Unfortunately, many people including physicians have a tendency to equate shorter scars with better, more advanced or state of the art results as well as a more talented surgeon. In situations where the results are exactly the same irrelevant of incision length, such as in gall bladder surgery, this belief can be well founded. However, this isn’t valid in breast lift surgery where I have always believed that if more or longer incisions would allow for an unequivocally superior contour and appearance, then the trade off would be worth it.

The goal of a mastopexy is to recreate a natural, conical shaped breast that has the areola situated at the most projecting part. An inverted-T (or anchor shaped) incision allows for the most precise reshaping of the breast and skin envelope in a three dimensional fashion. It also facilitates the accurate repositioning of the nipple-areola complex on the ideally recontoured and rejuvenated breast.

The limited incision periareolar mastopexy technique eliminates the vertical scar extending down from the areola as well as the horizontal scar in the breast fold. Therefore, essentially a two dimensional approach is expected to solve a three dimensional problem involving lifting and reshaping the breasts, resizing and repositioning the areolas and attempting to obtain improved symmetry. This all has to be performed with the asymmetric removal of a doughnut of excess skin from around the areola and then and purse stringing the larger circle to the smaller circle (areola) which tightens the skin.

This technique creates maximum tension around the areola which then translates into significant untoward and predictable consequences including:
1.)    flattening of the shape of the breast yielding more of a pancake contour rather than a conical one
2.)    a stretched and often flattened areola causing that can be irregular in shape
3.)    widened and thickened scars around the areola
4.)    the appearance of  skin pleats and lines emanating radially outward from the areola
5.)    limited flexibility in the precise placement of the areola on the breast mound
6.)    difficulty obtaining better symmetry of the breasts particularly when they were significantly different in size and or shape prior to surgery

A quite convincing illustration of these issues can be seen in the photos below. This 36 year old woman had a periareolar mastopexy performed by another plastic surgeon and was very unhappy with the outcome on several accounts. She saw me in consultation in order seek correction of her suboptimal results.

This is the outcome of a periareolar mastopexy that was performed by another plastic surgeon. The scars around the areolas are very noticeable, wide and unacceptable. A pleating effect - lines in the skin radiating outwards from the areola - can also be seen.

The scars resulting from the donut mastopexy are prominently visible. The flattening of the areolas as a consequence of the purse string technique is well illustrated in the right breast. Instead of the breasts being perky and somewhat conically shaped, they are flattened and underprojecting.

Very wide and unacceptable scar on the left breast from the periareolar mastopexy

For additional information on breast lift surgery with or without a concomitant breast augmentation or on any other plastic surgery procedure that I perform or 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

]]> http://www.arizonabreast.com/mastopexy/the-limited-incision-periareolar-mastopexy-severely-sacrifices-breast-shape-and-aesthetics/feed/ 0 http://www.arizonabreast.com/breast-reduction/the-appearance-of-the-nipple-areola-complex-in-a-free-nipple-graft-breast-reduction/ http://www.arizonabreast.com/breast-reduction/the-appearance-of-the-nipple-areola-complex-in-a-free-nipple-graft-breast-reduction/#comments Mon, 14 Jun 2010 12:00:22 +0000 admin http://www.arizonabreast.com/?p=371 Though the overriding goals in breast reduction surgery are to adequately decrease the sizes of the breasts and to obtain reasonable contours after doing so, the final appearances of the nipple-areola complexes also rate high. With everything else being equal, the nipples have a much better likelihood of retaining their aesthetic characteristics if they are not detached from their blood supply, ducts and underlying tissue.

However, in women with extremely massive breasts, this may not be possible if a free nipple graft breast reduction procedure is selected. This technique does provide for the most predictable and aesthetic outcome including size but does necessitate the removal and then replacement of the nipple-areola complexes as skin grafts. Consequently, there will be some deterioration of its structure and appearance.

What are the most common sequelae that are seen? The projection of the nipple usually is minimal and there may only be an outline of its location. The areola itself is thinner and not domal shaped. In darker complected women, there can be partial loss of pigmentation yielding a variegated pattern that may be either temporary or permanent.

One such example of the appearance of a nipple-areola complex following a free nipple graft reduction mammoplasty can be seen below. Pigmentation has been maintained as has some of the projection of the nipple. This result should not be considered to be representative of all outcomes with this procedure.

Example of the appearance of the nipple-areola complexes following a free nipple graft breast reduction.

For more information on breast reduction surgery or on any other plastic surgery procedure that I perform or to schedule a complimentary cosmetic consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

A vast majority of the patients that see me in consultation for breast reduction surgery exhibit indentations of their shoulders as a consequence of the weight of their breasts causing their bra straps to dig into their shoulders. The more massive the breasts and the longer a woman waits to undergo a breast reduction, the deeper these grooves may be.

In the photos below of a patient who saw me in consultation for breast reduction surgery, you can see the prominent indentations of the shoulders. Interestingly enough, the deeper groove is situated on the right, the same side as the much larger breast. These invariably persist even long term after successful surgery.

Woman with shoulder indentations seeking breast reduction surgery. The deeper groove on the right is also associated with the larger right breast.

Right shoulder. Deeper indentation here associated with the larger right breast.

Left shoulder. Indentation here is not as deep due to a smaller breast on this side.

If you would like to obtain more information on breast reduction surgery or on any other plastic surgery procedure that I perform or to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

My preference most of the time for the incision in breast augmentation is the inframammary one which lies along the crease at the bottom of the breast. It has numerous advantages over both the transaxillary and periareolar locations which can be discussed at the time of your consultation.

The patient whose underarm scar is shown in the photo, had her breast augmentation surgery performed elsewhere using the transaxillary incision. She developed thick hypertophric scars postoperatively which her plastic surgeon excised but they recurred. The problems that she faces now are scars which are prominent and visible when she wears sleeveless tops, gowns and bathing suits and which are occasionally associated with discomfort particularly when reaching.

Exposed keloid that resulted from a transaxillary incision in a breast augmentation. This already had been revised once by her original plastic surgeon.

If these same scars had been situated on her breasts, they would at least be covered by her clothes and not be so visible to others. As a result, she has to be very selective with the clothes that she wears including avoiding sleeveless tops which can make enduring Arizona summers with temperatures far in excess of 100 degrees Fahrenheit less tolerable.

For more information on breast augmentations, breast revision surgery or on any other plastic surgery procedure that I perform or if you would like to schedule a complimentary consultation, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

It is somewhere in between these two “extremes” that determining whether or not to insert breast implants may not be entirely obvious. This decision is also based on the facts that a mastopexy involves the removal of at minimum a small amount of breast tissue and compacts the volume of what remains, most women desire more volume at the upper part of their breasts (a push-up look) and most women would prefer to be a little bigger than a little smaller.

I have found that a vast majority of my patients who undergo a mastopexy also have a concurrent breast augmentation. Even a relatively small breast implant may create a firmer, fuller, rejuvenated appearance with improved cleavage that can be quite alluring.

For more information on a mastopexy, breast augmentation, breast implants or on any other plastic surgery procedure that I perform or to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

What are some of these reasons for its popularity? Having larger and more attractive breasts does provide women with a greater sense of confidence and assuredness, self-worth and an improved self image. In many ways they can further validate and enhance their femininity, attractiveness and allure all of which are important. Thus, the positive effects are a combination of physical, mental and emotional influences.

Most people nowadays seem to recognize the importance of the beneficial effects that breast enlargement has on women – and not from a self-serving perspective. I generally see husbands, boyfriends, family and friends being quite supportive for women considering this procedure – which is how it should be.

The following video is the heart felt testimony of a patient of mine that clearly expresses the positive impact that a breast augmentation has on a woman’s psyche, emotions and attitude and outlook:

If you want more information on breast augmentation or other procedures such as a breast lift or tummy tuck or to schedule a free consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

My unequivocal recommendation for anesthesia for a breast enlargement and what I use for all of my patients is general anesthesia administered by an anesthesiologist, a doctor specializing in this area. You simply go to sleep, wake up and remember nothing until after you have been in the recovery room for a while. No anxiety and no unpleasant experiences. Period!

An overwhelming majority of board certified Plastic Surgeons use general anesthesia when performing breast augmentations as well as breast lifts and breast revision surgery and do so in fully accredited facilities such as outpatient centers and hospitals. Your safety and the pleasantness of the experience are of utmost importance.

You also should be aware that many of the physicians either marketing or using a “twilight” anesthetic for their patients’ breast augmentations are not board certified plastic surgeons. More often than not, they may be an obstetrician-gynecologist, general surgeon, an internist or even a family practitioner. Compounding this quality and safety issue even further, they may have the anesthesia delivered either by a nurse anesthetist or by a standard nurse or
other office personnel under their direction.

Do you really want to risk your health, safety, well-being and results to maybe save some money – at least in the very short term?

I didn’t think so!

If you would like additional information on anesthesia and breast augmentations, breast lifts or breast revisions or on any other plastic surgery procedure that I perform or to schedule a free consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

My staff and I here at the Arizona Center for Aesthetic Breast Surgery have found and worked with several financing companies that do offer loans to qualified individuals for cosmetic surgery and procedures which could make your wish come true. Our patients have had the most success with CareCredit, myMedicalLoan.com and SurgeryLoans – and in that order. It has also been our experience that a rejection for a loan from one company doesn’t mean that you won’t be able to obtain one from another one. Some of our patients even obtain loans from more than one source.

How can you obtain information or apply for a loan? You can call my office to have your questions answered and even have us submit your application. Another option would be to go to the Financing page on my website, www.arizonabreast.com, and either click on the desired icon or call the listed toll free telephone number.

If you have some questions regarding financing your breast augmentation, breast lift or breast reduction or to schedule a free consultation with me, please contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

In the years that follow their breast augmentations, many women will have significant weight fluctuations or even permanent weight gains. Surely, there must be an effect on the breast size, appearance, etc. and there is. Even with sizable weight gains, persistence of good results can be possible. Pregnancy and breast feeding, on the other hand, can be quite detrimental to the elasticity of the skin as well as to the inherent density and volume of breast tissue resulting in drooping that may need to be addressed with a breast lift. However, with the presence of breast implants, significant volume and shape can still be maintained.

I have been fortunate enough to have seen many of my breast enlargement patients who had their surgery ten to twenty or more years previously. From this follow up, it is clear that a majority still have aesthetically pleasing improvements even despite marked weight gains. It should be pointed out that virtually all of the breast enlargements that I performed had the breast implants inserted in a submuscular pocket where there is better long term support against gravity. Implants that have been placed in a submammary pocket generally don’t do nearly as well over time because of the far greater drooping that will occur.

Before breast augmentation - front view

Before breast augmentation - side view

4 months after breast augmentation - frontal view

4 months after breast augmentation - side view

8 years after breast augmentation and 40 pound weight gain - frontal view

8 years after breast augmentation and 40 pound weight gain - side view

If you have additional questions regarding breast augmentation, breast implants or any other cosmetic surgery procedure that I perform or to schedule a complimentary consultation, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Fortunately, the solution to this problem is straightforward and long lasting: pursuing a breast reduction. With a significant decrease in the size and weight of the breasts along with their elevation and removal of excess skin, most if not all of the annoying symptoms can be alleviated. Then, all one would need when participating in vigorous activities is just one well fitting sports bra.

Many of my breast reduction patients over the years have told me that following their surgery, they were able to engage in sports symptom free which they could not do previously. This made them extremely thrilled. In addition, they also confided that it was much easier to lose their excess weight now because they could exercise more vigorously and comfortably.

For more information on breast reductions or any other plastic surgery procedure that I perform or to schedule a consultation with me, please contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona