Dr. Richard B. Schaefer, MD

There are a few different methods used to create the round shape of the breast on the chest. A flap of fat, skin, and muscle can be taken from the side, abdomen or buttock and implanted on the chest to create a breast from the patient's own tissue. Alternatively, the skin over the chest may be gradually stretched to allow for the placement of an implant. Stretching of the skin is done using expanders, which are similar to breast implants, except they increase in size when saltwater solution is injected into them. Many women also choose to combine the flap procedure with implant placement to achieve their desired result. Once the new breast shape is formed, a nipple can be created and even tattooed to match the other side.

Reconstruction may be done in a single surgery or broken up into multiple procedures:

• Immediate reconstruction rebuilds the breast right after mastectomy. This method is not recommended if additional chemotherapy or radiation is needed after surgery.
• Delayed reconstruction occurs after chemotherapy or radiation has been given. These treatments may decrease the volume or alter the color of the reconstructed breast, so they should be completed before the breast is rebuilt. This type of reconstruction may happen weeks, months, or even years after mastectomy.
• Staged reconstruction splits the reconstructive process into two parts. The first part inserts temporary expanders to stretch the skin and is done immediately after breast removal surgery. The second part replaces the expanders with implants after chemotherapy or radiation treatments have been given.

Breast reconstruction is not perfect. The two breasts may not always look exactly identical, although they will be close. There may be small scars, and a loss of sensation in the reconstructed breast. A reconstructed breast will not produce milk, so patients may have trouble breastfeeding. Still, reconstruction is a great option for women who want that part of their appearance back.

The patient and surgeon will discuss the patient's needs, preferences, and limitations to determine the type of implant and incision to use.

Using one's own fat for breast enlargement starts with a procedure called liposuction, which is the removal of excess fat from other parts of the body. After the fat is collected, it is rid of impurities and then injected into the breast. This option suits those who do not wish to have foreign materials placed inside their bodies.

Deformities such as tubular breasts may also be corrected using breast augmentation. Tubular breasts are characterized by small, droopy breasts and a narrow base. Aside from placement of an implant, the surgeon cuts the breast tissue to release the tightness and make the base wider.

Breast implants are not lifelong devices. They may rupture or may develop capsular contracture, which is the hardening of scar tissue around the implant. If these complications occur, another surgery may be required to replace or remove the implants.

While a breast augmentation enlarges the breast, a breast lift, also called mastopexy, raises the breast by repositioning the nipple and removing excess skin. Breast lifts can be done using three techniques. If there is only a small amount of sagging, removal of excess skin around the outline of the areola may accomplish the desired result. This technique is called a doughnut lift. If the nipples are just at or slightly below the level of the breast fold, a surgeon may recommend a lollipop lift. This type of lift involves a doughnut lift and a vertical incision from the bottom edge of the areola to the crease. If there is a lot of excess skin, a surgeon may recommend an anchor lift. This technique is similar to the lollipop lift, but it also involves a crescent-shaped incision along the breast fold to be able to remove more excess skin. Sometimes loss of breast volume accompanies sagging. If this is the case, an augmentation can be performed in combination with the lift procedure.

Because nerves around the nipple are cut during surgery and need time to heal, temporary loss of sensation in this area is common after having a breast lift. Sensation is usually regained after several weeks to a few months. Although uncommon, loss of sensation may also be permanent, especially if a significant amount of tissue around the nipple was removed.

Both breast augmentation and breast lift are typically done in an outpatient facility and do not require a hospital stay. Following surgery, patients should apply a cold compress over their breasts for the first 24 hours and keep their upper body elevated -- even during sleep -- for the first few days. Patients are also given a special type of bra to wear while recovering. Using cold compresses, staying elevated, and wearing the special bra help to minimize swelling and pain. Strenuous activities like running and working out should be avoided for four to six weeks, but light exercise may be started about one week after a breast augmentation procedure.

Professional cosmetic skin treatments exist to treat wrinkles, scars, dark spots, remove excess hair, tone and tighten skin, and otherwise improve the appearance of the skin. They may use lasers, light therapy, chemical peels, microdermabrasion, or many other forms of skin treatment.

Acne occurs when hair follicles become clogged with oil and dead skin cells, most commonly on the face or back. The clogged follicles can then become infected and inflamed. Treatments include antibiotics, anti-inflammatories, and retinoid creams.

Eczema is dry, sensitive skin that causes an itchy red rash, often in response to specific triggers. It is common in childhood but can sometimes last into adulthood. The main treatment involves keeping skin well moisturized.

Dermatitis is the medical name for any kind of skin inflammation or rash. Rashes can happen because of an allergy or contact with an irritating substance. They may be red, itchy, or even painful. They are often treated with antihistamines or moisturizing creams containing cortisone.

Psoriasis is patches of thick, red skin that is covered in silvery scales. It is often itchy and sore. Psoriasis is thought to be caused by an immune disorder, and it runs in families. Psoriasis is not contagious. There is no cure, but there are medicated creams available to treat the symptoms.

Skin growths, including warts and moles, are usually not serious. However, some skin growths should be examined by a doctor to make sure they don't cause problems in the future. Warts are harmless, rough, bumpy growths caused by a viral infection. They occur most often on the hands and feet. Because they are caused by a virus, they are contagious. Moles are brown or black spots that are sometimes raised slightly from the surface of the skin. They happen when clumps of pigment cells form in a cluster instead of spread out. Moles are harmless except that they are more vulnerable to cancer than other parts of the skin. Skin cancer is the most common form of cancer in the United States, and its risk increases with sun exposure and fair skin tone.

Skin issues can be embarrassing or irritating, but most are minor and can be treated without serious problems. Some, however, can be a sign of a more significant issue, so it is important to see a doctor for anything out of the ordinary.