Breast Surgeries

Breast Surgeries

Breast Reduction

If you find that your breasts are very large and heavy, and that they create discomfort to your shoulders, back and neck, you may be a candidate for a breast reduction. While a breast reduction can be performed in the teenage years, it is recommended that the procedure be undertaken only when breast development is completed and when sufficient maturity has been attained to understand all of the issues involved.

Childbirth and breast-feeding can also have a significant effect on the size and shape of your breasts. Though some women decide to have breast reduction before having children, you should discuss plans to breast-feed with your plastic surgeon, as this may not be possible after breast reduction. In assessing you as a candidate for breast reduction, your doctor will carefully check the size and shape of your breasts, the quality of your skin and the placement of the nipples and areolas. If you are overweight, your plastic surgeon may suggest that you lose weight before having surgery.
There are variations to the incisions used for breast reduction. Dr. Tumi usually uses a vertical incision technique.

After excess skin and breast tissue is removed, the nipple and areola are moved to a higher position. Skin that was located above the nipple pre-surgery is pulled down. Together these two maneuvers give a new shape to the breast.
Liposuction may also be employed to improve the contour of the breast. Because the nipples and areolas remain attached to the breast tissue, sensation in this area is preserved most of the time but numbness can occur after breast reduction.

Several days after surgery you will be able to move about comfortably. You may be asked to wear a support bra for a few weeks, until swelling and discoloration diminish. Incisions will be red at first and normally stay this way for several months following surgery. After breast reduction surgery, it is usually possible to return to work within a month of surgery.

For more information on the breast reduction, please visit ASPS and www.plasticsurgery.org

Breast Reconstruction

Mastectomy is a traumatic experience for any woman. Breast reconstruction is an alternative for women of any age providing your health is good enough for you to tolerate a general anesthetic.

There are two basic ways of reconstructing a breast or both breasts – prosthetic implants or using your own tissue. Your surgeon will discuss with you the risks and benefits of implants versus using your own tissue to reconstruct your breast(s).

Prosthetic implants usually consist of silicone shell implants enclosing saline (salt water) or silicone. Dr. Tumi prefers to use silicone implants. The implants are usually placed underneath the muscle of the chest wall. Although implant surgery is usually more simple and shorter than using your own tissue, the complication rate of implant surgery and the need to operate again at a later date is higher with implants. Implants have a higher rate of complications if you have had radiation to the chest skin.

Implants placed under the skin are more convenient than prostheses placed in your brassiere. However, the body’s reaction to these can be a capsule or envelope surrounding the implant making the breast hard and tender. In addition, implants do not have the same natural feel as would transplanting your own tissue.
After mastectomy, the skin envelope may not be large enough to allow for an implant and skin expansion may be required before the “permanent” implant is inserted. Tissue expansion is done by inserting an expandable silicone “balloon” which is inflated with salt water weekly by your surgeon. When enough skin is available the implant can be inserted.

Using your own tissue is called autologous reconstruction. Autologous reconstruction involves transferring soft tissues (skin, fat) from other areas of the body. Because of the frequent excess tissues and because of the convenient anatomy skin from the lower belly is often a preferred area for harvesting autologous tissues for breast reconstruction (TRAM flap reconstruction). Less commonly, other areas can also be harvested, i.e. buttock, thigh or back.

It is important to understand that a “normal” breast will never be obtained with a breast reconstruction operation and realistic expectations are in order. However, patient satisfaction is generally high.

For more information on the breast reduction, please visit ASPS and www.plasticsurgery.org

Breast Augmentation

Breast augmentation, technically known as augmentation mammoplasty, is a cosmetic surgery procedure to enhance the size and shape of a woman’s breast for a number of reasons:

• To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small.
• To restore breast volume lost due to weight loss or following pregnancy
• To achieve better symmetry when breasts are moderately disproportionate in size and shape
• To improve the shape of breasts that are sagging or have lost firmness, often used with a breast lift procedure
• To provide the foundation of a breast contour when a breast has been removed or disfigured by surgery to treat breast cancer
• To improve breast appearance or create the appearance of a breast that is missing or disfigured due to trauma, heredity, or congenital abnormalities.

By inserting an implant behind each breast, surgeons are able to increase a woman’s bust line by one or more bra cup sizes. If you’re considering breast augmentation, this will give you a basic understanding of the procedure — when it can help, how it’s performed and what results you can expect. Please ask Dr. Tumi if there is anything you don’t understand about the procedure.

Breast Augmentation Surgery

The method of inserting and positioning your implant will depend on your anatomy. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple) or in the armpit. In addition, a saline implant may be placed through an incision at the navel. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible.

Working through the incision the surgeon will lift your breast tissue and skin to create a pocket either directly behind the breast tissue (sub mammary or sub glandular placement) or beneath the pectoral muscle and on top of the chest wall (sub muscular placement). Once the implant is positioned within this pocket, the incisions are closed with sutures, skin adhesive and/or surgical tape. A gauze bandage may be applied over your breasts to help with healing.

The surgery usually takes one to two hours to complete.

While the majority of women do not experience complications, it’s important to understand and discuss the risks with Dr. Tumi during your consultation.

After Your Breast Augmentation Surgery

You’re likely to feel tired and sore for a few days following your surgery but you’ll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by medication.

Within several days the gauze dressings, if you have them, will be removed. You may be given a surgical bra. You should wear it as directed. You may also experience a burning sensation in your nipples for about two weeks but this will subside as bruising fades. Your stitches will come out in a week to 10 days but the swelling in your breasts may take three to five weeks to disappear.

The Best Candidates For Breast Augmentation

The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. Think carefully about your expectations and discuss them with Dr. Tumi. If you’re physically healthy and realistic in your expectations, you may be a good candidate.

Types of Implants for Breast Augmentation Surgery serving Richmond Hill, Bracebridge, and Collingwood

The choice of implant filler, implant size, shape and other features will be determined based on your breast anatomy, body type and your desired increase in size. Your lifestyle, goals and personal preferences, as well Dr. Tumi’s recommendations and sound surgical judgement are also determining factors. Implant manufacturers occasionally introduce new styles and types of implants, and therefore there may be additional options available to you.

Breast implants are medical devices with a solid silicone, rubber shell. The implant shell may be filled with either saline solution (sterile salt water) or elastic silicone gel. Both saline and silicone gel breast implants are approved by the U.S. Food and Drug Administration (FDA). Approval means that an implant has been rigorously researched, tested and reviewed by an independent panel of physicians for safety.

The size of a breast implant is measured in cubic centimeters (cc’s) based on the volume of the saline or silicone filler. Breast implants vary both by filler and in size, but there are additional features to consider:

• Texture: the implant shell may be smooth or textured
• Shape: the implant may have a round profile or one that is anatomic (teardrop or tapered shape)
• Profile: the implant may have a low, medium or high projection (the depth of the implant from the base to the highest point of the implant curve)
• Diameter: the width of the implant measured across it’s base (the side of the implant that will be positioned over the chest wall)

Adult women of any age can benefit greatly from the enhancement breast implants provide. It is usually recommended, however, that a woman’s breasts are fully developed prior to placement of breast implants. Saline implants are FDA approved for augmentation in women 18 years of age and older. Silicone implants are FDA approved for augmentation in women age 22 and older. Saline or silicone implants may be recommended at a younger age if used for reconstruction purposes.

You should be aware that breast implants are not guaranteed to last a lifetime and future surgery may be required to replace one or both implants. Regular examinations for breast health and to evaluate the condition of your implants are important whether you have chosen saline or silicone breast implants.

Breast Enlargement Planning Serving Barrie, Bracebridge, Richmond Hill & Southern Ontario

In your initial breast enlargement consultation, your plastic surgeon will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. If your breasts are sagging, your doctor may also recommend a breast lift.
Be sure to discuss your expectations frankly with your surgeon. You may want to ask your surgeon for a copy of the manufacturer’s insert that comes with the implant he or she will use — just so you are fully informed about it. And, be sure to tell your surgeon if you smoke and if you’re taking any medications, vitamins, or other drugs.
Dr. Tumi will also explain the type of anesthesia to be used, the type of facility where the surgery will be performed and the costs involved. Because most insurance companies do not consider breast augmentation to be medically necessary, carriers generally do not cover the cost of this procedure.

Preparing for Your Breast Implant Surgery in Southern Ontario

Your cosmetic surgeon will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking and taking or avoiding certain vitamins and medications. A mammogram may be recommended prior to your breast augmentation procedure to ensure breast health and serve as a baseline for future comparison.

In addition to explaining your surgical procedure, your plastic surgeon will discuss anesthesia, the recovery process and your obligations as a patient. You will also discuss where your procedure will be performed. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks and potential complications of your surgery. There may be a waiting period of several days to weeks from the time of your consent to the day of surgery.

While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.

Breast Augmentation Anesthesia

Breast augmentation can be performed with a general anesthesia, so you’ll sleep through the entire operation. Some surgeons may use a local anesthesia combined with a sedative to make you drowsy, so you’ll be relaxed but awake and may feel some discomfort.

Getting Back to Normal Following your Breast Implant Surgery in Barrie

You should be able to return to work within a few days depending on the level of activity required for your job. Follow the advice given on when to begin exercises and normal activities. Your breasts will probably be sensitive to direct stimulation for two to three weeks. Breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery. Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely.
Routine mammogram’s should be continued after breast augmentation for women who are in the appropriate age group although the technician should use a special technique to assure that you get a reliable reading.

Your New Look

For many women, the result of breast augmentation surgery can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance. Even if you believe your implants are functioning well, it is important that you follow-up as directed with your plastic surgeon to assess the condition of your breast implants. In addition, whether you choose to have breast implants or not, it is essential to your health that you practice a monthly breast self-exam and schedule regular diagnostic breast screenings.

For more information on the breast reduction, please visit ASPS and www.plasticsurgery.org

Breast Lift

Over the years, factors such as pregnancy, nursing and the force of gravity take their toll on a woman’s breasts. As the skin loses its elasticity the breasts often lose their shape and firmness and begin to sag. Breast lift, or mastopexy, is a surgical procedure to raise and reshape sagging breasts–at least, for a time. (No surgery can permanently delay the effects of gravity.) Mastopexy can also reduce the size of the areola, the darker skin surrounding the nipple. If your breasts are small or have lost volume–for example, after pregnancy–breast implants inserted in conjunction with mastopexy can increase both their firmness and their size. If you’re considering a breast lift, this information will give you a basic understanding of the procedure–when it can help, how it’s performed, and what results you can expect. Please be sure to ask if there is anything about the procedure you don’t understand.
While the majority of women do not experience complications, it’s important to understand and discuss the risks with Dr. Tumi during your consultation.

The Best Candidates for Breast Lift

A breast lift can enhance your appearance and your self-confidence but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

The best candidates for mastopexy are healthy, emotionally-stable women who are realistic about what the surgery can accomplish. The best results are usually achieved in women with small, sagging breasts. Breasts of any size can be lifted, but the results may not last as long in heavy breasts.

Many women seek mastopexy because pregnancy and nursing have left them with stretched skin and less volume in their breasts. However, if you’re planning to have more children, it may be a good idea to postpone your breast lift. While there are no special risks that affect future pregnancies (for example, mastopexy usually doesn’t interfere with breast-feeding), pregnancy is likely to stretch your breasts again and offset the results of the procedure.

Planning Your Surgery

In your initial consultation, it’s important to discuss your expectations frankly with your surgeon, and to listen to his or her opinion. Every patient — and every physician, as well–has a different view of what is a desirable size and shape for breasts.

The surgeon will examine your breasts and measure them while you’re sitting or standing. He or she will discuss the variables that may affect the procedure — such as your age, the size and shape of your breasts, and the condition of your skin–and whether an implant is advisable. You should also discuss where the nipple and areola will be positioned; they’ll be moved higher during the procedure, and should be approximately even with the crease beneath your breast.

Your surgeon should describe the procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. He or she should also explain the anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved.

Don’t hesitate to ask Dr. Tumi any questions you may have, especially those regarding your expectations and concerns about the results.

Preparing for Your Surgery

Depending on your age and family history, your surgeon may require you to have a mammogram (breast x-ray) before surgery. You’ll also get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.

While you’re making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.

Types of Anesthesia

Breast lifts are usually performed under general anesthesia, which means you’ll sleep through the operation. In selected patients–particularly when a smaller incision is being made–the surgeon may use local anesthesia, combined with a sedative to make you drowsy. You’ll be awake but relaxed, and will feel minimal discomfort.

The Surgery

Mastopexy usually takes one and a half to three and a half hours. Techniques vary, but the most common procedure involves an anchor-shaped incision following the natural contour of the breast.
The incision outlines the area from which breast skin will be removed and defines the new location for the nipple. When the excess skin has been removed, the nipple and areola are moved to the higher position. The skin surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around the areola, in a vertical line extending downwards from the nipple area, and along the lower crease of the breast.

Some patients, especially those with relatively small breasts and minimal sagging, may be candidates for modified procedures requiring less extensive incisions. One such procedure is the “doughnut (or concentric) mastopexy,” in which circular incisions are made around the areola, and a doughnut-shaped area of skin is removed.

If you’re having an implant inserted along with your breast lift, it will be placed in a pocket directly under the breast tissue, or deeper, under the muscle of the chest wall.

After Your Surgery

After surgery, you’ll wear an elastic bandage or a surgical bra over gauze dressings. Your breasts will be bruised, swollen, and uncomfortable for a day or two, but the pain shouldn’t be severe. Any discomfort you do feel can be relieved with medications prescribed by your surgeon.

Within a few days, the bandages or surgical bra will be replaced by a soft support bra. You’ll need to wear this bra around the clock for three to four weeks, over a layer of gauze. The stitches will be removed after a week or two.

If your breast skin is very dry following surgery, you can apply a moisturizer several times a day. Be careful not to tug at your skin in the process, and keep the moisturizer away from the suture areas.

You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This numbness usually fades as the swelling subsides over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.

Getting Back to Normal

Healing is a gradual process. Although you may be up and about in a day or two, don’t plan on returning to work for a week or more, depending on how you feel. And avoid lifting anything over your head for three to four weeks. If you have any unusual symptoms, don’t hesitate to call your surgeon.

Your surgeon will give you detailed instructions for resuming your normal activities. You may be instructed to avoid sex for a week or more, and to avoid strenuous sports for about a month. After that, you can resume these activities slowly. If you become pregnant, the operation should not affect your ability to breast-feed, since your milk ducts and nipples will be left intact.

Your New Look

Your surgeon will make every effort to make your scars as inconspicuous as possible. Still, it’s important to remember that mastopexy scars are extensive and permanent. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops.

you should also keep in mind that a breast lift won’t keep you firm forever–the effects of gravity, pregnancy, aging, and weight fluctuations will eventually take their toll again. Women who have implants along with their breast lift may find the results last longer. Your satisfaction with a breast lift is likely to be greater if you understand the procedure thoroughly and if your expectations are realistic.

For further information on Mastopexy please click here.

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