Cosmetic Breast Surgery From A to Z:
Everything Every Woman Should Know Before Making A Decision

Breast augmentation, reduction, mastopexy: these are cosmetic surgery terms we frequently hear in a country with a zealous interest in plastic surgery. For the patient who is contemplating having one of these procedures, the information that is available can be confusing and at times even misleading. Dr. Joel Roskind explains in layman’s terms what the various aesthetic breast surgery procedures entail and accomplish.

Breast Reduction

Surgical Goals:
“The main goal of this surgery is to give a woman relief of back pain, neck pain, and bra strap grooving. Frequently, patients complain of irritation under the breast due to the skin rubbing, and sensory changes in arms and hands (seen in extremely pendulous breasts).” “More importantly, the everyday activities most women take for granted, such as finding a bathing suit that fits, exercising comfortably, buying a shirt where the buttons don’t pull, and eliminating the self-consciousness of people looking only at their breasts are made easier by this procedure. If these women are overweight and then reduce, this often further exaggerates the difference in the proportion of their body; that is, a woman may wear a size six pant and a ten jacket. Therefore, breast reduction surgery will be very helpful in bringing the patient’s body into better proportion.”

The Procedure:
This procedure is performed either in an office operating suite or in a hospital, usually under general anesthesia. Prior to surgery, markings are made with the patient standing, determining where the nipple will go as well as the incision location and where the removed breast tissue will be. “Several techniques can be employed.” Dr. Roskind prefers a method called inferior pedicle reduction as it enables him to achieve a nice reduction in size while trying to maintain function, such as the ability to breast feed and maintaining nipple sensation. The operation does leave a scar around the areola, straight down to the crease underneath the breast, and underneath the breast for varying distance, depending upon the size of the reduction.

The good news is that even in a bikini the scars may not be visible. The previously used technique involves removing the nipple, reducing the breast tissue, and then reattaching the nipple. This is a technique Dr. Roskind rarely chooses and does so only on breasts so large an adequate reduction could not be performed otherwise or when intervening medical problems require it.

Pain and Recovery:
Even though there are ample incisions made, the pain is not severe because no muscles are cut. Moderate amounts of pain are handled with oral pain medications. Recovery time typically entails two weeks away from work for those with sedentary jobs, although pain and recovery time can vary on an individual basis.

•	Fat Transfer
•	Tumescent and Ultrasonic Assisted Liposuction
•	Abdominoplasty (Tummy-Tuck)

Breast Augmentation

Surgical Goals:
To enlarge the breast to the point where the patient is happy with the size and shape and yet maintain normal function.

Procedures:
For this procedure, Dr. Roskind uses a saline implant (a silicone shell filled with saline), and the implants are available in a variety of sizes and shapes. Dr. Roskind remarks that “although most patients look best with a round implant,” he “individualizes it based on the patient.” When performing the surgery, the doctor uses an incision from 4 o’clock to 8 o’clock around the lower edge of the areola. This gives him very good access to the breast and enables him to do all the work he needs to, as well as insert any size implant that is appropriate. Once the patient has fully healed, the scars are barely noticeable even if the patient is topless.” The skin is closed with dissolvable stitches, and recuperation is fairly fast. Dr. Roskind believes that the implants should be placed under the muscle, “because they stay softer, look more natural, and probably provide for better mammogram readings.” To avoid the unnatural “baseball look.” Dr. Roskind purposely overfills the implant because studies show that this makes rupture less likely. The pocket is made adequate so that the implant can be mobile allowing the breast normal movement.

Pain and Recovery:
Dr. Roskind concedes that “the first couple of days are uncomfortable because the muscle is lifted up, so frequently oral pain medications and muscle relaxants are used. Depending upon the patient’s type of work, most can return after one week but must avoid lifting their arms above shoulder level for the first two weeks. During the first two weeks following surgery, only lower body exercise may be done and absolutely no jogging as it is too jarring for the breast. After four weeks have elapsed, normal activity can be resumed without restrictions.” Dr. Roskind advises his patients to wear a non-underwire bra for the first four to five weeks following surgery, and no continuous underwire bras should be worn afterwards, as it can cause irritation to the implant.

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Joel L. Roskind MD, F.A.C.S., P.A.

• Diplomate of the American Board of Plastic Surgery • Plastic and Reconstructive Surgery • Fellow of the American College of Surgeons

About Dr. Roskind | Procedures | Breast Surgery
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