Bosshardt & Marzek Plastic Surgery Associates

Breast Reduction

Overly large breasts can cause some women to have both health and emotional problems. In addition to self image issues, you may also experience physical pain and discomfort.

The weight of excess breast tissue can impair your ability to lead an active life. The emotional discomfort and self-consciousness often associated with having large pendulous breasts is as important an issue to many women as the physical discomfort and pain.

Also known as reduction mammaplasty, this procedure removes excess breast fat, glandular tissue and skin to achieve a breast size in proportion with your body and to alleviate the discomfort associated with overly large breasts.

Is it right for me?

Breast reduction surgery is a highly individualized procedure and you should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.

Breast reduction is a good option for you if:

• You are physically healthy
• You have realistic expectations
• You don’t smoke
• You are bothered by the feeling that your breasts are too large
• Your breasts limit your physical activity
• You experience back, neck and shoulder pain caused by the weight of your breasts
• You have regular indentations from bra straps that support heavy, pendulous breasts
• You have skin irritation beneath the breast crease
• Your breasts hang low and have stretched skin
• Your nipples rest below the breast crease when your breasts are unsupported
• You have enlarged areolas caused by stretched skin

Breast Augmentation

Breast augmentation is procedure done to enlarge the breasts using implants. These consist of a shell, made of clear silicone material, which is filled with either sterile saline solution or with silicone gel. Both can produce wonderful results and the pros and cons of each will be discussed with you in order to select the best implant type.

Breast augmentation is now one of the most requested cosmetic procedures and has one of the highest satisfaction rates. No longer a privilege for a wealthy few, or the choice of exotic dancers, actresses, etc., breast augmentation is an affordable option for thousands of women. The reasons for desiring breast augmentation are many but fall under two general categories.

Some women never develop breasts to the degree that makes them feel well proportioned. They often have difficulty fitting into clothes, especially summer clothes and bathing suits. They may seek surgery for the simple reason of filling out their clothes properly. Some wish to feel more balanced, to match the rest of their figure. Other women come in because they once had breasts that they were happy with but aging, pregnancy, breast feeding, and/or weight loss have taken their toll. These women often just want to regain what they lost through these circumstances.

The costs have come down significantly over the years making this option affordable for many women. Most patients are not wealthy or unusually affluent. Financing options are available and can be very convenient. We discourage financing if this will place patients under a severe financial burden. The cost of a breast augmentation is less than spent on a typical vacation, and the results last much, much longer.

At their initial consultation, patients will talk to one of our surgeons who will inquire into their desires and goals. The procedure will be explained in great detail and this discussion will include explaining how the surgery is done, the various choices to be made as to implant type, incision, size, etc. and the anticipated recovery, and results. Our surgeons have a combined experience of over forty years performing breast augmentation and will be happy to provide information on their individual training and experience. Many patients have given permission for their pre- and post-operative photographs to be shown for education purposes and we will be happy to show you examples of our work. Risks and complications will be carefully explained so that patients will have all the information they need to make a choice they will be totally comfortable with. We believe our best patients are those who are most informed.

There are a number of decisions to be made regarding this surgery. Choice of incision is one. We generally use an incision along the margin of the areola or underneath the breast. Scars are small, usually no more than an inch, and well hidden. Implants may be placed directly underneath the breast tissue, or under a muscle , the pectoralis muscle, which runs across the upper chest. Each approach has advantages and disadvantages and the approach that we feel will work best for each patient will be recommended. There are several styles of both saline and gel implants; round ones, smooth ones, tear drop shaped implants, and fuzzy ones. We choose the implant that we feel will work best for each situation. We have found that the smooth, round implants work best in most women. All implants are guaranteed by the manufacturer to be free of defects for life.

Sizing of the breasts for implants is usually done during surgery in order to determine the best size implant for each patient. Patients can also pre-size by putting implants into their bra during their preoperative visit in order to see what they like. The final determining factor, however, is what the skin and tissues will accept and how the breasts look at surgery. We try our best to get you the perfect breast size for you.

We perform breast augmentation in our dedicated, state licensed surgical suite. General anesthesia is usually recommended as this is extremely safe and comfortable for patients. Many practices cannot offer this option. The procedure takes about an hour to perform and patients recover and return home in the care of a responsible adult within a couple of hours. Pain is well controlled by prescription pain medications that patients pick up in advance of the day of surgery so that it will be immediately available to them.
Our patients are also given antibiotics to reduce the risk of any infection.

Most patients are up and about the next day and able to resume routine daily activities in a few days. Some patients may return to all activities with no restrictions placed on them within 7 days. Several office visits will follow over the next 6 months to insure that everything is progressing as it should. Final results are usually seen between three and six months.

Patients wear a comfortable, compression bra or an elastic band after surgery to help the implants settle. These may be recommended for several months after surgery. Patients are instructed on a simple breast massage program, also to aid softening. Vitamin E or other medications may be recommended for some patients for the same reason.

Breast implants do not have a pre-determined life expectancy and may last a lifetime. It is unreasonable to expect any man made prosthetic device in the body to remain in place for 20, 30, 40, or more years without some risk of failure. Leakage of saline implants is uncommon, is harmless, and is easily corrected with a minor office procedure. We tell patients, especially if they are very young, that they should expect some time in their life to need or desire additional surgery as a result of having breast implants. This may be replacement with a new and better device, removal or exchange of a leaking implant, a breast lift, or replacement with a larger or smaller implant at some later time. Excessive firmness of the breasts as result of scar around the implants is infrequent and, if it occurs, usually will be evident in the first few months after surgery. In some rare cases, this firmness can develop even years later without an obvious cause. Such firmness, called capsular contracture, may require corrective surgery.

Given each patients unique characteristics, every effort is made to produce the best possible result for the patient. The goal is breasts that are natural appearing, soft, symmetrical, and of the size desired by the patient. We do not practice “assembly line” or “cook book” breast surgery and each procedure is individualized to provide the best result under those circumstances. Satisfaction rates for breast augmentation are among the highest in cosmetic surgery and run as high as 95% after ten years or more.

Breast implant surgery is one of the safest cosmetic procedures that we perform but like all surgical procedures it has some inherent risks. These will be discussed with you in detail at the time of your initial consultation. You may also go to Dr. Bosshardt’s blog on this web site which details some of these potential risks. In the same way that we do everything to produce the best result for each patient, we likewise take great pains to be sure that surgery is performed with as much safety as is humanly possible.

Our goal is for every patient to look back on this decision for breast augmentation as one of the best decisions they ever made and one they would do over again if given the chance.

Breast Lift (Mastopexy)

Many women seeking cosmetic breast surgery are not doing this in order to acquire larger breasts but are simply seeking to reverse some of the changes that come with time and the effects of pregnancy. These two factors are responsible for much, if not all, of the loss of firmness, volume, and "perkiness" of youthful breasts. Weight loss can also result in undesirable sagging of the breasts. In these cases, there is loss of elasticity of the skin, either due to the aging process, or due to the stretching of the breast skin from engorgement that accompanies pregnancy and milk production in the breast tissues.

Loss of volume can only be recovered by replacing the breast tissue with an implant. However, some women prefer to go with what they have and just want the sagging corrected. This is where a breast lift, or mastopexy, can help turn back the clock a bit. In this procedure, markings are carefully made to outline the excessive skin to be removed and reshape the breast into a more youthful contour. Skin is then removed, leaving all the breast tissue to fill out the remaining skin as much as possible.

Mastopexy is an outpatient procedure that can be done under local anesthesia with intravenous sedation, or with general anesthesia. Recovery time is rapid with most patients able to return to routine daily activities within a couple of days. The incisions vary with the amount of lifting necessary. In cases with minor sagging, a lift can be done using an incision located around the areola, the darker skin which surrounds the nipple. This incision leaves a fine scar which is well hidden in the margin of the areola and very inconspicuous. More extensive lifts may require additional incisions; down the middle of the lower half of the breast, and along the crease under the breast. These typically heal with fine, faint scars and the improvement in the overall contour and appearance of the breasts is usually well worth the tradeoff.

Sensitivity should be well preserved after a breast lift although any breast procedure can affect the feeling in the skin and nipple area. It should also be possible to breast feed after a lift in most cases. Future pregnancies can certainly affect the result and produce more sagging later. Lifts should not affect the ability to do a good breast self-examination or mammogram.

When additional volume is desired, a lift can be combined with a breast augmentation using implants. These can be either saline implants or gel implants. The procedure of doing a breast augmentation combined with a lift is a bit trickier than either alone because they are working at cross purposes; the augmentation attempts to expand the breasts while the lift attempts to constrict them. Compromises have to be made, either in the lift or the augmentation in order to achieve the best result for each patient.

Like many other procedures, breast lifts can be combined with other procedures such as an abdominoplasty or liposuction. One advantage of combinations is that recuperation is usually not prolonged over doing each procedure separately. Another is that the overall cost may be less than doing each separately since some of the separate expenses may be combined too.

Every effort is made in a breast lift, with or without implants, to produce a result which will look and feel as natural as possible, and equally as important, as youthful as possible. Even if we can't stop time, perhaps we can recapture some of the youthful look that time and circumstances have taken away.