Breasts play a significant role in how a woman perceives herself. Breast enhancement–whether that means breast augmentation, a breast lift, a breast reduction or a combination, gives the patient a heightened sense of confidence, a more balanced figure and a boost to their femininity. If you are one of the many women considering breast surgery, Dr. Lee will help you explore all your options to choose the right procedure for you.
“I see women in consultation every day that are self-conscious about their breasts. They may feel that their breasts are too small, too large, or just not as pretty as they once were. Delivering great results with breast surgery is not as straightforward as it may seem. Whether a patient is seeking breast augmentation, a breast lift, or breast reduction, there are many variables that need to be considered. There is no replacement for experience. I have years of high volume aesthetic breast experience that allow me to perform the operations at a very high level. Creating beautiful breasts is one of my favorite things about being a plastic surgeon. That’s because I have the ability to help patients achieve their goals and improve the shape and size of their breasts. It’s truly amazing to see the transformation that can take place.” — Michael Lee, M.D.
Breast Augmentation: If you want to increase the size, fullness and shape of your breasts, an augmentation is the best choice. In discussing breast augmentation, understanding how to choose an implant is an important part of the process. Finding the right implant for you is predicated on your actual chest wall, the width of the breasts, the amount of existing breast tissue and the characteristics of that tissue. Not every size and shape can be accomplished for every breast. The point is– one size does not fit all. Proper measurements and diagnoses are essential. Patients referred by a friend may schedule a consultation to “get the same implants my friend has.” Their body may in fact dictate a completely different implant to get a similar result in terms of size, shape and projection. The size of breast, or cup size the patient is expecting must be balanced with all the other variables associated with their body type and natural breasts. In addition, it is not wise for a surgeon to guarantee a certain cup size. Cup size varies even among brassiere manufacturers. When it comes to breast augmentation, shape is as equally important as size. Appropriate fullness is a component of the shape. During consultation Dr. Lee will explain the general rules regarding the volume of cc’s and how they relate to ultimate cup size for you.
Patients interested in breast augmentation to restore the size, shape, position or volume of their pre-pregnancy breasts may need to consider a breast lift (mastopexy) to achieve the best result possible.
Breast Lift (Mastopexy): If you want to restore a higher position to breasts that may have dropped, a breast lift procedure is the solution. It can be done with or without implants. Dr. Lee points out, the term “breast lift” is often misunderstood. Technically, the breast is not being placed higher on the chest wall, so is not a literal translation. What a lift accomplishes is a nipple that is usually made smaller and placed at a higher location while simultaneously removing excess skin and tissue below the fold and shaping and tightening the existing breast. This rejuvenation of the breast provides a more youthful appearance. Because we are taking out tissue and loose skin the overall breast size will be relatively smaller. A breast lift will elevate and reshape your breasts, but will not add volume. This is primarily why the vast majority of patients seeking a breast lift also want an implant, which gives the breast fullness. A lift with an implant creates a prettier breast mound, better position, more cleavage and an aesthetic shape. Patients may choose to forgo an implant, but must be willing to accept breast tissue settling over time making the upper pole of the breast less full.
Breast Reduction: To reduce pendulous breasts or large breasts that are bothersome, a breast reduction surgery might be the procedure you are looking for. “Some of the happiest post-operative patients are those who elect a breast reduction,” according to Dr. Lee. A breast reduction is similar to a lift. The difference is we are removing a significant amount of tissue and skin. Breast reductions are considered functional. Very large, pendulous breasts often begin in puberty and persist. Physical problems may include pain in the neck, back and shoulders; rashes in the crease of the breast and poor posture. Women with very large breasts have trouble finding proper clothing and are unable to participate in activities others take for granted. Prospective patients often speak of being self-conscious and inhibited. By reducing and reshaping the breasts, less weight is being carried and a more active lifestyle is possible. The objective is to bring a sense of proportion to the patient. While it’s not uncommon for a patient to ask that their JJ cup size be reduced to a C cup size, breast characteristics and nipple location will determine the final size of the breast since enough tissue must be preserved to make a pretty breast.
When seeking a surgeon to help them make the desired changes to their breast —regardless if it is a breast augmentation, a breast lift or a breast reduction—a patient should only consult with a Board Certified Plastic Surgeon. Dr. Lee is a double-board certified Plastic Surgeon with years of high-volume aesthetic breast surgery experience. Over the years, Dr. Lee has performed hundreds of breast augmentations, breast lifts, and breast reductions. It is this experience that patients should seek out when selecting a surgeon to take care of them.
Because of the popularity of breast procedures, there are many practitioners offering breast enhancement without the training or experience necessary to deliver the best result. It is a lot more challenging to perform a revision surgery to correct a situation where the wrong implant was used, tissue was damaged, the nipple is compromised or scars are conspicuous. “Choose a surgeon with whom you find it easy to communicate so you are confident you have the right surgeon for the right surgery to realize your goals” advises Dr. Lee.
A note about recovery: You must be willing to strictly respect and agree to all post-operative guidelines, especially those regarding exercise routines, strength training and lifting. Dr. Lee wants you to have the very best results possible and following these instructions are an important part of the process. These instructions are instrumental in that result.
Breast Augmentation: Be sure the surgeon is experienced and formally trained in implant placement (over the muscle, under the muscle), and offers to educate you on a variety of implants and incision locations. Familiarize yourself with your own asymmetries and appreciate anatomic parameters such as torso and breast width size. Another very important thing to recognize is that implants are not a lifetime devices. Over the years to follow breast augmentation, you will likely need exchange of the implants or possibly need to undergo a lift. “There is a definite value in finding a breast surgeon who can follow you throughout your lifetime and take care of you when your implants need replacing,” says Dr. Lee
Breast Lift: Not all breast lift techniques are the same. There are different ways to lift the nipple and also to determine what tissue is removed. There are also different scar patterns. You will want to accomplish your goals with the least amount of scarring possible. Patients are encouraged to find a board-certified plastic surgeon that discusses not only their technique but explains why that is their technique. Is it because it is the easiest – or because it is a reliable means of delivering the very best result. Be sure you are told the tradeoffs of one technique over another and consult with surgeons who are experienced in more than one type of incision. The operation’s success is predicated not only on your anatomy, but the doctor’s ability to choose the best technique. Also, it is smart to consider the differences between having a breast lift with and without an implant.
Breast Reduction: Many board-certified plastic surgeons can perform a breast reduction. Patients should focus on finding a surgeon that treats breast reduction as an aesthetic challenge rather than simply a functional surgery. A significant percentage of surgeons perform the operation with the large anchor patterned scar. Dr. Lee performs nearly every breast reduction through a vertical scar that extends slightly towards the outside of the breast since scars in the middle of the chest are more visible and don’t heal as well.
Dr. Lee’s priorities with every breast enhancement patient are twofold; communication and education. His consultations are intentionally a “no rush” zone so there is mutual understanding as to what is desired by the patient, what options are available to that patient, and what is possible through surgery. Dr. Lee treats every breast enhancement the same—striving for the best aesthetic result possible.
Breast Augmentation: To Dr. Lee, breast augmentation is all about customizing the procedure to your desired look and body type as opposed to just giving you bigger breasts. Based upon a comprehensive physical exam and the patient’s desires Dr. Lee will discuss how he will tailor the procedure accordingly. Listening to your goals relative to size is important to avoid a result that is perceived as “too big” or “too small.” Sizing is done as part of the consultation once Dr. Lee defines a range of implants for you. His approach will be based upon his understanding of your individual motivation and goals for breast augmentation and during the consultation he will take time to explain the short term and long term impact of having implants. Dr. Lee will then discuss with you how this information relates to selecting the best implant for your breast. It is important to realize that breast augmentation has trade-offs. These trade-offs are influenced by the implants that you choose – size, shape, fill. This is why Dr. Lee takes so much time educating his patients and making sure they understand it is not solely a matter of size, but of finding the “correct” size for your body.
Dr. Lee believes choosing the correct implant begins with objective measurements of your breast and chest. He begins by determining the width of your breast. This is very important because an implant that is too “wide” for your chest could result in crowding the underarm area. An implant that is too “narrow” could look unnatural and out of proportion. Once the width of the implant is selected, the projection of the implant is assessed. How much projection your breast already has plays a significant role in determining the amount of implant projection needed. Other measurements and characteristics of your breast are also noted. Dr. Lee will evaluate your nipple position and breast tissue stretch. These factors paired with the desired volume increase will help you and Dr. Lee focus in on the best implant for your body. Dr. Lee believes that spending time with his patients during consultation is a crucial component of successful breast augmentation. “Often women avoid looking at their breast prior to surgery. It’s something they are self-conscious about. Asymmetries go unnoticed. After surgery, the very opposite occurs – patients study their breast in the mirror pretty intensely. It’s so important to know what to expect after surgery before you ever go through the process.”
Dr. Lee sees his patients annually to make sure that everything looks appropriate. “Implants are not free of issues, even long term. My job is not just to do the breast augmentation, but to take care of that patient from that point on.”
Breast Lift: Dr. Lee believes that the goal should be the most aesthetic breast with the least amount of scar creation. Dr. Lee’s priorities with a breast lift is to perform the surgery with the smallest, shortest scar possible while delivering an outcome that meets your expectations. He also considers it imperative that each patient understands the difference in results when doing a lift with or without implants. In performing a breast lift with implants, Dr. Lee strives for balance to make breasts beautifully shaped and as symmetric as possible.
Breast Reduction: A well done breast reduction takes much longer than either an augmentation or a breast lift. Because it is an operation sought for the relief symptoms caused by heavy breasts (back and neck pain) it is classified as functional. Dr. Lee considers every breast reduction aesthetic as well as functional. It is a philosophical point of view—one that involves both time and technique. The time he takes in the operating room is evident in the final result which not only makes the breasts smaller, but “enhanced” as well. “My design takes more time and thought but spares the patient from having a scar that goes towards the middle of their chest. Scars in the middle of the chest are more visible and occasionally don’t heal as well. I think the extra time spent in surgery is worth the result I get.”
Breast Augmentation: The quantitative analysis done during consultation takes into account the key breast parameters for an optimal outcome. Although there are exceptions, Dr. Lee prefers the submuscular location for implants for a more natural appearance and lower rates of the capsule hardening (capsular contracture). Precise pocket dissection along with meticulous scar closure lowers the risk of complications and minimizes obvious signs of surgery.
Breast Lift: Dr. Lee’s goal is to accomplish a breast lift with the least amount of scar possible. With years of experience performing highly sophisticated breast surgery he considers each case a unique opportunity to deliver the very best result while often using a short-scar approach. This short scar approach differs from the anchor incision in that it does not continue towards the middle of the chest. The incision typically goes around the nipple and then down to the breast fold. Larger breast may require and extension towards the side of the breast. Dr. Lee likens the procedure to tailoring clothes. You only make the incision in as much as you need to remove excess.
Breast Reduction: Dr. Lee takes an inordinate amount of time in his breast reductions to be sure they are not simply smaller, but aesthetically pleasing as well. Type and location of the incisions are discussed at consultation and are dependent upon anatomy. Incisions are typically made around the areola, vertically down from the areola to the breast crease and may also include a horizontal component at the breast crease. If at all possible, Dr. Lee will do a shorter, vertical incision. This technique takes more time in surgery, but in Dr. Lee’s experience, creates a prettier breast. Excess fat, skin and tissue are removed through these incisions and the nipple is repositioned to match the new breast shape. Although the nipple is relocated, it remains attached to the blood vessels and nerves in order to optimize sensation and appearance. Liposuction can accompany a breast reduction procedure to further sculpt the chest and underarm area.
Anticipating Mastopexy: Patients often ask, “How do I know if I need a lift?” It is very rare that a “virgin” breast would need a lift unless a congenital abnormality exists. However, the majority of women who have had children or have experienced significant weight loss usually require a breast lift for the prettiest result. During pregnancy and nursing, the skin and tissue stretches out, but doesn’t necessarily rebound. Nipples descend and breast volume decreases. A lift essentially raises the nipple up and tightens the surrounding tissue. An implant will not lift a breast that has significant droop (ptosis.) Placing an implant in a breast that is droopy, with a nipple that is below the mammary fold will simply create a larger, droopy breast. Additionally, there is no such thing as a scarless lift, so it is important that tradeoffs are discussed and agreed upon. My years of experience doing breast lifts give me the confidence to offer a wide variety of lift options including those that use minimal scarring techniques. A breast lift with an implant creates a beautiful result because I can sculpt and shape the breast for an ideal outcome. It is a very artistic operation.
Longevity of Implants: Historically, manufacturers recommend changing out implants about every 10 years. Today’s implants are much more cohesive and made better than ever. As a breast surgeon, my point of view is, it’s all about long term follow up. I make it clear that implants are not lifetime devices and at some point, they will need to be exchanged. Sometimes the devices fail. Sometimes a patient wants a new size or a lift as time goes on. Once I operate on someone, I plan to take care of that patient for life. Annual visits are important to be sure there are no obvious changes in either the implant, breast, or the patient’s desires. It provides my patient and me peace of mind.
Fat vs. Implants-Fat grafting has enjoyed quite a bit of popularity in recent years. We now have a better understanding of fat behavior and survival than we’ve had in years past. However, it still remains more of an adjunct procedure and is reserved for select cases. The reason is that fat grafting is simply less predictable in terms of results. Not all of the fat placed survives, and the survival is often related to an individual’s breast characteristics. In patients seeking fat grafting to increase their breast size, a discussion during consultation on the benefits and down sides are necessary to decide on the best course of action.
Latest implant types: Lots of thought goes into an implant recommendation which is why you want a surgeon who is familiar with what each implant can accomplish for your particular desires. There are literally hundreds of implants on the market. The size, shape, filling, and projection options offer a veritable supermarket from which to choose. It is good to keep in mind that it is a vastly different process than choosing a bra. Very specific measurements must be taken of your chest. Your tissue characteristics are also important. In other words the type of implant is predicated on a host of variables, not the least of which are your expectations and the recommendation of the surgeon once the consultation and physical exam are complete.
Contact our office to schedule a private consultation with Board Certified Plastic Surgeon, Dr. Michael Lee. This is the next step to determine which Park Cities Cosmetic Surgery procedure is the best option, giving you the desired outcome after surgery. Dr. Michael Lee will spend time with you to learn about your medical history and your expected outcome for surgery, as well as explaining the procedure in detail and answering all of your questions.