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Plastic Surgery Questions

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By Nathan A. Kludt, MD

Q: I have been considering breast augmentation surgery, but there is so much information on the internet and much of it is contradictory, I don’t know where to begin. What is your advice?

A: Whether you’ve already made the decision to undergo breast augmentation – or are still in the research stage – it’s important to know about the incision sites, placement of the implants and type of implants available for your procedure. After all, the incision site can make a big difference in terms of how visible your scars may be, while implant type and placement can be the deciding factor in how natural your new breasts look and feel.

At the Plastic Surgery Center of Stockton and Lodi, we are dedicated to providing patients with the information they need to make their procedure decisions with confidence and ease.

During the consultation, we will discuss what incisions are best for your desired results. This is based on the type of breast implant to be used, the size of the implant, your body shape and size, and your ultimate goals. There are two classic incision sites, which are the most popular:

Periareolar Incision: An incision is made around the lower half of the areola.

Inframammary Incision: The incision will be made underneath the breast. The incision is usually kept small in order to minimize postsurgical scarring.

Once the incision site has been determined, we will opt to place the breast implant in either one of two locations: Underneath the chest
muscle. This is the most common type of placement, as it helps achieve a natural look, and behind the breast tissue and over the chest muscle.

Today there are numerous implant options, including silicone, saline, round, shaped, textured, etc. In our office over 95% of patients preferred
silicone implants. The benefits of silicone, are a lighter, softer, and more natural feel. There is also a lower deflation rate, less palpability, and less rippling, however, patients can expect to pay slightly more for a silicone breast augmentation.

For a certain population who desire a slightly smaller incision or less costly option, saline implants are often a great alternative to silicone. Ultimately, the patient is the final decision maker so it is important you are comfortable with your implant selection.

Ultimately, all of these factors along with your personalized preferences will determine the final decision.

Q: My friend was recently diagnosed with breast cancer and is very concerned about maintaining her sense of femininity. What are her options?

A: According to the American Cancer Society, breast cancer is the most common cancer among women in the United States, other than skin cancer. It is estimated that approximately 110,000 women who are diagnosed with breast cancer opt to have a mastectomy (removal of the breast).

Astonishingly, 70% of American women facing surgery for breast cancer are not aware of the options for breast reconstruction. Breast reconstruction is a surgical procedure performed by plastic surgeons that rebuilds the natural volume, shape and symmetry of a woman’s breast after breast cancer surgery.

Perhaps one of the best things about breast reconstruction is that it can be performed at any time. Regardless of the timing of the procedure, breast reconstruction enables women to feel whole again, not just physically, but also emotionally.

There are many reconstructive options ranging from breast implants to using the patient’s own tissue.

Breast reconstruction can be performed at the same time as the mastectomy (“immediate reconstruction”) or any time after mastectomy (“delayed reconstruction”). When the mastectomy and reconstruction are performed at the same time, a skin-sparing mastectomy can usually be performed which saves most of the natural breast skin envelope. Only the actual breast tissue under the skin is removed. The reconstruction then “fills” this empty skin envelope.

Skin-sparing mastectomy and immediate breast reconstruction can produce a very “natural” result. Patients undergoing immediate reconstruction avoid the experience of a flat chest altogether. When possible, immediate reconstruction is often the goal for patients with early breast cancer (stage I or II).

In some cases breast reconstruction cannot be performed at the same time as the mastectomy. Reasons include advanced breast cancer (stage III or IV), inflammatory breast cancer, and plans for radiation therapy after mastectomy, or lack of access to a reconstructive plastic surgeon.

Unfortunately, many women are not made aware of their breast reconstruction options when they are diagnosed with breast cancer. Many are also not aware that these procedures are covered by their health insurance. I strongly encourage all women interested in breast reconstruction to research their options and seek a referral or consultation with a plastic surgeon specializing in breast reconstruction.