Cosmetic Surgery Blog

Q: How best to fix breast asymmetry after weight loss? Major constriction on one breast. (Photo)

Submitted by cleemd on Tue, 06/21/2016 - 12:59

I have asymmetrical breasts (32 B and full C), with the left being constricted, or tubular. The nipples are the same size and shape and in the same location. I've lost 85lbs (from 217 to 132, at 5'5") and maintained it, and am ready to tackle this issue. I scar badly and would prefer not to do a lift if possible, unless it's my best chance at symmetry. I like the the shape of the right breast, but want implants to fill and correct. My skin is thinner, but still relatively elastic. Suggestions?

A: Would be reasonable to initiate treatment with breast augmentation

Thank you for the photos.  They are a good effort on your behalf to provide details of your situation but are limited in interpretation as the "selfies" usually position the arms in positions that exaggerate asymmetries.  Nevertheless, your photos provide a good deal of information.  I do not see any evidence of base constriction.  Your asymmetry is does show some difference in the vertical positions of the nipples.  I suspect an augmentation alone may adequately manage the volume disparity, however the nipple positional differences are  less predictable.  If the magnitude of your asymmetry on examination does not exceed what is visible these photos, I would recommend a breast augmentation and "save" the breast lift for scenarios where the outcome is less than expected.  Good luck in your endeavors!

Q: Pain 23 days post op. Should I go back to see my PS?

Submitted by Q-A from clee on Tue, 06/21/2016 - 12:38

I'm Still feeling pain in the lower side section of my breast 23 days post up. It's actually keeping me up at night now as it is quite uncomfortable. I'm trying to to do too much but I have a baby and so at times I have to lift her. Should I go back to see my PS?

A: Duration of pain and discomfort variable among patients

The magnitude of the symptoms you describe are more than I would expect at 23 days following surgery.  While this may still be within your normal healing response, it would be best to have your surgeon provide reassurance that all is well by scheduling a visit with him/her. 

Q: I have a curved nose (similar to attached picture), and blocked nostril. Any suggestions?

Submitted by Q-A from clee on Thu, 06/09/2016 - 17:39

please guide me what should i do my nose was broken when i was 12 years, and size of my nose is increasing, mostly one of my nostrils blocks, either left or either right one.that's why i have to take breath from just one nostril and most of the time i have runny nose and excessive sneezing,now,

A: Septal deflection with asymmetry can be difficult but amenable to improvement

Thank you for the photo and question.  Your photo shows a substantial deflection of the septum leading to the severe nasal asymmetry and may be the cause of your symptoms.  A more detailed review of your history and examination is necessary before one can conclude whether this has arisen from previous trauma.  Most patients with asymmetries presenting in my practice are developmental and not the result of an extrinsic event.  

Nonsurgical injectables have no role for this type of nasal anomaly.  Surgical straightening of a severe septal deflection is a technical challenge with full correction often not possible. Nevertheless vast improvement can be anticipated with a good surgical plan and meticulous technique.  I recommend you seek out a reputable nasal surgeon in your community to review you options. 

Q: How to improve breast sensitivity, stop numbness in the nipple and make the area below it feel touch and changes in temperature?

Submitted by Q-A from clee on Thu, 06/09/2016 - 11:43

I went for a breast augmentation -2011(implants over the pectoral muscle/inframammary incision. I felt numbness under the nipple area and loss of sensitivity. After 1 year, no changes. I decided in 2015 to have the implants removed, but the surgeon ended up putting a smaller one not to make big scars or have a saggy breast. my scar is bigger now. I am looking on how to improve sensitivity (stop numbness in the nipple and area below it to feel the touch and changes in temperature.

A: Loss of sensation not likely to improve 5 years following breast augmentation

The nerves giving sensory innervation travel on the external (lateral) border of the breast.  These nerves are not easily seen and often suffer a stretch injury during breast augmentation from the pocket dissection and implant placement.  In the vast majority of patients, the nerves are intact but "stunned" (medically termed neuropraxia) and sensation returns to normal.  This sensation usually returns within 3 months but may require up to 18 months.  Persisting loss of sensation beyond 18 months suggests that the nerves have sustained a greater degree of injury with resulting permanent residual sensory loss.  Regrettably, implant downsizing / removal  are unlikely to alter the state of the nerve damage after your primary breast augmentation.  It would be worthwhile to discuss this prognosis in greater detail with your plastic surgeon.  Wishing you well.

Going under the knife. Where to cut?

Submitted by Liz S Admin on Sat, 09/15/2012 - 10:29

There are various kinds of plastic surgery that can be performed. Ranging from abdominoplasty (“tummy tuck”) to rhinoplasty (“nose job”), but one of the most popular ones, especially among women, is breast augmentation.

Deciding on what type of breast implants to use is not the only difficult decision to make. Plastic surgery after all is a surgical procedure that requires making incisions on the skin. Scaring is typical after an incision is performed and it is unavoidable. Deciding where an incision will be done will determine where the scaring will be located. In a breast augmentation, the three commonly performed incisions are the infra-mammary incision, the peri-areolar incision, and the trans-axillary incision.

The infra-mammary incision is an incision that is done in the breast fold, which is the crease under the breast where it meets the chest. This is the most common incision in that it offers the plastic surgeon direct visual access making it easier to place the breast implants. Both silicone and saline breast implants can be inserted through this incision. If using silicone breast implants, this incision is preferred, especially if they are large sized ones.

The peri-areolar incision is done on the lower border of the nipple, where it will be hidden between the darker colour of the nipple and the lighter colour of the skin. Both implants can be inserted, but the size of silicone implants may be restricted depending on the border and size of the areola. This incision also gives the plastic surgeon direct visual access.

The trans-axillary incision is an incision done in the armpit. The scar can be noticeable when a woman wears sleeveless clothes. Saline breast implants are preferred over silicone breast implants when this incision is done. It is very hard to position large silicone breast implants and there is no direct visual access for the plastic surgeon. Small silicone breast implants are a better option when using this incision.

Regardless of the incision that is made, a scar will follow. It is an unavoidable end result of a breast augmentation but after obtaining the desired breast size, shape, and look, the scaring will be forgotten with time as the new breasts will steal the spotlight.

Reviving that long lost youthful appearance

Submitted by Liz S Admin on Sat, 09/15/2012 - 10:20

Plastic surgery has become an increasing trend among baby boomers as they prepare to enjoy retirement. People are living longer lives and women are deciding that they might as well look good in their old age. They are becoming tired of dealing with wrinkles and dropping skin, and the discomfort of sagging breasts. Some of the most common procedures done by older patients are breast augmentation and face lifts. Many grandmothers want to look good for their grandchildren and not give off an image of an old granny in a rocking chair.

Older patients are also opting for plastic surgery to be able to keep working without being discriminated by their age. People are not only living longer lives but healthier lives as well. Many baby boomers are in good health which qualifies them for surgery. Being healthy also means they don’t have to retire and can keep working. Image is everything in today’s society, from creating a brand image to an individual’s own image. It is a common fact that people feel great when they look great. As people age, it becomes depressing to see wrinkles appear and youth disappearing from the body. The desire to look good when another stage of life is starting is great incentive to have a breast augmentation or a face lift. This is especially motivating for older women who are thinking of dating again or pleasing their husbands.

Plastic surgery has become more accepted and many women have already gone under the knife. This makes it easier for older woman to not be criticized when they decide to do the same thing. If a younger woman can have the perfect body then an older woman can definitely have a youthful body. The thought of older people trying to make their bodies look youthful can be a bit unnerving but just because they are older doesn’t necessarily mean that their life has become dry and boring. They have not turned to mush. Older people still have jobs, a family, a social life and even a sex life. Why not have a nice body too?

Cup Size Dilemma: Local Anesthesia?

Submitted by Liz S Admin on Fri, 08/31/2012 - 00:13

Having the chance to increase a cup size or two is quite invigorating. The problem is, not knowing which breast size would look best. A woman can only imagine what her breasts would look like in a B-cup or a C-cup, but will only see the physical change after the breast implants have been inserted. To make a wise decision and have a satisfying result, it is important to consult with an experienced board certified plastic surgeon before surgery. Use his knowledge and experience to guide you in your decisions. An experienced surgeon will listen diligently and will work to find the appropriately sized implant to safely achieve your desires. An interactive rapport with your breast specialist is important. Inadequate communication is the most common cause of angst and upset from either too large or small implants.

Be sure to know your doctors credentials. Do not assume that the doctor offering breast augmentation is a board certified plastic surgeon. Some may not even have had formal surgical training in a reputable institution. Because of their limited surgical training, access to deliver full anesthetic and surgical procedures may be restricted. Some unscrupulous providers attempt to conceal this deficiency by promoting local anesthesia for breast augmentation. Such marketing schemes are touted as less expensive and more accurate breast implant sizing under local anesthesia so that the awake patient can participate in final implant sizing while on the operating table. 

The purpose of putting patients under general anesthesia is so that they won’t feel any pain during the procedure. A patient is rendered unconscious and the body relaxes. Another type of anesthesia is called local anesthesia and only a part of the body becomes insensitive to pain.  An anesthesiologist is required on site when performing surgeries that require general anesthesia but not local anesthesia. With local anesthesia expense is reduced as there is no longer a need to pay for an anesthesiologist. But is it safe? Without the specialist in anesthesia, the doctor performing the procedure now is responsible for the anesthesia as well as the technical aspects of surgery. It’s very risky in fact when a doctor promotes the use of local anesthesia during breast augmentation. Unfortunately, this downplays the seriousness of surgery. Surgery has inherent risks. 

Not only is pain better controlled by general anesthesia, a stable controlled environment permits the plastic surgeon to focus his efforts to achieving the best aesthetic outcome under safe conditions. Sure it would be great to see the doctor model the breast implants and check them in an overhead mirror, but what happens if something were to suddenly go wrong during the surgery? Would it be worthwhile afterwards? Even under local anesthesia, a patient is still a bit fuzzy in the head. Are they really making a wise decision when choosing their breast implants? It’s almost like drinking and driving which leads to impaired vision and judgment.


It’s risky business when a doctor promotes the use of local anesthesia to improve breast sizing during a breast augmentation.

Q: I Am 5'0, 125 Pounds is 440 in One Breast & 480 in Another Too Big for my Petite Frame?

Submitted by Q-A from clee on Wed, 06/22/2011 - 11:57

Met w/a surgeon today. I am 5'0, 125 pounds, chest width 34, hips 36.5, waist 30. Told him I liked the 400-450 implants after trying them on. At first he thought that would be too big for me. Then he changed his mind & recommended 440 in one & 480 in another due to one breast being larger than the other with a high profile implant (saline). Do you think I will look to big on a petite frame...should I go smaller?

A: Might be large for your stature

There is a great deal of subjectivity to the desirable sizing of breast implants in augmentation mammoplasty. One good rule of thumb is to choose implant dimensions not to exceed the base width of your natural breasts. This will prevent your augmented outer edge of the breast from bulging outward toward the inner aspect of your arm. I would recommend you review with your surgeon the implant footprint dimensions against your breast base dimensions so that the breast base width is not exceeded.

Q: Breast Reconstruction Options?

Submitted by Q-A from clee on Tue, 06/21/2011 - 23:45

I have been diagnosed with intermediate DCSI. My surgeon has performed a lumpectomy and the margins are not clear. Currently, it is considered 3.5 centimeters and was told I would need the 6-week radiation treatment rather than the 1-week because of the size. I would rather not do another lumpectomy at this time and do a mastectomy to be safe. I'm a heavy woman and am currently a DD. What is the best reconstruction option?

A: Mastectomy with sparing of skin and immediate reconstruction

Mastectomy with sparing of skin and immediate reconstruction is a good option as it avoids radiation and recurrence. Whether to spare the nipple, use your own tissue, or implant has much to do with your body habitus and aesthetic desires. DD sized breasts rarely have the nipple in a normal position and likely will require reduction in your breast skin envelope to yield an aesthetic breast reconstruction. It would be best to meet with an experience breast plastic surgeon to review the options, risks, and photos of the various surgeries.