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Board Certified Plastic Surgeon
Thank you for your question. This is an excellent one, as many people want to know the answer to this. There are two main things to understand. Inferior pedicle reductions are almost always associated with an anchor pattern scar. I do not prefer inferior pedicle reductions because they tend to bottom out after a year or so, but many surgeons utilize them in their practices with very good results. Inferior pedicles are great for patients who need very large reductions. In most cases I use a superior pedicle, where the blood supply to the nipple is maintained by tissue at the top of the breast. This type of pedicle does not bottom out as much, thereby maintaining fullness in the upper half of the breast and gives a good shape. With a superior pedicle, I can almost always do a limited lollipop incision. In some cases I need to add a short incision in the crease, but not the long one that is used in a full anchor pattern. The reason I sometimes have to add a short incision in the crease depends on the length of skin between the bottom of the areola and the crease. If this distance, or length of skin, is too long, it does not look as pretty as it should. So the shorten this distance, skin is removed and this requires a short incision in the crease. The lower the nipple is to start, the greater the distance it needs to be elevated and, therefore, the longer this distance from the areola to the crease will be. So if the nipple is very low, chances are you will need a short incision in the crease. I hope this helps.
Board Certified Plastic Surgeon
Thank you for your question and for providing the photographs. There are several considerations when deciding whether or not scarless reduction will meet your goals. First, as the other doctors have discussed, I assume we are talking about liposuction to reduce the breast. From your photographs, you appear to be young and many younger women have very dense breasts, which is not amenable to liposuction. Only fat can be removed with liposuction. If your breasts are dense, they have little fat and mostly glandular tissue, which cannot be liposuctioned. Now since your breasts got bigger after weight gain, it is possible that they have a lot of fat but you also noticed the increase after taking hormones. This would increase the size of the glandular tissue and, when you lost weight as you have, the breast size would not get significantly smaller. So if the increased size is due to the glandular tissue, then liposuction will not work and you need surgical breast reduction. If your breast has a large component of fat, then liposuction can work but it can lead to a very poor shape and sagging. If the goal is to be smaller with a good shape, I would recommend a surgical reduction with a superior pedicle and a limited (lollipop) incision. This would work well for you. Keep in mind that your ability to breast feed may be affected. Hope this helps.
Board Certified Plastic Surgeon
Thank you for your question. There is no doubt that a tummy tuck is the way to go. You have skin excess which will be removed by a tummy tuck. Liposuction will not do this and in fact will only increase the excess lax skin. As long as you are finished having children, this is your best option. Best wishes.
Board Certified Plastic Surgeon
Thank you for your question. It is typical that some women, and especially as we get older, have less dense breast tissue. Dense tissue is advantageous when we are trying to shape and auto-augment the breast. However, this does not mean you will not a good outcome. I have many patients with less dense breast tissue with good results after a breast lift. It is hard in any case, whether or not the patient has dense breast tissue, to keep the upper pole full after a breast lift. It is common for lifts to not last that long because of the inelasticity of the skin. During your consultation your board certified plastic surgeon should discuss with you the expected result, the longevity of the result and any special steps he/she takes to promote the longevity of the lift.
Board Certified Plastic Surgeon
Thank you for your question. It is a bit hard to see your picture. Also a photo of you sitting would be very helpful. In general, if you have laxity or excess skin above the belly button, full tummy tuck will give you the best result. If the laxity in mostly in the lower abdomen, below the belly button, a more limited surgery is an option. Hope this helps.
Board Certified Plastic Surgeon
Hi Leann, Thank you for your question and for providing the photographs. I need to know what result you are looking for in order to discuss which implants are best for you. I typically do not use high or ultra high profile implants because the majority of my patients want a natural looking result. With your thin tissues, these implants are going to be more obvious. But it depends on what result you are looking for. I also do not recommend high or ultrahigh smooth implants as they tend to stretch the tissues over time. If you wanted a full but natural looking result and considering your tissues, I would recommend subpectoral shaped implant with moderate or high profile. Hope this helps.
Tracy Pfeifer, MD, MS
Board Certified Plastic Surgeon
Thank you for your question and for providing the photographs. A breast reduction almost always includes a significant lift. You would benefit from this. Typically, bra cup sizes change every 100-150cc. So if 200 grams is removed, you will probably be one cup size smaller, possibly 2 cup sizes. Whether or not you would think that is small is subjective. Sometimes in the office I show a patient a 200cc implant and a 400cc one (grams = cc). That way you can tell what that amount of volume is and it makes it easier to visualize the postop size. Keep in mind that the more weight that is removed from the breast, usually the better long-term result one gets in terms of maintaining the lift. Breasts that need a lift are prone to sagging again, although you should not sag to the same degree you have now. In cases such as yours, patient with significant sagging, I typically use Galaflex to try and maintain the result longterm. Hope this helps.
Board Certified Plastic Surgeon
Thank you for your question and for providing your photo. Judging from your photo, it does not look like you will need a lift. However, you must be examined in person to get an accurate opinion; there are multiple factors that cannot be assessed via a photograph. It looks like your breast is positioned low on the chest wall, but that could be the position of the camera. This does not affect whether or not you need a lift but it might affect the implant selection. I like shaped implants in situations similiar to yours but a round implant is possible. With any implant your tissues can stretch over time and you might need a lift in the future. This is true for many women, not just you. I suggest getting a second in person opinion about your options. I hope this helps.
Board Certified Plastic Surgeon
Thank you for your question. I cannot see too much from the photograph and I certainly understand if you do not want to provide a photograph without clothes. From what I can tell, you look to have a nice size breast and you state that you are a D/DD but sagging. Typically, a patient who is happy with their size in a bra, only needs a lift. I would not recommend adding an implant unless absolutely necessary. Implants add weight to the breast AND when we are doing a lift, we are fighting gravity and the weight of the breast. The implant only adds to this. The challenge of a lift is maintaining the lifted breast over time. Your plastic surgeon can discuss this with you. In my practice, I often use Galaflex to try and achieve a longer-lasting lift. I hope this helps.
Board Certified Plastic Surgeon
I would highly recommend Dr Pfeiffer and her team. She's very down to earth and listens to what you want. I wouldn't hesitate to do the procedure again and would definitely go back to her in the future if I decided to get another procedure.
Dr. Pfeifer and her team are an amazing group of women. From the consultation, I knew she was the doctor for me! She is smart, caring and listens to all of your concerns and questions. A true artist. I was very nervous to have my procedure-tummy tuck and Dr. Pfeifer and her team held my hand the whole way. I am so happy I went through with the procedure. My results are amazing and I wish I did it sooner! The anesthesiologist was amazing as well!
I had contemplated getting a breast lift for nearly 10 years to fix what I would describe as my "sad and saggy" boobs. Though I continued to think about surgery as I was extremely self conscious without a bra on, uncomfortable in bathing suits, etc. I kept putting it off telling myself I would do it post-marriage, post-kids, etc. Around two months ago I decided that though I still wasn't married and didn't have kids, I was ready to proceed with surgery. Countless hours of research and consultations led me to Dr. Pfeifer and I couldn't be happier it did! She is beyond meticulous, explained every detail along the way never dismissing my questions/concerns and never rushing me out of the office or off the phone. I'm currently 5 weeks post-op and couldn't be happier with the results! My sad and saggy boobs are now not only perky and cute, but also totally natural looking!! Beyond Dr. Pfeifer, the entire office is truly unbelievable - Maureen, Arlene and the entire team have been by my side every step of the way and I couldn't appreciate their kindness, constant follow up and generosity more!! My only advice: If you are thinking about getting breast surgery, don’t wait 10+ years like I did, go see Dr. Pfeifer for a consult.. it will change your life like it did mine!
I wanted to write a review for Dr. Pfeifer and her office because although I ended up needing to have my surgery elsewhere, my experience with them was so outstanding. I had consulted with 2 other NYC PS but when I met Dr. Pfeifer I knew she was the Dr. for me. She runs late because she gives her patients her full attention and is not watching a clock so be patient and know that you are in the best hands. She was very supportive of my decision to explant and did my in office deflation. Her team (Maureen and Vicky) are also the best.
Dr. Tracy Pfeifer is without a doubt one of the most talented breast surgeons out there. I needed a very complicated Breast Augmentation Revision and went to 3 other incredibly reputable NYC plastic surgeons and each of them asked the names of the other doctors I was considering, and all of them recommended I go with Dr. Pfeifer. Initially I was upset because I thought they didn’t want to take on a case as complicated as mine. But now I realize they were right and were just trying to do the best thing for me in placing my case in Dr. Pfeifer’s hands. My initial Breast Augmentation through another doctor left me with a capsular contraction and implant pockets that were completely off and left my breasts uneven and quite honestly botched. What was even more upsetting is that all the doctors were surprised at how symmetrical my breasts were before my initial surgery, because they were so not symmetrical after! When I met with Dr. Pfeifer, I was depressed and felt hopeless. She was not only sympathetic and gave me hope, but she wanted to help me. Having said that, she was also quite realistic and did not give me any false expectations. I could not be happier with my outcome. If it wasn’t for her talent and willingness to take on my case I would still be horrified by my appearance and hiding my body. Thank you Dr. Pfeifer!
I haven’t seen many reviews for small implants on Real Self so I am sharing my journey here. First, I want to explain my reasons for choosing such modest implants, since it is a lot of money and pain for a modest change. I wear a size 30C bra and my breast width is 11cm, so my frame is pretty small. I am looking for soft breasts with a natural slope and want a VERY modest change. I work out a lot and do not want my breast implants to get in the way. I also don’t want to look bigger than I am and I think large breasts can sometimes make people look heavy if they are disproportionately sized. I am also concerned about being able to find bras and bathing suits that fit. It is already very hard to find a bra with a 30 band - most brands only go down to a size 32. I also want to be able to go braless sometimes. At the end of the day, I really just do not want to have large breasts, just largER and a little perkier than they are now. My current size, 30C, is not large at all. It is equivalent to a 34A. This is one of my pet peeves because even while interviewing surgeons, I got confused looks when explaining that I wanted to be a D cup, but only wanted a modest change. When talking to surgeons who had no idea how cup sizes work, I just gave in and said I want to be a full B cup. Luckily, I found Dr. Tracey Pfeifer, who not only knows about cup sizes, but she was also the ONLY surgeon who did not tell me that I actually wanted to go bigger than what I had asked for. The smallest sizers I was put in were 250cc high profile until Dr. Pfeifer, who listened to me and considered the pictures I brought in before trying 180cc moderate profile sizers. I loved them. I tried a few moderate plus sizers and I felt like I looked cartoonish. On me, they just looked way too pointy and huge. I do worry that I will wake up and wish I went bigger, but I know that, while I may be disappointed if they are too small, I will be mortified if they are too large. I do have some asymmetry and Dr. Pfeifer will make the final choice in the OR, but I trust that I won’t wake up with boobs that seem too large to me. My surgery is tomorrow and I am nervous about the pain and about not being able to help around the house. I hate not being able to do things, but I will try to take it easy. I am taking arnica, vitamin C, and Colace in preparation for surgery. I am also going to get a massage this afternoon, as my shoulder, upper back, and pec muscles are always pretty tight from working at a computer all day. Hopefully that will help the muscles relax a little. At the very least, it may help me relax! For recovery, I bought a Sakara Life meal plan. It’s expensive, but I am glad to have breakfast, lunch, and dinner taken care of for five days after my surgery, and to know they will all be healthy, anti-inflammation foods. I also have ice packs, pillows to sleep propped up, soft flannel shirts, and a bunch of shows I love to catch up on. My surgery is on a Monday and I took the whole week off. My boyfriend took Monday and Tuesday off to stay in with me. I also plan to take a car service in to work the first week I am back because I do not want to get bumped on the subway or get stuck underground for an hour standing up. Hopefully, I have thought of everything crucial and recovery will be smooth sailing. Updated on 8 Jan 2019: The doctor ended up using a 180 low profile smooth round implant on my left and 210 low profile on my right side. I am very happy with the results so far and will post pictures soon. They look symmetrical for the first time in my life! Even though the asymmetry was slight, I noticed it and it bothered me, so I am very happy that the surgery made my breasts more symmetrical. I have more pain today than I did yesterday, the day of the surgery. On the first day, it just felt like I had done 100 pushups, my pec muscles were so sore, especially under my armpits. When I woke up this morning, my whole rib cage was sore to the touch. I am also VERY bloated today. Thank god for elastic waist bands. I have felt a few “zingers,” but they weren’t too horrible. Hopefully I am not speaking too soon, but BA surgery has been much less painful than getting my wisdom teeth taken out. I have been managing the pain with vicodin and extra strength Tylenol (if the pain is bad, I use vicodin, which means I mostly take the vicodin when I wake up from naps). I am also on a muscle relaxer, which is probably why my pecs aren’t hurting me too much today. I took a shower today but was very gentle, so I still have marks on my chest from where Dr. Pfeifer drew on me. Tomorrow, I am going to try to wash my hair. One thing that I am so glad I did prepping for recovery is sign up for a meal delivery service just for the week of surgery. I chose Sakara ($350 for breakfast, lunch, and dinner Monday through Friday) because it super healthy, plant-based food with lots of fiber. Not having to think about what I am going to eat has been a godsend, not to mention not having to prepare anything myself. This is especially true because I have to ale the vicodin and my antibiotic with food. When I’m in pain, I do not want to be going through my cupboards trying to figure out what to eat with my meds. Sakara is pretty pricey, but the same could be accomplished by making your meals ahead of time and freezing them. Sakara is really expensive (at least for me) but it has been worth it to have one less thing to worry about. My boobs are still pretty high and they feel so tight, but I can already tell I am going to love the results. I can’t wait for them to drop and fluff! Updated on 11 Jan 2019: Today was the first day that I woke up feeling almost normal. I feel tightness and a mild discomfort, but nothing that I could describe as “pain.” Even the incision sites are just kind of itchy and sensitive. (My surgeon told me to put hydrocortisone cream around my steri-strips and that helped the itching a lot!) Even though I am physically feeling better, I am feeling more down about being helpless and tired. My boyfriend is doing everything around the house on top of going to work and I am so grateful, but wish I could do more. It’s depressing to be sitting at home alone and not be able to take care of the dirty laundry that is bothering me. I realize this is hardly something to feel down about, but maybe that just illustrates what a total mind f*** it is to go through healing-it may get you down no matter how ideal the situation is. One thing that helps a lot is taking little walks outside. I live at the top of a 6 story walk up, so any walk is a commitment, but I take the stairs slowly and am fine. Getting fresh air and a little sun makes me feel less grimey. Just make sure to bundle up because shivering really hurts. I am also forcing myself to take a shower every night and wash my hair every other night. That helps a lot as well. I am going back to work Monday (1 week post op) and I am confident that I will feel ready to go back. I am still pretty bloated and am waiting for them to drop and fluff. Pics to come soon.
I was recommended to Dr. Pfeifer by a friend who had her breast reduction down. I had always known I wanted to have my breast reduced but never followed through until this time. My biggest and only regret is not having my breast reduction surgery sooner. I knew Dr. Pfeifer was my doctor the first day I met her. She is extremely knowledgeable and very personable. I felt at complete ease and knew I was in good hands. The day of the surgery I was panicking, being that this was the first time I ever had surgery. Dr. Pfeifer was calming and helped to relieve the stress I was feeling. The surgery and recovery were definitely painful but completely tolerable. I was lucky enough to have my husband stay home with me because getting up and moving around those first few days is hard. I am now almost two months post-op. I feel AMAZING! I can't even put into words the relief I feel after having this surgery done. I was extremely big for my height (I am 5ft-4in). Everyday activities as simple as wearing a button down blouse to work was impossible and working out was always a hassle. Now, I can wear just one bra to the gym!! All of my clothes fit me so much better and having the surgery has really helped me increase my success losing weight. I am just that much more motivated. So, if you are considering surgery...DO IT! Dr. Pfeifer is the way to go! I promise you will not be disappointed. She is a PRO! My breasts are not flat (which was a big fear of mine), they are full and perky. I ABSOLUTELY love this new me!
I am so thankful and happy that Dr. Pfeifer was the one to do my surgery! She and her staff were wonderful and helpful throughout the entire experience. They are warm people and make you feel comfortable. Note that prior to the surgery, I had significant breast asymmetry due to childhood scoliosis. Dr. Pfeifer was extremely attentive to that and took steps to ensure that I would come out with breasts that were as even as possible. We tried many implants together (as I required two different sized implants), and she helped me decide what looked best. During the operation, she had different sized implants ready (as they can look a bit difference once actually inserted) as well, just in case. Ultimately, everything turned out great; I love the end result, and feel much more confident about myself. Can't recommend her office enough!
My breasts never fully developed and had large puffy areolas. When they were very cold though I liked them just fine. I didn't want implants and went to many surgeons and all of them said I needed implants. I looked up the best breast reconstruction doctor in NYC to see if he could help me. He said he didn't do under-developed breasts but to go to Tracy Pfieffer. She spent 3.5 hours just working on my areolas and removing some tissue from breast that is slightly larger. The scar healed so invisibly that I didn't mention it to a gynecologist who was doing my breast exam and she said "there is the faintest little line around your areolas..." (even she could not tell I had had surgery and was inspecting me very closely under bright lights). Everything from start to finish was completely professional and wonderful down to the facilities and the anesthesiologist. I was scared and asked him if I was going to die. He laughed and said no. I said asked if he promised (I was very scared and completely serious.) He promised. :)
The ENTIRE Staff is FABULOUS. She had the Best bedside manner And she really listened to me. I had two previous surgeries and I never received the care she provided. After my surgery, I received multiple calls from all of her staff as well as her. I couldn't be happier!!!! My breasts look amazing and I feel such relief as she was able to remove the scars from my previous surgeries.
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