Getting a Lift

New innovations improve breast reconstruction results

Whether you’re looking for implants after a mastectomy or have decided to improve what you were born with, you have more options for plastic surgery for the girls, thanks to innovations and new research.

“We’ve made tremendous strides in reconstructive surgery for patients who have to have mastectomy,” says Dr. Jonathan S. Jacobs of Associates in Plastic Surgery in Virginia Beach.

As for elective surgery, “This is a beach community,” Jacobs says. “It’s a common operation here. We’ve seen a tremendous increase in the number of breast surgeries, making breasts larger and fixing drooping breasts.” Most women want to go up a little over one cup size, to a C cup at least, he says.

In the last five or six years, plastic surgeons have been using a product called dermal matrix, sometimes made from cow or pig tissue, that closely resembles the tissue into which it’s implanted, Jacobs says. “We can use it for additional cover for the implants—it makes them look and feel much more natural,” he says.

For mastectomy patients, surgeons also can now begin reconstructive surgery during the same surgery when the breast is removed, Jacobs says. The surgeon can insert a device called a tissue expander to stretch the remaining skin of the chest to a size and position appropriate for what will become the patient’s new breast, he says.

That eliminates one surgery and anesthesia with all the associated risks of any operation, he says. Beginning the process right away also helps long-term results because no scarring has taken place yet, Jacobs says.

The next two stages of breast reconstruction are relatively simple, he says, replacing the tissue expander with an implant and then an outpatient procedure to add a nipple. For women who have always dreamed of being a cup size or two larger, there are more options today also. From 1993 to 2007, only saline implants were available for elective plastic surgery for breasts, Jacobs says.

The concern for a while was that gel implants leaked a miniscule amount after a long time, he says. “The material was tested and found to be innocuous,” he says. “There was never any indication that gel implants caused cancer.” So gel implants are once again available.

Here are the key considerations, Jacobs says. Gel implants are smoother, will not defl ate and have a lifetime warranty. But after a long time, there will be microscopic amounts of leakage. And, some data indicates that scars may be more likely to form around gel implants, Jacobs says.

Saline implants can’t be fi lled tightly enough to avoid wrinkles, especially in very thin women, he says. Second, the warranty is for only about 10 years. After that, the saline solution could leak out and the woman will have to have another operation to fix it, he says.

Gel implants also cost twice as much as saline implants, he says. The most satisfied patients might surprise you, though.

“Breast reduction patients, the ones that have been burdened with that problem, are typically the happiest people we take care of,” Jacobs says.

Medical insurance usually covers this procedure because heavy breasts can cause shoulder-grooving (where the bra straps are), breakdown of the skin under the breasts and back pain. “If five pounds of breast tissue is taken off the shoulders and neck, that’s a tremendous amount of reduction,” he says.

Again, many women are looking to be a C cup—but the reduction patients are heading for a C from a DD, F, G or custom bra, Jacobs says.

He’s performed reduction surgery on females ranging from 14 to 75.

“Girls who wish to be active in athletics are embarrassed by this,” he says. “They can’t perform at the same level. It’s not fair to tell a child they can’t have that fixed.”

If the girl continues to grow, the operation may have to be repeated later, he says.

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