How is Nipple Reconstruction Done?

Nipple reconstruction is the last step of breast reconstruction.  The goal of nipple reconstruction is to make a cosmetically pleasing nipple- the reconstructed nipple will never have sensation like the native nipple did.  Some patients opt to have nipple reconstruction, while others decide to forgo an additional surgical procedure; the decision is completely up to the patient, and nipple reconstruction can be done at any time (although most surgeons will wait until at least 6 months after the initial breast reconstruction to allow time for things to settle).

There are two main ways to reconstruct a nipple.

from http://www.breastdiseases.com/plast7.htm on 5/27/2014

from http://www.breastdiseases.com/plast7.htm on 5/27/2014

  1. Local tissue transfer: tissue is moved around to create the projecting part of the nipple.  A skin graft may or may not be used to fill in where the areola would be, depending on the type of local tissue transfer used. (See the diagram above for a skate flap, one of the most common types of nipple reconstruction).  A tattoo is later done to add the pigmentation.
  2. Tattoo-only reconstruction: no actual projection is created, so the nipple will look flap on profile view.  Shading is done to obtain a 3-D effect, and can look very realistic.

A third option for reconstruction uses local tissue transfer in combination with an implant, such as Alloderm, to help maintain projection.  Alloderm is a regenerative tissue matrix; it is cadaver skin that has had all the cells removed, leaving only the collagen framework behind.  It is very commonly used in breast reconstruction, and is now gaining popularity in nipple reconstruction as well.
Plastic Surgeons are trained in both local tissue transfer and medical tattooing.  The tissue flap procedure is done in the operating room, takes about an hour, and you go home the same day.  The recovery is generally fairly easy, although you will have to wear a protective plastic cup inside your bra for several weeks to keep the new nipple from flattening out.  The tattooing is done in the office, using numbing cream for anesthesia.  You may also have a tattoo done by a tattoo artist who specializes in reconstructive tattooing.

Do you have any questions about nipple reconstruction?

 

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

When Should I get Lip Filler?

It is fairly common to want to “spruce up” before a special event such as a wedding or class reunion, and I have many patients who come in looking for a temporary improvement from Botox or fillers.  The question is: how far in advance before a special event should you have treatment?  Today we’re going to answer this question specifically for fillers.  I’m using the example of filler in the lip area, but this applies to most areas on the face (except in the case of Sculptra, which works a bit differently).

photo credit: office.com

photo credit: office.com

In the lip area I recommend a hyaluronic acid filler such as Juvederm or Belotero.  The results from these fillers are immediate (i.e. what you see is what you get), but there will be some swelling afterward which can take a few days to go down.  In addition, the lip area especially is prone to bruising after injection, and these bruises can take over a week to fade.   Your doctor may be able to laser the bruises to help them fade more quickly (our office offers this service complimentary to all of our filler and Botox patients), but you should still expect some bruising for several days.  Also keep in mind that most doctors will error on the side of under correction, because it is much, much easier to add filler than to try and remove it.  If you do opt for a touch-up, you can expect swelling and bruising after the touch-up treatment as well. Both Juvederm and Belotero last around 6-9 months.

Based on all the above information, I advise my patients to have filler in the 2 week to 3 month range prior to a special event.  This way you have plenty of time to have a touch-up and let any bruising or swelling fade, but your results are still maximized at the time of the event.

 

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Scars after Breast Reduction

Breast reduction surgery has a very high patient satisfaction rate, with nearly 90% of women rating their results as “good” or “very good”.  One common area of concern, however, is the scars afterward.

Whenever I meet with a patient regarding breast reduction surgery, one of the first things I explain is that breast reduction surgery essentially trades large breasts for smaller breasts with scars.  There are a few different incision types, but by and large the most common is the Wise-pattern incision.  This type of incision is around the nipple, down the front of the breast, and underneath the breast in the inframammary fold (see diagram below).

original image courtesy of wikipedia.com

original image courtesy of wikipedia.com

For obvious reasons, this is also known as an anchor style of incision.  And like any surgical scar, the scars from breast reduction may widen and raise, or stay pink or red for many months.  But there is good news.  First, appropriate treatment after surgery can help minimize the appearance of scars.  This may include massaging the area, applying a silicone-based scar cream, or even laser treatments.  Second, the scars do fade with time.  After the first year, the majority of breast reduction scars are flat and skin-colored.  Finally, breast reduction scars are covered by a bra or a bikini top, meaning they won’t show in regular clothing.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Removing Breast Implants

Breast augmentation is a great procedure, with a very high satisfaction rate.  But unfortunately breast implants do not last forever.  Most commonly implants are removed if they rupture, or for capsular contracture (when firm scar tissue forms around the implant).  Many women opt to have the implant replaced in these instances, but some prefer to have the implant removed altogether.  If this is the case, the question arises:

Will my breasts sag if I have my implants removed?

image from shutterstock.com

image from shutterstock.com

Whether or not breasts sag after removing implants depends on several factors.

  1. First, how long have you had implants?  Breasts tend to sag with time regardless of whether you have implants, so you can expect more sagging if you remove implants 20 years later, rather than just a few years.
  2. Second, what size implants did you have placed?  Larger implants stretch and thin the overlying tissue, resulting in more sagging after removal.
  3. Third, have you gained and lost weight or had children since having your augmentation?  Both weight change and pregnancy may result in loss of perkiness.

The best way to know what to expect after implant removal is to consult with a plastic surgeon.  The more information you have regarding your initial augmentation surgery, the better your surgeon will be able to predict what your results will be after implant removal.  This information may include the location of the implants (under or over the muscle), where your incision is located, and the size and type of the implants.  Based on this information and a physical exam, your surgeon may recommend an additional procedure such as a breast lift to obtain optimal results.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.