Procedures - Breast Surgery

Dr. Weider's expertise encompasses both cosmetic and reconstructive breast surgery. His extensive training in both general and plastic surgery has provided him with a wealth of experience in all aspects of breasts surgery. This includes breast reconstruction, breast reduction, breast augmentation and breast lift (mastopexy). In addition, he also treats gynecomastia (male breast disease).

Breast Augmentation

Breast Augmentation is one of the most popular cosmetic procedures performed today. The two most common reasons for performing the procedure are to improve the body contour of a woman who, for personal reasons, feels her breasts are too small and to restore loss of breast volume after pregnancy. It is also used to restore symmetry to a woman who has different sized breasts. Breast augmentation involves the placement of a saline or silicone filled implant behind the breast tissue in order to increase the breast size and improve breast shape.

Right For You?

Breast augmentation can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon. The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you're physically healthy and realistic in your expectations, you may be a good candidate.

Types of Implants

A breast implant is a silicone shell filled with either silicone gel or a salt-water solution known as saline. Saline is a natural body fluid, accounting for 80% of a woman's body weight. Many people feel that silicone-filled implants give a slightly more natural look and feel to the breast. However, at the present time, silicone gel filled implants are available only to women participating in approved studies. The differences between the two implants can be subtle and you should discuss the best option for you with Dr. Weider.

Some Risk

Breast augmentation is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure. The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of the implant. As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood. A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted. Some women report that their nipples become oversensitive, undersensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients.

Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the man-made shell to leak. If a saline-filled implant breaks, the implant will deflate in a few hours and the salt water will be harmlessly absorbed by the body. If a break occurs in a gel-filled implant, however, one of two things may occur. If the shell breaks but the scar capsule around the implant does not, you may not detect any change. If the scar also breaks or tears, especially following extreme pressure, silicone gel may move into surrounding tissue. The gel may collect in the breast and cause a new scar to form around it, or it may migrate to another area of the body. There may be a change in the shape or firmness of the breast.

Both types of breaks may require a second operation and replacement of the leaking implant. In some cases, it may not be possible to remove all of the silicone gel in the breast tissue if a rupture should occur. While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast with an implant. Additional views will be required. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant. While the majority of women do not experience these complications, you should discuss each of them with your physician to make sure you understand the risks and consequences of breast augmentation.

Planning Your Surgery

During your initial consultation, Dr. Weider will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. There are numerous decisions to be made prior to the procedure including the implant size, the location of the incision and the implant shape (round or teardrop) as well as the location of the pocket (above or below the pectoralis muscle). After a thorough evaluation, Dr. Weider will help you make these decisions pointing out the options that will work best for you. If your breasts are sagging, he may also recommend a breast lift (mastopexy). Be sure to discuss your expectations frankly with your surgeon. And, be sure to tell your surgeon if you smoke, and if you're taking any medications, vitamins, herbal preparation, diet pills or other drugs. Dr. Weider will also explain the type of anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved. Because most insurance companies do not consider breast augmentation to be medically necessary, carriers generally do not cover the cost of this procedure.

The Surgery

The surgery is usually performed in a day surgery center, and the vast majority of patients go home the same day. The method of inserting and positioning your implant will depend on your anatomy, your surgeon's recommendation and your preference. The incision can be made either in the crease where the breast meets the chest or around the areola (the dark skin surrounding the nipple). Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible.

Working through the incision, the surgeon will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). During your initial consultation, Dr. Weider will discuss the pros and cons of these alternatives with you to make sure you fully understand the implications of the procedure. The surgery usually takes about two hours to complete.

After Your Surgery

You're likely to feel tired and sore for a few days following your surgery, but you'll be up and around in 24 to 48 hours. Discomfort is usually well controlled by medication prescribed by Dr. Weider. You should be able to return to work within a few days, depending on the level of activity required for your job. Within several days, the gauze dressings, if you have them, will be removed, and you may be given a surgical bra. You should wear it as directed by your surgeon. You may also experience a burning sensation in your nipples for about two weeks, but this will subside over the next few weeks. The swelling in your breasts may take three to five weeks to disappear. Dr. Weider will give you recommendations with regard to resumption of physical activity.

Before and After Photos

Before and after photos can be seen in the office at the time of your consultation.