Joseph Rucker, MD, FACS (retired)

Most definitely both procedures can be done at the same time.  This is commonly done and the benefits are:  1. a financial savings ( your insurance may well cover part of your anesthetic and hospital charge. 2. One recovery as opposed to two 3. One anesthetic   Good Luck 

After reviewing your photographs it appears that a removal of between 700-800 grams per breast should take you from your G cup to a large C cup.  The removal of this amount of tissue from each breast should place you in a good position for the breast reduction procedure to be covered by your insurance carrier.  Be sure to seek the advice of a board certified Plastic surgeon and good luck with your procedure.  

Sorry to hear about your problem.  It appears that you have a sylastic implant in place and (as they usually do) they can start to migrate toward the tip of the nose.  Unfortunately if this continues the implant can erode through the skin.  I am sure your surgeon will recommend the appropriate treatment but in my estimation I would 1. remove the implant  2. allow the area to heal (4-5 months) 3. then replace the implant  with a non-migrating implant such as Alloderm or a long lasting filler. Good Luck  

The shape of your nose and more specifically your nasal tip is primarily dependent upon hereditary factors (your parents may have passed the anatomical shape on to you).  Also,the shape of the nose can also be caused by a nasal injury that you may have suffered.  Either way the Rhinoplasty procedure is to merely elevated the skin and alter the nasal frame work to attain both a reduction in size and tip contouring. The asymmetry is addressed by the rearrangement of the cartilages beneath the nasal tip skin to produce a better alignment and a reduction in tip size.  Be sure the seek the advice of  a board certified Plastic Surgeon who has performed many of these procedures.  Good Luck  

I am in agreement with the previous answers and with time a significant portion of the swelling should resolve.  I have resorted to a direct removal of excess tissue in this area during the T.T. procedure in order to restore a smooth transition from the abdominal skin to the pubic area. I am sure your surgeon will offer you some type of revision options after the swelling has completely resolved.  Good Luck.   

After reviewing your photographs I am in agreement that you would benefit from a revision with additional (Colbert) fat preparation and injection to soften the over lying skin and to reshape the depressed scarring area.  Also, a revision of the left breast lift with a slight reduction to give you better symmetry would be recommended. Hope this helps. 

It is some what difficult to give you a definitive answer without the benefit of an examination but after reviewing your photos my recommendation and findings are: 

    1. Considering you small stature you may well be covered by your insurance carrier for a removal of 

        approximately 500 grams from each breast to take you down to a B+ or C- cup size. 

    2. Your symptoms are well documented  and a  history of your multiple symptoms associated with this condition such as:   Bra strap irritation, back problems, neck strain, rashes beneath breast and most importantly a diminished overall activity level must be included in your prior authorization letter. 

   3. A well documented attempt at improving the above noted symptoms for at least one year.. including: Treatment of rashes beneath breast, physical Therapy for back problems, medication: muscle relaxers, mild pain pills (tylenol) would also be extremely helpful. 

  4. My recommendation would therefore be a bilateral reduction of approximately 500 grams with a movement of your nipple/areola complexs more toward the midline without totally detaching them so as to preserve feeling and the ability to breast feed later. 

Be sure to seek the advice of a board certified Plastic and Reconstructive Surgeon. Good Luck

Insurance carriers have become much more demanding prior to approving coverage for the Breast Reduction Procedure:  One pound of tissue removed equals approximately 455 grams and is considered in my opinion a average amount of tissue to be removed from each breast.  It is important to understand that coverage is also dependent upon the height and weight of the patient. For example a one pound removal from a woman weighing 200lb would probably not be covered but the removal of the same amount from a woman weighing 150 lbs might well be approved.  Over a 30 year career we have found that the other important factors considered for prior-authorization besides the amount of tissue removed are.  

• History: long standing history of multiple symptoms associated with this condition:  Bra strap irritation, back problems, neck strain, rashes beneath breast and most importantly a diminished overall activity level. A letter from the patients medical doctor documenting the symptoms is also extremely helpful. 
• A well documented attempt at improving the above noted symptoms for at least one year.. including: Treatment of rashes beneath breast, physical Therapy for back problems, medication: muscle relaxers, mild pain pills (tylenol)
• Physical Examination: the weight is extremely important and if you are over-weight your chances of being covered are drastically diminished. Bra Size: Chest wall measurement and the anticipation of the amount of tissue to be removed from each breast by the examining physician. 
• A prior authorization letter is then sent to the insurance carrier with documentation of all of the above findings with photographs included. 
• We have our patients fill out their forms with the above information prior to their consultation and most patients will receive a response from the insurance carrier within 2 to 6 weeks.

Good Luck and be sure to seek the advice of a Board Certified Plastic and Reconstructive Surgeon

In my estimation you should be able to have both procedures done at  the same time.  The limiting factor would be what cup size your would like to be afterward.  To large of an implant would place to much pressure on the skin and could cause some unwanted problems.  But if you are looking to be a full C or small D it should not be a problem.  Either way Iam sure you surgeon will discuss this issues with you prior to the procedure.  Good Luck

The complication of nipple necrosis and poor healing after breast lift can usually be attributed to 1. Smoking 2. Placing to large of an implant which would secondarily place to much tension on the nipple areolar complex and could lead to decreased blood supply to the skin causing the problem that you inquired about.  I am sure you Plastic surgeon would share this information with you prior to the procedure. Good Luck