Breast Reduction Surgery

Breast reduction surgery is a common breast procedure that can provide great patient satisfaction. Patients who desire breast reduction surgery commonly state pre-operatively that they have back pain, shoulder pain, neck pain, and/or difficulty completing exercises. Not only does breast reduction surgery reduce the volume of the breast, it also places the breast in a more stable position so that the weight of the breast does not have the same impact on the neck, shoulders, and back.

Mastopexy Surgery

Mastopexy surgery is one of the more common procedures as women tend to age. As women age, the nipple areola complex tends to drop below the level of the inframammary fold or breast crease. When the breasts sag, this is called "ptosis". The only way to correct breast ptosis is to perform a lift procedure. The more standard lift pattern is called a "Wise" pattern or "T-lift" pattern.

It is often common for women to desire a breast lift without additional volume placed. That is, a breast lift without the placement of an implant. The recovery period for this procedure tends to be relatively short and associated with very little pain post-operatively.

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Capsular Contracture Surgery

Capsular contracture can be common in patients who have undergone breast augmentation. There are several steps that one can take to reduce the risks of capsular contracture in the future. At the time of capsular contracture surgery, we often take a culture of the fluid from the breast pocket. The fluid is sent off to the lab to determine if there is an underlying bacterial cause for chronic inflammation and capsule formation. Once the cultures have determined to be negative and/or any bacterial colonization is treated with an appropriate course of antibiotics then patients may be given a Medrol dose pack to reduce the risk of capsule formation. 

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Mastopexy Augmentation

Mastopexy augmentation procedures are common procedures. Patients who present for a mastopexy augmentation are typically patients who have had several children and have breast fed or who have lost weight for a variety of reasons. The mastopexy augmentation operation is a complicated one that requires careful planning. The operation is essentially two operations in one. The first part involves placing the implant and the second part involves tightening of the skin. 

The mastopxey augmentation operation differs from the standard breast augmentation in that there is significantly more healing that is required after the mastopexy augmentation. I tell the mastopexy augmentation patients that the overall healing time and time to settle takes at least 6 months to one year. 

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Revision Breast Surgery, Capsular Contracture Surgery

Capsular contracture of the mammary prosthesis and breast construct can occur for a variety of reasons.When performing capsular contracture surgery, it is important to appropriately select and create the appropriate pocket for the implant. Patients are often placed in a sports bra for 4 to six weeks to allow the breast pocket to heal well without any additional trauma.The final implant position and shape can take anywhere from six months to one year to completely settle in.



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Capsular Contracture Surgery

Capsular contracture surgery is common. When a breast implant is placed in the body, the body always forms a lining around the breast implant. Occasionally, the lining can form aggressively and contract. When the lining begins to contract aggressively, the implant starts to displace superiorly where there is less resistance than against the fold. Often the lining contracts against the muscles and the ribs, which can cause pain. Typically, the shoulder girdle on that side begins to get tight. Patients often complain of chest, shoulder, and neck pain.

Capsular contracture surgery often requires release or excision of the capsule. The capsule often adheres to the underlying pectoralis major and pectoralis minor muscle. The capsule is often excised or scored in this area to allow the shoulder girdle to open up. Often, after surgery, patients not only experience an improvement in their overall breast contour, but also in their overall pain. 

Capsular Contracture Surgery

Capsular contracture can occur in patients who have breast implants. While there can be many reasons to have capsular contracture, I find that the more common reasons tend to be 1) history of hematoma or undetectable hematoma, 2) history of previous infection or subclinical infection, 3) long duration of implant placement, 4) patient specific factors (i.e. prone to keloid, hypertrophic scar, capsular contracture, etc.).
In patients who have a history of recurrent capsular contracture, despite previous capsulectomy, I have added to my management plan the following: At the time of capsule surgery, the implant is removed and the implant pocket is cultured. Post-operatively, the patient is placed on Keflex if able to tolerate, or clindamycin if there is a cephalosporin allergy. If the culture result is a bacterium not sensitive to Keflex or Clindamycin, then an antibiotic is chosen to fit the appropriate bacteria.


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