, patients must have more fatty than glandular tissue in their breasts. Liposuction is also often used on men whose breasts are enlarged.

Male Breast Reduction

Mesa AZ | Gilbert | Scottsdale | male breast reductionGynecomastia, which is the overdevelopment of male breasts, affects an estimated 40 to 60 percent of men. It can be the result of hormonal imbalance, obesity, certain drugs or heredity, and can affect one or both breasts.

Candidates for breast reduction are men who have large or sagging breasts that make them feel physically and/or emotionally uncomfortable. Breast reduction can be performed on men whose breast development is complete; are in good health, both physically and emotionally; do not smoke; and are not overweight. Ideally, candidates have firm, elastic skin that will reshape itself to fit the contours of their breasts postsurgery.

Male Breast Reduction Procedure

Male breast reduction is usually performed under general anesthesia on an outpatient basis, and typically takes 1 to 3 hours. Male breast reduction is performed using liposuction or surgery, or a combination of the two.

If the enlarged breasts are caused primarily by excessive fatty tissue, the tissue is typically removed with liposuction, during which a cannula (a thin, hollow tube) is inserted through extremely small incisions, and then moved back and forth to loosen excess fat, which is suctioned out using a vacuum or a cannula-attached syringe. The incisions are made around the lower halves of the areolas or in the underarms.

If the enlarged breasts are caused primarily by excess glandular tissue, surgery is required. Incisions are made to allow for tissue to be removed. Repositioning the areolas/nipples and excising excess skin also requires incisions. Sutures are used to close the incisions, which are then bandaged, and the area is typically covered by a compression garment.


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