Breast Augmentation, Lift, Reduction & Reconstruction
BREAST AUGMENTATION, LIFT, REDUCTION AND RECONSTRUCTION
Breast augmentation not only changes appearances, but has also positively affected how our patients feel about themselves.
Enlargement of the breast
During your consultation with Doctor Cenedese, options of size, shape and implant type will be reviewed. Our goal is to choose the best approach and implant for your breasts and body. Implants may be inserted around the areola (nipple), underneath the breast, through the axilla (armpit) or umbilicus. Implant placement behind the muscle is preferred by most patients. A more natural, sloping upper and outer breast shape is achieved.
Obtaining maximum cleavage is an important goal. The amount of cleavage that we can obtain is determined by the original distance between the breasts and pectoral muscle insertions. The larger the implants and the closer together they are placed increase the resulting amount of cleavage.
The procedure lasts under two hours. You can recover and go home within two hours. Most patients experience some pain but can return to their new lifestyle in a few days. The safety of breast augmentation has become posssible after 40 years of refining the technique and extensive product research.
Saline filled implants are placed through smaller incisions surrounding the areola or through the armpit or umbilicus. They are then filled with a special fill tube through a self sealing valve built into the silastic shell of the implant. I prefer smooth implants as opposed to textured implants as they feel softer. There are fewer infectious complications as opposed to textured implants. The saline implant results in a very soft breast. They are ideally suited for the women who begins with adequate breast tissues and desires a one to two cup increase in size. Saline implants can be inserted through the umbilicus resulting in a scar less breast. This procedure although somewhat more technically demanding results in a very natural appearance. Modifications in implant position are the most frequent reason for revision surgery. The axillary incision and approach requires more cutting of the central pectoral muscles to prevent the implant from being pushed back and out towards the axilla. We have seen several patients with implants which have been placed or forced up or out resulting in too wide a space between or high lying breasts. Implants tend to settle from one half to an inch over the first two years.
Patients requesting a more natural appearance will realize this as time passes. The umbilical or axillary approaches may necessitate an additional incision in another area if repositioning becomes necessary. High profile saline implants appear to ripple less. Unless your breast and chest are broad these are my preferred implant style. If there is inadequate tissue to cover the implant or you desire to increase more than two cup sizes I suggest the use of gel filled implants. When saline implants leak there is no pain but the breast will decrease in size over a few weeks. Replacement of a leaking saline implant if addressed within a month is fairly straight forward and nearly painless. The rate of leaking is higher than that of silicone gel filled implants.
Silicone gel implants on the other hand feel slightly firmer but more natural. The majority of my patients have been selecting silicone gel implants. This follows the European and South American trends where saline implants are rarely used.
Since it is difficult to properly place a silicone gel implant larger than 350 cc from the axilla I have been using a new technique which makes the peri-areolar incision even less prominent than in the past. The statistics collected by the manufacturers indicate these to leak less often than saline filled implants. Please refer to http://www.breastimplantsafety.org
Silicone gell implants have become accepted as patients are becomming more aware of their safety, natural feel and appearance. Gel implants have recently been approved by the FDA as safe for the average patient. Silicone gel implants have been used for 30 years. Advances in design and manufacturing have made the latest implants more resistant to leaking yet maintaining a natural feel. A leaking gel implant can be replaced without complicated surgery if addressed within a few months of leakage. Failure of a silicone implant is usually detected by a change in shape or firmness of the affected breast. Mammography, sonogram and MRI are helpful in confirming a suspected leak. Please refer to http://www.siliconegelimplant.com for more information.
BREAST AUGMENTATION WITH FAT INJECTION has been a technique that I have been performing since the mid 1990’s. Fat harvested utilizing liposuction technique is purified and injected in small amounts to any part of the breast where it is most needed. Accounting for partial resorption of injected fat (25%-30%) one procedure typically accomplishes a 1/2 cup size increase. This fat may be placed in the upper inner breast quadrants to achieve greater cleavage; thereby producing a greater appearance than a similar amount augmented with an implant. Once the fat becomes assimilated into the breast it will survive just as normal breast fat will. Attempts to inject greater amounts of fat are associated with a greater risk of the fat not surviving and developing into oil cysts. These cysts require needle aspiration if large enough. This technique is especially well suited for patients looking to improve their shape and add perkiness as well as partial mastectomy patients as opposed to those seeking a sizeable enlargement. The bonus is that one or two other body areas are liposuctioned of excess fat as well. A new sub-fascial technique allows placement of implants below a thin firm layer of tissue overlying the muscle. This produces more cleavage a natural appearance and less pain with less manipulation of the pectoral muscles. Although the most reliable approach is using a one inch scar around the areola, the belly button, arm pit and infra-mamary folds are approaches which I will use to insert the implants. Please check our before and after gallery for a video demonstrating this technique.
When breast skin has stretched causing drooping a lift may be of benefit. A breast lift is performed by removing the skin above and below the areola which surrounds the nipple. The nipple/areola are left attached to the breast tissue thus preserving sensation and the ducts necessary for breast feeding. The breast and nipple become higher, perkier and fuller in appearance. Improvements are long-lasting unless you undergo large changes in breast size from weight changes or breast feeding. Thin scars around the areola extending to the bottom of the breast must be accepted. For patients who’s breasts are sagging to a moderate degree a periareolar or crescent breast lift can be performed . This approach maintains the incision and resultant scar around the areola without extension onto the breast skin. Significant amounts of breast lift can be accomplished with these techniques at the expense of increased pleating of the breast skin and scar irregularities. The conical breast shape will be diminished. Girls, now you have gone and done it! We can now accommodate your requests for bigger, more projecting nipples. For many years nipple enlargement was part of total breast reconstruction. The very same techniques can be used for cosmetic enhancement. The procedures involve minimal incisions and buried sutures. The risks however include difficulties with milk ejection, diminished sensation and rarely cyst development deep to the nipple areola. The areola can be decreased in size by excision or increased with medical tattooing. Nipple projection can be increased without major surgery and a low rate of sensory loss. Nipples can also be reduced and de-projected
Copyright © 2011, Luis A. Cenedese, M.D. F.A.C.S., Beaute des Arts Institute. All rights reserved.
30 Central Park South, Suite 1 C-D, New York, NY 10019 (212)371-0468