Summary

One of the primary goals of any aesthetic procedure is to restore aged or otherwise injured structures to a rejuvenated and youthful appearance. In many respects, quality breast surgery is as much a product of intelligent preoperative preparation and planning as it is a sound technical skill. Breast implants continue to evolve; we now have shaped, highly cohesive implants with a high fill ratio. The technique of autologous fat-graft injection to the breast is applied to correct breast asymmetry, breast deformities; breast reconstruction; trauma-damaged tissues, explantation of deformity for the improvement of soft-tissue coverage of breast implants, and the aesthetic enhancement of the bust. Although breast reduction is often performed to address medical issues, patients who do not have the symptoms of macromastia (large breasts) can still pursue breast reduction as an aesthetic procedure. With liposuction, from thirty to fifty percent of breast volume can be removed with good elevation, along with a reduction of the size of the areola without post-surgical wound side effects or the disfiguring inverted T-shaped scar.

One of the primary goals of any aesthetic procedure is to restore aged or otherwise injured structures to a rejuvenated and youthful appearance. The youthful ideal serves as a template for nearly every aesthetic procedure commonly performed in plastic surgery today.  In many respects, quality breast surgery is as much a product of intelligent preoperative preparation and planning as it is an excellent technical skill. This approach has made these results more consistent and helped tremendously.

Breast Augmentation (for Small Breast)

Inadequate breast volume can negatively interfere with a woman’s body image and social and sexual relationships. In recent years the central role of body image and personal aesthetics has been growing in importance worldwide. The demand for breast enlargement has constantly increased, and augmentation has become the second most performed aesthetic operation after liposuction. In many respects, breast augmentation is the defining procedure for the aesthetic breast surgeon. Obtaining outstanding results consistently requires sound judgment, technical expertise, and meticulous attention to detail. However, with experience comes the realization that developing this skill is more complicated than it might first appear to be. Perhaps the most significant reason for this is the tremendous variability in the preoperative appearance of patients who present for breast enhancement.

The technique of autologous fat-graft injection to the Breast is applied for the correction of breast asymmetry; of breast deformities; congenital disability correction” micromastia, and tuberous breast deformity, breast reconstruction: for post-mastectomy breast reconstruction (as a primary and as an adjunct technique; trauma-damaged tissues (blunt, penetrating), disease (breast cancer), explanation deformity (empty breast-implant socket).); for the improvement of soft-tissue coverage of breast implants and the aesthetic enhancement of the bust.

Breast Reduction (Mammoplasty)(for large Breast)

It is a widespread belief that a woman’s physical and mental well-being can be influenced by her breasts’ dimension, shape, and symmetry. An excessively large or tiny breast Anne in women alters at the petition of their body image, a reduction in their self-esteem, and worst cases, degeneration of social relationships in public and private spheres. Moreover, women with breasts that are excessively large compared to the rest of the body are often limited in choice of clothes and their lifestyle. Not to mention that a vast breast can make it differ from so different or even many daily life activities, which are eventually substituted by sedentary activities, creating a vicious circle and contributing to patients’ isolation. The dimension of a woman’s Breast influences her lifestyle and her personal and professional choices. Besides psychological problems, patients with large breasts can have physical symptoms such as headache, cervical pain, backache and shoulder pain, inadequate posture with shoulder incurvation, compression of the brachial plexus with paresthesias of upper limbs, mastodynia, heaviness and fullness, skin maceration at the infra-mammary fold, intertrigo, and dermatosis. These symptoms can considerably improve or completely disappear after reduction mammoplasty. The fact that reduction mammoplasty is a procedure that allows the plastic surgeon to improve the patient’s quality of life demonstrates that women undergoing this operation are among the most satisfied. After reduction mammoplasty, patients often have a new vision of life and are more prone to practice activities that I previously precluded. There is no other procedure in breast surgery where the surgeon has a more significant opportunity to demonstrate their aesthetic abilities than breast reduction. In these cases, there is an excess of skin, fat, and parenchyma usually coupled with an overall breast shape that is usually less than aesthetic. With careful surgical manipulation of the breast volume and intelligent incision planning, a beautiful and long-lasting breast shape can be created that complements the reduction in breast volume.

Breast Reduction by Liposuction Alone

With liposuction, from thirty to fifty percent of breast volume can be removed with good elevation, along with the reduction of the size of the areola without post-surgical wound side effects or the disfiguring inverted T-shaped scar Prof. Moawad added.

Breast Lift (Mastopexy)(for Breast Ptosis)

The Breast has a natural beauty when it is young but generally loses shape over the years, with volume variations due to pregnancy or weight gain. The surgeon should appreciate the patient’s motivation who has breast ptosis not only as an aesthetic wish but overall as a necessity to recover a sensation of body harmony and sensuality. The surgical correction of breast ptosis is a way to recover the female identity and recover personal satisfaction. The breast lift (mastopexy procedure) is derived from reductive procedures; the only difference is that no breast tissue is removed in pure ptosis.

Breast Augmentation (mammoplasty) & Breast Lift (mastopexy) (small breast & ptosis)

For many patients, breast hypoplasia and ptosis of either the gland or the nipple-areola complex (NAC) often occur together. Perhaps the most common scenario for this presentation is the postpartum patient who presents after having delivered and breastfed several children. After the transient increase in breast size that stretches out the supporting structures of the Breast, involution may occur that then leaves the skin envelope variably under-filled and ptotic. Also, the NAC is very often positioned low on the breast mound. In these patients, simply performing a breast augmentation alone can result in a superiorly mal-positioned implant about the breast mound and a NAC position that remains far too low to be aesthetically acceptable.

Conversely, performing a mastopexy alone may leave the remaining breast skin envelope under-filled as there is often not enough existing breast parenchyma to provide the result the patient is trying to achieve. For these reasons, to obtain the best result, it becomes necessary to combine the two procedures. While the rewards for such a surgical undertaking can be tremendously gratifying, the difficulty of the procedure is more significant than for either operation alone. This is related to the fact that the two operations have opposing goals. Breast augmentation increases the breast volume and expands the surface area to accommodate the new volume. In contrast, mastopexy generally reduces the skin surface area in accomplishing the lifting of the NAC. Therefore, any operative procedure designed to treat hypoplasia with ptosis must artistically coordinate these two competing surgical maneuvers in such a manner to allow lifting of the NAC and a reduction in the skin envelope but leave behind enough skin to accommodate the new breast volume provided by the implant easily.

Breast Asymmetry (Congenital and Acquired)

Breast asymmetry is a frequent and challenging problem for the patient and the plastic surgeon. The asymmetry of the breasts can be either congenital or acquired and includes breast mound volume, inframammary fold position, presence of base diameter constriction, and asymmetries of the nipple/areolar complex size and position. Management of the tuberous Breast represents perhaps the most significant challenge in all aesthetic breast surgery. In its most dramatic form, the preoperative deformity in breast shape can be significant. It is important to remember, however, that at times the condition can also be subtle and yet significantly impact in a negative way the result obtained after aesthetic breast surgery. To avoid poor results, it is essential to recognize which elements of the deformity are present preoperative and then develop a sound surgical plan designed effectively to correct the present anatomic abnormalities.

Breast reduction is a cosmetic surgery procedure that reduces the size and weight of large, heavy breasts, helping to create a more aesthetically pleasing breast contour that is better proportioned to a patient’s body. By removing excess breast tissue, fat, and sagging, stretched skin, a cosmetic surgeon can make the breasts smaller, lighter, and firmer and improve breast symmetry and eliminate sagging. Although breast reduction is often performed to address medical issues, patients who do not have the symptoms of macromastia (large breasts)  can still pursue breast reduction as an aesthetic procedure. Patients choosing to undergo breast reduction surgery for cosmetic reasons may cite any number of factors, including social stigmas and wardrobe concerns.

Breast reduction is a cosmetic surgery procedure that reduces the size and weight of large, heavy breasts, helping to create a more aesthetically pleasing breast contour that is better proportioned to a patient’s body. Women who have large, pendulous breasts suffer from neck pain, back pain, shoulder pain, and discomfort from bra straps. The most common method of breast reduction is excision, and several such surgical techniques are available where general anesthesia is usually needed.  Women, even with ideal symmetry, may still be distressed by well-healed scars resultant from traditional procedures. With liposuction, from thirty to fifty percent of breast volume can be removed with good elevation, along with reduction of the size of the areola without post-surgical wound side effects or the disfiguring inverted T-shaped scar Prof. Moawad added.

Gynecomastia is a condition of over-developed or enlarged breasts in men that can occur at any age. The state can result from hormonal changes, heredity, obesity, or the use of certain drugs. Gynecomastia can cause emotional discomfort and impair your self-confidence. Some men may even avoid certain physical activities and confidence to hide their condition. Gynecomastia is characterized by; excess localized fat, excess glandular tissue, sometimes excess breast skin, and it may present on one breast or both breasts. A cosmetic surgeon can help men reduce the appearance of enlarged chests with surgery. If the issue is isolated to fat, liposuction alone may be enough to achieve the desired results. However, the breast tissue, which is denser than fat, can be surgically removed in some cases. The incision location will vary but may include the areola, under the breast, or at the armpit.

A breast lift restores a firmer, perkier, and more aesthetically pleasing shape to sagging breasts. This not only can improve a patient’s appearance by restoring her youthful, feminine proportions but also help bras and swimsuits fit more comfortably and attractively. A cosmetic surgeon can create a more youthful breast contour by removing excess, stretched-out skin, reshaping the breast tissue, and raising the nipple & areola into a more forward position. The stretched, large areolae can also be reduced during breast lift surgery, creating an overall better proportioned, natural-looking breast.

Breast enlargement is typically done through the placement of silicone breast implants. The exact procedure is tailored to meet a woman’s individual needs. The choices include intravenous sedation and general anesthesia. The filling type, shape, profile, and size of the implants are discussed thoroughly in the pre-operative consultation. A breast implant will be inserted into a pocket either under the muscle or directly over the muscle. This will depend on the type of implant, degree of enlargement, and body type. Incisions are closed with layered sutures in the breast tissue and with sutures, skin adhesive, or surgical tape to close the skin. Oversized implants not only detract from the aesthetic appearance but are also physically destructive over time. Modern breast augmentation is about volume distribution, not just the addition of volume. The good shape should prevail over volume.

Over time, breast implants can change shape or size, and the overlying breast tissue can also vary, creating an appearance or feel to the breast that is less desirable than the first result. Also, many breast implants have a lifetime warranty on the actual implant device, but after ten years the costs associated with having surgery to replace the implants are no longer covered. Because of this, many women will elect to replace or update their breast implants at or around the 10-year time frame. Breast implant revision surgery is not a standard or routine procedure and needs to be explicitly tailored to the patient’s goals and desires.

Breast implant removal surgery aims to remove breast implants from breast augmentation or breast reconstruction patients. During these procedures, the surgeon may also remove silicone material from implant leaks and the breast capsule, which is the scar tissue that forms after the placement of a breast implant. Often, the scar tissue that forms after installing an implant is soft and does not need to be removed, but it may harden, causing pain and discomfort. This is often a reason to have the implants and scar tissue removed. Breast implants are not lifelong devices, and it is vital to have them exchanged or removed every 10-15 years. This decision is typically based on the individual and the patient’s needs and desires.

Today, fat grafting has gained an essential role in the plastic surgeon’s armamentarium as a safe and easy-to-use tool for an experienced surgeon. Fat grafting has the advantage of using autologous tissue that allows natural reshaping and volume augmentation and the double benefit of removing unwanted fatty deposits in donor sites by liposuction. The technique of autologous fat-graft injection to the breast is applied for the correction of breast asymmetry; of breast deformities; congenital defect correction” micromastia, and tuberous breast deformity, breast reconstruction: for post-mastectomy breast reconstruction (as a primary and as an adjunct technique; trauma-damaged tissues (blunt, penetrating), disease (breast cancer), explanation deformity (empty breast-implant socket).); for the improvement of soft-tissue coverage of breast implants and the aesthetic enhancement of the bust.