Breast Procedures (Top Surgery)
- Enhancing smaller breasts
- Restoring breast volume from weight loss or pregnancy
- Correcting asymmetric, uneven shaped breasts
- Improving the shape and contour of sagging breast, this is usually combined with a breast lift or mastopexy
- Reconstruction after breast removal from cancer, trauma, or hereditary defects
1. Bilateral Mastectomy with Free Nipple Grafts – This technique allows the removal of essentially all of the breast tissue and excess skin and allows for the proper placement and downsizing of the nipples. This technique is utilized most frequently because the majority of patients present with a combination of excess skin and a naturally low nipple position. This technique leaves a scar on each side of the chest. In order to make the scar less apparent, we place the scar along the lower border of the pectoral muscle fold. The nipple-areolar complex is downsized and placed as a graft in the appropriate location. A special medical dressing stays on the nipple graft for one week.
2. Peri-areolar Subcutaneous Mastectomy / Keyhole Incision – The peri-areolar, or ‘keyhole’, technique consists of breast tissue removal through a small incision around the nipple. This technique carries the advantage of significantly reduced scarring. However, a relatively small number of patients are actually good candidates for this technique. The suitable candidate for this type of mastectomy is typically the young, slim patient with a small amount of breast tissue, no excess skin, and a nipple position that is suitable and does not require repositioning.
3. Mastectomy Combined with Liposuction – The goal for liposuction of the breast is simple. This technique is used to improve the patient’s physical appearance by removing as much fat as possible while avoiding any damage to skin or muscles. With this technique there is minimal postoperative pain, rapid postoperative recovery, quick return to normal activities, and virtually no scaring.
4. Mastectomy with Dermal Pedicle Flap –A dermal pedicle flap is a flap consisting of the full thickness of the skin and the subcutaneous tissue, attached by tissue through which it receives its blood supply. This technique leaves a scar on each side of the chest along the lower border of the pectoral muscle fold. The nipple-areolar complex is downsized and placed through a new opening in the appropriate location and sutured in place.
5. Double Incision Mastectomy – The double incision mastectomy is designed for persons with larger or overhanging breasts. The advantage of this procedure is greater precision in nipple size, nipple position and scar placement. The disadvantage is the scar. During this procedure, the skin on the chest is opened along two horizontal incisions, at the top and bottom of the pectoral muscle. The techniques for treatment and placement of the nipples with the double incision method vary. Depending on the technique that is the best suited, the original nipples may be completely removed, trimmed to a smaller size, and are then grafted onto the chest in a higher, more aesthetically-male location. Or a “pedicle” technique, wherein the nipples are left partially attached to the body via a stalk of tissue. They are then repositioned in a more aesthetically-male location, while their connection to the body via the pedicle stalk remains intact. They may or may not be trimmed to a smaller size. The pedicle option is sometimes chosen in an attempt to maintain sensation in the nipples.
6. Anchor Incision Mastectomy – This technique is best used with overly large or ptotic breast tissue. The incisions will surround the areola on its outer edge. Then, the incisions continue down the midline of the breast below the nipple and across the inframammary crease. The placement of these incisions allows the reshaping and re-sculpting of the entire breast especially in overly large breasts that will have an increase in excess skin.