Many women feel uncomfortable with the size and shape of their breasts, which can affect body confidence and self-esteem.

Small or unevenly sized breasts can be enhanced and give women a fuller and better-proportioned look to make them feel more confident.Large breasts can cause a strain on the back and breasts that have lost elasticity can sag and feel uncomfortable. Breast surgery is one the most frequently performed cosmetic procedures to enhance breast size, restore a youthful breast position, or alleviate the discomfort associated with large breasts.It is also performed to help women who have significant dissatisfaction, complications or abnormal-looking breasts as the results of a previous surgery.

Dr. Paolo Montemurro is a world-renowned cosmetic breast surgeon and is regarded as an industry leader in breast augmentation and revision surgery. He is continually called upon to deliver educational programs at international training courses and conducts master-class workshops in surgical approaches and techniques.

Dr Montemurro is the author of numerous scientific publications in the field of breast surgery and has built his reputation on creating customized, tailored and natural-looking results.

Breast augmentation

The breasts have always been a symbol of femininity and each culture has its own ideal image of the female figure. Breast augmentation (also known as augmentation mammoplasty or colloquially known as “boob job”) is surgery to increase the size and change the shape of breasts that are naturally small. It can also restore breast volume lost after weight reduction or pregnancy, or improve breast size asymmetry. Cosmetic breast augmentation is one of the most popular plastic surgery procedures performed today, it involves placing silicone implants inside the breasts. For some women, it is a way to feel more confident. For others, it’s part of rebuilding the breast for various conditions. Many women want their breasts enlarged because they know it would make them feel more self-confident, more attractive, and will make them fit into clothes better. However, just like other types of cosmetic surgical procedures, breast augmentation also has certain limitations the primary of which is its inability to correct severely drooping breasts. A breast lift (mastopexy) may be required along with a breast augmentation for sagging breasts to look fuller and lifted.

The procedure is performed under general anesthesia in an outpatient surgical center and patients are able to go home the same day as the procedure. After making a short incision in the crease under the breast, the surgeon creates a pocket either behind or in front of the outermost muscle of the chest wall (pectoral muscle).

The implant is then inserted into this pocket and centered behind the nipple. After the breast implant is placed, the cut is carefully closed with absorbable stitches that will dissolve on their own. No drains are used.

Most patients report moderate pain during the first couple of days and a sensation of chest tightness. Pain medications are prescribed by the surgeon, soreness and swelling are likely to last for a few weeks after surgery. During the healing process, a sport bra needs to be worn for extra support and positioning of the breast implants. It is important to carefully follow instructions about returning to regular activities. Most patients feel well enough to return to work within a week if they don´t have a physically demanding job.

Strenuous activities (anything that could raise pulse or blood pressure), lifting or carrying heavy purses or bags must be avoided for at least three weeks. During the first few months the breasts will be sensitive to physical contact or jarring movements. After a 3 month long period, most of the swelling disappears, breasts become softer and start to look more natural. The surgical scars of a breast augmentation heal at 6-weeks post-operative, and fade within several months, according to the skin type of the woman.

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Natural results

There was a time when it was possible to spot a breast augmentation from across a room because the majority of implants were very large and conspicuously coconut shaped. But these days, more and more women are requesting breast enhancement that mimics natural breasts, and are concerned not just about size, but about shape and proportion too.

Natural-results focused breast enhancement strives to enlarge the breasts while maintaining a natural looking silhouette and this involves choosing a breast implant size that complements the natural figure. Creating a natural appearance is as much an art as it is a science. To make sure the final results appear as natural as possible, Dr Montemurro assesses his patients current body frame while envisioning how many variables (implant size and shape, natural breast tissue amount, implant placement, etc.) will alter the body’s appearance.

Proportion is more important than size. In most instances, the best way to achieve natural-looking results is to choose a moderately sized breast implant that is appropriate for the body dimensions. This will also help to avoid potential back and neck pain commonly associated with very large breasts, and it will enable to more easily engage in athletic activities. There is no concrete formula used to achieve natural-looking breast augmentation results as every woman is different. Instead, Dr. Montemurro will evaluate a variety of factors including the body type, the amount of natural breast tissue and the desired final breast size in order to craft the right treatment plan for each patient´s unique situation.

How to choose the right volume and shape

Implants come in many sizes and shapes, and choosing the right implant is a source of concern and anxiety among many women.

While many doctors and websites focus solely on implant volume, Dr. Montemurro offers a different approach to implant selection to help create the best natural look. The aim in breast augmentation is to make the natural measurements of the patient more beautiful and create a more harmonious, aesthetic appearance.

Implants that are the same shape or size look different on different women.

Thus, an implant size that looks great on a patient might not work for someone else. To get the most natural looking result, each patient´s characteristics need to be carefully assessed (height, build, skin quality, skin stretch, amount of natural breast tissue) in order to be able to suggest an implant shape and volume that is most appropriate for their body.

The wishes of the patient are obviously very important, but these have to be put in the context of her anatomy (for example, a patient with very tight skin cannot accommodate as much increase in volume as can someone with more skin. Or: smaller, petite patients need a smaller breast implant because larger implants would appear under their arms). During the initial consultation, Dr Montemurro considers the patient’s body shape, skin characteristics and preference to choose the most appropriate implant in order to develop a customized breast augmentation treatment plan that will achieve the desired outcome.

Short Scar Technique

As breast augmentation techniques evolve, the visible signs of surgery have become less prominent.

One of the techniques that Dr Montemurro employs during every breast augmentation procedure he performs, is the short scar augmentation.

This technique provides a reduced incision length and less scaring for the patients thanks to the use of both custom-made surgical instruments and a special sleeve called Keller Funnel.

This works like a “cake icing”, allowing the surgeon to push the implant inside the breast pocket squeezing the funnel.

This technique leaves a short and barely visible scar, hidden in the natural crease under the new breast.

Moreover, since the Keller Funnel replaces the doctor placing the implant into the pocket with the fingertips through the incision, it allows for “no touching” during insertion, minimizing bacterial contamination risk.

Using the Keller Funnel can also minimize trauma to the breast tissue, making for a quicker healing process and reducing post-operative pain.

Also, the Keller Funnel expedites the surgical procedure which means recovery and acclimation is far easier on patients.

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Breastfeeding

It is possible to breastfeed with implants, as the surgery does not affect the ducts or the areas of the breast involved in milk production.

Moreover, there is no evidence that silicone from breast implants leaks into breast milk: the last generation of silicone-gel breast implant is made of a semi-solid gel that mostly eliminates the occurrences of filler leakage (“silicone-gel bleed”) and of the migration of the silicone filler from the implant-pocket to elsewhere in the woman’s body.

Sensitivity

Changes in nipple sensation are very common after breast augmentation but they typically resolve spontaneously. Numbness is a normal part of any surgical procedure and can be expected for several weeks or months after surgery, as the nerves are traumatized by the operation and may be compressed by swelling. Sensation in the breast and nipple can increase or decrease after augmentation surgery, ranging from a total loss of feeling through to tingling or sharp twinges. Most loss of feeling will resolve in 2 to 3 months. However, some areas such as the nipples and the area directly around the scar line, can take up to 2 years to resolve. The last place to regain the sensation will be directly adjacent to the incision, as the nerves make their way from the periphery to the scar line. Permanent changes to sensation are not common although in some cases, sensation may never return to 100% of what it felt like previously over the scar area.

How long can I keep my implants?

The real answer to how long breast implants last is “it depends”. The lifespan of a breast implant is dependent upon several factors and the latest generation of breast implants has no date after they need to be replaced.

In general, many plastic surgeons believe that implant removal or revision is unnecessary unless the patient experiences a complication or is no longer satisfied with the look and feel of their breasts.

However, breast implants do not last forever and will most likely need to be replaced at some point in a woman’s life. The average silicone implants may last anywhere from 10 to 20 years but in some cases, they might need to be replaced sooner due to complications or cosmetic concerns.

Just as there is a range of body and breast types, as well as seemingly countless combinations of implant size, shape, shell and placement, there will be a variety of ways implants will age throughout their lifetime.

The breasts themselves will also change over time. Increased skin laxity, changes in body weight, and hormone shifts can all contribute to the look of breasts that have undergone augmentation.

Breast implants are designed to be long lasting and safe but every breast augmentation patient should approach the procedure with the understanding that additional surgery is a likely reality for the future. Whether this takes the form of a breast lift to correct drooping breasts or the placement of new breast implants, or another procedure entirely, is up to the patient.

Mammograms

Doctors often hear from women who mistakenly believe that they will not be able to get mammograms if they have undergone breast augmentation surgery. The truth is, having breast implants will not prevent a patient from being able to get a mammogram or breast cancer screening. All women 40 years old and over should have a mammogram once every year, or every other year. For women who have had breast augmentation, there is concern that breast implants can make detecting cancer more difficult. This is because the presence of an implant can get in the way during examination. Even so, it is still possible to get accurate and precise testing if it is performed by a technician experienced in taking mammograms on women who have breast implants.

Breast reduction and breast lift

When most people think about breast enhancement options, they typically think of breast augmentation surgery. But while there are many women who wish to increase the size of their breasts, there are also many women who wish to reduce or reposition them without adding extra volume.

Breast reduction and breast lift procedures can be great options for this category of patients. Many people are somewhat confused about the difference between these two procedures but both of them involve lifting and reshaping the breasts.

The only difference is the amount of tissue that is removed: a breast reduction aims to significantly reduce both the weight and size of breasts while mainly just skin is removed during a breast lift. It is not unusual for women to encounter both excess breast tissue and sagging. Commonly, these women get the best results by receiving a combination of breast reduction and breast lift procedures.

Breast lift

Breast lift surgery (also called mastopexy) is a procedure to lift the breasts in order to rejuvenate a woman’s figure and provide a breast profile that is more youthful in appearance. It helps restore the shape that may have been lost due to age, weight loss or breastfeeding.  A breast lift raises and firms the breasts by removing excess skin and tightening the surrounding tissue and it can also reduce the size of the areola that sometimes becomes enlarged over time. Because a breast lift repositions the location of the breasts, they can appear a little smaller. However, this procedure won’t significantly reduce the size of the breasts as only a minimal amount of tissue is removed. A breast lift can also be done in combination with breast augmentation in order to obtain firmer, perkier, and higher breasts on the chest.

Breast reduction

Breast reduction surgery (also called reduction mammoplasty) can instantly and effectively reduce breast size through the removal of excess breast tissue and alleviate excess weight in the chest area. It involves the removal of excess skin, fat, and glandular tissue, eliminating the negative issues associated with breasts that are larger than the patient desires. During this procedure breasts are also significantly lifted and enlarged areolas are reduced to keep them in proportion to the newly shaped breasts. Breast reduction surgery might help improve a woman´s self-image by creating a more aesthetically pleasing breast contour that is better proportioned to her body. It often relieves from years of back, shoulder and neck pain, difficulty exercising and rashes on the chest. It can also greatly improve clothing options and permanent shoulder grooves from weighted down bra straps.

The procedure

Breast reduction and breast lift are performed under general anesthesia, in an outpatient surgical facility.

They usually involve 3 incisions: one around the edge of the areola, one vertically from the areola to the breast crease, and one made along the crease underneath the breast. Excess breast tissue, fat, and skin are removed and the nipple/areola complex is moved to a higher position on the chest. The remaining breast tissue and skin is then reshaped and the areolas can be reduced to a more proportional size. The incisions are closed with dissolvable sutures and no drains are usually placed.

Both procedures are relatively easy to recover from and require 2 to 3 weeks of downtime. Patients are sent home in a surgical bra and the breasts are usually swollen and bruised for a few weeks. Pain and soreness are felt around the incisions and pain medications are prescribed to alleviate discomfort during this initial period.

Patients are usually able to get up and walk around the same day of surgery, but they should avoid straining, bending and lifting for 2-3 weeks after the operation. Most patients feel ready to return to a desk job within 1 week but they need to wait a minimum of 3 weeks before resuming exercise other than walking.

It is possible to notice an immediate change in the appearance of the breasts, although their shape will continue to change and settle over the following few months. Additionally, the breasts often heal at a different rate and some asymmetry during recovery can therefore be normal. It will take at least 6 months for the swelling to completely go down and for the final result to settle in.

Scars and sensitivity

Initially, scars will appear red and lumpy but they will soften and fade within one to two years.

Scars from a breast lift and breast reduction can usually be hidden by bras and bathing suits.

Changes in nipple and breast sensation are typical immediately following surgery and some extent of numbness might last for a few months. Usually these changes are temporary, lasting from a matter of weeks to a few years.

However, sensitivity usually returns to normal (or at least close to normal) in most cases.

Weight loss, pregnancy and breast feeding

The final result of these procedures is generally long lasting, although breast shape and size can change due to aging and many other factors. Women who are interested in losing weight by changing their diet and starting an exercise program or those who are considering pregnancy at any point in the future, should probably consider delaying getting a breast lift or breast reduction procedure. In fact, due to pregnancy and weight loss, breasts could stretch and offset the results of the procedure. Breast-feeding is a consideration as well, as women might have difficulty producing enough milk especially after breast reduction surgery. Each woman is different and, in some patients, the milk supply might not be affected at all. Other women may produce less breast milk but it is not possible to know how much milk can be produced before the baby is born.

Implant exchange/breast implant revision

Breast implants do not last a lifetime and they will usually need to be replaced to ensure breasts maintain their position and shape as intended during the initial surgery.

Implant exchange surgery involves removing and replacing the existing breast implants for several different reasons.

Some women undergo the procedure because they wish to change the size, shape, or position of their existing implants. Other women have the surgery due to complications like implants that rupture or shift, or those that have capsular contracture (a condition that occurs when the body forms a hard tissue capsule around the implant).

Also those who are dissatisfied with the results of a previous breast augmentation procedure or have changed their mind about their implant type and size can benefit from an implant exchange procedure.

A breast implant exchange is performed under general anesthesia and usually takes 1-2 hours depending on the case. Many times, this procedure can be performed utilizing the incision location made for the initial breast augmentation surgery, depending on the implant placement technique used in that operation. This means no additional scarring other than the scar that was already there. Dr. Montemurro is highly skilled with these types of procedures and will make every effort to ensure any residual scarring is as minimal as possible. A breast implant exchange is described by patients as being much less painful than their initial breast augmentation. The recovery is also faster, swelling and bruising will gradually subside within a few weeks. Nonetheless, to ensure adequate wound healing, patients should rest and limit physical activities during the first 3-4 weeks after surgery.

The success of a breast implant exchange procedure is clearly dependent on the meticulous planning, a patient’s realistic expectations and compliance, aesthetic sense of the surgeon, and skilled surgical performance of the surgery. Every breast is unique just as every patient is unique and it´s therefore vital that the procedure be tailored to each individual.

Dr. Montemurro starts every consultation by listening to the patient´s goals and performing a thorough physical exam in order to asses skin tone and elasticity, status of the natural breast tissue, placement and state of the current implant and nipple position. The surgical plan may be as simple as exchanging the current implant for a new one of the same size. Or it may require something more such as replacing the implant with a smaller one and tightening the breast envelope with a breast lift. A new implant is advisable as rarely the previous placed breast implant can be used.

Gynecomastia

Gynecomastia is a condition of overdeveloped or enlarged breasts in men that can occur at any age, leading to a womanly looking chest. While the precise causes of gynecomastia are unknown, this condition has been linked to use of certain medications and steroids. The growth of the mammary gland during puberty is normal, leading to a mild to moderate gynecomastia that typically resolves by itself by the time the boy reaches adulthood.

Gynecomastia is caused by additional glandular breast tissue, therefore it does not mean that someone has extra fat from being overweight. For this reason, gynecomastia does not respond to diet or exercise and can only be corrected via a surgical procedure.

Gynecomastia can cause emotional discomfort and impair self-confidence. Some men may even avoid certain physical activities and intimacy simply to hide their condition. As a male plastic surgeon, Dr. Montemurro understands that a firm, flat chest appearance is important for a healthy male self-esteem.

Gynecomastia surgery removes excess fat and glandular tissue to restore a flatter, firmer and more masculine contour to the chest. It is performed as an outpatient procedure with the patient under general anesthesia. Incisions are typically made on the border of the areola, so the resulting scars are usually well concealed in the natural contours of the chest and won’t be noticeable.

Following surgery, the patient will be provided with a compression garment to aid in the healing. Some bruising, soreness and swelling will occur, but any discomfort can be managed with the medications provided by the surgeon.

Heavy exercise should be avoided for 3-4 weeks, and the surgical scars should not be exposed to the sun for about six months. Most of the swelling usually resolves after a few weeks, but the full benefits of the treatment will not be evident until approximately 6 months following surgery. Some men experience a loss of sensation in the treated areas right after the operation, but this is almost always temporary as full sensation is gradually restored over the course of a few weeks or months. Permanent change or loss of nipple sensation are extremely rare. The result of gynecomastia surgery is permanent, as the removed glandular tissue cannot reform. However, due to a considerable weight gain, fat tissue may also accumulate in the chest area and enlarge the breasts.