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Category Archives: Breast Lift

Rejuvenate your breast shape and volume with simultaneous breast lift and fat grafting

Unfortunately gravity is unceasing and combined with age and sun related skin loss of elasticity a woman’s tissues surrounding her breast can lead to the breast mound falling lower on the chest. Additionally, the volume inside the breast can diminish with hormonal changes after pregnancy and menopause and with significant weight loss.  All these factors triumphantly combine to give an aged appearance that can be significantly disproportionate to the otherwise youthful feeling of a women. Sound depressing? Sure it does but the artistry and science behind plastic surgery can offset these changes to a woman’s breasts and make them feel good about the skin they are in.

If someone is unhappy with the appearance of their breasts it is helpful for analysis sake to deconstruct the breast into two separate components: the overlying skin brazier, and the volume and its distribution of the breast mound on the chest wall.

The mound itself may have adequate volume but most of the distribution of the volume is in the lower pole of the breast well below the breast fold requiring a bra to perform a heroic task of keeping the breast on the proper location on the chest wall. This situation can be improved by a mastopexy (lift) with creating a lower pole breast flap of tissue transposed under the rest of the breast mound and fixated to a non-mobile portion of the chest wall to provide upper pole fullness. In this situation the skin brazier is loose and has allowed the breast mound to sink inferiorly and requires and generous amount of skin to be removed and repositioned to be coincident with the newly shaped breast mound. For some women this may produce a nice result but particularly individuals who have a very long trunk with a great distance from the breast fold to the collar bone, creating the appearance of low set breasts, the above technique requires another means of providing upper pole fullness. Some women are comfortable with adding an augmentation with a breast implant to enhance shape and form and creating a nice upper pole roundness. Some surgeons are comfortable offering an augmentation at the same time as the mastopexy. Other surgeons would argue, based on data which has shown a 25% revision rate with the combined procedures, would prefer to stage these techniques. I personally like to perform the augmentation mastopexy in a single stage because I would rather have the implant in place to provide shape and volume to the overlying breast mound prior to tailoring the skin envelope of the lift procedure. I find this saves the patient a second general anesthesia, reduces expenses, and can be performed in the office setting with much less cost. Generally, it is only a minor skin re-tailoring to minimally reposition the nipple-areolar complex vertically on the breast mound.

Implants can provide structural shaping and volume enhancement of the breast mound but there are definitely limitations to their effect. Women who have structural limitations to their chest wall anatomy can have difficulty in achieving satisfactory results with implants alone. Individuals with very wide sternums and rapidly sloping chest walls cannot achieve meaningful cleavage with implants alone because the devise cannot be placed on the sternum. Another anatomic limitation eluded to in the above paragraph is the long chest wall with the accentuated length of the breast fold to collar bone giving the illusion of the low set breast. Even an anatomic shaped breast implant which is taller than it is wide still cannot mask this affect. In both of the above situations in which implants are chosen as the enhancer of choice the addition of fat grafting is necessary to create a much enhanced result. The beauty of fat grafting is that it can be placed in any position on the chest or breast. It can be similar to the concept of photo-shopping an image and allows the surgeon to truly sculpt the breast and chest wall to closer reflect an ideal form and helps to hide these difficult anatomic variants with your very own fat.

Other women may prefer to avoid implants all together and in consultation with their surgeon may choose to enhance the shape and volume of the breast mound and chest wall in conjunction with a mastopexy with just fat grafting lone without implants. Just as implants have limitations so does fat grafting. The current art and science of the techniques of autologous fat grafting has a yield of around seventy percent sustainable take of the viable fat implanted into the tissues. This has been reproducible shown over many series of papers presented in the literature. Since fat is a very soft material that cannot resist significant opposing forces of the skin it is difficult to globally enhance a breast mound much larger than a cup to a cup and a half sizes larger in one session. Therefore a women who has a large skin envelope and very limited breast mound volume and desires to have a very full shape should not consider enhancement solely with fat alone. A combined implant with fat grafting provides a much better and stable result. In my experience fat grafting alone is best to sculpt and shape the cleavage and upper poles of the breast and chest wall interface. It can enhance the overall volume by a cup size as well. The other nice advantage of fat grafting for breasts is it allows the removal of unwanted fat volume from places like the flanks, abdomen, and thighs to achieve improved breast shape and sculpting of the body contour.

If you feel self-conscious about the appearance of your breast and feel it is disproportionate to the rest of the body and how you feel about yourself, consult a board certified plastic surgeon to define your goals and options for rejuvenating your breasts.

The mommy makeover-Is it right for you?

Being a mom is one of the most challenging, frustrating, yet rewarding experiences a woman can have. You put forth blood sweat and tears, not to mention an untold strain on your whole body during pregnancy. It really boils down to the genetics of your skin and fascia as to how well you can bounce back after the weight gain and abdominal stretching from your baby. Many women lament that despite dieting, exercising and lots and lots of willpower your body is never the same as it was prior to child bearing. Fortunately for the masses of dissatisfied women there are options in Plastic Surgery to boost your self- confidence and your body image. Here is a list of body corrections (Mommy Make-over) that can be performed in tandem or separately to improve the shape and how you feel about your physique.

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Breast:
During pregnancy the glandular component of the breast must enlarge to ready for the enhanced production of milk. Additionally weight gain with fat storage all governed by the hormonal changes can increase the breast size immensely. Unfortunately fetal regulation also makes skin “stretchy” to accommodate the increased girth of the breast and abdomen. After the resumption of normal non-pregnant hormones and the lack of need for lactation the breast volume will revert back to baseline and can even reduce in overall size compared to the original baseline. Unfortunately many times the skin does not have the ability to shrink to the original size and will stay expanded resulting in a larger skin brazier with same or even less fill than before resulting in “saggy” breast shape. With increased skin length from the breast fold to the nipple it moves the breast mound lower on the chest with less upper pole fullness. I hear many women call their breasts “sad” in appearance when they come in for consultation. Ok enough depressing thoughts… what can be done? If the skin is not excessively enlarged, the nipple-areolar complex is correct and the fold to nipple distance is not greatly elongated the solution can be to place a silicone gel implant to act as a shaper and a filler of the breast envelope restoring a pleasing breast shape. If the breast has a low positioned nipple-areolar complex, with or without increase skin length from the fold to the nipple-areolar complex, then a mastopexy (breast lift) is required. Often times tissue volume might need to be enhanced to provide better shape and upper pole fullness, thus an implant or fat grafting can be incorporated at the same time. Sometimes upper pole fullness can be accomplished by transposing extra breast tissue in the lower pole and positioning it on the chest wall deep to the rest of the breast to enhance fullness.

Abdomen:
Hormones during pregnancy direct adaptive body changes that allow healthy growth of the baby but unfortunately create lasting changes to a women’s body. The abdominal skin stretches and often can result in stretch marks (tears in the dermis with intact epidermis). Excess skin rarely retracts in these cases leading to hanging skin that drapes over the pelvis. Next the abdominal wall is distorted to accommodate the growing fetus resulting in separation of the paired rectus muscles leading to increased abdominal circumference with permanent bulges in the abdominal wall both above and below the umbilicus. This unfortunately cannot be reduced with abdominal exercise because the stretched fascia between the muscles is not contractile and will not respond to muscle strengthening. Additional weight changes with aging often can be manifested with increased abdominal girth from excess fatty tissue. So what can a Mommy Make-over achieve in the abdomen?
If skin quality is excellent and the abdominal wall is only minimally distorted often liposuction with the addition of additional energy sources such as ultrasonic energy (VASER), oscillating power hand-piece (PAL), or hydraulic power can result in removal of excess fat and create skin retraction/redistribution to improve contour. However, many women will need a full abdominoplasty with correction of excess fat with liposuction, removal of excess lower abdominal skin with tissue resection, and abdominal wall restoration by returning the rectus muscles together with a permanent suturing technique. This can result in excellent contour of the abdomen but you will trade the contour for a scar. I find most people are surprised how long the scar has to be to create the contouring necessary. Once acquainted with the results, most women will gladly trade a scar for the results of a flat smooth abdomen.

Back and Flanks:
Some women can realize their goals by correcting the anterior abdomen by itself. However many women if given the opportunity would love to three dimensionally correct their torso by sculpting their midback (bra line folds) and flanks (muffin tops) at the same time as their abdomens to circumferentially adjust their shape. This can make a tremendous change on how clothing can be worn and how the individual feels about themselves. Liposuction with either PAL or VASER makes a great deal of improvement by releasing all the ligamentous attachments between the back and flanks and the superficial skin (which results in rolls on the back) and allows even removal of fat and the skin to re-drape much smoother.

Legs:
Some women naturally store adipose tissue in their lateral or medial thighs. Depending on the skin quality and the potential for the tissue to re-drape or tighten, fatty tissue can be sculpted just as on the back. Some have significant adipose tissue below the knee down to the ankle. I generally do not add the additional power source with liposuction in this area and have achieved good results.

Buttock:
Popular trends in body shape can change just like in fashion over time. The introduction of the Latin culture into the United States in conjunction with pop culture personalities have made the appearance of a full contour buttock something to aspire to. My preference for buttock augmentation is with fat grafting and not with a prosthesis. Utilizing concepts of tissue equilibration and liposculpturing we can remove unwanted fatty tissue, harvest it as a graft, and utilize the fat as a volumizer of the buttock- while improving the contour of the rest of the body. Women who have gained and lost weight may have loose sagging skin of the buttock and restoring volume can shape and lift the buttock with little or no scarring.

Women who are unhappy with their physical appearance after giving birth to one or multiple children can restore the body to a better place with a Mommy Make-over. To me this represents more than one area of the body to be rejuvenated simultaneously to make the woman feel refreshed and erase some of the “battle scars” of pregnancy so she can feel more confident in her appearance.

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Natrelle 410 Breast Implants

There are many different kinds of breast implants in the market right now, and it can be confusing for anyone to know what is best. That is why Dr. Lucas is here to help you sift through all the clutter and introduce the latest breast implant.

The FDA recently approved the Natrelle® 410 highly cohesive, anatomically shaped silicone-filled breast implant for use in augmentation, breast reconstruction and revision surgeries. These gel implants provide an important new alternative to traditional round implants for women. It is designed to mimic the slope of the breast and hold its shape over time while remaining soft to the touch.

The FDA approval of the Natrelle® 410 gel implants was based on an extensive review of various data and studies, including pre-clinical device testing and clinical data from Allergan’s 10-year prospective, multi-center pivotal study. It involved nearly 1,000 women who have undergone breast reconstruction, augmentation or revision surgery.

During your consultation for breast surgery with silicone gel implants, Dr. Lucas can discuss which implant options are right for you. Natrelle® 410 implants with the highly cohesive gel offer a shaped profile alternative to a round devise which might be right for you.

If you have any questions about this breast implant or any others, please contact The Lucas Center of Plastic Surgery at 865-218-6210.

Dr. Jay Lucas is a board-certified plastic surgeon located in Knoxville, TN. He has a decade of experience performing a variety of cosmetic surgeries, and his unique educational background at some of the nation’s most prestigious medical centers allows him to perform cutting-edge plastic surgery procedures for his patients. This includes face lifts, breast augmentations, tummy tucks and rhinoplasties.

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