Pittsburgh Plastic Surgery Glossary

Asymmetry

Asymmetry is when one breast is not the same size and shape as the other. Very few women have perfectly symmetrical breasts, especially in regards to nipple placement. In some cases, asymmetries of the breasts can be more obvious after a breast enlargement. Rarely, an asymmetry with respect to pocket placement of the breast implants can occur, where one breast implant sits a little higher or lower than the other. This breast augmentation complication may not be apparent during breast augmentation surgery, but may become a problem later, during recovery as healing proceeds. Minor cases of this breast augmentation complication can be corrected with massage or a special band worn above the higher breast. A secondary plastic surgery procedure may be required to correct the problem.

Augmentation

Breast augmentation surgery increases breast size through breast implants. There are two kinds of breast implants: saline or silicone-gel. Breast augmentation surgery applies the arts of plastic surgery to create youthful, graceful breasts that enhance a woman’s femininity while giving a woman a more voluptuous figure. Breast augmentation surgery allows women to be more comfortable and self-confident in their bodies and in the appearance of their breasts.

Benelli mastopexy

The Benelli mastopexy, named for the originator of the breast lift technique, refers to a type of breast lift that minimizes the breast lift scar to the area around the areola.

Breast Tissue

Breast tissue refers to the internal architecture of the breast including nerves, blood vessels, fatty tissues and the mammary gland.

Capsular Contracture

Capsular contracture is a breast augmentation complication that may occur. This is the rare case of a tightening of the natural capsule that your body forms around the breast implant. The capsule may need to be loosened or removed to provide a more pliable pocket where the breast implant can be positioned. The capsule where the breast implant was placed can shrink or contract and become thicker and tougher causing the breast implant to feel firmer. This can happen soon after breast augmentation surgery or years later, in one or both breasts. What causes this breast augmentation complication to occur is unclear, but some sources believe that a very low grade infection or blood around the breast implant could contribute. This breast augmentation complication is not a health risk and minor cases usually do not need further treatment, but if severe, a procedure called a capsulotomy may need to be done. This plastic surgery procedure opens up the capsule to loosen it, so the breast implant feels soft again. The risk of capsular contracture from breast augmentation surgery cannot be eliminated, but Dr. Pautler minimizes the risk during breast augmentation surgery and with early massage of the breast implant.

Circumareolar Approach

This plastic surgery technique requires that the plastic surgery incision for breast lifts or breast augmentations is made between the white and the pink skin of a portion or the entire areola. This approach is necessary if the nipple-areola area needs replaced to a higher location on the breasts.

Donut Mastopexy

This plastic surgery incision is limited to the area around the areola. Donut mastopexies are limited to breasts that need adjustment of nipple height rather than tightening of the breast mound. A donut mastopexy is also used for cosmetic surgery when a wide areola requires narrowing.

Double Bubble

This breast augmentation complication occurs when a breast implant is higher and the breast tissue is lower causing the appearance from the side view of two bubbles. This breast augmentation complication can occur after significant weight loss. Revisional surgery is required to lower the breast implant or to lift the breast.

Dual Plane Breast Augmentation

This type of breast augmentation refers to a pocket made partially beneath the muscle and partially beneath the breast tissue. It offers many of the benefits of submuscular placement and in some instances, can reduce scarring by obviating the need for a mastopexy in certain patients that have a slightly droopy breast.

Fat Necrosis

In some breast reduction cases, fat in the breast may scar internally and form a lump. Typically, these lumps soften in time, but in rare instances, they can persist. Dr. Pautler can remove the lump through a plastic surgery technique using the same incision as the breast reduction. The lumps are then sent off and analyzed by a pathologist to make sure that all they are, indeed, are fat.

Hall-Findlay Technique

This breast reduction incision, named for the originator of the technique, leaves a scar also known as a lollipop scar. This plastic surgery incision is around the areola and with an up and down limb to the crease underneath the breast.

Hematoma

A hematoma is a breast augmentation complication. It is normal to have a little bleeding around a breast implant after breast augmentation surgery, and your body will absorb this small amount. However, an excessively large amount of bleeding around the breast implant is known as a hematoma. The blood must be removed or it can become infected or cause thicker scar tissue around the breast implant. If this breast augmentation complication occurs, the blood is removed either by a special needle (by a radiologist) or in the operating room. In this case of additional plastic surgery, Dr. Pautler removes the breast implant, cleanses the pocket to remove the blood, and then the breast implant is replaced with a small drain that will be removed after recovery from breast augmentation surgery.

Implant Displacement

Implant displacement is a breast augmentation complication. A more common risk with shaped breast implants, but can also occur with round breast implants. This breast augmentation complication refers to dislocation of the breast implant from a variety of factors including: trauma, lifting arms over the head too early after breast augmentation surgery, or breast implant pocket stretching from a seroma or hematoma, described previously. If the breast implant displacement appears unappealing or causes a very obvious asymmetry, additional plastic surgery may be needed to reposition the breast implant.

Implant Distortion

Implant distortion is a minor breast augmentation occurrence. When the breast implant is placed under the pectoral muscle, flexion of this muscle can temporarily change the shape or flatten a breast implant but resumes its normal breast shape when the muscle relaxes. This is a normal condition of breast implant placement underneath the pectoral muscle and is not harmful.

Implant Palpability

This breast augmentation complication is the ability to feel the breast implant. It is normal to feel the breast implant at the bottom of the breast and all patients experience this sensation to some degree.

Implant Rupture

Athough rare, a breast implant can develop a leak or rupture. With silicone breast implants, it is recommended to monitor possible breast implant ruptures through an MRI starting 3 years after receiving your breast implants. With saline breast implants, it is obvious that a breast implant has ruptured. In either case, further breast augmentation surgery to replace the breast implant is required.

Inframammary fold

The inframammary fold is the crease underneath the breast. This location is often chosen to insert a breast implant and conceal any potential plastic surgery scar.

Inframammary incision

An inframammary incision is a plastic surgery incision placed underneath the breast in the inframammary fold.

LeJour Technique

This breast reduction incision, named for the originator of the technique, leaves a scar also known as a lollipop scar. This plastic surgery incision is around the areola and with an up and down limb to the crease underneath the breast

Mammary Gland

The mammary gland is the milk producing breast tissue that makes breastfeeding possible. A mammary gland is composed of breast nodes called lobules. These lobules join together to form a milk duct, which can produce milk. The ducts are connected to the nipple. Many women are able to nurse successfully after breast plastic surgery; however, it cannot be guaranteed. If breastfeeding is something you absolutely wish to do, you may want to consider holding off on the breast plastic surgery until finished with childbearing.

Mammogram

If you are 30 or older, Dr. Pautler will send you for a mammogram. A mammogram is a special way to take a digital image of your breasts. Having a mammogram is purely a precaution to make sure that there are no suspicious areas in your breast. If there is a positive finding on the mammogram, Dr. Pautler will consult with you and refer you to a general surgeon before proceeding with breast augmentation surgery. If you have a very strong family history of breast cancer, Dr. Pautler may send you for a mammogram even if you are younger than 30.

Mastectomy

A mastectomy is the removal of a breast due to breast cancer or due to the risk of breast cancer.

Mastopexy

A mastopexy is also known as a breast lift or the repositioning of the nipple and areola area higher on the breast mound.

Neosubpectoral pocket

During revisional breast augmentation, a breast implant may require repositioning. With a neosubpectoral pocket, a new pocket is created above the old pocket which previously held the breast implant. By repositioning the breast implant in new breast tissue but still underneath the pectoral muscle, the revisional surgery is less traumatic while solving potential breast augmentation complications.

Poland’s Syndrome

This medical condition is typically characterized by the absence of chest wall muscles including the pectoral muscle on one side of the body. Individuals with Poland’s Syndrome may have additional features, such as underdevelopment or absence of one breast and breast tissue, or absence of a nipple and areola. Poland Syndrome affects males more commonly than females and most frequently involves the right side of the body. The exact cause of the condition is unknown. Breast reconstruction surgery is a plastic surgery option to re-create a breast on the afflicted side to match the breast on the non-afflicted side.

Reconstruction

Breast reconstruction is the creation of a breast after removal of a breast due to a mastectomy.

Rectus abdominis muscle

The abdomen muscle used to form a breast in a TRAM flap breast reconstruction surgery.

Reduction

Breast reduction is the removal of breast tissue and excess skin thereby reducing an enlarged or over-sized breast to a more comfortable breast size and shape

Saline Implants

Saline breast implants are filled with a natural, salt-water solution. If you have breasts with different volumes, saline breast implants can be filled to different amounts, one side more or less than the other, making your breasts appear more even and balanced. A rupture, if it occurs, is fairly easy to diagnose just by physical exam. According to the FDA, women should be 18 years of age or older to receive saline implants. These implants can be rolled up and placed under the breast through a small incision, and are filled AFTER insertion. Some women think saline breast implants feel firmerthan silicone-gel implants.

Seroma

Similar to a hematoma, this is a collection of body fluid around the breast implant. It requires treatment due to risk for infection or capsular contracture. It would be treated just like a hematoma.

Silicone Implants

In thin skinned patients, silicone-gel breast implants tend to feel more natural. They are pre-filled with a safe, FDA-approved, man-made polymer substance. Numerous scientific studies over the years have shown that silicone gel-filled implants are both safe and effective for breast augmentation and reconstruction. Because these breast implants are pre-filled, their volume cannot be altered to adjust symmetry. In this situation, implants of different sizes are needed to balance out breasts that are different sizes. They also require a slightly larger incision. A rupture is much harder to detect and special diagnostic imaging may be required to detect any leakage. You must be over 22 when your body is considered fully matured to receive silicone-gel breast implants.

Standard Mastopexy

A standard mastopexy also known as a breast lift for additional tightening and lifting. This plastic surgery scar is around the areola, up-and-down from the areola, and underneath in the crease beneath the breast.

Subpectoral Placement

Subpectoral placement refers to the placement of a breast implant beneath the pectoral muscle.

Symmastia

Symmastia is a breast augmentation complication in which the breast implants move toward the middle of the chest and gives the appearance of one continuous breast. Revisional plastic surgery is required to reposition the breast implants.

Tear Drop or Anatomical Shaped Implants

These types of implants are either oval or short and wide implants. They are always textured in surface so that the texturing minimizes rotation of the implant. They can be used above or below the muscle. They are used on certain breast shapes that would not look aesthetically pleasing with a round implant.

Textured Saline or Silicone Implants

Texturing refers to a somewhat rough surface of the shell surrounding the implant. It can be on both saline and silicone implants. It is used for the subglandular or above the muscle technique to reduce tightening of the capsule or capsular contracture.

TRAM Flap

This is a type of breast reconstruction surgery. The breast is reconstructed by removing extra skin and tissue from the area below the navel, then placing and connecting it and the muscle to the chest area. In this breast reconstruction surgery, the removal of skin and tissue is similar to a “tummy tuck”; however, in this case it requires a longer incision and the muscle is shifted at one end up to the chest. A TRAM flap breast reconstruction surgery takes longer than implants (approximately 6 hours – 9 hours under general anesthesia) and recovery can be longer with discomfort around the abdomen. Recovery is approximately 6 weeks.

Transaxillary Approach

This plastic surgery incision is made in the “armpit”. To be a candidate for this approach, the breasts need to be very symmetric is size and shape with minimal droopiness . This approach is used only for saline implants.

Tuberous breasts

Tuberous breasts are breasts that appear elongated, droopy, and have an extremely large puffy areola.

Vertical Mastopexy

This plastic surgery technique for a breast lift is also known as a lollipop mastopexy. The plastic surgery incision is around the areola and with an up and down limb to the crease underneath the breast.

Vertical Technique

This breast reduction incision leaves a scar known as a lollipop scar. This plastic surgery incision is around the areola and with an up and down limb to the crease underneath the breast.

Wise-Pattern Breast Reduction

This type of breast reduction plastic surgery incorporates the scar around the areola, up-and-down from the areola, and underneath in the crease beneath the breast.