Breast Surgery in Manhattan, NYC
by Dr. Lloyd Hoffman.

Manhattan Breast Augmentation

Breast augmentation is a very popular procedure for women and among the most commonly performed cosmetic surgery procedures. A saline-filled implant is inserted under the crease in the breast, around the nipple or through the armpit. The implant can be placed under the breast tissue or beneath the chest wall muscle. After surgery, breasts will appear fuller and more shapely in contour. Incision scars will fade or disappear over time. In certain unique instances silicon implants can be used.

One of the most frequently performed cosmetic surgery procedures in the U.S., breast augmentation can give women with small or unevenly sized breasts a fuller, firmer, better-proportioned look through the placement of implants in the breast. Women may elect to undergo breast augmentation for many different medical and aesthetic motivations, including balancing breast size and compensating for reduced breast mass after pregnancy or surgery. The procedure may be combined with others such as a breast lift for more satisfying results.

Implants are silicone shells filled with saline (salt water) and are placed behind each breast, underneath either breast tissue or the chest wall muscle. The procedure lasts one to two hours and is typically performed with general anesthesia, although local anesthesia combined with a sedative is also possible. After surgery the patient’s bustline may be increased by one or more cup sizes.

Incisions are made in inconspicuous places on the breast to minimize scar visibility (in the armpit, in the crease on the underside of the breast, or around the areola, the dark skin around the nipple). The breast is then lifted, creating a pocket into which the implant is inserted.

Placement behind the chest wall muscle offers a few advantages over placement beneath the breast tissue only. These include reduced risk of capsular contracture (post-operative tightening around the implant) and less interference with mammogram examinations. Possible disadvantages include need for drainage tubes and elevated pain in the first few days following surgery.

After the implants are placed and centered beneath the nipples, incisions are stitched, taped and bandaged. In a few days these bandages may be replaced with a surgical bra. Most patients feel tired and sore after surgery, but this usually passes in a day or two and many patients return to work within the week. Stitches are removed in a week to 10 days and any post-operative pain, swelling and sensitivity will diminish over the first few weeks. Scars will begin to fade in a few months and will continue to fade for months or years.

Complications following surgery are uncommon and usually minimal. They may include capsular contracture, swelling and pain, infection around the implant, a change in nipple sensation, milk production if you nursed a baby within a year before the procedure, and breakage or leakage of the implant as a result of injury or the normal compression and movement of your breast (if this happens the implant will simply deflate in a few hours and your body will absorb the salt water).

Breast Lift

Over time, the effects of gravity along with the loss of the skin's natural elasticity begins to have an effect on the appearance of a woman's breasts. These factors, combined with pregnancies and nursing will often cause the breasts to lose their youthful shape and firmness. A breast lift, or mastopexy, is a surgical procedure to raise and reshape sagging breasts.

The procedure can also reduce the size of the areola (the darker skin surrounding the nipple). Breast implants inserted in conjunction with a mastopexy procedure can increase both firmness and size. Dr. Hoffman has extensive experience in this area, one of the most difficult in plastic surgery.

A breast lift, or mastopexy, is performed to return youthful shape and lift to breasts that have sagged as a result of weight loss, pregnancy, loss of the skin’s natural elasticity or simply the effects of gravity. The procedure can also reduce areolar size (the dark skin surrounding the nipple), and it can be combined with mammoplasty (breast augmentation) for added breast volume and firmness. Breasts of any size can be lifted, but results last longest when they are originally small and sagging.

Women planning to have children are advised to postpone surgery, since pregnancy and nursing can counteract its effects by stretching the skin. However, mastopexy should not affect your ability to breast-feed.

Mastopexy may be performed in a hospital, an outpatient surgery center or a surgeon's office-based facility. It is usually done on an outpatient basis under general anesthesia, and lasts from 1-½ to 3-½ hours.

A number of pre-operative steps are typically taken such as a mammogram, measurement of the bustline, and discussion with the surgeon about the desired size and shape of the breast and placement of the nipple. During the procedure an anchor-shaped incision is made from the location of the new nipple down to and around the crease beneath the breast. The surgeon removes excess skin, relocates the nipple and areola, and reshapes the breast using skin from around the areola before closing the incisions with stitches.

Patients with small breasts and minimal sagging may be recommended for smaller-incision mastopexy. One such modified procedure is concentric ("doughnut”) mastopexy, in which two concentric circular incisions are made around the areola and a doughnut-shaped swathe of skin is removed.

After surgery the breasts are wrapped with gauze dressings, over which an elastic bandage or a surgical bra is placed. After a few days this is replaced with a soft support bra which is worn 24 hours a day for about a month. Breasts will probably be bruised, swollen, and uncomfortable for a few days but this will pass. Numbness in the breasts and nipples should lessen as swelling subsides, although occasionally it lasts for months or even permanently. Stitches are removed after one to two weeks, and many patients return to work then.

Complications are uncommon but may include bleeding, infection, numbness, uneven positioning of nipples and widenening of scars. Scars can be covered even beneath bathing suits and low-cut tops.

Breast Reduction

Large, pendulous breasts may cause a woman to potentially experience various medical problems caused by the excessive weight of the breast tissue. Problems with posture, skeletal deformities, back and neck pain, skin irritations and breathing problems are common with this condition. Bra straps often leave indentations in the shoulder area. Many women, especially teenage girls, are very self-conscious because of their unusually large breasts.

Breast reduction (reduction mammaplasty) removes fat, glandular tissue, and excessive skin, resulting in smaller, lighter and firmer breasts that are better-shaped in proportion to rest of the body. In most cases, the vertical technique is used to avoid long scars under the breast.

Large breasts can cause pain, improper posture, rashes, breathing problems, skeletal deformities, and low self-esteem. Breast reduction surgery is usually done to provide relief from these symptoms. Performed under general anesthesia, the two- to four-hour procedure removes fat and glandular tissue and tightens skin to produce smaller, lighter breasts that are in a healthier proportion to the rest of the body.

Breast reduction surgery is not recommended for women who intend to breast-feed, since many of the milk ducts leading to the nipples are removed.

During the procedure an anchor-shaped incision is made from the new location of the nipple down to and around the crease beneath the breast. The surgeon removes excess glandular tissue, fat, and skin, relocates the nipple and areola, and reshapes the breast using skin from around the areola before closing the incisions with stitches. Liposuction may be needed to remove excess fat from the armpit area, and in some cases when only fat needs to be removed from the breasts, liposuction alone is used for breast reduction. For a few days after surgery the breasts are bound with an elastic bandage or a surgical bra and you may be given surgical drainage tubes for fluid removal. Stitches come out in a week and the surgical bra must be worn for about a month.

A little pain is normal after surgery, whether it’s mild discomfort, swelling during menstruation, a measure of numbness or sensitivity, or random, shooting pains that may last for a few months. Swelling, bruising, crusting and slight changes in breast size are also common. Most patients return to work in about two weeks, although you should avoid heavy lifting for three to four and only gentle contact with the breasts should occur for six weeks.

Scars fade with time but will not disappear, although they can be hidden with a bra, bathing suit or low-cut top.

Risks are rare and usually minor but may include bleeding, infection, reaction to the anesthesia, small sores around the nipples, slightly mismatched breasts or unevenly positioned nipples, and permanent loss of feeling in the nipple or breast.

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