Absolutely the most talented Plastic Surgeon and I ever worked with. An artist at heart, Dr. D can turn back time with his surgical abilities. His work is remarkably natural and exceptionally noticeable.
Breast Reduction Aventura
Are you feeling like your breasts are too heavy or too big? Are you always trying to hide them with minimizing bras and clothing? Breast Reduction can get rid of that “too big” complex and give you the young, “proportional to your body” breasts you always wanted. Using the anchor incisions to remove breast tissue, skin and fat will produce breasts that’s are lifted and proportioned to your body. Smaller, tighter, lifted breasts and with areolas that point forward instead of down. Now, that is what you have been waiting for, right? Back pain is often aggravated or caused by large breast too. This operation can help.
Every patient is unique and requires individual evaluation by Dr. DiGeronimo. This is a highly individualized procedure, a breast reduction may be the right choice, if you:
- Are physically and psychologically healthy
- Have realistic expectations of the procedure
- Have breasts that are fully developed
- Are unhappy with having overly large breasts
- Have physical or emotional discomfort resulting from overly large breasts
- Have breasts that are asymmetrical
Location Of The Incision
Depending on the extent of the reduction needed, there are different options for incision placement:
- Periareolar Incision – a circular pattern around the areola.
- Keyhole Incision – around the areola with two incisions vertically down to the breast crease.
- Anchor Incision – around the areola, vertically down to the breast crease, and horizontally across the inframammary fold.
Breast reduction is performed under general anesthesia. After the incision is made, the breast tissue is lifted, reshaped, and held in place with sutures. Excess tissue and skin are removed, and the incisions are brought together to produce a smaller breast. Liposuction may also be used in conjunction with this procedure to remove tissue from the sides of the breasts. In some cases, liposuction may be used as the sole method for scarless breast reduction if excess skin does not need to be removed.
A breast reduction may involve nipple and areola repositioning to a higher location if skin above the nipple is reduced. In cases of extremely large breasts, the nipple and areola may need to be transferred as a skin graft to the new position. In addition, if a nipple reduction is also desired, excess skin at the perimeter of the areola may be excised.
As with all surgical procedures, there runs a risk of complications durning and after a procedure. The risk for breast surgery include, but are not limited to, infections,changes in nipple or breast sensation, bleeding, poor wound healing, breast asymmetry, problems with breastfeeding, and fat necrosis.
As with any surgery, depending on the patient; the breast reduction recovery time could vary and is a gradual process. The typical patient with encounter some pain and discomfort for two to three days following surgery. Although there will be prescribed pain medication to relieve the pain if necessary. Depending on what the patient’s occupation may be, they may be able to return to work in about a weeks time after surgery. Also, regarding exercise patients may be able to resume their workout routines within one to two weeks, but it must include non-impact lower body exercises. Following that, in about four to six weeks patients can fully return to their normal exercise routine.
The breast reduction procedure will result in smaller, more youthful looking breasts that will be instantly visible after the swelling and bruising subside. At first, scarring may appear predominantly noticeable but they will fade with time if tended to properly. After patients go through with this procedure their confidence tends to escalate due to feeling more comfortable with their breast knowing that their breast is a bit more lifted and more in proportion to the rest of their body. For this procedure results will be long-lasting and will be relieved from physical pains or limitations caused by their previous breast size.
General Facts Regarding Breast Reduction and Breast Lift (Mastopexy) Surgery
Breast reduction and breast lift procedures are designed to reshape the breast and reposition the nipple on the breast.
It must be realized that in contrast to a breast augmentation (enlargement) which is generally associated with a smaller and easier hidden scar, that the breast reduction and breast lift procedures generally have MUCH MORE VISIBLE, OBVIOUS AND EXTENSIVE SCARS.
Routinely the scars for the breast reduction or breast lift extend in three basic areas. (1) Entirely around the areola (the pigmented area around the nipple). (2) From the areola in a vertical direction down to the fold or crease under the breast. (3) Along the area of the fold or crease under the breast extending for a variable length and possible as long as from the midline of the chest to the side of the chest under the arm. In selected cases in which a minimal breast lift or mastopexy is performed, there may be times when only a peri-areolar (pigmented area around the nipple) incision is indicated. This may or may not leave “pleating” of the skin in which in most instances will resolve with time, but may require revision at a later time.
Each individual’s needs vary and your specific surgical technique will be discussed in full with Dr. DiGeronimo.
Generally, the greater the reduction or the greater the amount of “lifting” needed, the longer will be the horizontal portion of the scar. This is the portion in the fold under the breast that extends from the middle of the chest area to the side of the chest areas under the arm. It is very important to realize that the breast area generally does not heal with a very fine or nearly invisible scar; rather, the breast scars around the areola down from the areola to the crease under the breast and in the area of the crease under the breast generally heal with a visible noticeable scar.
Of course, every effort is made to reduce the amount of scarring present, but even with the finest of plastic surgical techniques, these scars often do not heal as well as the patient (or plastic surgeon) would like or hope. In addition to the scar being very visible, these scars can also on occasion cause significant discomfort, itching and even pain or burning sensations. Various treatment and scar revisions can be employed following the surgery to try to further improve the appearance or reduce the symptoms of these scars, but all of these treatments and possible revisions have definite limitations, further risks, possible complications and degrees of unpredictability.
Most often these procedures are accomplished by reshaping the breast around the attached nipple. In certain rather cases, usually with extremely larger breasts, the nipple-areola complex may have to be completely detached from the breast and re-attached (grafted).
In conclusion, patients proceeding with a standard breast reduction or breast lift procedure may expect obvious and noticeable scars in the area around the areola (pigmented area around the nipple), down from the areola to the crease under the breast and horizontally in the area under the breast from the central chest area to the side of the chest area under the arm.
Patients proceeding with a peri-areolar breast lift (mastopexy) may expect obvious and noticeable scars around the areola only. These may include “pleating” of the skin.
Due to the inexact nature of skin and wound healing and the unpredictability of individual patient’s response to surgery, in some instances wide, thickened or elevated scars are also possible with any incision. These scars can also be painful.
In selected cases of Mastopexy (breast lift) surgery, a saline prosthesis, is used in breast augmentation (enlargement) is implanted in order to enhance the shape of the breast. In these cases, all potential risks and complications associated with breast augmentation (enlargement) surgery will apply. In this instance, patients will be given information, instructions and consents for breast augmentation surgery as well as information, instructions and consents for mastopexy (breast lift) surgery.
Any patient proceeding with these procedures must realize that these are major surgical operations with inherent risks and possible complications. These are various types of anesthesia that may also be employed.
General anesthesia is most often used for breast reductions and breast lift (mastopexy) procedures.
These procedures are done in a hospital operating room or outpatient surgical facility under general anesthesia administered by a D.O./M.D. Anesthesiologist or nurse anesthetist (CRNA) under the supervision of a D.O./M.D. Anesthesiologist.
There are certain specific problems that can develop following breast reduction or breast lift surgeries. Some of the specific possible problems include numbness or abnormal sensations or even pain in the nipple or breast area. As previously discussed, obvious, very noticeable and sometimes even painful scars and keloids can develop following this surgery. Quite often women’s breasts are not symmetrical to begin with. Although every effort will be made to make the breasts as symmetrical as possible, asymmetry in the size and shape of the breasts as well as in the nipple location can occur. Palpable masses or areas of hardness within the breast can also occur.
An unlikely, but potential complication, is complete nipple-areola loss which would require reconstruction or rebuilding of the nipple-areola complex which would result in delayed healing as well as further surgery, risk and expense.
It must also be realized and accepted that there is as strong a likelihood that reduction patients will be unable to breast feed following breast reduction surgery.
It must also be realized that there are possible risks associated with all forms of anesthesia and medications ranging from very mild to very severe or even fatal.
All of the above considerations must be fully understood prior to any patient proceeding with any of these procedures.
To Prepare for Surgery
1. Every patient must have a written medical clearance from his/her family physician with the following:
a) a history and physical and a letter stating that he/she is in good physical condition and able to undergo the surgery.
c) Electrocardiogram if you are forty years of age or older or have cardiac problems
d) Mammogram if requested by physician:
2. Do not take any aspirin or medications that contain aspirin, Advil, Motrin, Ibuprofen or Vitamin E for two weeks prior to surgery and for two weeks following surgery. Tylenol or Extra Strength Tylenol may be taken as needed. Please refer to the list available from the office of aspirin related products to make sure you avoid them for at least two weeks prior to surgery.
3. Patients who smoke must refrain from doing so for at least two weeks prior to surgery and two weeks following surgery. Smoking will increase the risks and possible complications associates with surgery, healing and with anesthesia.
4. If you take any medications such as for your heart or high blood pressure pills, diabetes medication, birth control pills, etc., please be sure to discuss these with Dr. DiGeronimo. You will be given special instructions regarding the taking of these medications prior to the surgery. If you are going to a recovery facility following the surgery, bring all the medications with you on the day of surgery.
5. At least two weeks prior to surgery you may begin taking 1000 mg of Vitamin C, 50mg of Zinc, 200 mg of Bromelain and a multi-vitamin with NO Vitamin E on a daily basis. These are optional.
6. In addition to your prescribed medications, please purchase sterile 4X4 gauge sponges.
7. Carefully shave under the arms 48 hours prior to surgery. If there are any long hairs in the area of the nipples, carefully slip them with a small scissor. DO NOT SHAVE OR PLUCK THEM.
8. On the night before the surgery be certain to take all medications that you have been instructed to take such as antibiotics.
9. On the night before surgery take a shower and wash your hair. Carefully wash your chest, arms, shoulders and underarms. This should be repeated on the morning of surgery. Do not use deodorant or skin lotions after you shower.
10. DO NOT HAVE ANYTHING TO EAT OR DRINK INCLUDING WATER after midnight the night before the surgery unless otherwise instructed by Dr. DiGeronimo.
11. If you are not returning home following the surgery, bring with you an overnight bag in which you have changes of underwear, a fresh robe which opens all the way down the front or pajamas which open all the way down the front, slippers without heels, toiletries and ALL MEDICATIONS.
12. Please be sure to provide the office with the name of someone to contact if necessary. If you are not going to a recovery facility or are not staying overnight in the hospital, please make arrangements to have a responsible adult drive you to and from the surgery and spend at least the first night with you.
The Day of the Surgery
1. As previously stated, shower the morning of the surgery.
2. Brush your teeth (using a very small amount of water) and use a mouthwash on the morning of surgery.
3. Do not wear any makeup, hair spray, jewelry, pantyhose or stockings on the morning of surgery. Leave all valuables at home.
4. Please be prompt. Please be sure you have followed all the instructions. Preparations will begin when you arrive.
5. When you arrive for surgery, you will change into a gown. An Intravenous line will then be started in your arm and you may be given some medications through the intravenous line. Dr. DiGeronimo will generally make some marks on your chest with a felt tipped marker prior to the surgery prior to your being brought into the operating area.
6. Surgery time varies with each patient. Please inform your family and friends that you will be with us for several hours.
After the Surgery
1. After the surgery is completed you will have a dressing in place under a surgical bra. If you have undergone breast lift surgery (mastopexy) with implants there will be an ace bandage or elastic Velcro type dressing in place. Do not remove these dressings. The dressing will generally be changed the day following the surgery.
2. You are to go home or to a recovery center (Breast reduction patients will generally remain in the hospital for an overnight stay) and remain in bed with your head and shoulders elevated on two or three pillows with bathroom privileges with assistance. Continue to sleep with your head and shoulders elevated for one week following the surgery. Elevating the mattress at the head of the bed with two pillows placed under the mattress can also be helpful. This, of course, should be done prior to the surgery or by someone other than the patient following the surgery.
3. Remain as quiet as possible for the first 48 hours following the surgery.
4. Take all prescribed medications.
5. You may have moderate amounts of liquids and soft foods as desired and tolerated the first night following the surgery. The following day you may resume a normal diet. No alcohol for period of seven days following the surgery.
6. If you have undergone breast lift surgery (mastopexy) with implants, ARM MOTION IS TO BE COMPLETELY RESTRICTED. DO NOT EXTEND YOUR ARMS ABOVE THE SHOULDER LEVEL. DO NOT LIFT. DO NOT PUSH. DO NOT PULL. DO NOT REACH. DO NOT BRACE YOUR ARMS WHEN GETTING OUR OF A CHAIR OR BED.
7. If you have undergone breast reduction or breast lift (mastopexy) surgery without implants, DO NOT EXTEND YOUR ARMS ABOVE THE SHOULDER LEVEL, DO NOT PUSH. DO NOT PULL. DO NOT REACH. NO HEAVY LIFTING.
8. Wear clothing that fully opens down the front for the first two weeks following surgery.
9. With this type of surgery, it is not unusual to have seepage which will soil your dressings. In some cases, the seepage will soak through the dressing requiring you to change or reinforce your dressings at home. This can be accomplished by unfastening your surgical bra and carefully removing the excessively soiled dressings and replacing them with sterile 4X4 gauze squares or a similar type dressing.
10. In this type of surgery, it is also not unusual to experience uneven healing along the incision lines which may require home care in the form of peroxide and daily dressing changes.
11. Avoid the sun and heat until after the swelling and bruising have subsided. You should avoid hot showers or baths during the first two weeks following surgery. Increasing the temperature of the chest and breast area can cause blood vessels to dilate and may increase the chances of bleeding, bruising and swelling. You must avoid direct sun exposure to any scars or incision area from the surgery. Sun exposure may make scars darker and more obvious following the surgery.
12. You may experience some swelling, tingling, itching and numbness of the breasts or nipples and various other parts of the chest, shoulders and arms. This may last for a variable length of time. These generally subside gradually, although some numbness, tingling, and itching may remain on a permanent basis. Complete healing takes approximately 12 months.
13. Report any sudden increase in pain or size of breast immediately at any time. Moderate and gradual lessening in pain and swelling are normal and are to be expected following this surgery.
14. If you have the trans axillary approach (incision under the arm) you should avoid shaving your arms and the use of underarm deodorants until all of the stitches have been removed.
15. In both reduction mammoplasty and breast lift (mastopexy) surgery the sutures are generally removed in seven to ten days.
16. No under wire bra should be worn for at least 12 weeks following the surgery.
17. Generally, the following instructions apply. However, there may be exceptions from individual to individual. Discretion should be used in following these instructions. Do not push yourself. Let comfort be your guide as to how fast you progress. “IF IT HURTS, DON’T DO IT.”
A. AFTER ONE WEEK YOU MAY:
1. Drive a car with an automatic transmission.
2. Do light cooking.
3. Take a shower after the dressing is removed making sure the water is luke warm and not hot.
4. Use underarm deodorant (unless underarm incision was used).
B. AFTER TWO WEEKS YOU MAY:
1. Indulge in limited sexual activities.
C. AFTER THREE WEEKS YOU MAY:
1. Wash and set your hair (Prior to this time you may have someone else wash and set your hair)
D. AFTER ONE MONTH YOU MAY:
1. Do light exercising. NO STRENUOUS BIKE RIDING, GOLF, TENNIS, JOGGING OR HIGH IMPACT AEROBICS.
2. Indulge in normal sexual activities
3. Sun bathe with incisions covered with a bandage or with the use of #30 sun block.
E. AFTER TWO MONTHS YOU MAY:
1. Indulge in heavy exercise and sports
2. Do heavy housework
3. Take a sauna or steam bath
After a three-month period following surgery, you may purchase any type of bra you wish. Under wire bras are not recommended for daily use. If you have undergone breast lift surgery (mastopexy) with implants, remember – your breasts have added weight, support is necessary to prevent sagging. This does not mean that you cannot go braless on occasion, but support is recommended for the majority of the time.