I once had a license plate holder that said ‘All I want in life……… is an unfair advantage!”  Attractive breasts are like that.

Features that make breasts attractive are a complementary size (i.e. one that matches the body), an uplifted shape and symmetry.

Although our society is enamored with large breasts, there can definitely be too much of a good thing.  Breasts that range from cup size DD to Z can produce neck, shoulder and back pain, curvature of the spine and rashes under the breasts.

The solution is a breast reduction.  This procedure removes excess breast tissue and skin, producing C to D cup breasts that are lifted.  Because the nipple and areola are left attached to their blood, nerve and duct supply, sensation, erectility and even breastfeeding are maintained in most cases.  The price paid – scars around the areola, from the areola to the fold and across the fold under the breast. Covered by most insurance companies, I usually let the patient spend the night of surgery in the hospital.  I use a pain pump to eliminate most of the pain. This is a tiny tube I insert through the skin, deep into the breast where it infuses a local anesthetic numbing the nerves.

Breast reductions also need drainage tubes for one to two weeks to remove fluid that might build up in the breasts.  Cold packs for 5 to 7 days reduce bruising, swelling and discomfort. Most women can return to work three weeks after surgery.  The main regret women have after breast reduction surgery: that they didn’t do it sooner!

Some women with “normal” amounts of breast tissue complain about saggy “granny” breasts.  The good news is that they don’t need an implant, only repositioning of the nipple and areola and removal of excess skin.  Scars are similar to a breast reduction but usually considerably shorter.

The bad news is that insurance does not cover breast lifts.  Much less complicated than breast reduction surgery, I perform breast lifts in my fully accredited office surgical suite as an outpatient procedure.  More good news! Usually no drains or pain pumps are needed and recovery is about half as long as breast reductions.

Women whose breasts are too small for their physique usually benefit from breast implants.  Silicone gel filled implants are now FDA approved and available for augmentation. They do have a more natural “squeeze” than saline implants.  Although studies have shown that silicone implants do not cause auto-immune illnesses, I do believe that rupture of a silicone implant can potentially expose the body to a “toxic dose” of silicone, causing illness.

Therefore, I prefer saline implants.  If they rupture, no worries – it’s only salt and water.  I also like the tiny incisions (1 ½ inches) along the border of the areola I use to insert the deflated implant.  I inflate the implant with a removable fill tube once it is in the pocket. Although not as natural feeling as silicone, I place the saline implants deep under the breast tissues and pectoral muscles so that they are covered with natural-feeling tissue.  I have even had patients tell me that their gynecologists couldn’t tell they had saline implants!

A few good and bad points. First, implants have never been found to increase the risk of breast cancer.  My placement of the implants under the muscles makes mammography easier and more accurate.  Second, the average life expectancy of a breast implant is ten years. Therefore, women with implants need to expect a re-operation approximately every ten years.  Next, breast augmentations are not covered by insurance. To keep costs down, I perform these procedures in my office surgical suite under general anesthesia, using a certified registered nurse anesthetist with over 30 years experience.  I use the pain pump to keep my patients smiling. A two week recovery is all that is required for normal work and three weeks for heavy physical work.

Asymmetries of the breasts can often be corrected by “mixing and matching” the above procedures.  For example, a large sagging breast on one side can be reduced while the opposite smaller, sagging breast can be lifted and augmented with an implant.

The more distant future is very exciting with the possibility of augmenting small breasts using 100% natural breast tissue from stem cells.  I hope to see you there.

From my H-Art,

Yale M. Kadesky, M.D.