Breast Surgery at the Emory Plastic and Reconstructive Surgery Center
Emory has been a consistent source of innovation, development, and refinement in the procedures and techniques of breast surgery. As far back as 1975, Emory plastic surgeons developed the musculocutaneous flap procedure that became the foundation for methods that are now standard for reconstructive breast surgery. In 1993, Emory plastic surgeons adapted endoscopes for plastic surgery procedures. Shortly thereafter, the Emory Plastic and Reconstructive Surgery Center became one of the better known providers of minimally invasive techniques for breast reconstruction and augmentation in the country.
Available Procedures:
Breast Reconstruction
Depending on the patient's overall health, breast reconstruction can be a component of the original mastectomy procedure or performed later. It may also involve more than one operation, though follow up procedures are often performed on an outpatient basis. Occasionally surgery is performed on the natural breast so that it will look similar to the reconstructed one.
The four methods of breast reconstruction practiced by Emory surgeons are:
- Skin Expansion with Breast Implant
This is the simplest of breast reconstructions and involves a tissue expander placed under the skin of the affected breast. Blood transfusions are not required, pain is often minimal, and recovery is fairly quick. Upon the removal of sutures, saline is added to the expander on a weekly basis, gradually stretching the skin. When sufficient stretching has been achieved, the expander is removed and replaced by a permanent breast implant in a two-stage procedure. Nipple reconstruction, if desired, is a separate procedure.
- Latissimus Dorsi Myocutaneous Flap
In this procedure, the triangular, flat muscle covering the lumbar region and the lower half of the thoracic region known as the latissimus dorsi is moved to the chest along with the overlying skin from the back to create a new breast mound. If necessary, a breast implant can be placed under the flap to balance any difference in size between the breasts. The incision is usually made along the bra line to conceal the scar. Blood transfusions are typically not required and nipple reconstruction is done later.
- Rectus Abdominus Myocutaneous Flap
Considered the most complicated reconstructive procedure, often involving approximately four-to-five hours of surgery, this method involves the tunneling of the rectus abdominus (the paired muscle that runs vertically on each side of the anterior wall of the abdomen) and its overlying skin up to the chest. The breast mound is then created to match the opposite breast. A blood transfusion may be required. Implants are usually unnecessary since the tissue is generally adequate to match the size of the other breast. If the opposite breast is large or pendulous, a simultaneous breast reduction can be done. Contouring of the new breast mound may also be performed, and a synthetic mesh may be placed over the area where the muscle is moved to strengthen the abdominal wall and minimize the chance of hernia formation. Nipple reconstruction is done as a second procedure.
- Nipple Reconstruction
This simple outpatient procedure is often performed with local anesthesia and takes about one-to-two hours, the goal being to recreate a nipple using skin from the patient's breast that will match the appearance of the opposite breast.
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Breast Augmentation
Patients may undergo breast augmentation, or augmentation mammoplasty, to restore symmetry between the two breasts, to enlarge small breasts, or to correct breast volume reduction after pregnancy. Augmentation mammoplasty is done on an outpatient basis, usually under general anesthesia. An implant is placed through an incision made under the breast tissue or its muscle. The incision can be made under the breast, around the nipple, or under the arm. The implant is composed of an outer silicone shell filled with saline (the FDA has restricted the use of silicone gel implants) and is available in various shapes. A breast lift may be done at the same time.
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Breast Lift
Factors such as pregnancy, nursing and the force of gravity may cause skin to lose elasticity. A breast lift, or mastopexy, removes the loose skin, repositions the nipple, and re-shapes the breast. Since the procedure only removes the excess skin to maintain the natural size of the breast, it should not be confused with breast reduction. While occasionally performed in a hospital, mastopexy is typically an outpatient procedure performed under general anesthesia, though local anesthesia may be used in conjunction with a sedative depending on the size of the incision. The most common method involves making an incision along the natural contour of the breast where excess skin will be removed. The nipple and areola are repositioned, the skin surrounding the areola is brought together to reshape the breast, and stitches are placed around the areola and the lower breast. For smaller lifts, the incisions are usually limited and result in a circular scar around the areola. Larger lifts can leave scars that either extend down the breast or that can be hidden in the crease under the breast. Mastopexy is commonly performed in conjunction with breast augmentation to increase breast firmness and size.
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Breast Reduction
Women with large, heavy breasts often develop symptoms such as back, shoulder, and neck pain and can find their daily activities hampered. Recurrent skin irritation, skeletal deformities, breathing problems, and headaches can also be caused by the weight of the breasts. Breast reduction, or reduction mammoplasty, can alleviate these symptoms while preserving breast shape by removing excess skin and breast tissue, repositioning the nipple, and shaping the breasts while generally preserving the patient's sensation and ability to breast-feed. Done under general anesthesia on an outpatient basis or in the hospital, the surgery removes fat, glandular tissue and skin from the breasts while also reducing the size of the areola. Incisions are made around the pigmented nipple-areolar complex and extend vertically below the nipple and into the fold under the breast. The nipple-areolar complex is moved upward to the desired location, the incisions covered with a light dressing, and the breasts placed in a surgical bra that will hold them symmetrically during initial healing. Any discomfort generally subsides over time and can be controlled with oral medications. Scars usually fade in 6-18 months. Liposuction can further enhance the results.
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Male Breast Reduction
Gynecomastia is enlargement of the male breast caused by side effects of certain medications, hormonal imbalance, or significant weight gain. The procedure removes fat and or glandular tissue from the breasts either by liposuction or direct excision through an incision below the nipple-areola. In extreme cases, excess skin needs to be removed to produce a flatter, firmer chest.
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