CHOOSING DR. MEGAN FOR YOUR SEATTLE BREAST PROCEDURE
As a Female Plastic Surgeon, Dr. Megan combines her meticulous attention to detail with her expertise in breast shape to achieve natural, beautiful results.
SEATTLE BREAST AUGMENTATION
WHAT IS A BREAST AUGMENTATION?
A Breast Augmentation is a surgical procedure to place an implant underneath the breast tissue in order to enhance or ‘augment’ the natural volume of the breast. It is one of the most popular cosmetic procedures performed in the United States currently. There are a number of reasons why women seek out a Breast Augmentation-- to restore breast volume after children, breast feeding, weight loss or natural aging-- or to create a more proportional breast volume in relation to the rest of the body. Whatever the reason, the ultimate goal of a Breast Augmentation is to restore and boost a woman's self-confidence by providing her with a natural, aesthetically pleasing result. As a female plastic surgeon, Dr. Megan understands the importance of our physical appearance on our self-confidence and body-image and strives to provide each and every patient with the care and results they deserve. By balancing the unique characteristics of each patient's anatomy with their individual goals and expectations, Dr. Megan is able to create natural, feminine results.
AM I A GOOD CANDIDATE?
An ideal candidate for a Breast Augmentation is healthy, has a stable weight, and is in overall good health. Most importantly, an ideal candidate seeks natural results and has realistic expectations. Often, a Breast Augmentation can be combined with other procedures such as a Breast Lift, or as part of a “Mommy Makeover.”
A Breast Augmentation is a relatively short, outpatient procedure that can be done in less than an hour and will take place in our State-of-the Art Surgical Suites at Baxter Plastic Surgery. Most patients will undergo a General Anesthesia (completely asleep) administered by our outstanding Anesthesia Team.
First, a carefully placed incision is made at one of three locations-- under the breast (Inframammary fold), around the areola (periareolar), or in the armpit (transaxillary). Then a pocket either above the Pectoralis Major muscle or below it is created for eventual implant placement. Once the pocket has been created and each side of the chest has been evaluated for symmetry, the implant is placed through the incision using a funneling device that resembles a pastry bag. The purpose of the funnel is to avoid contamination as part of a "No Touch" technique and allow us to place implants through smaller incisions.
Following implant placement, the patient is placed in a sitting position so that position and symmetry can be evaluated. Once Dr. Megan feels she has achieved her optimal results, the incisions are closed with multiple layers of dissolvable stitches all placed underneath the skin. A small strip of tape is placed over the incision and a soft, non-underwire bra is then placed on the patient. Once awoken from anesthesia and ready for discharge, the patient can then go home to recover.
Patients generally note a couple days of downtime after a Breast Augmentation procedure during which they will have soreness and possible muscle spasms that may require some stronger pain medications to control. Patients will not be able to shower until after the first postoperative appointment with Dr. Megan. Most patients will take approximately one week off of work to recover, though this can vary depending on the nature of work. We ask that a patient refrain from lifting any objects heavier than 10lbs for the first 4 weeks after surgery to allow for everything to heal. Swelling is normal over the first couple of weeks and tends to be most prominent at the upper pole of the breast. By three months, most implants have settled into their pocket and the breasts have reached their new baseline.
Breast Implants come in all shapes and sizes, and this can often be overwhelming for patients to choose what they feel is the “perfect implant.” There are multiple factors to consider:
Saline Implants vs Silicone Implants
Textured vs Smooth
Shaped vs Round
Profile-- High, Moderate or Low
Ultimately, how Dr. Megan will help her patients find the “perfect” implant is a delicate balance between patient goals, patient lifestyle and patient anatomy. Dr. Megan will perform careful measurements at your appointment to better understand your anatomy and also help you to understand how your anatomy affects the type of implant she might recommend.
WHERE WILL MY INCISION BE?
There are 3 common incisions used to perform a Breast Augmentation. The most common is through the Inframammary Fold, or at the lower breast crease. This incision usually measures around 3cm in length and is made to be hidden in the natural crease of the breast so as to not be visible when a patient is wearing a bra or a bikini. An incision around the Areola, or a periareolar incision, is another popular option for women. This incision is carefully placed at the junction between the darker areolar skin and the lighter breast skin in order to camouflage its location. Lastly, an incision in the armpit can be used in order to place a Breast Implant. This option is very appealing to patients because of its lack of scar placement on the breast itself but is not always the best choice in many patients. All scars will flatten, soften and fade over time but the healing process can take upwards of a year.
HOW DO I PICK AN IMPLANT SIZE?
Implant size can be a very overwhelming choice for patients. Dr. Megan does not believe in “choosing” a size for her patients. The “perfect” size of an implant is an individualized and multifactorial decision involving a number of factors that must be considered-- lifestyle, age, skin quality, height, weight, chest circumference, breast width, existing breast tissue and patient goals. Dr. Megan’s goal is to walk her patients through each of these considerations so that, together, they can agree on the best size for the patient.
WHAT POCKET WILL DR. MEGAN USE?
There are 4 potential anatomic positions that a Breast Implant can be placed in. The two most straightforward are either completely above the Pectoralis Major muscle (subglandular), or underneath the Muscle (submuscular). To place the implants in a pocket under the muscle, the muscle is released from its rib attachments to the midline of the chest to allow for an appropriately positioned pocket for the implant. Less straightforward are a Subfascial Pocket and a Dual Plane Pocket. A Subfascial pocket is where the implant is placed above the Pectoralis muscle and directly underneath the fascial layer covering the muscle. The idea behind a Subfascial pocket is to leave the muscle undisturbed and utilize the strength of the fascial layer to help hold the implant in its position over time.
A Dual Plane pocket is in essence a hybrid between a Submuscular Pocket and a Subglandular pocket where the implant is covered superiorly by the muscle and inferiorly by the glandular tissue. This is Dr. Megan’s preferred method of Augmentation when she has a patient with a lower nipple position or some glandular tissue that hangs below the breast base.
Ultimately, patient anatomy combine with patient goals will best help us decide which pocket is correct for each patient.
SEATTLE BREAST LIFT
WHAT IS A BREAST LIFT?
There are many reasons why breasts change over time-- having children and breastfeeding, weight loss or weight gain, and the natural process of aging. All of these changes lead to excess skin, drooping (ptosis), and deflation of the breasts. A Mastopexy or Breast Lift is a surgical procedure designed to reshape and lift the breasts into a more perky and youthful position and shape. Through this procedure, the excess skin of the breasts is tightened and removed, the breast tissue is rearranged, the nipple is lifted, and the areolar size is reduced. In many women it is often combined with the addition of a Breast Implant to enhance the volume of the breast. To ensure the ideal breast shape is achieved, Dr. Megan will often also utilize liposuction to help her shape the sides of the breasts and to remove the axillary (armpit) fat.
AM I A GOOD CANDIDATE?
The ideal candidate for a Breast Lift (Mastopexy) is someone in good overall health and is at a stable and healthy weight. If a patient has a strong family or personal history of Breast Cancer or is at the recommended age for cancer screening they may be required to obtain a Mammogram prior to surgery. Patients who are happy with the overall volume of their breasts but have sagging of the nipple and breast tissue are good candidates for a Breast Lift alone. When a patient also desires to restore or add volume, an Augmentation can also be combined with a Breast Lift.
A Breast Lift can safely be done in our Ambulatory Surgery Center in approximately 2-3 hours. Patients usually undergo general anesthesia by our outstanding team of Anesthesia Providers, and can go home to recover after the procedure. Immediately before surgery, Dr. Megan will mark the patient as a “road map” for the surgery. Once the surgery has begun, she relies on a method of “tailor tacking” in which she temporarily rearranges and lifts the breasts to ensure that she has the most optimal shape, size and symmetry prior to proceeding. This method is done both with the patient on the bed and also with the patient in a sitting position to ensure that the breast shape is optimal in both positions.
Once all the extra skin has been removed, the nipple lifted and the breast tissue rearranged, two layers of sutures are placed beneath the skin to close the incisions. Final placement of the nipple and areola is done with the patient in a sitting position. Lastly, a fine liposuction cannula is used to obtain the perfect shape of the outer breasts and remove any armpit fat that, once the breasts are lifted, will become more apparent if not removed in surgery. Tape is placed over all incisions and the patient is placed in a soft, non-underwire bra.
After surgery the patient will be discharged home to recover. We ask that patients wait to shower until their first visit after surgery. Ice packs on the chest and avoiding laying flat will help manage postoperative swelling. Pain medication will be prescribed so that it is available if needed. There are no stitches to be removed and the tape over the incisions at the time of surgery will be removed at 2 weeks.
Most patients take one week off work to recover from a Breast Lift. Patients are restricted to lifting no greater than 10 lbs or reaching above the head for 4 weeks
after surgery. The surgical incisions will flatten, soften and fade over the course of 12 months after surgery.
WHAT WILL MY INCISIONS LOOK LIKE?
In order to move the nipple and the areola, an incision must be placed at least around the areola and vertically down the breast. This is referred to as a Vertical Mastopexy or a “lollipop” incision pattern. Many patients will also require a horizontal incision in the crease of the breast as well. This pattern is called a Wise Pattern Mastopexy or an “Anchor” or “Inverted T” incision. Although we always strive for the fewest incisions possible, the incision pattern is ultimately determined by how best to achieve the ideal lift and shape of the breasts.
FAT GRAFTING TO BREASTS
WHAT IS FAT GRAFTING TO THE BREASTS?
Fat grafting is a surgical procedure that transfers fat from one area of the body to another. In the breasts, fat can be transferred to help correct minor asymmetries in volume, enhance cleavage or provide a slight increase in volume. A large majority of the fat cells transferred will remain in place permanently.
AM I A GOOD CANDIDATE?
Fat grafting is best performed on patients who are in good overall health and are looking to add a slight enhancement to one or both breasts. Patients must also have an area of sufficient bulk from which to transfer the fat from. Fat grafting is not a good surgical alternative to those seeking a true Breast Augmentation and is often done in conjunction with other surgical procedures.
The surgical procedure is done at our State-of-the-Art Surgical Facility as an outpatient procedure. The level of anesthesia required depends on the extent of the liposuction and fat grafting planned. First, a solution of Saline, Epinephrine and Lidocaine is injected into both the areas where fat will be harvested and where the fat will ultimately be transferred. Small incisions (2-4mm) are used for access with a liposuction cannula through which the fat is collected. Once a sufficient volume of fat is harvested, it is concentrated and injected into the desired area. Dissolvable sutures placed under the skin are used to close the incisions. Once the patient has recovered, they are discharged home to recover.
After surgery patients may experience pain and discomfort for a couple of days. Depending on the volume of fat harvested and the location it was taken from, a compression garment may be provided for the patient to wear in the weeks after surgery. We ask that patients refrain from showering until their first postoperative visit. Most patients will only require a couple days off work if this procedure is done in isolation.
WHAT IS A BREAST REDUCTION?
Women with excessively heavy, large breasts often suffer significant symptoms related to the size of their breasts which negatively impact their quality of life. Often these patients report chronic neck and back pain, rashes under the breasts, difficulty exercising and low self esteem related to their chest. A Breast Reduction (Reduction Mammaplasty) is a surgical procedure aimed at reducing the size and weight of the breasts while maintaining their aesthetic shape and proportion. In some cases, with well-documented symptoms, this procedure may even be covered by insurance.
AM I A GOOD CANDIDATE?
The ideal candidate for a Breast Reduction is in overall good health and at a relatively stable weight, and suffers from significant physical and emotional symptoms due to the size of their breasts. Age must be a consideration as well-- patients over 40 or with a strong family history of Breast Cancer will be required to obtain cancer screening prior to surgery. The ability to breastfeed may be altered with a Breast Reduction and this must be discussed with the patient in detail prior to deciding the right time to undergo surgery.
ABOUT THE PROCEDURE:
A Breast Reduction can be safely done in an outpatient setting in our State of the Art Surgical Facility. The procedure takes 2-3 hours to complete. Patients undergo a general anesthetic from our outstanding team of Anesthesia Providers. Prior to entering the operating room, the patient is marked in a standing position for the area of skin and tissue removal. Once in the operating room, the incisions are made around the areola, down the breast and, if needed, along the base of the breast. The excess tissue and skin are removed, and the areola size is reduced. The nipple and areola remain attached to their blood supply and are elevated into their new position. The remaining tissue is reshaped and the skin is then temporarily redraped and closed. Dr. Megan will then sit the patient up to ensure she has the best shape and symmetry of the breasts before closing the skin edges with stitches. Dissolvable sutures are placed beneath the skin. Drains are not used in a breast reduction. Tape will be placed over the incisions and the patient will be placed in a comfortable, non-underwire bra for discharge. The patient is then discharged home for recovery. We ask that patients refrain from showering until their first postoperative visit.
WHAT WILL MY INCISIONS LOOK LIKE?
In a Breast Reduction procedure excess skin and breast tissue are removed, the size of the areola is reduced, and the nipple is elevated to a more youthful, perky position. In order to accomplish this, scars will inevitably be placed on the breast. There are two common types of incisions used: an “Inverted T” or “Anchor” incision or a “Lollipop” or Vertical incision pattern. An “Anchor” incision goes around the areola, vertically down the lower breast, and along the breast crease creating the appearance of an Anchor. A “Lollipop” incision pattern goes around the areola and vertically down the lower breasts, taking on the appearance of a lollipop. Ultimately, the type of incision pattern utilized in surgery depends on the size and shape of the breasts.
WILL INSURANCE COVER THIS?
In some cases insurance will cover a Breast Reduction. In these instances, the patient must have well-documented symptoms and often will have to verify conservative treatment options that they have previously used (massage therapy, physical therapy, etc.) to combat their symptoms prior to seeking surgery. Body surface Area calculations are used to calculate the specific weight of breast tissue which MUST be removed in order for insurance to cover the procedure. In some cases, the amount of tissue required to be removed from the insurance company will likely leave the patient too small for either their desired size or to be proportional to their body. In these cases, the patient will often opt out of insurance coverage.
After a Breast Reduction procedure, the patient will be discharged home for recovery. The patient will be required to wear a non-underwire bra for a minimum of four weeks. Most patients require a week off from work for their recovery. The patient will be restricted to any lifting greater than 10 pounds or placement of their arms above their head for a minimum of four weeks.
BREAST IMPLANT REMOVAL
BREAST IMPLANT REMOVAL:
There are many reasons a woman may choose to have her Breast Implants removed. Maybe she feels she has outgrown them, that they no longer fit her body, or for health reasons. Implants can easily be removed in surgery but what the breasts will look like afterwards can be challenging to predict. As patients age and their bodies change, the skin of the breast will stretch out. Simply removing the Breast Implants can leave the breasts deflated and saggy, which is why many women who undergo Breast Implant Removal also undergo a Breast Lift as well.
Breast Implant removal can safely be removed in an outpatient setting. Simple removal of implants can often be performed using only a local anesthetic. When removal of the capsule or a Breast Lift are also performed, a general anesthesia will be used. Breast Implants can be removed directly from the incision with which they were placed. If the implants are removed due to a Capsular Contracture or a rupture, part or all of the internal capsule surrounding the implant may require removal as well.
After surgery, patients will be discharged home to recover. Compression of the chest using an ACE bandage will be required for the first few days after surgery. Drains may be used depending on the extent of surgical dissection and the indication for removal. The tissue of the breast will take approximately 3-6 months to settle before reaching its final shape.
Tuberous Breast Deformity is a common congenital breast abnormality with varying degrees of breast constriction, areolar herniation and breast asymmetry. In its most mild form, it may be difficult for the untrained eye to detect the deformity. However, when severe, can pose significant challenges to improving the overall aesthetic appearance, shape, and size of the breasts.
Tuberous Breasts tend to be smaller since the breast gland itself is constricted and sits directly behind the nipple and areola. Because of the position of the gland, it often bulges through the areola, effectively enlarging the areolar diameter. In a non-tuberous breast, the majority of the breast tissue sits below the level of the nipple. In a tuberous breast, however, because the gland is constricted and sits directly behind the areola, it does not fill out the base of the breast. There is often tight, constricted skin at the breast base and an elevated inframammary fold.
GOALS OF CORRECTION:
Correction of a Tubular Breast has multiple goals: increase the size of the breast, release the constricted gland so that it can be evenly draped atop the implant, lower the inframammary fold, fill out the base of the breast, and decrease the size of the areolar diameter. Although this is not as straightforward as a simple Breast Augmentation in a non-tuberous breast, great results are still possible. To obtain those results however, you need to have an experienced surgeon and a good deal of patience.
Surgery for correction of a Tuberous Breast Deformity begins through a Periareolar skin incision (placed at the junction between the pigmented areola and the surrounding lighter skin). Through this incision, the preexisting, constricted gland can be released (scored) with cautery to help redistribute its volume. The lower pole of the breast is dissected out to accommodate the breast implant, and the implant pocket is made. During expansion of the lower pole, the skin is stretched and the fold is lowered. Finally, the areola is resized by removing the excess skin circumferentially around it.
Understanding the anatomic features of a Tuberous Breast Deformity and the specific goals of surgery help to illustrate the challenges faced to achieving aesthetically pleasing results. One of the most challenging parts of surgery is the expansion of the lower breast pole. Because this skin is constricted and tight, it can be extremely resistant to filling out the projection of the implant in a rounded, aesthetically pleasing shape. Expanding the lower pole of the breast also means lowering the inframammary fold which can predispose a patient to complications such as bottoming out (when the implant continues to descend after surgery because of an unstable, unsupportive breast fold) or a double bubble deformity (persistent native breast crease). Lastly, circumferentially reducing the size of the areola while adding the volume of a breast implant can put pressure on the newly sized areola and cause it to widen again over time.
The body is incredibly adaptable but can seem slow relative to our desire to see immediate results. It can take months for the skin and tissue to stretch out at the base of the breast to give a natural, aesthetically pleasing appearance. In the interim, the implant may feel positioned unnaturally high. The same is true for the native (high) inframammary fold. While it may be present immediately after surgery as a slight crease, it often disappears over time as the skin stretches out and redistributes its tension.