The correction or reconstruction of Tubular or Tuberous Deformity remains a very challenging issue for most Plastic Surgeons. Older traditional surgical methods often produced unacceptable scarring and often poor results. However more modern techniques have improved results significantly and in many cases this deformity can now be corrected with much less visible scarring.

What is the Tubular or Tuberous Breast Deformity?

Tubular Breast Deformity is an inherited or congenital condition that appears during puberty when glandular development starts. The breast is small with inadequate growth of glandular tissue and what is called a constricted shape. The skin of the breast is constricted or tightened around the developing gland tissue which causes the breast to have a tubular or elongated shape.

In some cases the areola appears unusually large as it appears larger than the diameter of the gland. In some cases when the nipple-areola also fails to develop the nipple-areola can be very small. In some cases this is called Hypoplasia or Agenesis. In many cases there is asymmetry with unevenness and in some cases Tubular Deformity can occur on only one side.

Breast Implants to Correct Tubular Deformity

Fortunately, today many patients with Tubular or Tuberous Deformity can achieve an excellent cosmetic result with simple Augmentation with Implants. This technique requires a Sub glandular Implant rather than the Sub muscular Augmentation and requires a modification of the breast gland. There are constricting bands that hold the gland in a tubular shape and these bands are released surgically from underneath the breast gland. This allows the implant to stretch the overlying gland tissue and skin to a more natural appearing breast shape.

In the photo below the patient had a tubular shaped breast on one side and Agenesis or Hypoplasia on the opposite side. She chose, wisely in my opinion, not to have a nipple-areola enlarging procedure on the left side, as this would have created very visible scarring. The implants do provide some stretching and enlargement of the hypo plastic nipple-areola complex.

Before and after correction Tubular or Tuberous Breast Deformity with Breast Implants Right Oblique View

Before and after correction Tubular or Tuberous Breast Deformity with Breast Implants Right Side View

Before and after correction of Tubular or Tuberous Breast Deformity with Breast Implants Left Oblique View

Before and after correction Tubular or Tuberous Breast Deformity with Breast Implants Left Side View

Soft Tissue Expansion for Tubular Breasts with Ptosis or Sagging

In patients who have Tubular Deformity with significant Ptosis or sagging, a technique called Soft Tissue Expansion of often works well. A small inflatable saline implant is placed beneath the breast and gradually inflated by injecting saline through a small port beneath the skin. Over a few months, the expanding implant gradually stretches the breast and creates a more normal shape. This technique can also increase the size of the nipple-areola complex. When the final breast and shape is achieved the expander is removed and a final implant is placed.

Mastopexy or Lift and Implants

In patients who have Tubular or Tuberous Deformity with a very large Areola or significant asymmetry or uneven breasts a Dermal Mastopexy or Breast Lift is often done to achieve better symmetry.The Mastopexy allows for reduction of the Areola if necessary and lifting of the sagging breast.

In the patient pictured below a lift or Mastopexy and Implant was done on the left side and an implant on the right. The left side was sagging or Ptotic and both breasts were constricted but were not “extreme” forms of Tuberous Deformity. These photos are only 2 weeks after surgery and there is still a scab on the left side which went on to heal very nicely. Notice how the left Areola has been reduced to match the right side.

Before and after Breast Implants and Mastopexy or Breast Lift to correct uneven breasts or breast asymmetry front view

Before and after Breast Implants and Mastopexy or Breast Lift to correct uneven breasts or breast asymmetry side view

Donut Mastopexy

Donut Mastopexy is an operation that excises or removes the tight or constricted skin surrounding the breast done to leave behind a more normal shape. The problem with this operation is that the scarring is terrible. I have never used this procedure and doubt that it is done very often now that newer soft tissue expansion is available for severe cases.

Who Should Do Your Surgery?

You should consult a surgeon who is certified by the American Board of Plastic Surgery and who is experienced in Cosmetic Breast Surgery. Ask the doctor if he has experience treating this deformity and if possible show you the results that he/she has achieved. Good results require an expert who knows how to treat this condition.

Call me at 978-369-4499 for more information or read about Breast Implants on my blog. You may contact me and submit breast photos and I will answer your questions by email. You may want to sign up for our Plastic Surgery Newsletter to learn about new non-surgical and surgical treatments in Plastic Surgery.
Dr. Seckel
Concord, Massachusetts
Boston, Massachusetts

Before and After Photos Silicone Gel Breast Implants 300 ccs

Before and After Photos Silicone Gel Breast Implants 300 ccs

Breast Augmentation with Breast Implants is a very popular and common Plastic Surgery procedure. If you are considering having Breast Implants there are many decisions that you will have to make with the help of advice from your Plastic Surgeon. You will have to choose the size and style of Breast Implant, where you want your incision, and whether you want your Breast Implants placed over the chest muscle (see above Before and After Photo) or under the chest muscle (see Below Before and After Photo.)

Before and After Photos Silicone Gel Breast Implants 325 ccs

Beofre and After Photo Silicone Gel Breast Implants 325 ccs

The major muscle on your chest is called the Pectoralis Muscle and there are two of them, right and left. Breast Implants may be placed beneath the muscle, and this technique is called a Subpectoral or Submuscular Breast Augmentation. If the Implant is placed on top of the Pectoralis Muscles, the procedure is called a Subglandular (beneath the breast gland) Breast Augmentation or Prepectoral Augmentation.

To help you decide whether you want a Subglandular or Submuscular Breast Augmentation let’s discuss some of the advantages and disadvantages of both techniques.

Advantages of Subglandular Breast Implants
• Less discomfort
• Quicker Recovery
• Implant falls to normal position more quickly
• Looks better in sagging breast without need for breast lift

Disadvantages of Subglandular Breast Augmentation

• More visible Implant in thin women with little breast tissue
• Breast may sag more over long time
• Folds or Ripples, especially in Saline Implants, may be more visible
• May have higher incidence of firmness long term

Advantages of Submuscular Breast Augmentation

• More tissue covering Implant-less implant show in thin women with little Breast tissue
• Less prone to firmness over long term
• Ripples in Saline Implants less likely to show
• Daily action of muscle provides Implant Displacement exercises
• Some feel a more natural look

Disadvantages of Submuscular Breast Augmentation

• More discomfort
• Longer Recovery
• May interfere with pushups, weight lifting and other exercise
• Visible motion and distortion of Implant with Pectoralis Muscle contraction
• Holds Implant higher thus will need a Breast Lift if you have sagging Breasts
• Need for revision may be more common

How to Decide Under or Over the Muscle

First, you need to have a consultation with one or two experienced Board Certified Plastic Surgeons who are experienced in Cosmetic Plastic Surgery. Visit the website of the American Society of Aesthetic Plastic Surgeons for a list of Board Certified doctors in your area. Discuss you options thoroughly with the Doctor. There will be specific issues regarding your anatomy, lifestyle, and goals which will swing the decision one way or the other.

Also read as much as you can about Breast Augmentation with Breast Implants so you are well informed. Another good source of information is the website of the American Society of Plastic Surgeons.

You and your surgeon will make the final decision however some general guidelines are:

• If you are very thin, with little Breast Tissue and no Ptosis or sagging, the Submuscular approach may be your best choice.
• If you have had children or lost weight and do not want the scars associated with a Breast Lift, and your surgeon feels that you can avoid a lift, then the Subglandular approach may be better for you.
• If you participate in vigorous physical exercise such as weight lifting and pushups and visible motion of your implants will bother you, then the Subglandular approach may be better for you.
• If you are primarily concerned about avoiding capsular contracture or firmness of your implants the Submuscular approach may be best for you.
• If you must have Saline Implants and are concerned with folds or ripples then the Submuscular approach would be better.
• If you want a quick recovery and are concerned about pain or discomfort the Subglandular approach may be better for you.

What is Most Important?

Both Subglandular and Submuscular Breast Implants can provide Beautiful Results and have done so for hundreds of thousands of women. The key is the experience and skill of your Plastic Surgeon. Your choice of a Plastic Surgeon will be the most important factor in your decision.

See more than one doctor, make sure they are certified by the American Board of Plastic Surgery and that they are an expert in Cosmetic Surgery of the Breast. Try to find friends who have had this surgery and ask them about their surgeon. Be sure you feel confident in and comfortable with the doctor who you choose.

Dr. Seckel
Boston, Massachusetts
Concord, Massachusetts

If you are pleased with the appearance of your breasts after augmentation, and you have no medical complication caused by the implants, then there is no reason to remove them.

There is a great deal of confusion about whether stable prostheses have to be removed after 10 years. This is because of the FDA guidelines written a few years ago when they approved the new Silicone Gel Breast Implants. The FDA estimates the “useful life” of these products to be 10 years. Thousands of patients have had similar devices in place for over 40 years and have not had problems. It is important for you to understand that the FDA recommendations were not based on any scientific long-term study as there were no such studies for the new approved devices when these new devices were approved. Thus the FDA recommendations are essentially an estimate of “useful life.”

if you are happy with your result and there is no evidence of rupture or any other problem, I do not recommend removing breast implants unless you no longer wish to have them. Just because they are 10 years old does not mean that you “have” to remove them.

There are situations in which I do recommend removal and, if you desire, exchange to new implants. There are however some serious medical reasons that require removal.

Some of the reasons for removal are listed below:

• Infection-rarely the prosthesis can become infected. I have seen infection once in 30 years and it occurred after a nipple piercing. Infection of an implant can be life threatening and removal is a surgical emergency. Signs of an infection are redness on the skin and fever and if this occurs see your doctor immediately.

• Exposure- if there is a break in the skin and the device is exposed removal is almost always recommended immediately.

• Rupture- if your Silicone Breast Implant ruptures it should be removed according to current guidelines. New ones can be placed back into the breast after removing all possible Silicone. If they are Saline, the device deflates and the saline is reabsorbed by the body safely. However deflation creates an asymmetry and you will most likely want a replacement.

• Capsular contracture-capsular contracture presents as firmness or hardness around the prosthesis. It is caused by scar tissue forming around the device. In severe cases it can cause discomfort. If you are considering re-augmentation, then the surgeon will remove the scar tissue, called a Capsulectomy, so that the new prosthesis will be softer. However, if you have developed capsular contracture there is a 50% chance that it will recur after removal, Capsulectomy and insertion of new prostheses.

• Rippling of Saline Implant-many women are troubled by palpable or visible ripples along the side near the axilla or arm pit. This happens most frequently with Saline prostheses. It is not a medical problem but a cosmetic one. Silicone gel prostheses are less prone to this problem, which is more common in thin women with little glandular tissue.

• Displacement, abnormal position or bottoming out-in some patients the prosthesis can become displaced to the side or sag down on the chest. This is again a cosmetic problem and most women opt revision and replacement.

• Double Bubble-in some cases the device falls below the mammary gland and creates a second “bubble” or fullness below the crease. This is usually repaired and the prostheses replaced.

• Snoopy Deformity-in some cases the prosthesis fails to drop down to a normal position under the mound. This can create a bulge above the nipple which from the side view has the appearance of the cartoon character Snoopy. Revision is usually done.

• You want a larger size.

• You want a smaller size.

• Your breasts have sagged and become smaller after having children, or with age. In most of these cases a breast lift or Mastopexy is done and new prostheses are placed.

• You simply do not want to have them any longer.

How difficult is the removal procedure?

If your breast implants are normal and there are no medical issues then removal is very simple and usually not painful. If you want them out, have them removed. Do not be concerned that you will look deformed or abnormal. You will just look smaller, but if there are no problems with the device such as capsules or rupture, you will look fine.

Capsular contracture or tight scar can require more extensive surgery to remove the scar. Some glandular tissue can be removed in these cases and create visible depressions.

In summary there is no specific time at which your breast implants have to be removed as long as there is no medical reason. Most removals are followed by the insertion of new ones after correction of a cosmetic problem.
If you want or need them removed, don’t worry about how you will look. You will, in most cases, look smaller but normal.

For frequent updates on Plastic Surgery and medical Aesthetics sign up for our Free Newsletter.

Dr. Seckel
Boston, Massachusetts
Concord, Massachusetts

Before and after Breast Augmentation for small breast after pregnancy

Are you thinking about breast implants but afraid of the scars? Have you had a breast augmentation and are wondering how to improve the look of your incision site. There are many tips that you can use to improve the look of your incision after surgery.

Usually the Breast Augmentation or Implant incision site is very well concealed and most form a small white line after healing. However initially during the first 6 weeks after surgery, the incision line can appear red and lumpy. This is usually normal healing but there are many steps you can take to improve the final outcome.

If you already have a wound problem there are many new treatments that can improve the end result. Understand that all surgical incisions are pink on average for 7 months and most all of them are white by two years.

The following scar care tips will help you achieve the best result:

• Gently massage your incision starting at about 14 days after your breast implant surgery. Use a lubricating cream or moisturizer that contains Aloe and Vitamin E to avoid friction and gently massage or rub in a circular motion twice a day. Remember, be gentle, do not force lumps down, you could break a deep stitch that will dissolve in time. Continue this until the wound is smooth without lumps or uneven areas. This can take 6 to 12 weeks.
• Use a Topical Skin Solution. I have found Scar Guard the only one effective in my practice. The best ones contain a silicone solution.
• Avoid Under-wire Bras or tight fitting bras. Rubbing and irritation will make your incision red and swollen.
• Avoid sun exposure. Direct sun exposure on a new incision will cause inflammation and redness. Be careful wearing a bikini as some allow sun to get through. Avoid direct sun on the incision site for at least a year.
• Eat Healthy. A diet rich in Colored Vegetables and Antioxidant containing foods plus supplemental Vitamin C will support wound healing.
• Avoid very strenuous exercises and lifting for the first few weeks after surgery. These activities put stress on the incision. Stress on the incision stimulates the body to produce more scar tissue and causes irritation and redness.
• Avoid skin Irritation. If your clothing is causing irritation of the incision place a soft sponge or cotton over the area to protect it.
• See your Plastic Surgeon at regular intervals-2 weeks, 6 weeks, and 3 months to evaluate the progress of your scar. If trouble is brewing, early intervention to correct a problem is essential.

How to correct problem scars after Breast Augmentation

Although most Breast Implant incisions heal well occasionally problems can occur. Incision sites that are red and raised are called Hypertrophic. If your wound is red raised, lumpy or irritated there are interventions that your Physician can do to help you:
• Steroid injections have been used for many years and will reduce Hypertrophic tissue and lessen redness. However prolonged use of Steroid Injection can cause atrophy of the fat beneath the skin and result in a depression in the skin, and excessive blood vessels can grow in the overlying skin. Injections should be 6 weeks apart and no more than 2 or 3 sessions.
• Steroid Containing Skin Tape can be applied to a red raised incision usually on for 24-36 hours and off for 12 hours for no longer than 6 weeks.
• IPL or Intense Pulsed light is very effective at reducing the redness in wounds. Usually 3-4 treatments 6 weeks apart are required. Today I prefer this therapy over steroids because of the potential steroid side effects.
• 1540 Non ablative Fractional Erbium Laser treatments are very effective at smoothing and flattening raised lumpy incision sites. Typically 4-5 treatments 6 weeks apart are used.

Breast augmentation is a very popular procedure which produces happy results for many women. Using these scar care tips will help you achieve the best results.

If you are planning to have breast augmentation be sure to consult an experienced surgeon Certified by the American Board of Plastic Surgery. The expertise and skill of your surgeon is the most important factor in determining the quality of your final result.

Boston, Massachusetts
Concord, Massachusetts

One of the most difficult decisions that you will have to make after deciding to have Breast Augmentation is what size of Breast Implant to choose. Many factors go in to your decision about the size of your Breast Implant. Of course you have to rely on the advice of a Board Certified Plastic Surgeon who is experienced at Breast Augmentation, but ultimately you have to make the final decision as to what size of Breast Implant you will be happy with.

Before and after Breast Augmentation for small breast after pregnancy

Before and After Photos Silicone Gel Breast Implants 300 ccs

Easy Test Methods to estimate the best Breast Implant Size for you.

• The Rice Test- This simple and effective test is one that you can do in privacy at home and is one of the best methods for you to see what different sizes of Breast Implants will look on you. It involves filling a non-Zip Lock plastic storage bag with a measured amount of rice, placing the bag into your bra until you have a size you are comfortable with, and converting that amount to cc’s of the implant. (cc’s or cubic centimeters is the unit of measure used to size Breast Implants.) See the conversion table below

• 1 cup = 236cc
• 1/2 cup = 118cc
• 3/4 cup = 177cc
• 1/4 cup = 59cc
• 1/3 cup = 78cc
• 2/3 cup = 156cc
• 1/8 cup = 30cc

• Placing A breast Implant Into your Bra- This is a common method used by many Plastic Surgeons however it is not nearly as accurate as the Rice Test. The Breast Implant does not conform to your breast shape and does not accurately show what the implant will look like once inside your body. Best results are achieved by placing clothing over the implant and bra, gently pressing down on the top of the implant to make the lower part bulge and checking your dressed profile from the side in a mirror.

Before and After Photos Silicone Gel Breast Implants 325 ccs

Beofre and After Photo Silicone Gel Breast Implants 325 ccs

• View Before and After Pictures on your Doctor’s and Implant Manufacturer’s Websites- Most doctors who do Breast Augmentation have Before and After pictures either in their office or on their website. These can be helpful for you especially in evaluating the quality of the doctor’s results and his/her concept of what a pleasing and appropriate Breast appearance is. It can also give you an idea of what various size Breast Implants look like on women of different size and with different Breast shapes. Manufacturer’s websites such as Loveyourlook provide a very wide range of Before and After Photos showing various Breast Implant sizes in women with a wide variety of Breast Shapes and Body Types

• Ask friends who have had Breast Augmentation to share their results-Close friends who have had Breast Augmentation are often willing to share their experience with you. Sometimes a really good friend will actually allow you to see her result and share her Breast Implant Size with you. This can be very helpful to you and your Plastic Surgeon in determining what size and shape you are really looking for.

Important factors in choosing the size of your Breast Implant:

Before and After Photo 350 cc Breast Implants

Before and After Photo 350 cc Breast Implnats Side View

• What is the size and appearance of the Breast that you want to achieve? Do you want to have full large Breasts so that your Cleavage and Breasts are a prominent feature of your appearance in or out of clothing? Do you only want to regain the firmness and fullness of the Breast that you had before weight loss or having children? Are you an active person who exercises or runs frequently and just want a nicely formed small full Breast that looks normal in running or exercise clothing? Do you just want to improve the shape of your breast to a more normal appearance and do not care to be much larger? These are very important questions to answer. Look at fashion magazines, health and fitness magazines, modeling photos and decide what look you hope to achieve.

• Your Height, Weight and Body Type-These factors are also important in determining the size of Breast Implant that will be best for you. Petite women generally require a smaller implant than taller and larger women. The size of your Breast implant used for Breast Augmentation should blend nicely with your body for a natural non-operated look.

• The Shape and Size of your Natural Breasts-There is a wide variation in the natural shape of the Female Breast. Breasts can be Ptotic (sagging), Tubular (constricted), atrophic (absent Breast Tissue), very small, average, and almost all women have asymmetry where one Breast is larger than the other. Experience and skill is required of your surgeon to achieve a natural looking Breast when different shapes are present. Some Breasts require a Mastopexy or Breast Lift. Very specific techniques are required to correct a Tubular Breast. The size and shape of your Breast will have a very important influence on the size of the Breast Implant that can be used on you.

• Your goals for your appearance after Breast Augmentation- To repeat, your goals for your final Breast appearance are crucial for you to understand. Are you conservative and want a modest but natural full breast or do you want your Breasts to be larger with full Cleavage that will enhance your fashions and wardrobe.

Choose an Experienced Surgeon Certified by the American Board of Plastic Surgery

Finding the best Surgeon for your Breast Augmentation is very important. Most Plastic Surgeons do Breast Augmentation but fewer specialize in Cosmetic Surgery and have a great deal of experience in Aesthetic or Cosmetic Breast Surgery. Do your homework and find a doctor that you are comfortable with, trust and who has a good reputation. Trust is essential before you undertake this step which can be a very happy experience that makes you feel better about your appearance. The American Society of Aesthetic Plastic Surgery provides information and locations of Board Certified Plastic Surgeons who have special interest and experience in Cosmetic Plastic Surgery.

For more information visit this link on Breast Augmentation, or call 978-369-4499.

Dr. Seckel
Concord, Massachusetts
Boston, Massachusetts

In 1997 the FDA approved Silicone Gel Breast Implants for use after a 15 year period during which only Saline Breast Implants were approved.

My patients want to know about the safety of the new implants. The new Silicone Gel Implants are safe, but there are many factors you need to consider when choosing which type of implant you want.

My first comment is that breast augmentation or enlargement with silicone gel breast implants or saline breast implants, if done on an appropriate candidate by an experienced board certified plastic surgeon, and with satisfactory healing, should produce an equally pleasing and successful aesthetic or cosmetic result. (Below-Before and After Saline Breast Implants)

The main difference in the result of breast augmentation with saline breast implants from that with silicone gel breast implants is the feel of the implant. If there are no complications such as hardening of the implant, and the result of the surgery is satisfactory, then a silicone gel breast implant will feel more natural than a saline implant-the silicone gel implant often feels more like breast tissue than does a saline implant. In addition, Saline Breast Implants are more sensitive to temperature change-for example they may feel cold after swimming in water that is less than body temperature.

However, this difference is subtle not dramatic, and there are many people who have saline breast implants in place, and I cannot tell the difference from a silicone gel implant.

There are many factors which contribute to the different feel of the Saline implant and most of them can be predicted or managed. In very thin women with very little breast tissue to cover the implant, the saline will be more palpable. Saline Breast Implants also have more of a tendency to form folds which can be visible along the side of the breast. Folds can also happen around silicone gel implants, but they are less common. Overfilling the saline implants can help minimize folding. (Below Before and After Silicone Gel Breast Implants)

Placing the saline breast implant beneath the chest muscle helps prevent palpability and over filling the implant helps prevent folds. Meticulous surgical technique and avoidance of bleeding during surgery also helps avoid the capsule or scar tissue which can make the implant feel hard. Capsular contracture or hardening of the new Silicone gel implants is less common than with the older implants and much closer to the rate of Saline Implants.

A silicone gel breast implant which has been placed under the breast or muscle which does not form a capsule or hardening does result in the more natural feeling breast. A “perfect result” with a silicone gel implant does feel more natural than a “perfect result” with a saline breast implant, but visually, the way they look, is about the same, in my opinion.

There are however disadvantages to silicone gel implant breast augmentation. The new FDA guidelines require that you have frequent MRI exams to check for rupture-this is expensive. In addition if the implant does rupture and needs to be replaced, the surgery to replace a silicone gel breast implant is more complex than that for a ruptured saline breast implant. Gel implants are also more expensive. You must be 21 years old to have Silicone Gel Implants placed.

Most of my patients find the decision very easy and come in knowing what type of implant they want. Patients who are averse to having anything foreign in their body choose saline. Many younger women, single with no children, who have read a lot about breast augmentation and want the most natural feeling breast implant choose silicone. Patients who want a replacement of a Saline implant for a larger size also usually choose the Silicone Gel implant.

It comes down to your priorities and your situation. Both Saline and Silicone Gel implants can produce a beautiful natural result. In my opinion the most important factor is the skill and expertise of your surgeon and your body’s ability to heal with minimal scarring. Careful technique with minimal trauma at the time of surgery is very important to achieve the best possible result.

If you are considering breast augmentation, the most important thing is for you to find an experienced board certified plastic surgeon who has done many breast augmentation operations and can give you an honest informed opinion. Please call me at (978) 369-4499 with your questions or email me through my website.

Dr Seckel

Concord Massachusetts

Boston, Massachusetts,

Before and After Photos Silicone Gel Breast Implants 300 ccs

Before and After Photos Silicone Gel Breast Implants 300 ccs

Experience, artistic sense, and a shared image of your goals for breast augmentation are important factors in achieving a good result.

Most women seeking breast augmentation do so because they feel:

• They have always wanted bigger breasts
• Their breasts have become smaller and less full after pregnancy
• Their breasts have sagged
• They do not like the shape of their breasts
• They want to look better in a bathing suit
• They want to look better in clothes
• They just want fuller more voluptuous breasts
• They want a more feminine looking body
• They just want big breasts

Before and After Photos Silicone Gel Breast Implants 325 ccs

Beofre and After Photo Silicone Gel Breast Implants 325 ccs

Breast augmentation is one of the most frequently performed plastic surgery operations done in the US today. Overall results are excellent and patient satisfaction and happiness with their new breasts is very high.

With the recent FDA approval of Silicone Gel Breast Implants the options and choices available to you are many. There are also many options for placement of the incision and the implant.

The Breast Augmentation Procedure

What bothers my patients most is the lack of breast fullness and cleavage of their breasts. They just want to have fuller breasts and be able to fill out their bathing suit and look good in today’s fashions.

If your breast is small or is normal size but has no sagging, the breast augmentation procedure is very straightforward and requires little modification.

If you have sagging breasts after weight loss or childbirth, depending on how much the breast has sagged, you may need a dermal mastopexy or breast lift in addition to the breast augmentation.

For most women, however, the breast augmentation procedure can correct the post pregnancy or weight loss breast appearance without the need for a breast lift or mastopexy.

The key issue in making this decision is the position of your nipple. Check the crease in the skin below your breast. This is called the inframammary crease. If the nipple is above this crease then chances are a breast augmentation can be done without a breast lift.

Most often I place the breast implant through an incision in the fold beneath the breast, called the inframammary breast augmentation. This scar normally does not show unless the breast is lifted up. The implant can also be placed through an incision in the armpit called a transaxillary breast augmentation.

If you have had children and your breast has sagged only a small amount I often use a technique called the Transareolar Breast Augmentation. Using this technique I make a very small incision in the areola—the round pink part surrounding the nipple. I then modify the breast gland so that it falls nicely over the implant. If you heal well the scar is hard to notice.

The Transareolar approach does push the nipple up and places the volume of the implant under the nipple and which is where the volume of the normal breast was during pregnancy.

The breast implant can be placed either under the breast gland, called the sub glandular breast augmentation, or under the chest muscle, called the sub muscular breast augmentation. There are advantages and disadvantages to each technique which I will explain to you at the time of your consultation.

Today you have a choice between saline breast implants and silicone gel breast implants. The main difference in the result of breast augmentation with saline breast implants from that with silicone gel breast implants is the feel of the implant. If there are no complications such as hardening of the implant, and the result of the surgery is satisfactory, then a silicone gel breast implant will feel more natural than a saline implant-the silicone gel implant often feels more like breast tissue than does a saline implant.

However, this difference is subtle not dramatic, and there are many people who have saline breast implants in whom I cannot tell the difference between a saline and a silicone gel implant.

There are many factors to consider when making your decision about which type of breast implant to chose. I will give you information about both types of implants at the time of your consultation.

Your Consultation

When we meet I will talk with you and ask you to explain to me the specific goals you hope to achieve with breast augmentation. I will examine you and tell you my findings and recommend the breast augmentation procedure which I believe is best for you.

I will discuss the procedure, your recovery, and expectations and answer your questions. Photos of your breasts will be taken. You will be given an estimate or quote of the cost of the procedure. Financing is available.

Pre OP

The pre operative visit is the time when we will sit down and clearly define your goals. We will discuss what you hope to achieve and what I believe I can achieve with the breast augmentation procedure.

You will also undergo a history and physical exam to make certain that you are healthy and have no medication allergies or contraindications to surgery. An EKG (electrocardiogram) may be done if you have a history of heart problems or have reached a certain age. You will also be given prescriptions for post operative medications.

You also will be asked to read and sign surgical consent forms which outline the risks, potential complications, limitations and expectations of breast augmentation surgery.

The Operation

Breast augmentation is done with you asleep under general anesthesia. Very experienced, superb anesthesiologists will be taking care of you. Safety is our first concern. We use modern, very safe anesthesiology techniques, and take precautions to avoid nausea after surgery.

Breast augmentation scars are usually not noticeable. The scar is usually hidden beneath the breast, in the armpit, or within the pink part of the areola. You will not have visible sutures or suture marks following surgery. I use buried sutures to close your incision. Buried sutures produce less noticeable scars and help avoid the old style “railroad track” suture mark seen when interrupted external sutures are used.

Breast augmentation is done as an outpatient or day surgery. You will go home the same day after surgery. The operation takes about an hour.

After you wake up you will be taken to the recovery room where a nurse will be taking care of you. The nurse monitors you, makes certain you are comfortable and checks your vital signs. You will spend 1-2 hours in recovery. After that, as soon as you are comfortable, able to drink and eat a bland food such as crackers or cookies, and able to go to the bathroom, you will be discharged. The nurse will escort you by wheel chair to your car.

We require that someone bring you to the surgery center and take you home, and that you have someone staying with you the first night after your surgery.

Post op- What to expect

In the recovery room you will be given medications to control any discomfort you are experiencing following your surgery. You also will have medications to take for discomfort at home. You will experience discomfort in the breast area for the first 3-4 days after surgery. If the breast implant is placed under the chest muscle, the discomfort is greater than if the implant is placed under the breast gland.

The day after surgery I will have you start implant displacement exercises. I have you use your hand to massage and move the implant. This technique helps avoid hardening of the implant and actually reduces the length of time you will feel discomfort post operatively.

Most patients are quite comfortable by day 5 post op and some are able to return to work. Generally full recovery takes 2 weeks. I ask you to wait 3 weeks before heavy weight lifting or aggressive work outs.

A Consultation with Dr Seckel

I can tell you a great deal more about breast augmentation and how it would work for you if I see you in person. Call me to set up a consultation or contact me by email. If you would like to email me your questions or photos I can email you my thoughts about which procedure I would most likely recommend for you. For more information on breast augmentation read my articles about breast augmentation.

I look forward to meeting you. Call 978-369-4499 for an appointment

Dr Seckel

Boston, Massachusetts

Concord, Massachusetts