BREAST CLINIC : BREAST COSMETIC SURGERY

Breast is the symbol of femininity, sexual attractiveness & motherhood. Contemporary concepts of female beauty and femininity necessitates that the breasts be aesthetically acceptable in all situations of dress and undress. There are many women who are unhappy with their breasts. Self- conscious, because their breasts are too small, embarrassed because their breasts are too big or disappointed because the shape and the size of their breasts has deteriorated over the years. Whatever the problem is, it can often have a serious impact on women’s self- esteem.

We perform following Cosmetic Surgeries in our specialized Breast Clinic:

• Breast Implant
• Breast Lift
• Breast Reduction
• Breast Reconstruction
• Nipple Surgery
• Breast Cancer Surgery
• Breast Swellings

BREAST IMPLANT:

Breast enlargement using breast implants is one of the most frequently used methods throughout the world. It is one of the commonest aesthetic procedures in USA & Europe. In India, there is rising trend & demand for breast implants in urban population. It is also known as a breast augmentation or breast enhancement or breast enlargement or augmentation mammoplasty, which increases breast volume by one or more cup sizes , depending on the size of breast implants used. Breast Augmentation can enhance appearance, self-image and self-esteem. This procedure increases fullness as well as projection of the breast using silicone implants. In many females breasts volume is decreased after child birth due to involution atrophy, hence some of them may demand breast implants for regaining the pre-pregnancy breast shape & confidence.
In this Cosmetic Surgery insertion of silicone gel (most common) or saline implants is done to increase the breast volume. The implant can be inserted under or above the pectoralis muscle behind the breast gland through either a small incision above the inframammary crease (the natural fold under the breast) or incision at the lower border of the areola (nipple area).

The other common indications for Breast Implant surgery are: patients in which breast is removed for breast cancer or in those female born with absent breast (Poland’s syndrome) or with asymmetry of breasts or Tuberous breasts. (The lower portion of the breast is constricted, resulting in a breast which is larger on top than on the bottom, is narrow & points downward and the areola protrudes abnormally.)

Most of these women want breast size to be increased by one cup size only, which can be done using smaller implants of sizes 175cc to 250cc. As per the patient need bigger sized implants can be used. Bembde Hospital operation theaters are specially designed to maintain strict sterility & best air quality with Class 100 Laminar air flow for reducing the chances of infection in such implant procedures. Patients who have undergone a breast augmentation are routinely screened for breast cancer using mammography.
A breast augmentation procedure takes approximately 1 hour. Patients are discharged home on the 2nd day of surgery and are prescribed an antibiotics, a pain reliever and given needed instructions. Patients are instructed to wear the post-operative bra as much as possible the first week following surgery for comfort and compression. Patients may return to normal activities as soon as they feel comfortable but are advised to avoid heavy exercise or lifting for 4 weeks.
Dr. Bembde also perform Breast enlargement using Autologous Fat grafts injection filling in selected cases. In selected cases we also suggest use of the BRAVA device before and after surgery to maximize the breast “envelope” or space into which fat can be grafted.

BREAST LIFT (MASTOPEXY):

A mastopexy is a breast lift performed to relieve breast drooping, also known as “Breast ptosis.” Gravity, pregnancy, breast-feeding, aging, weight gain and loss all take their toll, due to which breasts sag, droop, soften, flatten out and erect youthful position of breasts is often lost. Breast lift, or mastopexy, is a surgical procedure to raise and reshape sagging breasts. Sagging breast skin causes the nipple areola complex to be located lower than it should and in addition, breast fullness becomes compromised with loose & lax breasts.

Mild breast drooping may require minimal skin removal just above the areola, while severe laxity of breasts may require the incisions like for the breast reduction to remove adequate skin to lift the breast. Mastopexy can also reduce the size of the areola, the darker skin surrounding the nipple. Breast lift surgery does not significantly change the size of your breasts or round out the upper part of your breast. Hence Breast implants can be inserted in conjunction with mastopexy to increase their firmness and size with additional volume and fullness in the upper portion of the breast. If you want your breasts to look fuller, consider breast lift and breast augmentation surgery. If you want smaller breasts, consider combining breast lift and breast reduction surgery.

Good candidates for a breast tightening include women who are in good health with realistic expectations with a loss of shape & volume of the breast and drooping of nipple. Also useful for females whose breasts have a flatter, elongated shape or are pendulous & when unsupported the nipples fall below the breast crease. Some women whose nipples and areolas point downward & those having stretched skin and enlarged areolas or one breast is lower than the other are also good candidates for breast lift .

The surgery takes two to three hours to complete and is performed with general anesthesia. The recovery after the breast lift takes about seven to ten days.

BREAST REDUCTION:

The aim of Breast Reduction Surgery (Reduction Mammoplasty) is to achieve a breast size in proportion with body statistics.
Breast reduction can be very liberating, both physically and emotionally, for women who are having large breasts since young age.
Not only can big breasts be extremely uncomfortable, it can also cause neck and back pain. Also, large busted women often find it difficult to find clothing that fits correctly.
Breast reduction is surgical procedure designed to reduce sagging and heaviness of large breasts by reducing them in size and lifting them to a higher position on the chest.
Breast reduction can produce excellent aesthetic results as well as immediate relief from neck, back, and shoulder strain. In fact, breast reduction patients are among the happiest of plastic surgery patients. Good candidates for breast reduction include healthy women with large, heavy, sagging, or pendulous breasts.
Breast reduction techniques are similar to those in breast lifts. Excess breast fat, glandular tissue and skin is removed and the nipple is repositioned to achieve a bust size that is more proportional to your body shape and size. The procedure also corrects breast sagging. Liposuction is often used in the armpit region to achieve a better breast contour.
Breast reduction surgery is sometimes also a treatment for male breast enlargement known as Gynecomastia.

The procedure takes about three hours to complete and may be performed with general anesthesia.
The surgery requires two to three days of stay in the hospital. Once discharged, patients are prescribed an oral painkiller and are instructed to wear a post-operative surgical bra. Patients should avoid strenuous activity, exercise or heavy lifting for at least 4 weeks.

Breast Reconstruction:

Breast reconstruction is a type of surgery for women who have had a breast removed. You can start talking about reconstruction as soon as you know you have breast cancer. You will want your breast surgeon and your plastic surgeon to work together to come up with the best possible plan for reconstruction. Women choose breast reconstruction for many reasons: To make their chest look balanced when they are wearing a bra or swimsuit, to permanently regain their breast shape, so they don’t have to use a form that fits inside the bra (an external prosthesis).

Breast Reconstruction Surgery combines reconstructive and aesthetic principles for the best results possible. The goal of breast reconstruction is to restore the appearance of the breast and to improve a woman’s psychological health after cancer treatment. We also screen the patients for early detection of Breast cancer & other diseases. Our team along with Oncosurgeon does one stage Breast Cancer surgery & ?Breast Reconstruction for the needy ones. There are psychologic and financial benefits to having a single stage primary reconstruction of breast.
For any women, removal of one or both breasts due to cancer can be emotionally very traumatic. But such patients now have options of immediate or delayed reconstruction of removed breast.

Dr. Bembde restores the beauty of the female form and symmetry with the opposite breast following a mastectomy using the procedures best suited for each patient. Women who have had only the part of the breast around the cancer removed (lumpectomy) maynot need reconstruction. Breast reconstruction is done by a plastic surgeon. Options for breast reconstruction include autologous tissue reconstruction (using your own tissue) as well as reconstruction using tissue expansion and implants. Flap reconstruction of breast uses tissue from other parts of the patient’s body, such as the back, buttocks, thigh or abdomen. You can decide if you want to have your nipple and the dark area around the nipple (areola) reconstructed. Nipple and areola reconstructions are optional and usually the final phase of breast reconstruction. Nipple reconstruction is usually delayed until after the breast mound reconstruction is completed so that the positioning can be planned precisely.

Nipple Surgery:

Nipple Inversion: 1)Congenital: It may be present from birth or from the time of breast development & is usually bilateral. In this case it is a developmental problem caused by insufficient growth in length of the major milk ducts underneath the nipple. The short ducts pull the nipple inwards causing inversion. Indications for Surgery are either Cosmetic or Functional-for breast feeding. Surgical techniques include, Lactiferous ducts preserving surgery & Transection of lactiferous ducts-usually in severe degree of inversion.
2) Acquired: may be due to inflammatory or malignancy. Breast cancer can also pull on the breast ducts and cause nipple inversion, it is therefore very important to have a breast check if you noticed that your nipple has recently come inverted.

Breast Swellings:

Breast cysts: These are probably the commonest cause for developing a discreet lump in the breast. Nearly every woman will have cysts in the breast at some time during her life. They are usually very small and women are not aware of these cysts until they have an ultrasound scan. Breast cysts primarily develop as the result of hormonal changes in the breast and are uncommon after the menopause except in women who take hormone replacement treatment (HRT). The most common age to develop breast cysts is between 30-50 years becoming more common the closer one gets to the menopause.
Breast cysts are best diagnosed by an ultrasound scan. It is very unusual indeed to develop any serious consequences from breast cysts. They are nearly always entirely harmless and this is very effectively demonstrated by the scan. It is only in very rare cases that breast cysts develop pre-cancerous changes, and when one considers that nearly every woman will have breast cysts at some time in her life you should not consider breast cysts as having any significant malignant potential. Most surgeons will advise that breast cysts are left alone. If the cyst is large and uncomfortable a needle can be inserted in the cyst and the fluid contents withdrawn. The cyst will then disappear and it is uncommon for it to refill.
Fibroadenoma: A Fibroadenoma is the most common cause for a lump in young women, often between the ages of 15-30. In contrast to a cyst a fibroadenoma is a solid lump comprising of swirls of fibrous tissue with occasional compressed breast ducts. Fibroadenomas are entirely painless Fibroadenomas tend to slowly grow.A fibroadenoma can be removed by a small operation.

Breast Cancer:

Breast cancer is a malignant tumor having a group of cancer cells that can grow into surrounding tissues or spread to distant areas of the body. The disease occurs almost entirely in women, but men can get it, too. Breast cancer is often divided into non-invasive and invasive types. The disease occurs almost entirely in women, but men can get it, too. Breast cancer is often divided into non-invasive and invasive types. We have a team of specialist forming a” Breast Team” consisting of the Radiologist, Oncosurgeon, Medical Oncologist, Radiation Oncologist, Physician, Physiotherapist , Dietician & Consular.

Breast Cancer Detection:

Most breast lumps aren’t cancerous, but it’s always best to have them checked by your doctor. You should also see your surgeon if you notice any of the following:

• a change in the size or shape of one or both breasts
• discharge from either of your nipples (which may be streaked with blood)
• a lump or swelling in either of your armpits
• dimpling on the skin of your breasts
• a rash on or around your nipple
• a change in the appearance of your nipple, such as becoming sunken into your breast

About one in eight women are diagnosed with breast cancer during their lifetime. There’s a good chance of recovery if it’s detected in its early stages, hence it is important that women check their breasts regularly for any changes and always get any changes examined by their surgeon.
Mammographic screening is the best available method of detecting an early breast lesion. However, you should be aware that a mammogram might fail to detect some breast cancers. Women with a higher-than-average risk of developing breast cancer may be offered screening and genetic testing for the condition. As the risk of breast cancer increases with age, all women who are 50-70 years old are invited for breast cancer screening every three years.

Treatment of breast cancer:

If cancer is detected at an early stage, it can be treated before it spreads to nearby parts of the body. Breast cancer is treated using a combination of surgery, chemotherapy and radiotherapy. Surgery is usually the first type of treatment, followed by chemotherapy or radiotherapy or, in some cases, hormone or biological treatments. The type of surgery and the treatment afterwards will depend on the type of breast cancer.

Surgery for breast cancer

Most women with breast cancer need surgery to treat the breast tumor. The purpose of surgery is to remove as much of the cancer as possible. Surgery is also needed to find out whether the cancer has spread to the lymph nodes under the arm & also to restore the breast’s shape after a mastectomy,
or to relieve symptoms of advanced cancer.

Breast-conserving surgery (BCS)

This type of surgery removes only a part of the breast depending on the size and place of the tumor and other factors. If the breasts look very different after surgery, you might be able to have “Reconstructive or breast implant surgery” to improve the appearance of breast. Sometimes surgery is done on the opposite breast so that both breasts look more alike. BCS usually needs to be followed by radiation treatment. Women who can’t get radiation (or who aren’t willing to get it) often cannot have BCS.

Mastectomy

Mastectomy is surgery that removes the entire breast, sometimes along with other nearby tissues. Many women choose to have their breasts reconstructed after these surgeries. It may be a good option to have mastectomy and reconstruction done in the same operation.

Radical mastectomy: In this operation, surgeon also removes the muscles of the chest wall under the breast. This is only needed if the cancer is growing into the muscles under the breast.

Lymph node surgery

To find out if the breast cancer has spread to lymph nodes under the arm (axillary lymph nodes), one or more of these lymph nodes may be removed and looked at under the microscope. This is an important part of staging, and the results affect treatment and outcomes.
Axillary lymph node dissection: In this operation, about 10 to 40 lymph nodes are removed. Axillary lymph node dissection is usually done at the same time as the mastectomy or breast-conserving surgery
Sentinel lymph node biopsy: A sentinel lymph node biopsy is a way to learn if cancer has spread to the lymph nodes under the arm without removing so many of them.

Reconstructive or breast implant surgery:

After mastectomy or breast-conserving surgeries, a woman may want to think about having the breast mound rebuilt to restore the way the breast looks. If you are having breast surgery and are thinking about having breast reconstruction, you should talk to a plastic surgeon before your operation. There are choices to be made, such as when the surgery can be done and exactly what type it will be.