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  • Plastic Surgery at Rhode Island Hospital

  • Breast Reconstruction

  • Plastic surgery services include aesthetic breast reconstruction, both for patients who have undergone trauma to the breast area, including mastectomy, and for patients who request services for purely cosmetic reasons. Surgeons employ a wide range of techniques, ranging from breast tissue expansion to tissue transfer.

    Augmentation

    Breast enlargement or augmentation is a surgical procedure to make the breasts appear larger and fuller. It can be pursued for a variety of patients, including those with underdeveloped breasts, those whose breasts have decreased due to pregnancy, breast-feeding, or weight loss, and those who simply want fuller and larger breasts. Breast augmentation can be accompanied by a Breast Lift to create more lift in the nipple and areola.

    The surgery consists of making an incision and lifting the breast tissue and placing an envelope containing a soft, natural feeling implant material underneath. The implant most often used for augmentation is made of a silicone rubber sack, which is filled with a saline solution. There are a variety of implant designs, and the surgeon will select the best design based upon the patient's needs.

    Breast augmentation generally takes one to hours. Surgery is generally performed in the office operatory and the patient returns home the same day. Local anesthesia with sedative is typically recommended.

    Please note: There has been a great deal of media attention about possible complications associated with breast implants. We will discuss these issues and other information during a consultation. Another good source of information on this is the "Food and Drug Administration Information for Women Considering Saline-Filled Breast Implants"- courtesy of McGhan Medical Corporation and the FDA. To obtain a copy contact the McGhan Medical Corporation, FDA. Consumer Information Line at 1-800-532-4440.

    Gynecomastia

    Gynecomastia is the medical term for the development of enlarged breasts on men. Although rarely discussed, gynecomastia affects roughly 40 to 60 percent of the male population. Symptoms range from excess breast and fatty tissues to development of female glands. There is no known cause, but there are various triggers. Gynecomastia can develop in adolescence resulting from hormonal changes and certain drug, diet and lifestyle stimulated hormonal modifications. Anabolic steroids, increased age and weight are able to contribute to developing the excess breast and fatty tissues. It should be noted that changes in lifestyle and diet may reverse conditions and 90% of adolescents who experience gynecomastia will note conditions disappear within one to two months. The only other option for correction is surgery.

    During the gynecomastia procedure, the surgeon will make a small incision just below the areola through which liposuction is used to remove fat and excess breast tissue. Following surgery, a compression garment or ace bandages should be worn to support recovering breasts.

    Gynecomastia is normally performed in a doctor's office or surgical suite and is an outpatient procedure. A local or general anesthetic is utilized. Recovery time is normally between 1 to 3 weeks with the patient advised to ease back into normal activities.

    Mastopexy (Breast Lift)

    The breast lift, also known as mastopexy, is performed to address the sagging or drooping of breasts. Sagging and drooping occurs when the skin envelope has become larger than the contents of the breast, either because the skin has stretched or because the breast tissue has shrunk, or both. Patients seeking to lift the breast up can either increase the size of the breast volume or decrease the size of the skin. In some cases, a combination of these techniques gives the best results. Breast lifts can be performed at the same time as Breast Augmentation.

    Surgery for a breast lift removes excess skin from around the areola, and sometimes also from the bottom of the breast. The skin is then shifted and tightened. Additional volume is created by inserting an implant to reposition the nipple and areola in an elevated position.

    A breast lift procedure generally takes anywhere from two to five hours, depending upon the combination of techniques used. Breast lifts may be performed in a surgical facility and patients often return home the same day.

    Reconstruction

    Reconstruction of a breast that has been removed due to cancer or other disease is one of the most rewarding surgical procedures available today. New medical techniques and devices have made it possible for surgeons to create a breast that can come close in form and appearance to matching a natural breast. Frequently, reconstruction is possible immediately following breast removal (mastectomy).

    Some women prefer to have the reconstructive surgery immediately following the mastectomy to spare the experience of seeing themselves with no breast at all. Others are overwhelmed with the diagnosis of cancer and the surgery for breast removal, and choose to wait until after the mastectomy has been performed. Some women with other health conditions, such as obesity, high blood pressure, or smoking, may also be advised to wait. In most cases, health insurance policies will cover most or all of the cost of post-mastectomy reconstruction.

    There are many options available in post-mastectomy reconstruction, including:

    Skin Expansion

    The most common technique combines skin expansion and subsequent insertion of an implant. Following mastectomy, the surgeon inserts a balloon expander beneath the skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, the doctor periodically injects a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has stretched enough, the expander may be removed in a second operation and a more permanent implant will be inserted. The nipple and areola are reconstructed in a subsequent procedure.

    Flap Reconstruction

    An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks. In one type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of the skin, fat, and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast itself. Another flap technique uses tissue that is surgically removed from the abdomen, thighs, or buttocks and then transplanted to the chest by reconnecting the blood vessels to new ones in that region.

    Breast reconstruction usually involves more than one operation. The first stage, whether done at the same time as the mastectomy or later on, is usually performed in a hospital under general anesthesia. Follow-up procedures may also be done in the hospital, or, depending on the extent of surgery required, it may be done in an outpatient facility under local anesthesia.

    Reduction

    Breast reduction is performed on women who seek to minimize the excessive weight and strain associated with large, heavy breasts. Breast reduction consists of removing excess breast tissue and reshaping and lifting the breast. The surgery is designed to reduce the weight of the breasts to make it easier to be active. Because of the functional problems associated with abnormally large breasts, insurance will often cover some of the costs associated with the surgery.

    The breast reduction surgery generally takes about three hours and can be performed in the hospital under general anesthesia. Most patients can return home after the operation. Recovery is quite easy, with some soreness after surgery. Normal activities can usually be resumed within a few days.

    The risks associated with breast reductions are not unlike risks associated with any surgery, including the risk of bleeding, allergy to the anesthetic, and infection. Patients are less likely to experience these if they carefully follow the recovery plan.

    The surgical incision for this surgery is quite extensive, resulting in considerable scarring. Scars remain pink or brown for several months. They can, however, be hidden by most traditional bathing suits.

    Innovative Research

    Plastic surgery research at Rhode Island Hospital focuses on developing innovative techniques for breast reconstruction and improving on existing techniques. Researchers, led by former Rhode Island Hospital plastic surgery chief Armand Versaci, MD, have made pioneering discoveries in the area of tissue expansion.

    Have questions? Find out more information

    For more information about plastic surgery services please call 401-444-4188.