Sound Plastic Surgery

A: - Having a second breast reduction is termed a "re-reduction," and this is a procedure I have performed numerous times.

- The key with this operation is blood supply to the nipple areolar complex

- I perform all of my primary breast reductions with a superior-medial pedicle. "Pedicle" is the medical term for the tissue that has a nerve and blood supply in it. In this case the pedicle supplies the nipple and areola.

-When performing a breast re-reduction, the concern is making sure that the blood supply to the nipple and areola are not compromised.

-If you have an operative report showing that a superior or superior-medial pedicle was performed when you had your first breast reduction, then you could show that to your plastic surgeon so he/she will know more about blood supply issues that could affect your nipple/areola, BUT it is unlikely that you have that operative report, AND that's just fine!

-When I perform breast re-reductions, I just assume that the old fashioned, or more popular, way of performing breast reductions in the past was likely used, whereby an inferior pedicle was used. The issue here is: that is exactly in the area of your breast where tissue needs to be removed.

-Of course removing that tissue also removes the dominant blood supply to your nipple and areola.

-Therefore, for patients like you, I remove all of that excess inferior (lower) breast tissue and skin, and de-epithelialize (remove the top layer of skin) around the areola, and allow the nipple and areola to be nourished by a random pattern blood supply. The key here is not moving the nipple and areola too much higher, but it can certainly be raised several centimeters very safely.

-The other option would be to try to re-create the old inferior pedicle, but that is purely guesswork as the old pedicle can not be readily identified, and it can take a long turn to the side under the skin before reaching the nipple and areola, so I never try that technique.

-Lastly, a free nipple graft is an option, but loss of sensation and some loss of pigment accompanies that method. And healing time takes longer.

-The above is very technical, but important! The key is this: meet with a board certified plastic surgeon (ASPS Member) who has a lot of experience with breast re-reductions!

-Best of luck to you, and thanks for sharing!

A: - Congrats on the major weight loss you have achieved! - We perform many lower body lifts, all on an outpatient basis, and our patients experience very few if any complications. The most common complication would be a minor one involving a spitting suture. - For the past decade we have also placed all of our lower body lift patients on a one week course of Lovenox (an injectable blood thinner) post-operatively to prevent blood clots as well. - We have never had to admit any of our body contouring patients to the hospital, so that definitely speaks to the safety of these procedures. - I would recommend setting up a consultation with a board certified (ASPS Member) surgeon who commonly performs body contouring procedures for patients after massive weight loss. - We often add on breast surgery as the same time as a lower body lift. Additionally, some patients choose to have an arm lift (brachioplasty) performed at the same time as their breast surgery. - Thanks for your question and wishing you the best as you complete your weight loss journey with body contouring!

A: -When you choose an implant that is wider than your breast width, you can expect to have more "sideboob" post-operatively. -You certainly do not have to go with an implant that is the same width as your current breast width. Many of our patients go with a width smaller than their own, and they are very happy. -Breast implant sizing is very important prior to your operation. -We have all of our breast augmentation patients decide on their implant size weeks prior to their operation. - When I first sit down with my breast augmentation patients at their initial consultation, we discuss their goals, the technique of the operation, post op recovery, and potential complications. Then, one of our very experienced staff members does "sizing," using actual silicone implants and a bra. This allows our patients to find which implant size feels best. - At a "pre-op" appointment, two weeks prior to the breast augmentation, our patients go through the sizing process again to confirm their choice. -We have found over the last 13 years that having our patients pick the implant really helps make certain the correct size is used. Very occasionally a patient picks an implant that just seems way too large or way too small to meet her goals. In these cases, we will help guide them to a better choice. However, this rarely needs to be done. - I have seen patients from other practices where their plastic surgeon picked the implant for them, rather than have the patient decide, and in some cases the implant chosen by the plastic surgeon was too large. -Thanks for your question, and best of luck to you!