Breast augmentation is a surgical procedure that increases woman's bust line by one or more bra cup sizes. By implants breasts easily go up to two sizes, i.e. “A” cup size can easily go up to “C” cup size and “B” cup size can easily go up to “D” cup size. Breast augmentation by implant provides immediate result and is the most rewarding cosmetic surgery for the patient as well as surgeon.

 

 

 

 

 

     

 

 

Women may choose to under go breast enlargement surgery for various reasons:

 

Breast Augmentation / implant options:

 

 

Textured Silicone gel filled implants are the most commonly used implants for Breast augmentation because of its better & natural feeling and very less chances of complications as compared to saline filled implants. But beware of some cheaper quality Chinese made low standard implants, which may save some of your money but are not safe for long term & may harm you seriously.

 

Fat grafting is also used increasingly for breast augmentation. Fat cells are very rich source of Stem Cells, and when injected into the breast, it augments the size of breast significantly without any long-term side effects. We are using Cell Enriched Fat Grafting, which contains large number of Stem Cells & Growth factors to provide good long-term beneficial effects. The importance of breast augmentation by using Fat Grafting is that no foreign material is inserted in your body and it is your own fat (harvested from your own tummy or inner thighs) used to increase the breast size. So there is great psychological benefit of no fear of any long-term side effect of any implant. It provides dual benefit in the sense that it enhance your bust size and simultaneously reduces the fat deposits from your tummy & thigh as well, so ultimately beneficial to your figure. But the draw back of fat grafting is that the ultimate size of breast enhancement is unpredictable and you may need to under go 2-3 sittings of fat grafting to get desired result.  
The size and type of breast implant recommended, the method of inserting and positioning the implant will be determined by your goals for breast enhancement, your body frame and your existing breast tissue.   

A short incision can be made either in the crease under the breast (infra-mammary crease) or around the areola (the dark skin surrounding the nipple) or in the armpit.   Armpit incision leaves no scar on the breast and this method of implant placement is called 'Endoscopy-assisted' breast augmentation. The infra-mammary incisions are most commonly used because of its hidden nature, least visibility and minimum disturbance to natural breast tissues. Working through the incision, a pocket will be created, either directly behind the breast tissue or underneath your chest wall muscle (pectoral muscle). There are different reasons for placing the implants on top of or underneath the muscle, which will be discussed with you before surgery.

 

                                               Incision                                                                                    Plane of Implant

 

Following your breast augmentation surgery you may feel a little stiff and sore in the chest region for few days.  Dressing will be removed in few days, and you may be instructed to wear a support bra. You may experience difficulty raising your arms for a week or two. You should not engage in any strenuous activity. Some discoloration and swelling will occur initially, but this will disappear quickly in one or two weeks. The residual swelling will almost resolve within a month.  Overall the social downtime after breast augmentation is 2-3 days or a maximum of a week or so. The scars will fade with time and will become very less visible but on very closer look they will never disappear completely. In the initial few weeks there might be reduced sensation over the nipple or breast, but this is usually temporary and comes to normal in a month or two. 

The most common concern after breast augmentation is its effect on pregnancy, breast-feeding or its long-term side effect as cancer. Here, I would like to say that the breast Implants are placed below the breast (and not inside the breast itself), so there in absolutely no relation or any effect with future pregnancy or breast feeding. You can conceive & breast fed your baby normally. Regarding cancer, it is now proved with long term studies that the new generation silicone cohesive gel implant are very safe and will not cause any kind of cancer and they are now FDA approved.

 

Before                                  After                                                 Before                                        After

 

     

 Before                                                         After

 

 Before                                      After

 

 

 

 

BREAST REDUCTION

 

Breast reduction or reduction mammoplasty is a common surgical procedure which involves the reduction in the size of breasts by excising excess fat, skin and glandular tissue; it may also involve a procedure to counteract drooping of the breasts. As with breast augmentation, this procedure is typically performed on women, but may also be performed on men afflicted by gynecomastia.

Candidates

Breast reduction surgery is oriented toward women with large, pendulous breasts, especially gigantomastia (severely enlarged breasts), since the weight of their breasts may cause chronic pain of the head, neck, back, and shoulders, plus circulation and breathing problems. The weight may also cause discomfort as a result of brassiere straps abrading or irritating the skin.
Even if physical discomfort is not a problem, some women feel awkward with the enormity of their breasts in proportion to the rest of their smaller bodies. Except in unusual cases, this procedure is performed on individuals with fully developed breasts.

Procedure

The procedure always performed under general anesthesia. During pre-operative visits, the doctor and patient may decide on new, usually higher, positions for the areolas and nipples and the desired new size of breast.
(For males, excess tissue may simply be removed through a tiny incision in each breast. This leaves minimal scarring.)
Patients may take a few weeks for initial recovery, however it may take from six months to a year for the body to completely adjust to the new breast size. Some women may experience discomfort during their initial menstruation following the surgery due to the breasts swelling.

Techniques of Breast Reduction

The inferior pedicle technique, sometimes also known as a keyhole, inverted-T, or "Wise pattern" reduction, involves an anchor-shaped incision, which circles the areola. The incision extends downward, following the natural curve of the breast. Excess glandular tissue, fat, and skin are removed. Next, the nipple and areola are moved into their new higher position. A drawback of this technique is sometimes "square" looking breasts, but this is a common option for women with the largest, droopiest breasts. Inferior pedicle techniques can also be performed through shorter scar incisions in some patients.

The vertical scar techniques are gaining popularity in the United States as well as India due to their shorter scarring and projecting shape post-surgery. These types of procedures can involve the use of superior, inferior, medial or laterally based pedicles to the NAC. As compared to traditional incisions, they may have a limited or absent horizontal component. These procedures are best suited to smaller reductions with less excess skin to limit the scar length. Advantages include increased projection by the gathering of tissue medially, shorter scar length, and quicker surgery times. This technique keeps its results the best in the long term. The breast is reduced through removal of the lateral and inferior tissues, leaving the upper pole mostly untouched. We are performing breast reduction through this technique in most of our patients.

The Horizontal scar techniques involve the use of a scar along the inframammary fold and a round cutout for the NAC. These procedures typically require an inferior or inferior-lateral pedicle like traditional "Wise pattern" surgeries but eschew the vertical wedge excision. They permit a shorter scar option in women who are too large for vertical scar techniques. Advantages include the absence of a scar on the visible meridian of the breast and better scarring of the NAC inset. Disadvantages are the potential for "boxy" shaped breasts and poorer scarring that can be produced along the IMF.

The liposuction-only technique is used for women with breasts that are not quite as large as with the other procedures or where there skin is not much hanging or in patients who are anesthesia risks for longer procedures. For the best outcomes, women who choose this procedure have fatty, non-dense breast tissue with good skin and little ptosis (droop). As few women with larger breasts possess those characteristics, the widespread use of this technique may be limited. The result is not as drastic as the other techniques, but it involves a quicker healing time and little scarring.

 

The free nipple graft technique is used primarily for high-risk patients of ischemia to the NAC to reduce the chance of sloughing it postoperatively. Typical candidates would include diabetics, smokers, longer breasts approaching 20 cm from the IMF to the nipple, and breasts with significantly larger than normal resection requirements. In this procedure, the areola and nipple are completely removed for relocation and replaced as a skin graft higher on the breast. In these cases, sensation from the areola area will be lost and it eliminates the ability for lactation. This technique is sometimes used during surgery or postoperatively if the NAC viability is questionable. By eliminating the requirement for a pedicle, this procedure allows significantly greater amounts of tissue to be removed safely.

 

                                              Before                                              After                                              

 

Before                                                    After

 

 

BREAST REDUCTION + ABDOMINOPLASTY (Combined)

Before                                                                                        After     

                                           

 

 

An abdominoplasty is a component of a lower body lift and can be combined with breast reduction, breast lift. Abdominoplasty is most commonly combined with breast reduction to shape almost whole de-shaped or hanging body. A popular name for breast enhancement procedures performed in conjunction with an abdominoplasty is a "mommy makeover"

POST CANCER BREAST RECONSTRUCTION

Breast reconstruction is the rebuilding of a breast, usually after cancer surgery. It involves using autologous tissue or prosthetic material to construct a natural-looking breast. Often this includes the reformation of a natural-looking areola and nipple. This procedure involves the use of implants or relocated flaps of the patient's own tissue.

Techniques

There are many methods for breast reconstruction. The two most common are:

Flap reconstruction- this is the most common procedure for post cancer breast reconstruction and uses tissue from other parts of the patient's own body, such as the back, abdomen, buttocks or thigh. This procedure may be performed by leaving the donor tissue connected to the original site to retain its blood supply (the vessels are tunneled beneath the skin surface to the new site) or it may be cut off and new blood supply may be connected at required site using micro-vascular tecjnique.
The latissimus dorsi muscle flap is the donor tissue available on the back. It is a large flat muscle, which can be employed without significant loss of function. It can be moved into the breast defect while still attached to its blood supply under the arm pit (axilla). A latissimus flap is usually used to recruit soft-tissue coverage over an underlying implant. Enough volume can be recruited occasionally to reconstruct small breasts without an implant.
The abdominal flap for breast reconstruction is the TRAM flap or its technically distinct variants of microvascular "perforator flaps" like the DIEP/SIEP flaps. Both use the abdominal tissue between the umbilicus and the pubis. The DIEP flap and free-TRAM flap require advanced microsurgical technique. Both can provide enough tissue to reconstruct large breasts. The contour of the lower abdomen is reliably improved by these procedures, which remove the same tissue as an abdominoplasty (tummy tuck.) TRAM flap procedures may weaken the abdominal wall and torso strength, but are tolerated well in most patients. Perforator techniques such as the DIEP (deep inferior epigastric perforator) flap and SIEA (superficial inferior epigastric artery) flap require precise dissection of small perforating vessels through the rectus muscle, and purport the advantage of less weakening of the abdominal wall, though rectus abdominis muscle function may still be compromised. Other total autologous tissue breast reconstruction donor sites include the buttocks (superior or inferior gluteal artery perforator flaps (SGAP or IGAP)). The purpose of perforator flaps (DIEP, SIEA, SGAP, IGAP) is to provide sufficient skin and fat for an aesthetic reconstruction while minimizing morbidity from harvesting the underlying muscles.

Tissue Expander - Breast implants- This is the second most common technique used worldwide. The surgeon inserts a tissue expander, a temporary silastic implant, beneath a pocket under the pectoralis major muscle of the chest wall. The pectoral muscles may be released along its inferior edge to allow a larger, more supple pocket for the expander at the expense of thinner lower pole soft tissue coverage. In a process that can take weeks or months, saline solution is percutaneously injected to progressively expand the overlaying tissue. Once the expander has reached an acceptable size, it may be removed and replaced with a more permanent implant.
Reconstruction of the areola and nipple are usually performed in a separate operation after the skin has stretched to its final size.

 

 

                                                   Before                                              After                                                                                           

 

                                                         

   

 

GYNAECOMASTIA (Male Breast)

Before                                                        After     

             

 

Read More about Gynaecomastia.....