Breast reshaping following pregnancy

With the rise of the ‘mummy makeover’, post-pregnancy breast augmentations are becoming increasingly popular. Leading plastic surgeon Mr Gary Ross offers an insight into this procedure and how to make it work for you.

The effects of pregnancy and breast feeding often lead to the sagging of skin and a decrease in the amount of breast tissue. New mothers are frequently concerned about both the size and shape of their breasts and the aim of aesthetic breast surgery is to both change and improve the appearance. Personally, I aim to achieve these improvements by concentrating on the individual patient’s needs and expectations. Pre-operative consultations are an important part of my service, as they allow the development of our patient/surgeon relationship and provide a means to discuss any concerns and clarify the patient’s needs and expectations. Techniques available for post-pregnancy breast surgery include both augmentation and mastopexy (uplift) and these two techniques can be combined in one surgical procedure and tailored to the individual to provide the optimal result. The two main aspects of aesthetic breast surgery are size and shape. When the patient has sufficient size but poor shape and if there is enough remaining breast tissue, an uplift alone may be sufficient to achieve the desired result. Where the nipple height is already at an optimal level and the patient has good shape but insufficient size an augmentation alone may suffice. Often, however, there are elements of both poor size and poor shape and a combination procedure including both uplift and augmentation is required to deliver a natural, lasting result.This can be performed in one operation or as two separate procedures. Different techniques, different implants, differing scarring patterns and different positioning of the implants require detailed discussion. atients before the surgery, explaining the benefits of each option, which allows them to make an informed decision about which procedure is best for them individually. Optimising results without compromising safety is paramount.

 

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Breast Reduction Explained

Suffering from overly large breasts? Plastic surgeon Mr Gary Ross explains how breast reduction surgery can dramatically improve your quality of life.

Aesthetic breast surgery aims to both change and improve appearance. The expectations of breast surgery are based on individual requirements. Breast reduction or reduction mammoplasty is a surgical procedure that involves the reduction of the size of the breasts.

It involves the excision of excess fat, skin and glandular tissue and the reshaping of both the remaining breast tissue and the breast skin and the repositioning of the nipples.

Worldwide, the size of the average breast is increasing and younger women are requesting breast reduction surgery, aiming towards a natural, long lasting result. Patients opting for reduction surgery complain that their breasts hinder their mobility, impair them functionally and often they experience back and neck pain.

The additional weight on the shoulders may lead to skin irritation due to the pressure of the bra straps. Patients are also frequently concerned with the shape of the breasts and an inability to find bras and clothes to fit. Sometimes the size of the breasts causes emotional as well as physical discomfort with a detrimental effect on self confidence.

Breast reduction is a surgical procedure that may be combined with other cosmetic procedures such as breast lift and liposuction. These techniques vary depending on the individual requirements of each patient. These requirements dictate the number and length of incisions. The most important aspects of breast surgery are in relation to size and shape.

I aim to change and improve appearance by concentrating on the expectations and needs of the individual patients. Preoperative consultations allow the development of the patient / surgeon relationship and are a means to discuss any concerns and prioritise your needs and expectations.

Changing techniques

Breast reduction is usually combined with lifting of the nipple to a new position (mastopexy) and often liposuction. A combination of procedures are tailored to the individual to provide the optimal result.
Providing a natural, longlasting result is paramount and the procedure involves careful consideration of the different elements of breast surgery and addressing each component individually. Excess breast tissue can be removed and the remaining tissue moulded to create an enhanced shape. The nipple is moved to a position relative to the stature and chest width of the patient and the excess skin is adjusted to redrape over the new breast in such a way that the blood supply to the nipple and the skin are not compromised. Final touches can be applied to remove fat by liposuction or place fat via a lipomodelling technique to give a symmetrical aesthetic result.

Newer techniques such as the vertical scar only technique prevent the need for a scar underneath the breast and all three examples shown have been performed using this method. Drains are not required and minimal dressings are applied immediately postoperatively. The results of surgery are therefore immediately apparent and patients are able to see the results instantaneously.

Patients can mobilise on the day of surgery and are encouraged to wear a sports bra day and night for the first four weeks following surgery. Bruising and swelling does occur although this has almost subsided by one week postoperatively when the minimal dressings are removed. All the stitches are dissolvable thus minimising discomfort and maximising outcome.

Results

The results of breast reduction are immediately apparent although it does take six weeks for all bruising and swelling to settle. Results can be dramatic with immediate relief of the pain associated with excessive breast tissue. The scarring following breast reduction can take longer to settle and scars remain pink for the first few months before usually fading into fine white lines. Change in mobility and functionality combined with the dramatic improvement aesthetically allows breast reduction patients a substantial improvement in quality of life.

Safety first

Optimising outcomes without compromising safety is paramount. By practising and operating aesthetically in one hospital I am able to provide patients with a dedicated service. Preoperative consultations and all post operative visits are with me and provision of 24-hour perioperative anaesthetic cover with dedicated intensive facilities ensures that every eventuality for all patients can be provided for on a single site.

 

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Size Matters: Breast Augmentation

Breast augmentation is the most common aesthetic procedure worldwide and as such it is often perceived as a simple procedure, where the same technique is applied to every patient. This is a common misconception – as with any procedure, the technique needs to be tailored to each patient’s individual needs. My clinic has recently become a referral centre for revisionary breast augmentation procedures and I have been shocked at some of the things I am seeing, all of which would have been easily avoidable had the patient been aware of all the options available in the first place. There are many important decisions that need to be discussed, often during multiple consultations, to determine the most appropriate size and shape to give a long lasting natural result.

The size of the implant is determined by the width of the implant base, the implant height and the implant profile. Although patients will request certain cup sizes, the width of the chest wall is the most important factor in determining the maximum size of implant possible. Once the base diameter or width has been assessed, the height of the implant and the profile of the implant can be altered to give the overall shape. Shape is altered by not only the implant but the anatomical position of the sternum, the height of the chest wall and the position of the nipple or breast tissue. Nipples and breast tissue can be lifted using certain implant shapes and/or by altering the position of the inframammary fold on the chest wall. Certain implants can be chosen to create fullness in the top or the bottom of the breast. One of the most important discussions centres around the sternum and the width of the sternum in relation to the muscle insertion.

It is this anatomical position that determines how the implants will sit to create the cleavage. Often patients request ‘overs’ or ‘unders’, i.e. implants positioned either over or under the muscle. A careful examination of the amount of breast tissue, the location of the pectoralis muscle and the position of the sternum will dictate the pros and cons of the pocket placement. The benefits of ‘unders’ are that the implants at the top and in the cleavage have more coverage with a muscle layer and so there is less chance of feeling the implant. ‘Overs’, although more prone to be palpable at the top and in the cleavage area do allow one to create less of a gap and more of a cleavage, especially in a bra. A combination of both these techniques, called a ‘dual plane’ technique, allowing a more reliable positioning of the breast tissue than the solely ‘under’ technique, has become the preferred method when a patient wants to have the implant under the muscle or has minimal breast tissue. It still has a tendency to produce slightly more of a gap in the cleavage area. If the breast tissue and nipple lie below the level of the inframammary fold then it is important to discuss the benefits of a mastopexy at the same time as a breast augmentation and patients consulting for breast augmentation should consult with experienced surgeons with experience in mastopexy implant to obtain a full understanding of the limitations of breast augmentation alone. This will avoid the need for revisionary procedures at the outset. Revisionary procedures are extremely rare if the correct implant and the correct technique are performed. This often requires multiple consultations to determine the individual needs and expectations of each and every patient.

 

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Open Your Eyes: Periorbital Rejuvenation

Consultant plastic surgeon Mr Gary Ross describes how he combines these techniques to provide individualised results. The eyes are one of our most striking facial features and rejuvenation of the eyes in the form of blepharoplasty helps to provide a more youthful look with minimal downtime. Upper blepharoplasty is a common procedure where the skin of the upper eye is removed, placing the scar in a natural crease line. It is one of the commonest aesthetic procedures and results in minimal downtime with minimal risks and complications. It can often be performed under local anaesthetic. Sometimes small amounts of fat need to removed and occasionally fat needs to be added in the form of autologous fat transfer. The ageing process leads to weakening of the muscles of the eye and drooping of the contents and this is particularly important in the lower eyelid. Lower eyelid blepharoplasty is often performed in combination with upper blepharoplasty. In lower eyelid blepharoplasty, the contents of the orbital septum need to be tightened and patients often need treatment of eye bags and hollowing, which result from ageing of the lower lid and sagging of the mid-face.

This lid-cheek junction and mid-face sagging often is not addressed by a standard blepharoplasty technique but by using the same minimal scars as a lower blepharoplasty the mid-face can be lifted so that the sagging tissue of the mid-face can be repositioned into the lid-cheek junction, disguising the hollowing and rejuvenating not just the eyes, but also the midface. It is well known that the ligaments of the mid-face relax as we age, with thinning of the tissues and sagging of the soft tissue. The aims of mid-face rejuvenation are to reposition this sagging tissue. Previously, facelifting techniques would be required to lift the mid-face through separate scars and although in certain patients this still remains the best option – especially in patients with drooping of the jowls and lower face – the mid-face can often be addressed adequately through this minimal scar technique. The mid-facelift in combination with blepharoplasty can tighten the sagging lower eyelid and the mid-face through a minimal incision with a net effect that minimal tissue needs to be removed and the tissue is simply repositioned into a higher position. Sometimes additional tissue in the form of autologous fat needs to be added. The recovery following this surgery is a lot quicker than standard facelifting techniques.

 

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Body Contouring: Skin tight

Many people who have lost a substantial amount of weight are overjoyed at their success. But after losing weight you may still have some to lose due to the heavy folds of skin left that can be left behind, reminding you of your former self. Surgery can remove the extra skin and improve the shape and tone of tissue in your arms, thighs, breasts, buttocks and abdomen. Plastic Surgeon Gary Ross explains to The Cosmetic Surgery Guide what options are available to patients after bariatric surgery.

Body contouring after major weight loss reduces the excess skin and fat that is left behind after a major weight loss. The expansion of skin, loss of fat and lack of tissue elasticity results in sagging skin that commonly develops around the face, neck, upper arms, breast, abdomen, buttocks, and thighs and can make your body contour appear irregular. The success of body contouring, whether it is done to reduce, enlarge or lift, is influenced by your age and by the size, shape and skin tone of the area to be treated.

Some contouring procedures leave only small, inconspicuous scars. More noticeable scars may result when surgical removal of fat and skin is necessary to achieve your desired result. Most patients find these scars acceptable and enjoy greater self-confidence. Any area that affects the patient could potentially be treated by surgery. Generally the abdomen is probably the commonest area that patients wish to have addressed. Options involve panniculectomy (removal of overhanging tissue only), abdominoplasty (tummy tuck) and total body lifting (removal of tissue circumferentially around the body).

Arm lifting and thigh lifting are also commonly performed to remove excess tissue and improve contour while mastopexy implant is the most commonly performed rejuvenation procedure for the breast. Above all, body contouring surgery must be tailored to the patient’s individual needs and requirements, and treatments must be individualised accordingly.

 

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Treatment in Focus: Breast Augmentation Revision

Revisionary breast augmentation is an increasingly specialised field of breast surgery. With all breast reconstruction one must consider the patients wishes for improvement in terms of size, shape and symmetry. Both clinician and patient need to establish what can be achieved and whether all expectations can be met.

 

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Thanks to the body lift, I was able to get rid of my saggy skin after losing 9-and-a-half stone

It is one of the most drastic and, some might say, barbaric cosmetic operations: the body lift.

Used to tackle the legacy of dramatic weight loss – the unsightly apron of flesh left behind after skin has stretched to accommodate fat – the four-hour procedure involves virtually cutting the patient’s body in half to remove the unwanted tissue and tighten the underlying muscles, before stitching it back together.

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Would you brave a mum-tum tuck?

Would you brave a mum-tum tuck? It costs up to £6,000 and carries drastic risks, but it’s still become Britain’s fastest growing cosmetic surgery

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Spotlight On…Mummy Makeover

The term ‘mummy makeover’ is increasingly being used in cosmetic practice and in the media. For this issue’s Spotlight On… feature, we ask Mr Gary Ross to explain exactly what this involves and how combination treatments can transform the body after pregnancy.

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Reconstruction of larger breasts following mastectomy

Immediate reconstruction following prophylactic mastectomy for larger ptotic breasts is difficult. Tissue expansion in these patients often results in poor cosmetic outcomes. Autologous options may not be possible due to clinical unsuitability or patient choice. Using the inferior dermal flap with implant achieves lower pole fullness and allows a one-stop reconstruction in the larger ptotic breast.

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