Although breasts are often not the same in terms of size and shape significant differences in both size and shape can be distressing for patients. Correction of asymmetry can involve a variety of techniques such as breast augmentation, tissue expansion, mastopexy (breast lift), breast reduction and liposuction.
Large breasts can lead to both functional and aesthetic concerns. Breast reduction aims to both reduce the breast tissue volume and also recreate and improved breast shape. Different techniques are available and can be combined with liposuction.
This is the most commonly performed aesthetic operation and involves the placement of either ones own tissue into the breast (autologous fat), breast implants (silicone) or hyaluronic acid (macrolane). The commonest of these techniques is the use of silicone breast augments and involves placement of the implants in a pocket either above or under the muscle or a combination of these (dual plane). The incisions for the insertion of silicone breast implants can be in the fold: most commonly armpit, areola or through the tummy button.
Where a nipple has been removed due to previous surgery a new nipple can be created using the remaining tissue of the breast. Flaps of skin may be used to create the nipple. This usually results in scars that are 1-2 cm in length at the side of the new nipple. Areola reconstruction is often performed following nipple reconstruction to provide more natural areola coloring. Both nipple and areola reconstructions can be performed as day case local anesthetic procedures
Following mastectomy various techniques are available to improve cosmesis. These include tissue expansion/implants, autologous fat transfer and the use of flaps either with or without implants. The use of the latissimus dorsi muscle can be brought from the back into the new breast leaving a scar on the back. The abdominal tissue from the tummy can also be used. It can be taken with its blood vessels and then moved onto the chest. The small vessels within the chest can be dissected and the blood vessels joined using a microscope. This form of free tissue transfer does not require the need for an implant and thus ages with the patient giving a long lasting result. Free flaps can also be harvested from both the thighs and the buttocks.
Revisionary Breast Reconstruction
Patients undergoing breast reconstructions especially those undergoing an implant-based reconstruction may require corrective surgery as a result of age related changes associated with implants. Correction of these deformities often requires revision of the implant pocket, the overlying skin and replacement of the implant in a different position. Where there are irregularities within the breast reconstruction autologous fat transfer can help to give a better contour and overall result
Just as female breast can over develop so can male breast tissue. This can give significant aesthetic concerns to patients. Removal may require a combination of liposuction and direct excision and is dependent on the amount of tissue needing to be removed.