The size, shape, and proportions of a woman’s breasts are key elements of her body contour and self-image. Having full, shapely breasts that are proportionate to the rest of your body can make you feel sexier and more confident. If you are seeking breast surgery in Cincinnati or Dayton, choose a surgeon with the skill and artistry needed to achieve natural, beautiful results. With over 15 years of experience performing breast surgery, Dr. Kurtis W. Martin, MD can help you realize your dreams.
Breast augmentation
Breast lift
Breast reduction
Liposuction breast reduction
Breast augmentation revision
Gynecomastia correction
Breast augmentation (enlargement) is one of the most sought after procedures in plastic surgery. Last year over 335,000 women choose breast enlargement surgery according to the American Society of Plastic Surgeons. When considering breast implant surgery one must consider the indications and risks as well as the long term benefits. The only way to increase the size of your breasts is by surgical placement of breast implants. Don’t waste your time on oral supplements or fancy suction bras and don’t ever consider fat transfer to the breasts (it’s condemned by most plastic surgery organizations). Breast implants can increase your cup size, improve the shape of the breasts, increase your cleavage, improve asymmetry, and provide minimal lifting. Breast implants will not give you a "breast lift" and can not improve stretch marks.
Common misconceptions regarding breast implants:
"Breast implants cause cancer".
Long term studies reveal lower rates of breast cancer in women who have implants. The reason for a diminished incidence of cancer is unknown. The bottom line is breast implants (saline or silicone) do not cause cancer.
"Breast implants must be replaced every 10 years".
Saline implants only need to be replaced when they deflate. Saline implants last up to 20 years but do eventually wear out. They develop a small hole in the shell and the saline (salt water) simply is reabsorbed by your body. The newer generation silicone implants (cohesive) will most likely last a lifetime. Even if the outer shell is disrupted, the silicone inside the implant is like jello and therefore does not leak.
"Where my incision is located will affect the overall result of the breast enlargement".
Many different incisions can be used for breast enlargement. The outcome is more affected by the skill and experience of the plastic surgeon then where the incision is placed. If you desire a certain location for your incision then choose a surgeon who performs that type of incision.
"I have to limit my activities after my breast enlargement so I don’t rupture the implants".
The implants are very durable and long lasting. You may resume all activities that you enjoyed previous to your augmentation. Don’t worry about rupturing your implants.
"I have to massage my implants to keep them soft".
In the past surgeons placed the implants over the muscle and it was felt that massage would keep the pocket a certain size allowing the implants to remain soft. These days most surgeons place the implants under the muscle where the constant action of the pectoralis muscle “massages” the implant. It is thought the constant massage by the muscle is one reason implants placed under the muscle have a lower rate of hardening (this is disputed by some). There is no harm in massaging your breasts following an augmentation and some surgeons continue to recommend it.
"I can’t breast feed after an enlargement".
Implants placed under the muscle have little to no effect on the milk ducts and therefore should not impair breast feeding. Implants placed above the muscle (directly under the breast) also have minimal effect on breast feeding.
Once the decision has been made to inquire about breast augmentation, you will schedule a consultation with Dr. Martin. At the consultation Dr. Martin will listen to your expectations and desires. It is important to make clear your objectives so that the desired result can be obtained. A complete history and physical will be taken. Questions will include current cup size and desired size of breasts, history of child birth and breast feeding, history of breast cancer in the family, history of any biopsies or fibrocystic disease, and yearly exams and mammograms. If you have a strong family history of breast cancer or any history of biopsies you may require clearance from a breast surgeon. You will require a mammogram prior to surgery if you are over 35-40 years old. During your physical examination several parameters will be noted including the shape of your breast, size of areola, skin thickness, asymmetry, lumps or masses, amount of loose skin, and amount of cleavage. Measurements include the nipple to sternal notch distance, width of breast, cleavage, and distance from the nipple to the crease under you breast. Pictures will be taken to later compare to your postoperative result. Dr. Martin will then choose an appropriate size implant for you to try on. Placing an implant inside of a sports bra is a very good way to simulate the expected result. The consultation will also include looking at many before/after pictures on the computer as well as a comprehensive discussion of the risks and complications of the procedure. Before proceeding with a breast augment a number of decisions will need to be made. The most important variables are discussed below.
Type of implants – There is no “perfect” implant for all patients. Your surgeon will recommend a specific implant based on his experience and judgment. Advantages of saline implants include lower price, adjustability, smaller incisions, and the possibility of a lower capsular contracture rate. Disadvantages include a slightly firmer feel and higher incidence of rippling or wrinkling. Advantages of silicone implants include a softer, more natural feel and a minimal chance of rippling or wrinkling. Disadvantages include higher cost, non adjustability, and a larger incision. For more information regarding silicone breast implants go to www.breastimplantsafety.org.
Shape of implants – Breast implants come in many different sizes and shapes. The most commonly used implants are round and designated as low, moderate, or high profile. The higher profile implants have a narrower base and more projection while the lower profile implants have a wider base and less projection. Anatomic (contour) implants have more projection in the inferior pole which some surgeons believe results in a more natural look. These are used frequently in breast reconstruction.
Shell type – Smooth implants feel much like saran wrap and are very slippery. Many surgeons believe that smooth implants move more and therefore stay softer. Textured implants have a fuzzy coating which feels kind of rough. These implants stay in place and do not move in the pocket. These were developed in the belief that a textured surface would reduce the incidence of capsular contracture (this has not been proven). Dr. Martin prefers smooth wall implants as they are less palpable and have a longer lifespan.
Location of incision – Many incisions can be used to place breast implants. The most common are the inframammary fold, periareolar, nipple, and axilla (armpit). Others include the TUBA (trans umbilical breast augment) and access from other procedures (tummy tuck). Dr. Martin prefers the periareolar incision because it leaves a minimal scar that can be easily hidden in the border of the areola. This incision also allows for future access for fills or implant replacement under local anesthesia. The inframammary incision works well but there is nowhere for the scar to “hide” when the patient is lying down. The transaxillary incision is somewhat of a more difficult access but in experience hands works well. One downside is the possibility of seeing the incision in the armpit even when the patient is dressed. The TUBA is rarely performed and is technically more difficult. Any further breast surgery will usually require a new incision.
Size of implant – There is truly no limit to the size of a breast implant but expect an increased number of complications. A too large implant can look very unnatural due to stretching and thinning of breast tissue. Other complications include increased chance of sagging, capsular contracture, loss of nipple sensation, chronic pain, and infection. Dr. Martin’s advice with size is not to go overboard! There are many factors which determine the correct size of an implant including height, weight, width of chest and breast, current size of breast, amount of loose skin, elasticity of skin, etc. Dr. Martin will take into consideration many factors in determining the correct size implant for you.
Above/below muscle – The current trend is to place most implants below the muscle (subpectoral) as opposed to the subglandular position (above the muscle). Many feel subpectoral placement of the implant causes a diminished capsular contracture rate. Also, since the implant is covered mostly by the muscle the incidence of wrinkling and rippling is diminished. Radiographic studies show less disturbance of breast tissue when implants are under the muscle leading to easier reading of mammograms. Dr. Martin feels that under muscle implants cause less droopiness in the breast. One disadvantage of this location is the possibility of pectoralis pull on the breast. This can lead to abnormal movement of the breast when flexing your pectoralis muscle. Advantages of putting the implant over the muscle are less recovery and more correction of the saggy breast. Deciding which location to place the implant can be confusing and therefore should be made after careful consideration of the facts.
Combining a mastopexy with an augmentation – Many women require a breast lift in addition to the augmentation. These procedures can be performed at the same time but with some modifications. In a mastopexy/augmentation an adjustable implant is used with very little fill initially. After 2 weeks (to allow for adequate healing) the implants are filled in the office to the desired size. This minimizes the chance for skin breakdown secondary to excessive tension. Another advantage of this technique is the ability to adjust the size of the implant following surgery. When a minimal mastopexy is planned, standard saline or silicone implants can be placed.
Despite being one of the safest and most commonly performed plastic surgery procedures, complications can and do occur. Below is a discussion of the most common complications.
Capsular contracture – Capsular contracture is a hardening of the tissue surrounding the breast. Mild cases cause some firmness of the breast while severe cases lead to pain and visible distortion of the breast. Treatment can include removal of the implant and capsule with replacement of an implant in a different location. With most implants now placed under the pectoralis muscle, the rate of capsular contracture has been markedly reduced with some studies showing a 1% or fewer incidences. Causes of capsular contracture are thought to be varied and can include genetic predisposition, bacterial contamination, or a history of bleeding or seroma.
Asymmetry – One of the most common complaints from patients is “my breasts are not exactly the same”. This is entirely normal as no two breasts share perfect symmetry. Asymmetries of the breast should be noted and discussed prior to surgery. Most asymmetries remain even after placement of breast implants. Some abnormalities can be made better by moving the nipple areola complex, adjusting the pocket, or placing a larger or smaller implant.
Migration of implant – Following placement of a breast implant, scar tissue is deposited around the implant forming a “pocket”. This pocket normally keeps the implant in place. If the pocket becomes too large or is improperly dissected, the implants can migrate to an incorrect position. Frequent areas of malposition include migration to the inferior or lateral part of the breast. Migration to the medial part of the breast can lead to a deformity known as “bread loafing” where the breasts actually touch each other in the midline. The majority of these cases are caused by over dissection during placement of the implant. Correction involves repositioning the implant by tacking up the capsule and closing off the space. A supportive bra must be worn for 4-6 weeks.
Hematoma – Bleeding into the breast following an augmentation is very rare. Management is usually nonoperative but may require surgical removal of the hematoma.
Seroma – A seroma is a collection of serous fluid inside the breast pocket. Most resolve spontaneously but some require drainage via a needle. vLoss of nipple sensation – During dissection of the pocket the main nerve to the nipple (4th intercostal) may be stretched or damaged, resulting in loss of sensation to the nipple. Most nerve injuries are temporary and recover fully. Return of sensation may take up to 2 years.
Rupture of implant – Immediate rupture of the implant is almost always a result of damage to the shell by the surgeon. Long term rupture is inevitable and will occur in 10-20 years as the implant wears out. Mentor and McGhan implants are warranted for life and will be provided free of charge by the companies. Implant exchange in the event of a rupture is a minor procedure and can be performed under local anesthesia in the office.
Infection – Infection of breast implants is very unusual and occurs in less then 1% of cases. Many infections can be treated with antibiotics only. More serious infections involving drainage or exposure of the implant require removal of the implant and drainage of the breast. After 6-12 months of healing a new implant can be placed into the breast. Prophylactic antibiotics for procedures such as teeth cleaning are usually not needed.
Pain – Long term pain in the breast is very rare and usually occurs in patients with very large implants. Treatment involves placing a smaller implant or surgical removal of scar tissue.
Milk production – Some procedures may cause temporary production of milk from the breast. This is usually self limited but can cause concern because of its similarity to signs of infection.
The decision to have breast implants requires careful research and planning to ensure excellent results. Dr. Kurtis Martin specializes in cosmetic breast surgery in the Cincinnati and Dayton areas and has the artistry and skills necessary to achieve beautiful results in breast augmentation surgery. For more information on breast implants go to www.breastimplantsafety.org.
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All women wish to have youthful, shapely breasts. Unfortunately, genetic factors as well as breast feeding and weight gain can all lead to undesirable changes in the shape and contour of the breast. To return the breast to a more youthful shape requires a procedure known as a mastopexy (breast lift). With a breast lift some volume will be lost so if you desire a larger, fuller breast an implant will be needed. Many types of breast lifts have been described in the literature. The simplest type of lift is a circumareolar mastopexy which is used for minor lifts. This lift involves removing a circular piece of skin from around the areola which will leave a small circular scar. For more moderate lifts a vertical mastopexy is indicated. This type of lift is accomplished by removing skin around the areola and continuing down toward the base of the breast (inframammary fold). This is known as the “lollipop lift”. When major amounts of skin need to be removed a traditional inverted T or anchor incision is used. More modern mastopexy techniques now focus on reshaping the breast through internal suturing which allows for a more conical shaped breast. Most mastopexies require 1-2 hours of surgery and are done on an outpatient basis. All sutures are placed under the skin to reduce the chance of railroad type scarring. No suture removal is necessary. A sports bra is worn for 2-3 weeks and you may resume normal activity in 2 weeks. Don’t be disappointed with the shape of your breasts right after surgery. Initially they will be boxy and very high but over the next 6-12 weeks they will drop down and assume a more normal appearance. Complications can include asymmetry, skin or nipple necrosis, bleeding, infection, and seroma. If you smoke you may not be a good candidate for this procedure (unless you quit). During your consultation with your surgeon ask which technique will be used and be sure to look at before/after photos in order to get a realistic expectation of expected results. Again, if you desire a fuller breast and really want that “wow” factor consider placement of an implant which can be done at the same time as the lift (combination mastopexy/augment). When combining a mastopexy/augment an adjustable saline implant is used which minimizes the chances of post operative asymmetry.
With modern advances in breast lifting surgery one can achieve a natural, shapely breast. If you are considering breast lift surgery choose a board certified plastic surgeon with the experience and skill needed to achieve consistent, beautiful results.
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Large, pendulous breasts can lead to a variety of social and physical problems. For some women, large breasts attract unwanted attention leading to feelings of embarrassment and low self esteem. For others, large breasts interfere with exercise and work. Common complaints related to large breasts (macromastia) include headaches, upper and lower back pain, shoulder grooving, rashes under the breast, breast pain, and neck strain. If your breasts are DD cup size or larger you may qualify for insurance coverage for a bilateral breast reduction. You must first schedule a consultation with Dr. Martin where a detailed history and physical exam will be performed. Pictures will be taken and a letter will be dictated and sent to your insurance company. Approval may take up to 30 days. Once approval is received your surgery will be scheduled. It is important to discuss with Dr. Martin the anticipated amount of reduction and the expected size following surgery. Generally it is wise to leave a C or D cup breast as over resection is one of the most common complaints following this procedure. Just prior to the surgery you will be measured and marked out with a permanent marker (don’t worry- the marks will easily wash off). During the procedure incisions will be made and skin, fat, and breast tissue is excised. The nipple remains on the breast mound and is usually not removed (except in rare cases) but merely repositioned. The areola (pigmented part around the nipple) is also reduced in size. All sutures are placed under the skin and do not need to be removed. Drains are normally not used. Most reductions take 2 to 3 hours to perform and are performed as a same day surgery. Recovery is 1-2 weeks and pain is minimal to moderate. Typical amounts of tissue removed range from 500 grams per breast all the way up to 6,000 grams or more. Complications can include tissue necrosis, wound breakdown, loss of areola or nipple, loss of sensation, bleeding, infection, and seroma. Most patients retain sensation in the nipple and are able to breast feed following surgery. There are many types of breast reductions and you should let your surgeon decide which method is best for your particular situation. All breast reductions result in scarring and if you desire a scarless breast reduction see liposuction only breast reduction.
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Women seeking smaller, more uplifted breasts without the traditional scarring can now choose liposuction only breast reduction. Perfected over the last 15 years, liposuction breast reduction is a much less invasive procedure then standard breast reduction with advantages such as less scarring, less bleeding, shorter operative time, and quicker recovery. In a typical breast reduction large amounts of skin and breast tissue are removed. In a liposuction only breast reduction only tissue is removed, leaving the skin to contract as it heals. Candidates for this procedure include women with minimal sagginess, small to medium breasts, or very young patients. Liposuction only breast reduction can lead to improvement in breast shape and amount of laxity but cannot achieve the same results as a standard reduction. The procedure is begun by making one or two small, inconspicuous incisions in the breast fold followed by instillation of tumescent fluid. This fluid acts to anesthetize the breast and also constricts the blood vessels resulting in diminished bleeding. A small canulae (hollow tube) is inserted into the breast and the excess tissue is siphoned away. The entire procedure takes much less time then a traditional reduction typically lasting less then 1 hour. Post-operative healing is relatively easy with some swelling and minimal pain. A sports bra is worn for 2-4 weeks and normal activity may be resumed in 1-2 days. Complications are unusual but can include prolonged swelling, inadequate reduction in size of the breast, and sub optimal correction of laxity of the breast. In rare cases the liposuction is ineffective and the reduction will need to be converted to an open technique. There are no contraindications to having a standard breast reduction following a liposuction only breast reduction if the patient is unhappy with their results. Dr. Martin is one of the few plastic surgeons performing liposuction breast reduction in the Cincinnati and Dayton areas. With over 10 years of experience with this technique, Dr. Martin has the skill and experience to help you achieve the result you desire.
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Although breast surgery is generally a highly successful procedure, complications can and do occur. Most complications can be corrected or improved to patient satisfaction. Unfortunately, some complications are permanent. Listed below are some of the most common complications and their treatment.
Ruptured silicone implants – A suspected or proven rupture of silicone implants requires complete removal of the ruptured implant along with removal of abnormal breast tissue. Newer generation silicone breast implants can then be placed back into the breast. These newer implants are cohesive and less likely to cause a problem if ruptured. The implants are usually placed in the sub pectoral position and may be accompanied by a breast lift.
Capsular contracture (hardening of the breasts) in breast augmentation - Capsular contracture of the breast following breast augmentation occurs in less than 5% of patients and in some studies may be as low as 1%. It is generally believed that silicone implants have a higher rate of capsular contracture then saline implants. Capsular contracture can occur anytime during the life of the implant. Etiology (cause) of capsular contracture is unknown. Treatment consists of removal of the capsule (scar tissue) around the implant and replacement of the implant in the sub pectoral (below the muscle) position. In rare cases the implants must be permanently removed.
Infection of breast implants – Minor infections can be treated with antibiotics. Serious infections require removal of the implants and further antibiotic treatment. Generally a wait of 6 months is necessary to let the infection heal up so that new implants can be placed.
Malposition of implants – Following breast augmentation, a capsule develops around the implant which is a normal response to a foreign body. The capsule consists of scar tissue (collagen) which keeps the implant in place. Sometimes incorrect surgical technique can lead to a pocket which is too big or is over dissected in a specific direction. This can lead to implants which are too low, too far medial (near the sternum), or in the armpit. Malposition of the implant can also cause changes in the shape of the breast or in the position of the nipple-areola complex. Correction of this deformity can be complex and can reoccur despite the best surgery. Basically the pocket is sutured together to close off the abnormal space thus positioning the implant in a normal position.
Pectoralis Jump (abnormal movement of the breast during exercise) – One of the few disadvantages of placing implants under the pectoralis muscle is abnormal upward movement or distortion of the breast during use of the pectoralis muscle. This rare problem can lead to quite visible distortion of the breast in a few patients. Treatment requires reoperation with revision of the sub pectoral space or conversion to a sub glandular (above the muscle) implant.
Dissatisfaction of breast size following breast reduction – Further reduction of the breast can be accomplished by liposuction only or a secondary breast reduction. Over resection of breast tissue resulting in too small a breast can only be remedied by placement of breast implants.
Unacceptable scarring following breast surgery – Most scars can be revised with successful improvement in appearance. The quality of the scar is more dependent on the patient’s skin color and genetic predisposition then on the surgeon performing the procedure.
Recurrent laxity following breast lift – Some relaxation of skin is expected, but in certain individuals a secondary lift will be needed due to poor elasticity of the skin. A secondary lift is generally less extensive and will result in a long lasting lift.
