Category: Breast Reduction

After the Weight Loss

scaleOne of the good things about our nation’s obesity epidemic is that there are so many people affected by it learning to reverse the weight gain. I often ask people what made them ready for change.  In my practice about half of the massive weight loss patients I see had bariatric surgery and half used diet and exercise alone. Make no mistake. Both are hard work.

The US population has obesity levels that are sky rocketing compared to our parent’s generation.  Theories abound about the cause of this unprecedented rise, but there is no doubt that it has become a serious public health problem. Health benefits of massive weight loss are large, but people often endure aesthetic and functional impairments that do not go away with weight loss alone.

Studies show that people are pleased with the changes in their appearance after massive weight loss, but their body image satisfaction decreases after 2-3 years.

The change comes from quality of life limitations created by the deflated hanging skin. They experience functional impairments including limited mobility from excess inner thigh skin, postural instability from abdominal skin excess, and increased hygiene demands from areas where the overhanging skin rubs.  16% report sores, rash and skin breakdown. 60% are dissatisfied with the appearance of their thighs.  Many continue to feel uncomfortable about their appearance which can have an impact on sexual and social interactions. The removal of excess skin by body contouring plastic surgery can contribute to better, physical, psychological, and social function. 

Studies have shown that 75-85% of those who have sustained massive weight loss desire body contouring surgery. The desire for plastic surgery after weight loss is twice as frequent in women and inversely related to age.

For more information refer to the December 2012 issue of Annals of Plastic Surgery.

Beauty, Body Contouring, Breast Augmentation, Breast health, Breast Implants, Breast Reduction, Cellulite, Mommy Makeover, Uncategorized, Weight loss

Current Trends Show Fat Grafting the Breast Is Popular

Breast Fat TransferA recent survey of board certified Plastic Surgeons confirms that plastic surgeons are using fat transfer with increasing frequency and success.
80% reported using fat in parts of the body other than breast.
70 % actively perform fat grafting to the breast.
62% used fat transfer as a good choice for improving breast shape and
contour in reconstructive breast surgeries.
28% of the surveyed surgeons employ this technique for cosmetic purposes.



Here are some of the ways this valuable technique is being used:

  1. Breast implants in thin women can show wrinkling or visible borders. Fat can provide a thicker soft tissue cover to hide implant characteristics.
  2. Fat grafts can cover prominent ribs or an irregular chest wall.
  3. Congenital breast problems, such as tubular breasts or lack of growth of one breast can be reshaped with fat transfer as part of the procedure.
  4. In breast reconstruction after mastectomy, fat can help camouflage the borders of an implant, or fill in a deficit in a flap contour or after a lumpectomy defect. Fat can treat irradiated tissue and seems to improve skin quality. 

There were nearly 72,000 fat grafting procedures reported by US board certified surgeons for 2012, according to the American Society for Aesthetic Surgery. 

For more detail visit the July 2013 issue if Plastic and Reconstructive Surgery,

Anti-aging, Blepharoplasty, Body Contouring, Breast Augmentation, Breast health, Breast Implants, Breast Reduction, Fat Transfer / Fat Grafting, Mommy Makeover, Tubular Breasts


WomanRedheadAccording to the American Society of Plastic Surgery there were 286,000 breast augmentations in the United States last year, an increase of over 200% since 1997. In my last blog, I reported on evidence that shows a high degree of satisfaction with the choice to have breast implants. We know that breast implants do not last a lifetime, but women want the satisfaction with their procedure to last a very long time. The US implant manufacturers advise that implants will need to be removed or replaced eventually. So what are some of the reasons for revising breast surgery?

A study (published last month in Aesthetic Surgery Journal) looked at 110 consecutive women that underwent revision of their breast implants between the years 2004 and 2009. The reoperation rate in this study was 16.3% with an average time from first surgery to revision of 8.9 years.

Here are the reasons for re-operation in this surgeon’s practice:

1. 42%developed sagging (ptosis) of their breast, a natural progression of biological change.

2. 29% had capsular contracture (scar tissue around the implant resulting in firmness).

3. 19% were re-operated for a high riding implant.

4. 14% indicated implant position was not where it belonged (malposition).

5. 7% had infection.

6. 5% developed breast cancer.

7. 4% objected to rippling of implant.

8. 4% had synmastia (implant pocket lifting up over the sternum).

9. 3% had a “double-bubble” where implant and breast did not merge in a smooth transition.

10. 2% deflation.

As humans age their skin thins, loosing elasticity. As breast volume fluctuates with weight changes and pregnancy, there is a natural sagging of the breast. Implant placement can accelerate these natural changes. This report shows that the majority of revisionary breast implant surgery is to improve appearance and reverse changes of aging, rather than for medical necessity. That is a good thing if you are the patient, because you can choose the time when it matters to you.

Anti-aging, Beauty, Body Contouring, Breast Augmentation, Breast Implants, Breast Reduction, Mommy Makeover, Personal Fitness, Uncategorized

Staying Fit as the Seasons Change

Seattle had a beautiful summer this year that stretched out through most of September. It was easy to stay inspired for outdoor sports. As the leaves are turning and daylight is shorter don’t let weather hold you back from training. Here are a few suggestions:

  1. Train with friends. Having a buddy helps to keep you accountable. It is too easy to let yourself off the hook when you are tired, and besides you can accomplish your social goals at the same time as your fitness goals. Consider it multi-tasking.
  2. Work on your core. The stronger your trunk muscles are, the better your balance and stability.  It enhances any other sporting activity. Yoga and Pilates classes are popular ways to strengthen your abdomen and back.
  3. Increase aerobic endurance. Thirty minutes three times a week is an important baseline for aerobic fitness. Make that 30 minutes increasingly difficult to improve stamina after your routine becomes habit.
  4. Return to the gym. Spinning classes, swimming pools and treadmills are easier to use when there are others around. The energy from other people is contagious. Sports equipment at home is a great idea, but it seems to collect dust before it ends up in garage sales.

What ever you do, be adventurous, creative and open-minded. Staying fit is good for your mood, good for your brain, good for generating energy, and good for your health. Don’t let it lapse when it is unseasonable!

Anti-aging, Beauty, Breast health, Breast Reduction, Doctor-Patient Relationship, Personal Fitness

The Ideal Breast

Breast-augmentationWhat’s ideal? What’s normal? Women’s breasts vary so widely that there really is no way to define the “normal.” Each person’s experience, cultural background and preferences create  their personal “ideal” and there is remarkable difference of opinion. So what do plastic surgeons consider when trying to get the very best appearance for each woman choosing breast surgery? In order to communicate aesthetic ideas with their patients, plastic surgeons analyze basic characteristics of the breast and try to describe what features are possible to change and how to create the best surgical strategy for improvement. After your surgeon has listened well to your preferences, these are a few of the features that your surgeon may want to analyze with you.

  1. Where is the breast located on the chest wall?  The base of the breast (breast disc or footprint) should meet the chest wall in a way that is the foundation for the overlying three dimensional structure of the breast. This footprint is constant throughout life. An abnormal location of the footprint or an irregular chest wall can interfere with the aesthetics of the breast. Is your breast fold too high or too low?  Is your spine straight?  Does one side of the chest project more than the other?  Are your ribs crooked? 
  2. What is the shape or “conus” of the breast? Breast shape varies widely among women and quite a bit over a given woman’s lifetime. In adolescence the breast is cone shaped. Over time there should be a progressive transition with a greater portion of its volume resting in the lower outer quadrant. The nipple should be at the area of maximum breast projection, roughly at the apex of the cone shape. 
  3. What is the quality and quantity of the breast skin? Too much skin leads to a drop in the breast position on the chest wall. The skin provides the major support for the breast gland. If elasticity is poor, the skin envelope cannot contain the gland in a suitable shape.
  4. Is the areola size a good match for the volume of the breast? Is the nipple position correctly located on the projecting portion of the breast and in the middle or slightly lateral to the middle of the breast?
  5. Do the two breasts look alike? Most women’s breasts are more like sisters than identical twins, but symmetry is one feature of the hoped for end result.
  6. Is the volume appropriate for the rest of the body’s proportions? You should express your size concerns to your surgeon and have a careful discussion about any possible downsides to your choice. 

Tubular Breasts

The term “TUBULAR” refers to SHAPE for a tubular breast. It is used to describe a breast shape that is long and narrow, rather than being broad at the base with a gradual decrease in width up to the top, like a cone or pyramid. Women that have tubular breasts often have a very high fold at the base of their breast, and they have puffiness in the nipple-areolar region where the breast seems to bunch out of the top. A mild tubular breast shape is quite common. Extreme tubular breast deformity can be very troubling  to have, and women often want the shape improved.

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Beauty, Breast Augmentation, Breast health, Breast Reduction, Mommy Makeover, Tubular Breasts

Why Would a Man Be Uncomfortable Removing His Shirt?

Gynecomastia, Male Breast Enlargement

Gynecomastia-Male-breast-reductionMen that are uncomfortable in the locker room or at the beach may be those whose chest appears more like an adolescent female than a male. Male breast enlargement, called GYNECOMASTIA, is common and can be a source of embarrassment.

Recently a 16-year-old boy came in with his parents to talk about his gynecomastia. Brian had become increasingly unhappy at school. He socialized less comfortably than he had as a little boy and he refused to participate in sports. He spent more time alone playing computer games and had put on a lot of weight. At 5’8″ he was 225 lbs. He had trouble losing the weight because he was humiliated to take his shirt off in front of others and did not want to participate in sports. Teenage boys at school targeted him as the brunt of their jokes.  

Brian had a very extreme case of male breast growth that was made worse by his weight gain. His embarrassment was understandable. He had been evaluated at the Children’s Hospital endocrinology clinic and no cause had been found for the breast enlargement. He and his parents wanted to remove the stigma as soon as possible.

Brian’s surgery incorporated a variety of surgical techniques. LIPOSUCTION of the chest wall helped to smooth the contour with removal of the extra fatty component. The dense glandular tissue was removed through a small incision camouflaged at the junction of normal skin and the brown areola, a variation on a SUBCUTANEOUS MASTECTOMY. The TUBULAR BREAST shape was corrected by a PERIAREOLAR MASTOPEXY, which means that extra skin was removed and constricting fibrous bands were removed to reshape his chest.  

Brian had an enormous sense of relief immediately after his procedure. He is more confident and outgoing and relieved of the sense of shame he felt about his chest. He is hoping to tackle his weight issue next.


Male breast enlargement happens commonly at two times in a man’s life. At mid to late puberty there can be an excess of free ESTROGEN before adult levels of TESTOTERONE have been produced. Breast enlargement at this phase goes away within a year 95% of the time. If it lasts longer, it is likely to persist unchanged. The second time that breast enlargement is common is in late life as testosterone level is falling. 50% of men have decreased free testosterone by age 70.  

The vast majority of the time no cause can be found for gynecomastia. Rarely there may be tumors of the testes or adrenal that produce feminizing hormones. Failure of the testes to produce testosterone can also result in breast growth. Obesity can be a cause of gynecomastia as increasing BMI results in converting adrenal hormones into estradiol, which stimulates glandular growth.

Men with severe liver failure, kidney failure, and hyperthyroidism can all be associated with benign growth of the male breast.

There are a number of medications that have been known to stimulate breast growth, including certain diuretics and anabolic steroids.  

There is not complete agreement on whether or not biochemical studies should be ordered for the evaluation of gynecomastia, because the tests have a low yield. The cause is usually found with a careful history and physical exam. Medications including estrogen inhibitors have been largely unhelpful. If the gynecomastia has lasted for more than a year, then surgical removal of gland and fat improves their appearance.

Reference: New England Journal of Medicine 357;12 p.1229.

Breast Reduction, Gynecomastia, Male Breast Enlargement, Male Breast Reduction

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