Question:
I believe I have gynecomastia.  My chest is just far too female-like for a guy.  Can I have surgery to fix this or do I first need to see a doctor to treat the gynecomastia?

Answer:
We see many patients who have gynecomastia in our practice.  In our center, it is a combination of a surgical fix and nonsurgical fix.  We do hormonal tests for everybody with gynecomastia to check their estrogen levels to make sure that these are within normal limits.  Otherwise, we believe that gynecomastia will come back after treatment if the estrogen levels are too high.  Surgery usually involves Vaser liposuction to sculpt the chest.  However, sometimes excisional procedures are needed.

Question:

What has changed with silicone implants that they’re now considered safe?

Answer:

The answer is the FDA re-approved silicone implants because it’s their finding that the previous studies and media blitz surrounding the older implants were scientifically unfounded and that, in terms of the safety of the implants, they were very sound and very safe.  However, the silicone implants we use nowadays are slightly thicker or more cohesive than the implants we used in the past with much less tendency to break.  Also, the quality control from the implant companies has gone way up.  So there’s much less of a tendency for these implants to break.  However if they do break, they are safe.

Question:

I lost a significant amount of weight and my breasts shrunk quite a bit and left me with some stretch marks.  There isn’t any real sag so I don’t think I need a breast lift.  I’m considering augmentation but worried that the stretchmarks will look worse.  How will breast implants affect the stretch marks?

Answer:

Breast implants will actually improve many of the stretchmarks on the breast caused from weight loss, but it is individual and some may see no improvement.  Our tendency is to treat some of these stretchmarks with the different types of laser therapy which can help minimize some of the stretchmarks on the breast or even on the body.

Question:

How extensive is the scar after a breast lift?  Are there any techniques to minimize scarring?

Answer:

There are many different techniques for breast lift, including circumareolar mastopexy which is an incision around the areola or vertical mastopexy which is an incision around the areola and then down vertically.  The full Wise pattern or a T-type of mastopexy is an incision around the areola, down vertically and across the breast crease.  My tendency is to treat the patient individually. Some people just will not do well with a minimal type of breast lift, while other people will do very well with a minimal type of breast lift.  Patients need to come in for consultation or send us photos for us to evaluate that. In terms of scar therapy, we use many different types of scar therapy afterwards including taping the wounds for three months and then treating with different lasers and other scar techniques to really minimize scarring so that after some time the scars do go away to almost nothing.

Question:

I’m debating between a breast lift with implants or implants alone.  I’m relatively young and my breasts are only somewhat droopy.  I’m not sure that my case warrants the extensive scarring of a breast lift.  Can you tell me who the usual candidates are for breast lift with implants versus implants alone?

Answer:

To determine who is a candidate for a breast lift with implants versus implants alone, you need to really look at the patient and evaluate the amount of droopiness to the breast and the skin quality.  Some patients who just want a minimal increase in size will not do well without a full lift, while some of these patients who have a slightly larger implant will fill out the breast more and not really need a lift.  Other patients, no matter what implant size you choose, you will need a lift if they’re significantly droopy.

Question:

My breast are about two cup sizes different, is it possible to get a breast reduction for just the larger breast?  Would health insurance cover this?

Answer:

For asymmetric breasts, it is very possible to get a breast reduction on the larger breast and not the smaller breast.  Patients need to send photos or come in for a consultation to really determine this.  Health insurances vary.  They may or may not cover this type of surgery.

Question:

If you look on the internet, it seems a lot of breast reduction surgeries go wrong and lead to dead tissue or horrible wounds. Why does this happen and how can it be prevented?  How safe is breast reduction surgery?

Answer:

Unfortunately, only the worst cases and problem cases end up on the internet.  People don’t really share their wonderful experiences.  In fact, breast reduction is the number one surgery in plastic surgery for satisfaction rates.  Most heal very well with very satisfied patients.  Patients who smoke oftentimes have wound healing problems, so we don’t operate on smokers for breast reduction and make the patients stop at least 30 days with no patch or no nicotine gum prior to their breast reduction surgery.