Frequently Asked Questions:   Cosmetic Surgery / Breast Surgery

Breast Reduction (Reduction Mammaplasty):

v     Reduction mammaplasty is an aesthetic (cosmetic) surgical procedure aimed at reducing overly large or sagging breasts to a more comfortable shape and size. This procedure is indicated if one feels uncomfortable with large breasts. One may suffer pain in the breasts, shoulders, lower neck or back. One may also have discomfort during physical activity. A breast operation minimizes these problems, enhances the posture, and helps improve your overall appearance and self-esteem. Mammography (x-rays) may be required before the final decision.

v     There are currently several techniques for reduction mammaplasty. They all aim to remove excess breast tissue, recontour the breasts, and reposition the nipples. The scars are situated around the areolae of the nipple and under the breasts. They usually fade over 6-12 months. Thus although scars will be present, most patients believe they are worth it. There may be an alteration in sensation of the nipples, but this often improves with time. Current techniques of breast reduction may preserve the ability to breast-feed but one should discuss this with your surgeon. There is normally a slight difference in size between the breasts and this may persist following procedure.

v     Reduction mammaplasty is usually performed under general anesthesia. The average length of stay is two to four days. Most patients are back to their regular routine in about three weeks. Returning to work or your normal activities is an individual matter

v    Although Cosmetic surgeon will make every effort to keep them as inconspicuous as possible, scars are the inevitable result of any surgery. The scars should however be hidden on the undersurface of the breasts and thus become less visible after a period of time.

 Breast Augmentation (Enlargement):

v     Augmentation mammaplasty is an aesthetic (cosmetic) surgical procedure to increase the size of breasts. Augmentation mammaplasty will also correct slight sagging of the breast and can increase breast firmness. A similar procedure can be used to recreate a breast after mastectomy.

v     There are currently several techniques for augmentation mammaplasty. They all involve the insertion of a saline (salt water) filled implant either behind the breast tissue or behind the pectoral muscle. The implant is inserted through a small incision either under the breast, around the nipple or in the armpit.

v     One may have some bruising and swelling of the breasts for 2 or 3 weeks. One should be able to resume your normal routine in 2-3 weeks although one may wait a little longer before undertaking strenuous exercise.

v      Occasionally a capsule of scar tissue forms around the implant that makes the breast feel firm. In addition an implant may become fixed in a slightly high or low position. As the implant is filled with saline solution, it is possible that the implant will deflate and therefore require replacement. There is no evidence that the implants currently in use do not cause breast cancer or other diseases nor do breast implants interfere with breast-feeding.

v     Although scars are the inevitable result of any surgery, every effort is being made to keep scars as inconspicuous as possible. The scars are usually just a few centimeters long and are located in such a way as to become barely noticeable as they fade with time.

Breast Reconstruction:

v     Reconstruction of a breast that has been removed due to cancer or other disease is one of the most rewarding surgical procedures available today.

v     Frequently, reconstruction is possible immediately following breast removal (mastectomy), so the patient wakes up with a breast mound already in place, having been spared the experience of seeing herself with no breast at all.

v     Breast reconstruction usually involves more than one operation. Following mastectomy, a balloon expander is inserted beneath the skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, a saline solution is injected periodically to gradually fill the expander over several weeks or months. After the skin over the breast area has stretched enough, the expander is removed and a more permanent implant will be inserted.

v     A breast implant is a silicone shell filled with either silicone gel or a saline solution. Because of concerns that there is insufficient information demonstrating the safety of silicone gel-filled breast implants, the Food & Drug Administration (FDA) has determined that new gel-filled implants should be available only to women participating in approved studies. This currently includes women who already have tissue expanders and who choose immediate reconstruction after mastectomy, or who already have a gel-filled implant and need it replaced for medical reasons. Eventually, all patients with appropriate medical indications may have similar access to silicone gel-filled implants.  The alternative saline-filled implant, a silicone shell filled with salt water, continues to be available on an unrestricted basis, pending further FDA review.

v     Flap reconstruction, an alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks. The flap, consisting of the skin, fat, and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself, without need for an implant. Another flap technique uses tissue that is surgically removed from the abdomen, thighs, or buttocks and then transplanted to the chest by reconnecting the blood vessels to new ones in that region known as micro vascular surgery The transported tissue forms a flap for a breast implant, or it may provide enough bulk to form the breast mound without an implant.

v     Many reconstruction options require a surgical drain to remove excess fluids from surgical sites immediately following the operation, but these are removed within the first week or two after surgery.  Most stitches are removed in a week to 10 days. Scars at the breast, nipple, and abdomen will fade substantially with time, but may never disappear entirely.

v     Follow-up surgery may be required to replace a tissue expander with an implant or to reconstruct the nipple and the areola or to enlarge, reduce, or lift the natural breast to match the reconstructed breast. If an implant is used, there is a remote possibility that an infection will develop, usually within the first two weeks following surgery. In some of these cases, the implant may need to be removed for several months until the infection clears. A new implant can later be inserted.  The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of the implant.

v     Reconstruction has no known effect on the recurrence of disease in the breast, nor does it generally interfere with chemotherapy or radiation treatment, should cancer recur.