Mommy Makeover Season 1: Episode 6

Types of Mastopexy

There are two major different types of Mastopexy. (Breast Lift) The first one is a skin only mastopexy which is able to remove excess skin and lift some of the tissue. This is only appropriate when the amount of breast tissue is minimal and the main problem is the excess skin. The more common case is when the whole breast itself needs to be lifted by re-shaping and repositioning. Especially if the breast is larger in size. These two surgeries are substantially different.

A Major mastopexy takes longer to perform and is more risky. It is more likely to harm nerves and blood vessels. The blood flow to the nipple has to be considered in these cases to keep it safe and prevent necrosis. If the measurement from the inframammary crease to the nipple, is greater than 15 cm then a free nipple graft should be considered. This allows for a more powerful reshaping of the breast to be performed. The following are some examples of skin only Mastopexy‘s versus a Major Mastopexy.

Next week we will show discuss free nipple graft in in more detail..


Mommy Makeover: Season 1 Episode 5

Breast Lift

So far we have focused on the nipple and its Postpartum changes. The same changes that affect the nipple may affect the entire breast.  Sometimes, breast size will increase 2 or 3 cup sizes during pregnancy.  Most of the time this excess volume, and even some of the original breast tissue will disappear after breastfeeding.  This is called “involutional hypomastia.  Often the remaining skin and nipple drops below its original position. The following is an example:

One of the most common questions that I get in regards to Mommy Makeovers is, “Will I look good with implants alone or do I need a lift”

A good rule of thumb is that if the nipple has descended beneath the inframammary crease, then a lift will be necessary.  Sometimes, subtle differences between people’s breasts can make it so that one person may be able to look good with implants alone and another may need a lift.

Am I a Good Candidate?

One of the big considerations when deciding whether or not to do a mastopexy (which is just another name for a Breast Lift) is the age of the patient and their history of scarring. Younger patients with a history of hypertrophic or keloid scars are not good candidates for breast lifts.  Older patients typically heal more slowly with scars that are thinner and less noticeable, due to their immune systems not being quite as vigorous as a younger person. 

Also, when somebody is greater than 40 years of age, the aesthetic quality and shape of the breasts may have deteriorated to the point where the improvement in shape is worth the scars. Whereas, a younger person may have experienced some negative changes to the shape of appearance of their breast from the pregnancy but it’s not bad enough to justify the scars.

I believe that in order for a mastopexy to be worth it, the end result has to be better, not just different.  In other words if we get the shape perfect and the scars are excessive, then the surgery may not be worth it.  A slightly imperfect breast with implants alone may still look better than the scars of a Mastopexy. 

Next time we will discuss the different types of Mastopexy. 


Mommy Makeover: Season 1 Episode 4

Changing the Position of the Areola

Last time we discussed making the areola smaller and more round. Today I will discuss 2 major techniques for moving the nipples. After pregnancy, if the breast becomes deflated and sags then the nipple can be repositioned higher with a technique that is similar to the one previously described. An oval is drawn around the inner circle that is marked. As these patterns are brought together the nipple will move up to 3 cm in the direction that the oval is oriented. The following is the markings of the pattern described and a one week result in a patient that I performed it on.

   

Free Nipple Graft

If during pregnancy the breast increases massively in size and never returns to normal the nipple may need to move so far that it can’t be done without detaching it. This is called a free nipple graft. The nipple areola are marked with the cookie cutter and the nipple is removed with a scalpel. Next the nipple is thinned to the perfect thickness and it is sewn back on in a spot that has been deepithelialized in a shape that matches. The following is an example of nipples that have been removed and thinned.

Patients are warned that sensation will be lost after this technique. However, some patients have told me that it eventually did come back for them.


Mommy Makeover: Season 1 Episode 3

The Areola

We have discussed altering the shape and size of the center of the nipple. Today’s discussion will focus on the areola. When we refer to the nipple in common speech it includes the areola. However, for surgical treatment, we tend to focus on the nipple as that central portion of the breast that protrudes above the level of the skin. The rest of the nipple is the darker, larger, flat area around the base of the nipple referred to as the areola. There really is no "normal" for its size and color. We rely on the “eye of the beholder” to decide what the best sized nipple is for each breast.

As surgeons we use “cookie cutters” to outline the center of the areola when we are making surgical alterations. The above is a photo of a couple of those circular tools. They come in all sizes but a rule of thumb is that a 38-40 mm areola looks good on a B-C cup breast, 40-42mm looks right for a breast in the D cup range. A breast that is DD or larger may require a 45mm areola or bigger. Most of the time people getting plastic surgery for their breasts have an A-B cup and are looking to be bigger or a DD or bigger and are looking to be smaller. Therefore most of the time an areola that is 38-42mm in diameter is used.

The mark that is made with the cookie cutter is the new outside of the nipple. All of the extra pigmented skin around this is then removed. A “purse string” suture is used to pull the two circles together as seen below.

This is the technique that is used to reduce the size of the areola and make it a perfect circle. Next time I will discuss one of the 2 different ways of moving the nipple to a new spot.


Mommy Makeover: Season 1 Episode 2

Nipple Inversion

With pregnancy and breast-feeding sometimes the opposite of enlarged nipples can happen. This is termed “inverted nipples.” This happens when the ducts of the breast do not stretch to keep up with the breast growth. Oftentimes, this becomes a permanent problem especially if the breast does not return to its original size.

There is a simple solution for this. After breast-feeding is finished, the nipple can be recovered by dividing the ducts.

Step 1

                           

This office procedure involves numbing the nipple first with ointment and then with an injection. If this is done with patience there is no pain involved.

Step 2

After the nipple is numb an 11 blade scalpel is used to divide the ducts.

Step 3

Then a device is used to hold the nipple in its new position so that it will heal properly. When done correctly the new appearance of the nipple will be maintained long term.

After the procedure it is possible for normal sensation to return. However, sometimes nerves are injured and sensation may be reduced. After this procedure it will not be possible to breastfeed again. If an unplanned pregnancy occurs then when the milk comes in it will go away similar to when you quit breastfeeding as there is no outlet for the milk.

Next episode we will talk more about changes to the nipple from pregnancy. Specifically the size shape and color of the areola and what can be done to improve it.


Multi-Part Series: Mommy Makeover Season 1 Episode 1

👋 Dr. Bruggeman here.  I will be writing all the content for this blog myself.  This will give me a chance to offer mini-consults through the internet. There will be photos involved so that you can compare the things discussed here to yourself or someone you know.  All of the photos are mine unless otherwise specified.  There’s no substitute for an in person consult but this will be an effective way to help you decide if a consult is worth it.

What is a Mommy Makeover?

I’ll begin with a multi-part series that covers Mommy Makeover . A mommy makeover can be a confusing term because it covers a lot of different things.  Basically the term applies to the correction of any of the negative changes that happen to your body after having a baby.  Mostly this involves the change in size and or drooping of the breasts.  Another major body area of concern is the abdomen.  It experiences a lot negative effects from the increase in overall size and stretching of the skin.  Also, with childbearing there is weight gain that is healthy for you, and the baby as well, but sometimes it can be difficult to lose the unwanted weight after pregnancy.  These areas are often good targets for liposuction and skin tightening modalities.

Starting From the Top Down- The Nipple

Let’s start from the top down.  Today’s topic will begin with the nipple.  It is usually positioned on the top and in the center of the breast.  It may be the first thing that is noticed when you look at your breast.  With breast feeding the nipple can change.  It may change positions, usually to a lower part of the breast, this contributes to the droopy appearance referred to as “ptosis.”  Also, the size of the areola and the nipple itself can change.  If the nipple maintains a disproportionately large size after the breast’s volume has gone away it can be fixed.  Often times the size or shape off the nipple is a topic that gets overlooked in consults because patients may not be aware that anything can be done safely, or the doctor may assume that if the patient doesn’t bring it up then they must be happy with it.

 

The above photos are examples of enlarged nipples that detract from the overall aesthetic appearance of the breast.  The procedure used to reduce the height of the nipple is safe and can be done in the office with local anesthetic.  As you can see here nothing is amputated and no nerves or ducts are severed, because the reduction comes from excising the excess skin around the nipple.  Sutures are placed to bring the height of the nipple down. Any size can be selected for your desired end result.

                             

Here are examples of two different heights resulting from the same procedure.  The sutures are left in place for 1-2 weeks.  The sensation and the ability to breast feed in the future remain intact.

Season 1 Episode 2- COMING SOON!