Posted on March 1, 2010 in Breast augmentation, Breast implants, Breast lift (Mastopexy), Breast reconstruction, Saline implants, Silicone implants
Breast implant exchange surgery is the replacing of one or both of one’s implants for a newer one or pair after previously having had a breast augmentation, mastopexy with implants or breast reconstruction. Why would a woman elect to undergo such a procedure? There are many reasons for this with some of the more common ones being:
- size change – usually to increase the implant volume and therefore the breast size; rarely to decrease
- to modify the breast configuration such as to make them more projecting or less wide
- to switch from saline to silicone implants; rarely, silicone to saline
- replace a ruptured breast implant
- in the course of treating one of a variety of aesthetic breast issues such as drooping or capsular contracture, replacing older implants with newer ones.
The most common reason for implant exchange is that a woman is unhappy with the selected size and wants to be significantly larger. It is fairly infrequent to desire a smaller size and this is often due either to the surgeon placing a far too large implant initially or the patient gaining a considerable amount of weight resulting in a marked enlargement of breast tissue.
In my practice, it is fairly rare for my patients to desire a change their breast implant size and if they do, it is usually years later. Why can I keep this rate extremely low? When evaluating my patients in consultation, I listen carefully to exactly what they want or think they want. I also measure and size them in the office, have them try on a variety of implants, and show them photos of other patients to provide them with a greater understanding and visualization. During surgery, this is fine tuned, as I will employ temporary implants in order to assess the effects of various sizes and configurations.
By offering many different styles of breast implants, I can customize the appearance that would be most appropriate and desirable for my patients. For example, patients who are very narrow and desire significant projection would be best served with higher profile implants whereas women who are broad with a moderate amount of breast tissue present may benefit more from moderate profile implants. Many of the patients that I perform implant exchanges on were done elsewhere and indicated that they were never offered or explained the options.
It is essentially unanimous that women prefer the silicone implants over the saline ones as they feel similar to breast tissue. When switching between fill materials, virtually all go from saline to silicone whereas the opposite is almost never performed due to aesthetic issues.
If you would like more information on silicone or saline breast implants, breast augmentation, breast lifts or any other plastic surgery procedure that I perform or to schedule a consultation with me, you can call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on February 1, 2010 in Breast augmentation, Breast implants, Breast lift (Mastopexy), Breast reconstruction, Saline implants, Silicone implants
During the moratorium imposed by the U.S. Food and Drug Administration between 1992 and November 2006 that limited specific uses of silicone breast implants, women who wanted to have a breast augmentation could only be offered saline breast implants. Since the end of 2006, silicone breast implants have once again been available without restriction for all women desiring breast surgery. This includes for breast augmentation as well as breast lifts (mastopexy) with implants, breast reconstruction and those who want or need to exchange their implants for different ones.
Having been in plastic surgery practice for over 22 years in Scottsdale and Phoenix, Arizona, I have long been involved and dealt with and witnessed the multitude of factors and issues regarding silicone and saline breast implants. Prior to 1992, my patients used silicone implants exclusively and were quite happy. During the period of the moratorium in which all my breast augmentation patients and some of my mastopexy and breast reconstruction patients utilized saline implants, I noted that the aesthetic results and level of satisfaction with the naturalness of outcome were decreased and compromised compared to results with silicone implants.
This sentiment came as no surprise. Why? Silicone breast implants feel very natural and “soft”, like breast tissue, so that when they are in place, it often is very difficult to discern their presence particularly for the non-professional. Saline implants, on the other hand, can often be detected, either by sight, feel or both. This is exacerbated in very thin patients who often have “rippling” seen through their skin. These issues and others such as deflations do detract from their popularity. In patients of mine who have had both types of breast implants, every single one of them preferred and were far more satisfied with the silicone ones.
In the more than 3 year period since the lifting of the moratorium on the usage of silicone breast implants, virtually none of my patients select saline implants for their breast surgery which translates to around 99% silicone usage. For the rare few who do, it is only because of the lower cost of the saline implants.
If you are interested in obtaining additional information on silicone or saline breast implants, breast augmentation, mastopexy or any other plastic surgery procedure that I perform or to schedule a consultation with me, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on November 30, 2009 in Breast augmentation, Breast lift (Mastopexy), Breast reduction
In an earlier post, we noted that women pursue breast reduction surgery for either functional or aesthetic reasons. The vast majority of women that I see as well as those who seek out a breast reduction in general, are doing so in order to alleviate the symptoms associated with their considerably enlarged breasts. These symptoms can include neck, back and shoulder pains, headaches, rashes, and discomfort and limitations engaging in sports and exercising.
However, just because you have one or more of these issues does not mean that your enlarged breasts are a cause or even the only cause of your problems. The best way to ascertain whether a reduction mammoplasty would benefit you is to consult with a Plastic Surgeon certified by the American Board of Plastic Surgery such as myself. If your plastic surgeon determines that a breast reduction could help to alleviate or resolve some or all of your symptoms, then you would be a good candidate for the procedure.
Some women desire their breasts to be reduced in size (and lifted if indicated) solely for aesthetic reasons and not because they are experiencing any related symptoms. They simply want smaller and perkier breasts. A breast reduction can surely accomplish this though a plastic surgeon like myself can assist you in arriving at a prudent decision based on your concerns and goals.
If you have the appropriate functional or aesthetic reasons for pursuing a breast reduction as confirmed by a plastic surgeon and you are a relatively low surgical risk, then you would indeed be a good candidate for breast reduction surgery.
For more information on a breast reduction, breast lift (mastopexy), breast enlargement or any other plastic surgery procedure, you can contact our office at 480-451-3000 or send us an e-mail.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on November 23, 2009 in Breast augmentation, Breast lift (Mastopexy), Breast reduction, Eyelid surgery, Liposuction, Tummy tuck (Abdominoplasty)
Just what is a “Mommy Makeover”? You probably have been hearing or seeing this expression used in advertisements recently and wondered what it is. Essentially a “Mommy Makeover” is the correction by plastic surgery of the changes that occur as a result of having children in order to regain a more pre-pregnancy figure. Often, related cosmetic procedures can be performed concurrently to improve one’s overall appearance. Pregnancy permanently affects to variable extents women’s breasts, abdomen and body fat deposition and so these are the areas that are addressed.
Following pregnancy, many women lose some firmness, shape and volume of their breasts which may also become droopy and develop stretch marks. These changes can be further exacerbated by breast feeding with the duration and number of children affecting the outcome. A few women actually have a net increase in breast size though the shape and positioning usually suffer. Procedures that can effectively address these changes include a breast augmentation, breast lift with or without a breast enlargement and a breast reduction.
Permanent changes in the appearance of the abdomen following pregnancy are quite variable among women and are affected by a multitude of factors. The often is some residual degree of laxity of the skin and the underlying muscle layer along with changes in the distribution of fat. Cosmetic procedures that could improve the appearance of the abdomen include a mini tummy tuck, a standard tummy tuck (abdominoplasty) and liposuction. Liposuction can also be performed elsewhere including the hips, thighs, knees and even back.
The combination of the appropriate cosmetic procedures of the breast and abdomen with or without liposuction performed at one surgical setting constitutes the “Mommy Makeover”. Of course, other procedures such as eyelid surgery can be done at the same time if warranted and indicated. This rejuvenation of one’s body back to a more desirable shape can do wonders for your psyche, self-confidence and sense of attractiveness.
If you would like additional information on breast augmentation, breast lifts, liposuction, tummy tucks (abdominoplasty) other cosmetic surgery procedure that I perform or you would like to schedule a complimentary consultation, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on November 9, 2009 in Breast lift (Mastopexy), Lollipop mastopexy, Nipple-areola complex, Perioarolar mastopexy
A patient recently sought my expertise regarding the poor results that she obtained from a mastopexy with implants that was performed elsewhere (by a surgeon who was not board certified). She was very unhappy with the outcome for many reasons but the abnormal shape including the flatness and lack of appropriate projection and the low position of her breast on the chest were the most important issues. To her, the breasts looked bizarre making her feel very self-conscious and frustrated.
She originally presented to the surgeon with drooping (ptosis) and wanting to be larger. The physician recommended a lollipop mastopexy to her without enumerating its pros and cons and did not discuss the much more commonly used inverted-T incision. (A lollipop mastopexy is a breast lift that involves an incision around the nipple-areola complex that then extends down to the breast fold but does not extend along this fold which is employed in the inverted-T technique.)
Her photos can be seen below on the left:
The patient's "lollipop" mastopexy performed by another surgeon. Note the flatness of the breast and droopy appearance with it hanging down well below the breast crease.
This is a mastopexy using a T-shaped (anchor) incision. Note the more pleasing and natural conical shape with greater projection and fullness.
Ignoring factors specifically related to the surgeon, her results also reflect the inherent deficiencies with a lollipop mastopexy. As I noted elsewhere (Periareolar Mastopexy: Sacrificing Shape for Less Incisions), the goal of a breast lift is to recreate a more conically shaped breast with the nipple-areola positioned at the most projecting part. The “standard” inverted-T or anchor shaped approach allows for the precise recontouring of the skin envelope in addition to the underlying breast tissue by utilizing a three dimensional approach. This also facilitates greater accuracy in the placement and size of the nipple-areola so as to create a well shaped aesthetically pleasing breast.
Though the lollipop mastopexy can provide a better shape than what can be obtained with the even more restrictive periareolar mastopexy, its shortcomings are obvious as you can see in these photos. Without being able to adequately remove most of the vertical skin excess that occurs with droopy breasts, the breast remains droopy and abnormally flat including at the nipple-areola complex. Volume that could be used to increase forward projection and yield a more conical shape is instead hanging down, well below the breast crease that is should remain largely above.
Similar to my sentiments regarding a periareolar mastopexy, it is my opinion that a lollipop mastopexy is rarely indicated except for limited situations involving very minor drooping. The tradeoffs in shape and position are too high a price to pay for most women versus the vastly superior results that can be obtained with an additional incision along the breast crease.
If you would like additional information on breast lifts, breast augmentation or any other cosmetic surgery procedure that I perform or you would like to schedule a complimentary consultation, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on October 26, 2009 in Breast augmentation, Breast implants, Breast lift (Mastopexy), Breast reconstruction, Nipple-areola complex
There are many advantages of placing breast implants behind the pectoralis major muscle for a breast augmentation, breast lift (mastopexy) and in breast reconstruction. The most significant of these include:
- Better ability to detect abnormalities on mammograms versus in front of the muscle (submammary)
- Lower risk for capsular contracture (hardness of the breast caused by the formation of scar tissue around the implants)
- More soft tissue coverage overlying the implant resulting in a lower risk and extent of visible rippling
- Provides a better and more natural interface of the implant with the chest wall
- Serves to provide better support of the implant long term as compared to above the muscle where the weight of the implant will cause greater stretching and thinning out of the skin over time as well as its descent on the chest wall
Implants above the muscle. Note the rippling, harsher contours, stretched areolas and unnaturalness of the result. (not my patient)
Implants behind the muscle. Note the more natural shape and smoother curves. This approach is recommended for most of my patients.
Except for some rare exceptions, most women are best served with the submuscular placement of their implants. As a result, this is my recommendation for virtually all of my patients.
If you would like additional information on a breast augmentation, breast lift, breast reconstruction or any cosmetic surgery procedure or to schedule a consultation, you can call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on October 19, 2009 in Breast lift (Mastopexy), Nipple-areola complex, Perioarolar mastopexy
A periareolar mastopexy, also known as a purse string, doughnut or circumareolar mastopexy, is a breast lift that accomplishes the result with just one incision: around the areola. Many women find the idea attractive because of the idea that there may be fewer scars on the breast. Unfortunately, unless there is minimal drooping to begin with, the trade-off is a poorly shaped flattened breast.
The goal of a breast lift or mastopexy is to recreate a more somewhat conical shaped breast with the nipple-areola situated at the summit of the most projecting part. A “standard” inverted-T or anchor shaped incision allows for precise reshaping of the skin envelope in addition to the underlying breast tissue by utilizing a three dimensional approach. The nipple-areola complex can then be more accurately placed and sized so as to result in an aesthetically pleasing contoured breast.
Inverted "T" Shaped Incision
The periareolar mastopexy approach eliminates the vertical scar as well as the horizontal scar in the fold at the bottom of the breast. Through a two dimensional approach involving just the incision around the areola, it has to both lift and reshape the breast. It accomplishes both by removing excess skin asymmetrically around the areola, taking a larger circle and purse stringing it to make a smaller circle, thereby tightening the skin.
With this approach, the area of maximum tension is centered around the areola. Some of the untoward consequences of this can include but are not limited to:
1.) a flattening of the breast shape creating more of a pancake configuration than a cone
2.) stretching and flattening of the areola causing distortions and irregularities of shape
3.) unsightly pleating of bunched up skin around the areola resulting from the purse string closure
4.) widened and thickened scars around the areola
5.) limitations in the precise positioning of the areola on the breast
6.) difficulty in obtaining closer symmetry is breasts that are significantly different prior to surgery
Periareolar Mastopexy (A). Though mild in this case, flatness and some pleating of the skin of the left breast can be seen centered at the areola (not my patient)
Periareolar mastopexy (B). Greater flattening can be seen including at the lower part of the breast
I strongly feel that a periareolar mastopexy is very rarely indicated except for certain limited situations involving very minor drooping. The trade-offs as noted above are too high a price to pay for most women versus the far superior results that can be obtained with a few more incisions.
If you would like additional information on breast lifts, breast augmentation or any other cosmetic surgery procedure that I perform, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on October 5, 2009 in Arm lift, Belt lipectomy, Body contouring after Massive Weight Loss, Breast augmentation, Breast lift (Mastopexy), Massive Weight Loss, Panniculectomy, Tummy tuck (Abdominoplasty)
We are in the midst of an unparalleled epidemic of obesity in this country. This is related to a combination of a general overindulgence in food, excessive consumption of foods high in fat and calories, and a more sedentary life style. Many of these people have realized that, for a variety of reasons, this excess weight needed to be shed. Through arduous dieting, exercise often in conjunction with bariatric surgery such as lap banding or gastric bypass they have lost tremendous amounts of weight, often far exceeding 100 pounds.
Success, finally! Celebration? Maybe not quite yet. Despite the massive weight loss that was so difficult to achieve, what many people didn’t anticipate was the permanent consequences on their bodies of first gaining then losing this sizable poundage. The figure that they envisioned following all this effort is not what they are seeing in the mirror. Instead of being slimmed down, contoured and generally smaller, most are left with unsightly deformities consisting of an excess of lax, irregularly contoured stretched skin that frequently cascades in rolls creating hygienic issues and an aesthetic nightmare.
Which areas are affected? From the face on down, the sequelae from massive weight loss may be seen. There is considerable variability among individuals as to the severity and areas that are most affected. Common areas include the abdomen, buttocks, circumferential trunk, inner and outer thighs, breasts, arms and even face and neck.
Fortunately, cosmetic procedures have been designed and refined that can address essentially any and all deformities related to post massive weight loss deformities. Examples of these procedures include abdominoplasties, thigh lifts, belt lipectomies, breast lifts, breast augmentations, arm lifts, face lifts and back lifts. A strategy for body contouring can be uniquely tailored for your individual needs based on your deformities and goals which could be determined at the time of consultation.
If you would like to obtain additional information on body contouring surgery such as for a tummy tuck, belt lipectomy, breast lift (mastopexy), breast augmentation, arm lift and face lift, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on August 17, 2009 in Breast lift (Mastopexy), Breast reduction
Women seek to have the size of their breasts reduced for two reasons that can be interrelated: functional and aesthetic. Most commonly breast reductions are sought out because of the symptoms that are associated with markedly enlarged breasts such as neck, back and shoulder pains, headaches and rashes. Even with reductions where the intent is to alleviate symptoms, there is an aesthetic component as the result will be lifted, smaller and perkier breasts.
Most of the time that women seek a reduction solely for aesthetic reasons, it is where the breasts are a little larger than ideal but not massively enlarged where they would be associated with discomfort. For example a woman may feel self conscious and uncomfortable with all the attention and comments that she may garner with enlarged breasts. Even though she may not be experiencing physical symptoms related to the increased size, by undergoing a breast reduction her breasts will be less conspicuous.
Another example of an aesthetic reason for a breast reduction are breasts that are droopy (ptotic) and larger than she desires. A small reduction and a lift would be the treatment of choice.
There may be some confusion between what constitutes a breast reduction versus a breast lift or mastopexy and some of this relates to insurance company mandates for coverage. An intrinsic component of most breast reductions is a lift. By the same token, a mastopexy or breast lift can be performed with a small reduction in size. Both procedures often employ the exact same incisions. The difference essentially is in the amount of breast tissue removed though there is no exact amount that distinguishes one from the other. In the past, a reduction in size of less than 300 grams per side along with the lift was considered to be a mastopexy with a small reduction.
In essence, this is just semantics as no matter what it is called, the surgical outcome is smaller, lifted and rejuvenated breasts.
If you would like more information on breast reduction or mastopexy surgery or any other cosmetic surgery procedure, you can contact my office at 480-451-3000 or send us an e-mail.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on July 27, 2009 in Breast lift (Mastopexy), Breast reduction, Nipple-areola complex
Many of my breast reduction consultations ask me the following question before I even discuss the procedure: “Dr. Turkeltaub, will my breasts also be lifted when I have a breast reduction?” After making what I think is a humorous comment about that it would depend on their insurance plan, I let them know that this is an intrinsic part of the procedure.
A breast reduction, also called a reduction mammoplasty, involves a significant reduction in the size of the breast, lifting the tissue up to a more appropriate level, making the breast less wide, reducing the diameter of the nipple-areola complex and elevating it to an ideal vertical height. Most of the time this is accomplished through an anchor shaped/ inverted “T” shaped incision. The result is a smaller, lighter, higher, perkier and more rejuvenated appearance.
Just what the Doctor ordered and what my patients want!
Before Breast Reduction
After Breast Reduction
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on July 14, 2009 in Breast implants, Breast lift (Mastopexy)
Over time and due to genetics, aging, weight fluctuations, pregnancy, breast feeding, lack of support and even chronic tanning, a very large number of women will experience drooping of their breasts known as ptosis. When they are seen in consultation in order to rejuvenate their breasts, I explain to them that they would benefit from a mastopexy (breast lift) with or without breast implants. For a “standard” mastopexy, the incision required to recontour and lift the breast is anchor shaped and extends from around the areola/ nipple area, then vertically downward to the crease at the bottom of the breast, then along this crease. When performed meticulously, most patients heal their incisions well though there are genetic and other factors that can affect the result.
When recommending and describing the incision entailed in a lift, invariably many patients express apprehension just with the vertical component – not even the one that encircles the areola. Some are so concerned about its presence that they either won’t pursue surgery or will only do so if the scar is limited to just around the areola which will yield an inferior result.
It has been my experience that the vertical component usually heals very well and at times even more inconspicuously than the other areas. By trying to limit the incision length and therefore the scarring by just employing an incision around the areola, the outcome is a flat breast with decreased projection and non-aesthetic contour. The reason for this is that by resecting the excess skin of the breast with the necessary purse-string tightening around the areola, it causes flattening in the exact area that should be the most projecting. Hence, the procedure is also called a donut mastopexy.
To better illustrate the difference between the two approaches using food comparisons, wouldn’t you rather have your breasts look more like a giant Hershey’s Chocolate Kiss, firm and conical in shape, than a flat donut? Unless you hate chocolate, I suspect that you would!
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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