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Breast Augmentation Surgery Available for the Bellevue, WA, Area

The breasts have long been a symbol of femininity and sexuality, and are often an important aspect of a woman’s sense of self. Enhancing one’s breast appearance can improve self-confidence and bolster one’s sense of femininity and self-image. There are many aesthetic surgical options available to create a more proportional and balanced breast appearance. Smaller breasts can be enhanced with breast implants, and larger bulky breasts can be reduced in size and attractively shaped. Aging or drooping breasts can be revitalized with a mastopexy, or breast lift. Revisionary breast surgery can be performed to improve upon existing results, correct asymmetry, alter breast shape or size, or correct a wide variety of problems arising from ruptured or aging breast implants or previous surgical procedures. Male breast contour can also be aesthetically improved to bolster male self-confidence and correct overly large male breasts.

Dr. Nygaard is a recognized expert in breast surgery, which is a core specialty in her practice. She has performed over 5000 breast surgical procedures in over two decades in practice. She personally believes that being a female plastic surgeon gives her additional insight and appreciation to the art of breast surgery. She can help you to achieve beautiful, shapely breasts, regardless of your starting point, and help you to achieve the naturally beautiful breast appearance that you desire.

BREAST AUGMENTATION

Breast augmentation is a surgical procedure where either silicone gel or saline implants are placed in the breasts to enhance their fullness and projection, and create balance to complement any patient’s silhouette. Women often have breasts that are smaller than they wish to have, but augmentation can also be used to restore breast volume lost after pregnancy and breast feeding. Breast augmentation can also correct asymmetries in the breast region, enhance overall breast volume in patients undergoing breast lift, enhance one’s sense of femininity and sexuality, and bolster self-confidence and self-esteem. There is a wide range of objectives and expectations that patients seek out in breast augmentation. Some patients seek a more subtle enhancement, while others seek a more noticeable or dramatic increase in their breast volume. There are breast implants available to help achieve every patient’s goals and desires. Breast augmentation is a highly customized procedure, based on individual patient anatomy as well as the desired end results. Dr. Nygaard will help determine the best implant option for each patient. Recommendations for various implant styles and sizes will be made, depending on the patient’s presenting breast appearance, their body frame size, and their expectations and goals. Dr. Nygaard has significant experience and expertise in breast augmentation, with an artistic eye, to help patients achieve their objective of fuller, shapely, soft and very natural-looking breasts.

Types of breast implants:

There are two types of breast implants available: the cohesive silicone gel variety, and saline filled implants. Most patients feel that silicone implants provide a significantly softer and more natural feel to the breasts. Silicone implants also typically create less visible or palpable implant rippling or wrinkling. Silicone implants have been used for decades, but received formal FDA approval in 2006, after 15 years of intense evaluation, research, and testing. Since that time, silicone gel implants have become the most frequently placed breast implants, as they create breasts that are softer and more natural feeling. Most patients favor the silicone gel implants. Saline implants tend to have a slightly less natural feel and there may be issues with more rippling and wrinkling of the overlying breast skin and soft tissue. This is especially important with thin women, or those seeking the most natural result. Saline implants have the benefit of allowing for volume adjustment during surgery, which can optimize correction of asymmetries. Occasionally, patients simply feel that saline implants are somehow “safer”, although this is not supported by research. A variety of sizes, styles, and profiles of implants are available to help achieve individualized patient goals, ranging from smaller, more conservative implants that create a subtle, discrete and proportional change, to larger high profile implants that can create a more dramatic or voluptuous look. Round implants are typically utilized, as they provide the greatest amount of lift, fullness, and cleavage, along with a very natural breast shape. Implant selection is customized to meet each patient’s preferred outcome, within the constraints of individual anatomy and body proportions. Both silicone gel and saline implants are warrantied by the manufacturer for problems related to implant deflation or rupture. Replacement implants are provided free of charge to the patient from the manufacturer in cases of rupture or deflation. Financial assistance for the surgical replacement procedure may also be offered under the warranty program, if the rupture or deflation occurs within ten years of implantation. Details of the warranty program will be reviewed during your initial consultation.

Procedure description:

Breast augmentation is performed as an outpatient procedure under a general anesthetic. The procedure usually only takes about an hour or so to perform. Implants are typically placed in the subpectoral position (under the pectoralis muscle). A “pocket” is then created under the muscle. Subpectoral placement typically results in less visibility and palpability of the implant and carries a decreased risk of capsular contracture. In addition, the implants tend to stay where they are placed, and provide upper pole fullness that is extremely long-lasting. This subpectoral placement may also offer better visualization of breast tissue during mammograms. Dr. Nygaard typically places implants through an inframammary incision (in the fold under the breast). This scar becomes very inconspicuous. Typically any sort of revisionary surgery is performed through an inframammary incision as well, and therefore the original surgical incision can be utilized for a revision, if needed. The inframammary location minimizes the potential for two separate scars on the breast, if a revision is required in the future. The best implant for each patient has a base diameter and projection that matches the patient’s chest and breast profile, creating the degree of fullness requested by the patient. Implant position is carefully evaluated intraoperatively for precise placement and symmetry. The incisions are closed with dissolvable sutures.

What to expect:

  • Most patients are back to work in one week, unless substantial arm motions are required at work. In that case, two or three weeks of time off work may be recommended.
  • Moderately significant pain for the first three or four days, which can be managed with narcotics and muscle relaxants.
  • Lesser degrees of pain may last for an additional week or ten days.
  • Minimal bruising.
  • Minor swelling, which is typically gone by three or four months postoperatively. The breasts may be rather firm to the touch for several weeks after surgery, but soften and feel extremely natural with time.
  • There are fairly strict arm motion restrictions necessary for six weeks, to minimize the potential for implant shift or migration. All forms of physical activity can be resumed at six weeks.
  • A sport bra is typically worn for six weeks postoperatively.
  • Patients are provided with a surgical bandeau strap to help keep the implants precisely positioned.
  • Scars are firm and pink for a few months and gradually fade with time, becoming very inconspicuous.
  • Nipple sensation is frequently unchanged, although sensation may be somewhat reduced, especially if very large implants are placed.
  • Implants typically will not last a lifetime, and replacement at some point is likely.
  • Manufacturers provide free replacement implants in the event of rupture or deflation.

BREAST LIFT - (MASTOPEXY)

A breast lift, or mastopexy, is a procedure that re-shapes and repositions the breast tissue mound, to achieve a more youthful and perky breast appearance. The aging process, excessive weight loss, pregnancy, and breast feeding can leave women with sagging, drooping and “deflated” breasts. Breast appearance frequently will change significantly over time, for a variety of reasons. Pregnancy and breast feeding, weight fluctuations, the aging process, and hormonal influences can result in loss of volume and fullness in the breasts. This creates a drooping or sagging appearance to the breasts that can detract from their appearance. The nipple areolar complex also can become larger with breast feeding, and can be reduced as part of the mastopexy, if necessary. A mastopexy can reshape the breasts by elevating the breast mound, removing excess skin, reshaping the breast contour, tightening the skin envelope, and reducing the size of the nipple areolar complex, when necessary. A breast lift can be performed alone, or in combination with breast augmentation, which creates additional fullness in the breasts and increases upper pole breast fullness. A mastopexy alone cannot increase breast volume.

Breast lift procedures are individualized, depending on the starting breast shape and volume, as well as the degree of sag present in the skin envelope. The greater the droop, and the more significant the amount of excess skin, the longer the mastopexy scars will need to be, in order to excise the increasing amount of excess skin. Simultaneous placement of implants can enhance breast size and help to minimize the amount of excess skin requiring removal. This occasionally can help to shorten the length of the mastopexy incisions.

In Dr. Nygaard’s clinical practice, the most common type of mastopexy incision is the “anchor” shaped incision, or the “Wise pattern” mastopexy. The scars are designed around the areola, running vertically to the inframammary fold (lower breast crease), and continuing horizontally along the crease, in the underwire area.

For lesser degrees of sag or “breast deflation”, shorter scar techniques are available. One option is the periareolar mastopexy, or the “doughnut mastopexy”. This procedure involves excision of a “doughnut” of excess skin from around the areola, leaving a circular scar around the border of the areolar complex.

Another option is the vertical mastopexy, or the “lollipop” breast lift. In this case, the incisions are located in a circular fashion around the areola and then extended vertically from the base of the areola to the inframammary crease in the lower breast.

When performed by itself, it is important that patients understand that a mastopexy does not increase breast volume. Although the procedure is very long lasting, it will not be “permanent”. Multiple factors affect the longevity of a mastopexy, including poor elasticity of the skin, a history of significant weight fluctuations, and a flaccid or fatty breast, which may droop more quickly. Time and gravity can negatively affect the longevity of the procedure.

What to expect:

  • A moderate degree of pain for the first 2 to 3 days, but typically the pain is controlled with use of narcotics and becomes fairly minimal over 7 to 10 days.
  • Most women return to work within one week.
  • Six weeks of restricted arm motions and limited excersise.
  • Use of a sports bra for six weeks postoperatively to support the breasts.
  • Scars are most typically located around the areola, vertically and along the inframammary crease. The scars are initially raised, firm, and pink to reddish, but will improve over time, and become quite inconspicuous.
  • Nipple sensation is typically preserved.
  • The breasts will settle slightly over first few months after surgery, and some of the the initial upper pole fullness will become less pronounced.

MASTOPEXY/AUGMENTATION

Sometimes, especially with massive weight loss, aging, or with breast changes resulting from pregnancy and breast feeding, a combination of problems develop, and the breasts demonstrate both loss of volume and a generalized sagging of the skin. This combination of problems is most effectively treated by performing breast augmentation to add fullness to the breast mound, and mastopexy to tighten the breast tissue and skin envelope.

This is perhaps the most technically complex breast procedure to perform, and achieve long-lasting results, as the breast implants which are needed to create volume, tend to stretch out the already thinned inelastic breast skin and tissue even more. This makes the potential for asymmetry, or need for minor revisions, a bit more common. Most patients prefer to have both the mastopexy and the augmentation performed at the same time, as it allows for one surgery, one anesthetic, and one recovery period. Occasionally, a two stage procedure may be preferable, typically in extremely saggy breasts when there is a significant amount of thin, stretched, inelastic tissue. In this case, mastopexy would be performed first, followed by the augmentation procedure several months later. However, the prospect of two surgeries and two recovery periods, combined with the expense of two procedures, makes this a less attractive option for most patients. Evaluation of final outcomes show that revision rates are not significantly higher in the combination procedure, compared to a two stage procedure. Patients undergoing mastopexy-augmentation have to be aware that a revisionary procedure, typically minor in nature, may be needed to obtain the overall most pleasing and symmetrical results. Dr. Nygaard will determine which technique will be the most effective route for treating your particular breast issues.

Typically breast implants are placed in the subpectoral pocket, utilizing the incisions required for the mastopexy. The breast tissue and skin envelope is then tightened around the implants, eliminating the droop and sag of the breast tissue, while creating fuller, perkier breasts. The nipple areolar complex is typically elevated on the breast mound, centering the nipple complex on the newly shaped breast mound. The diameter of the areolar complex can also be reduced if necessary. The resultant anchor shaped incisions usually fade quite nicely and are hidden by the curves of the breasts. The scars are typically raised and reddish or pink for several months but eventually fade and flatten over the next year or so, becoming pale and flat. Typically, nipple sensation is preserved, although it may occasionally be slightly diminished on one or both sides.

This combination of procedures allows for creation of a very aesthetically pleasing breast shape, as well as enhanced breast volume, and achieves a spectrum of results that cannot be accomplished with either augmentation or mastopexy alone. Additional information about each of these procedures (breast augmentation and mastopexy) can be found in the appropriate sections of this website.

What to expect:

  • Moderately significant pain for the first three or four days, which can be managed with narcotics and muscle relaxants.
  • Lesser degrees of pain may last for an additional week or two.
  • Minimal bruising.
  • Minor swelling which is typically gone by three or four months postoperatively. The breasts may be rather firm to the touch for several weeks after surgery, but soften and feel extremely natural with time.
  • There are fairly strict arm motion restrictions necessary for six weeks, to minimize the potential for implant shift or migration. All forms of physical activity can be resumed at six weeks.
  • Most patients are back to work in one week, unless substantial arm motions are required at work. In that case, two or three weeks of time off may be recommended.
  • A sport bra is typically worn for six weeks.
  • Patients are provided with a surgical bandeau strap to help keep the implants precisely positioned.
  • Scars are firm and pink for a few months and gradually fade with time, becoming very inconspicuous.
  • Nipple sensation is frequently unchanged, although sensation may be somewhat reduced especially if very large implants are placed.
  • Implants typically will not last a lifetime. Manufacturers provide free replacement implants in the event of rupture or deflation.

BREAST REDUCTION

Breast reduction is a surgical procedure with both therapeutic and cosmetic benefits. The procedure reduces excessively large breasts, re-shapes and elevates the breast mound and reduces the size of the nipple areolar complex, where necessary. The procedure also entails a complete breast lift, repositioning the breast mound on the chest wall.

Excessively large breasts can be a significant physical burden to women, causing limitations in ability to exercise, and typically resulting in progressive or chronic neck, back, and shoulder discomfort. There can also be associated problems with intertrigo (rashes) in the region under the breasts, as well as grooving of the soft tissue of the shoulders due to bra strap pressure. A breast reduction results in a more balanced, proportional and pleasing breast size and shape, which can significantly improve the symptoms associated with excessive breast volume. The procedure can also boost self-confidence and create an enhanced sense of attractiveness and femininity. The procedure is often life-changing, regardless of the age at which it is performed, and results in tremendous patient satisfaction, with symptom relief, as well as enhanced self-esteem and self-confidence.

Dr. Nygaard typically utilizes the traditional “Wise pattern”, or anchor shaped technique, which creates a shapely and balanced breast appearance. Compliance with our requested arm motion restrictions for six weeks postoperatively typically results in scars that are very acceptable and well hidden, around the areolae vertically extending down from the areolae and horizonally in the fold under the breast mound. Patients typically retain nipple sensation, as well as the ability to breast feed, although neither of these can be absolutely guaranteed.

The procedure is performed under a general anesthetic and can be performed in our JCAHO accredited ambulatory surgery center, or occasionally in the hospital, based on patient health history or insurance requirements. Incisions are typically made around the nipple areolar complex, and then extended vertically below the nipple areolar complex and across the fold under the breast. Excess skin, fat, and breast tissue will be removed and the breast mound will be elevated and re-shaped. The nipple areolar complex will be relocated to a more aesthetically pleasing location. No drains are used. Dr. Nygaard also contours the “bra fat” roll, often located on the sides of the chest wall, utilizing liposuction, during her breast reduction procedures. In addition, the small fat pad on the front of the chest, near the arm pit area, will also be contoured with liposuction. This contouring of excess fatty tissue in the vicinity of the breasts may be overlooked by some surgeons, but significantly enhances the overall results of reduction mammoplasty. Dr. Nygaard has personally performed over 2000 breast reduction procedures, bringing significant personal satisfaction to many patients’ lives.

What to expect:

  • Return to work in about one week.
  • Exercise and arm motion restrictions for six weeks postoperatively.
  • Moderate discomfort, well controlled with prescribed medications.
  • A sport bra will be worn for six weeks postoperatively and no underwire should be worn for 3 to 4 months.
  • Temporary bruising, swelling, pain and numbness.
  • Typically most nipple sensation is preserved, as is ability to breast feed, however neither can be guaranteed.
  • There will be permanent scars on the breasts but typically scar quality is excellent, if arm motion restrictions are followed.

Insurance:

Dr. Nygaard is a preferred provider with several different insurance companies and her office will help to obtain preauthorization for this procedure from your insurance carrier. Our insurance billing coordinator will help patients to navigate the insurance process and will help delineate patient financial responsibilities. Insurance coverage is often available for procedures done both in our office operating suite as well as the hospital. We advise patients to contact their insurance carrier prior to their initial consult to determine if this procedure is a covered benefit under their particular plan. Please contact our billing specialist with any questions related to insurance billing for this procedure.

REVISIONARY BREAST SURGERY

Patients occasionally experience less than ideal outcomes following breast surgery. Unwanted changes can occur years after the original surgery. Body and breast changes associated with pregnancy, aging, or with weight fluctuations can lead to unwelcome changes in breast shape or size over time. Most of Dr. Nygaard’s surgical breast revision patients had their original breast surgery performed somewhere else, but on occasion she also revises breast surgery patients that she has operated on herself, who experience problems or changes in their breasts. Revisionary breast surgery is a highly individualized, and sometimes complicated, surgical undertaking. Dr. Nygaard has the expertise and insight to manage even the most challenging breast revision cases. Revisionary surgery, especially when breast implants are involved, is not an exact science, nor are revisionary breast procedure outcomes always completely controllable or guaranteed.

When breast implants are involved, the breast shape can change, malposition of implants can occur, creating breast asymmetry, or capsular contracture (hardening of the breasts) can develop. In addition, the breast tissue may sag over the breast implant mound or the implants may become palpable, wrinkled, or misshapen. Aging silicone gel implants can rupture, and aging saline implants can deflate. Patients may develop a variety of aesthetic concerns, including unsightly breast scars from previous surgical procedures, disappointment in postoperative breast size or shape, or a “bottomed out” appearance to the breasts. Asymmetrical breast appearance may be present; the areolar complexes can widen, or patients may wish to change from saline implants to silicone gel implants to minimize breast tissue rippling.

Dr. Nygaard is a highly skilled breast surgeon with extensive personal experience in addressing the spectrum of issues that may require revisionary breast surgery. Sometimes the problem lies with the implants, and sometimes the problem lies with the breast tissue; most often it is a combination of both of these factors. The goal of revisionary breast surgery is to create an improved breast contour and feel, and to create symmetrical, attractive and natural-looking breasts. Many factors are assessed and addressed with revisionary breast work. Often existing incisions can be utilized, and scars improved upon. Breast implants can be exchanged to create a harmonious, soft, and proportional breast appearance. The breast soft tissue envelope can be reshaped, repositioned, or tightened, and the nipple position can be altered. Implant pockets can be revised to improve overall breast shape. Multiple revisionary options are available, depending on the exact nature and extent of the underlying problem.

Capsular contracture:

The capsule around the implant (a soft scar tissue membrane) can tighten or shrink, which creates a firm to hard, unnatural feel to the breasts. Occasionally the capsule can thicken or become calcified. Somewhere between 5 and 10% of breast implant patients may develop some degree of capsular contracture over time. The exact cause remains unknown, despite decades of research, but likely is related, at least in part, to “biofilm”. Biofilm is the presence of bacteria in the moist environment that surrounds the implants. Correction of capsular contracture typically involves removing the contracted capsular tissue, revising the pocket, and placing a new breast implant. Despite best efforts, occasionally capsular contracture can recur. This possibility can be diminished by placing a “sling” of a natural product called acellular dermal matrix.

Ptosis – (Sagging tissue):

The breast tissue made droop off of the implants, creating an aging appearance to the breasts. On occasion, this is called a “double bubble” deformity. This may be due to laxity of the breast skin, or loss of breast tissue due to hormonal or pregnancy related changes. Weight loss or gravitational effects may also cause excessive drooping of the breast tissue. Correction may involve mastopexy (a breast lift), and/or a change in implant size, or shape.

Implant malposition:

Implants may appear high riding or laterally displaced, which can be the result of improper positioning, overuse of the arms in the initial recovery period, or an isolated shift in implant position related to trauma or some other issue.

Implants may also “bottom out”, or migrate inferiorly. The inframammary fold, at the underwire area, can gradually detach from the underlying chest wall and this allows the implant to drop down past the natural lower boundary of the breast. This creates a “bottom heavy” breast appearance with a flattened or volume deficient upper pole of the breast. The nipple areolae complex may appear to be “too high” on the breast mound.

Implant rupture:

Implants cannot be guaranteed to last a lifetime and patients should expect to have to replace the implants at some point. Implants are warrantied by the manufacturer, so that if a rupture or deflation occurs, typically the replacement implant itself will be provided by the manufacturer, without charge to the patient. If there is a rupture or deflation within 10 years of the initial surgery, financial assistance from the manufacturer may be available to help with the cost of replacement surgery. The warranty program will be discussed in more detail with you at your consultation. Rupture or deflation of breast implants can be due to aging implants or to a general “wear and tear” phenomenon on the implants themselves, during years of activity and minor trauma. Occasionally implant rupture is related to direct trauma to the breasts. Sometimes overfilling or under-filling saline implants can contribute to the risk of deflation in saline implants. Most often, the exact cause of implant rupture or deflation cannot be identified. Correction typically involves replacing the implant, although sometimes a pocket revision is required as well. If needed or desired, an implant size change can also be performed. The pocket can be revised or changed from the subglandular position to the subpectoral position. Sometimes aging gel implants are noted to be “leaking” on mammogram, and surgical replacement is indicated.

Dissatisfaction with breast shape or size:

Occasionally larger or smaller breast implants are desired. Implants may be visible or palpable with wrinkling and rippling noted, especially along the sides, in slender patients. Pocket dimensions can be too large or too small, creating either excessive lateral drift of the implants while the patient is lying supine, or a more “immobile” or fixed type of implant appearance. Sometimes the implant shape, and therefore the resulting breast shape, is less than optimal. A different profile implant, such as the high profile implant, can then be placed, changing the projection of the breasts. Correction of unsatisfactory breast shape can typically be accomplished by revising the existing pocket, occasionally creating an entirely new pocket, and by utilizing different shapes, styles and sizes of implants.

Request for implant removal:

Occasionally women tire of having their implants and simply wish to have them removed. Occasionally, one implant ruptures or deflates and the woman elects to have both of the implants removed. Depending on patient anatomy and the size of the implants to be removed, an acceptable breast shape and size can remain following explantation of the implants. More commonly, another adjunct surgical procedure, such as a breast lift, may be necessary to re-shape the remaining breast tissue once the implants have been removed. Occasionally patients can be dissatisfied with the smaller appearance of the breasts following explantation and may elect to have implants replaced.

Revisionary breast reduction:

Occasionally significant weight gain, implementation of hormone therapy, or pregnancy and breast feeding can result in the development of excessive breast tissue following a previously performed reduction mammoplasty procedure. Recurrence of large, symptomatic breasts can necessitate a secondary breast reduction.

Sometimes patients, who had their original breast reduction performed in the earlier teenage years, can continue to experience “hormone storm” with continued breast growth, and these patients may require a secondary reduction mammoplasty once the breasts stop developing.

On occasion, unsatisfactory shape can develop in the breasts if the original procedure was performed via the “vertical technique”. This procedure can occasionally result in widened and obvious vertical scars and a less than ideal breast appearance, which can necessitate a revisionary breast reduction, occasionally converting to an anchor type of incision. Less than ideal shape can also develop after the anchor reduction mammoplasty. Occasionally, breasts become very “bottom heavy,” with flattened upper poles.

Aesthetic concerns:

Widened, thickened, unsightly breast scars, malpositioned or asymmetric nipple areolar complexes, breast asymmetry, and unsatisfactory breast shape can also be addressed, with the goal being to create a more harmonious, symmetrical and attractive breast shape. Exact surgical plans will be tailored to solve each patient’s individual concerns.

Revision after breast reconstruction:

Although Dr. Nygaard does not perform primary breast reconstruction following mastectomy, she is very skilled at revising expander/implant breast reconstructions, and a variety of aesthetic concerns that can develop following breast reconstruction after cancer treatment. Whether this involves revision of the reconstructed breast, or revision of the unaffected opposite breast to enhance symmetry or refine results, there are several options available. Fat grafting, implant repositioning or breast size adjustment, scar revision, or implant pocket revision can be undertaken. There are a wide variety of options available to adjust or “fine tune” the results of breast reconstruction, and such techniques are individualized based upon each patient’s presentation and their wishes.

Overview:

Revisionary breast surgery is a highly individualized procedure specifically tailored to meet each individual patient’s goals in the manner most appropriate for what the patient’s objectives might be. Options are determined based on the presenting breast appearance or problems that the patient brings to the operating table.

Many factors determine how extensive or complicated a revisionary breast procedure will be. The type of revision depends on what the actual problem or concern is. Sometimes not all goals or objectives can be perfectly met, but often significant improvement in breast appearance can be obtained following revision. The cost of these types of procedures depends on the complexity of the case and any supplemental supplies required, such as the need for acellular dermal matrix graft material, as well as the anticipated length of surgical time needed to complete the revisionary procedure. Revisionary breast surgery involves an attempt to restore harmony and balance to the breast area and correct unsatisfactory outcomes. We request that patients obtain their previous breast surgery records and any implant information available, to help us in planning the best revisionary approach, and in minimizing complications. Previous operative notes are the most important documents.

Revisionary breast procedures are typically done as an outpatient under general anesthesia, although less complicated procedures can sometimes be performed under IV sedation. Revisionary breast surgery is typically not as traumatic to the breast tissues as the original surgery may have been. Pain and discomfort is therefore typically less, although the standard recommended six weeks of postoperative arm motion restrictions still applies. Individualized postoperative care instructions will be reviewed at each patient’s consultation based on the surgical plan. A supportive sports bra is usually used for several weeks after the procedure. Surgical drains are rarely utilized. In many cases improvement in overall breast appearance is noted immediately, but it may take weeks or months before the final result is apparent.

Revisionary breast surgery occasionally may be frustrating or disappointing to the patient. It is also typically more difficult for the surgeon, regardless of their level of skill, and the surgical challenges may be significantly more difficult. Usually, no “discount” can be given, financially, for a revisionary procedure performed following a procedure performed by another surgeon, because the “repair work” can be more difficult than the original procedure. Dr. Nygaard determines financial matters for a revision of her own patients on a case by case basis. Exact postoperative results cannot be guaranteed. Please keep in mind that perfect symmetry or flaw-free appearance sometimes just isn’t obtainable, depending on the complexity of the presenting problems. Sometimes issues arising from problems with the original procedure limit the degree of improvement that can be obtained. Sometimes the revisionary procedure can be trickier or more difficult than the original surgery. Our office will help to create reasonable and realistic expectations so that patients are informed on what to expect and understand what may not be obtainable.

Dr. Nygaard’s expertise in this field, and her artistic eye, should create a noticeable improvement in even the most complicated of breast surgery revisions. More specific information can be discussed at your consultation.

MOMMY MAKEOVER

As the mother of 7 children herself, Dr. Nygaard is well aware of the significant changes that can occur in the female body, due to pregnancy and breast feeding. Although the joys of having children surpass the sometimes disheartening changes in the body, sagging breasts and protuberant abdomens often leave women wishing for their pre-baby body back. The so-called “Mommy Makeover” can help mothers of all ages reclaim their bodies, boost self-confidence, and reverse the physical effects of pregnancy and breast feeding.

Dr. Nygaard specializes in the spectrum of procedures that create a Mommy Makeover. This combination of breast and belly surgery is customized for each individual patient, depending on their body’s “starting point” and their specific concerns and goals. These procedures cannot re-create the exact shape of the body prior to pregnancy, but they can radically improve appearance and create a body that any mother could be proud of again. The Mommy Makeover can address tummy bulging or sagging, excessive abdominal fat, loose skin and stretch marks as well as “deflated” smaller breasts with overall volume loss, drooping or sagging breasts with large areola, and excess body fat that diet and exercise alone just cannot improve.

Typically the Mommy Makeover procedure entails a combination of abdominoplasty, breast augmentation, breast lift, and/or liposuction. For breasts that became larger with breast-feeding, a breast reduction procedure can re-create smaller, perkier breasts to compliment a flatter, contoured abdomen. Patients often prefer to have both their breast and abdomen issues corrected under one aesthetic, with one recovery period, rather than with two or more separate procedures.

Abdominoplasty:

An abdominoplasty creates a flatter, sleeker, abdomen and usually involves tightening of the abdominal wall muscle, and removing all of the excess fatty tissue, loose skin and stretch marks between the navel and the pubic area.

Breast augmentation:

Breast augmentation enhances the breast volume a little, or a lot, depending on patient preference. Silicone gel or saline implants can be used for this procedure, and Dr. Nygaard will help you to select the size and style of breast implants best suited to meet your goals for fuller breasts.

Mastopexy:

A breast lift can reshape sagging or drooping breasts and reposition the breast mound higher on the chest wall. Enlarged areolae (the darker skin around the nipple) or enlarged nipples themselves can be reduced to create a more youthful breast appearance. Breast size is not significantly altered if a mastopexy (breast lift) is performed alone.

Mastopexy/augmentation:

Mastopexy/augmentation is a combination of procedures that creates fuller, perkier, more rounded and youthful appearing breasts, by combining breast augmentation with a breast lift. The implants also help to create lasting upper pole breast fullness. A variety of mastopexy techniques are available, based on the preoperative appearance of the breasts and the patient’s desires. Often, both mastopexy and breast augmentation is requred to achieve optimal restoration of pre-pregnancy breast appearance.

Breast reduction:

Sometimes breast volume is increased noticeably with pregnancy and breast feeding, and may not decrease following delivery or the cessation of breast feeding. Breast reduction can restore a smaller, perkier, or shapely breast size to better match a slimmed-down tummy. Excess breast tissue and fat are removed, and the areolar complexes are reduced to create a more harmonious balance in breast appearance, and the “skin brassiere” is tightened.

Liposuction:

Liposuction can remove diet and exercise resistant areas of “baby fat” from the abdomen, the waist area, the hips, flanks, buttocks or thighs, helping to create a more slender silhouette. Liposuction cannot re-create smooth tight skin or correct cellulitic dimpling.

Summary:

The recovery time from a Mommy Makeover depends which combination of procedures is performed, as well as individual patient factors. Ideal options for each individual patient will be explored at the consultation and the most appropriate combination of procedures will be recommended, depending on the mom’s presenting body shape and her individual goals. Often, the recovery from a combination of procedures is about the same as for an abdominoplasty alone. Postoperative medications make the recovery period manageable and you will be supported through your journey in the realm of your Mommy Makeover.

Additional details about each of these procedures can be found in the breast and body sections of Dr. Nygaard’s website.

TUBEROUS BREAST DEFORMITY CORRECTION

This is a congenital breast problem (meaning that the woman is born with the condition), but it does not manifest until puberty occurs and the breasts develop. An unusual, but characteristic, breast shape variant arises, wherein the breast base is very narrow and constricted, there is a generalized lack of lower pole breast tissue and the nipple areolar complexes are overly prominent and herniated, or excessively “puffy”. The breasts are typically quite underdeveloped and may be asymmetrical as well. Patients affected with this condition do not even know that there is a particular name for this breast deformity; they just know that their breasts look “different”. There can be a very wide spectrum of breast shapes and sizes that fall into this category. The more severe the deformity, the more difficult it can be to correct. If asymmetry also exists, the surgical challenge is even more complicated.

Correction of the tuberous breast deformity usually involves placement of breast implants to fill out the constricted lower pole of the breasts, and often requires scoring of the lower pole breast tissue to help relax and expand this tissue. Typically silicone gel implants are placed, as there is a lack of natural soft tissue “padding” to mask the implants. The gel product typically provides a softer, more natural breast feel. Typically reduction in the areolar circumference is undertaken and some type of breast lift is usually performed to correct the excessively large and often inferiorly displaced nipple complexes.

Depending on the severity of the condition, the required surgical intervention gets progressively more complicated, and in some cases, not all aspects of the conditions can be completely corrected. Typically patient satisfaction is very high, especially in light of the presenting circumstances. The results of this procedure are typically very long lasting, but breast shape or volume can be adversely affected by pregnancy and breast feeding, significant weight changes, gravity, the general aging process, and other forces that typically affect the breasts.

What to expect:

  • Most patients are back to work in one week, unless substantial arm motions are required at work. In that case, two or three weeks of time off may be recommended.
  • Moderately significant pain for the first three or four days, which can be managed with narcotics and muscle relaxants.
  • Lesser degrees of pain may last for a week or ten days.
  • Minimal bruising.
  • Minor swelling which is typically gone by three or four months postoperatively. The breasts may be rather firm to the touch for several weeks after surgery, but soften and feel extremely natural with time.
  • There are fairly strict arm motion restrictions necessary for six weeks, to minimize the potential for implant shift or migration. All forms of physical activity can be resumed at six weeks.
  • A sport bra is typically worn for six weeks.
  • Patients are provided with a surgical bandeau strap to help keep the implants precisely positioned.
  • Scars are firm and pink for a few months and gradually fade with time, becoming very inconspicuous.
  • Nipple sensation is frequently unchanged, although sensation may be somewhat reduced, especially if very large implants are placed.
  • Implants typically will not last a lifetime, and replacement at some point is likely.
  • Patients must understand that in the most severe of cases, the condition cannot be fully corrected, or may require additional surgery to improve results.
  • Minor asymmetries or less than perfect results are common.

TRANSGENDER BREAST SURGERY

Dr. Nygaard is well-known in the transgender community for performing male chest contouring surgery in female to male transgender patients, and for creating soft, shapely breasts for male to female transgender patients. “Top surgery” can be the first surgical procedure that a patient chooses to undergo during their gender confirming journey, and at Renaissance we strive to make this step of the journey a pleasant and satisfying one. Dr. Nygaard’s knowledge and expertise in this field will instill confidence, as she helps patients to achieve their desired results. She takes the time to help transgender patients fully understand their options as well as any limitations that their body might bring to the operating table. Transgender breast surgery is a highly customized procedure for each patient, and surgery is designed to help patients achieve their vision of a natural-looking chest or breast area.

Male chest contouring:

Female to male top surgery involves a spectrum of procedures designed to help trans-men achieve a more masculine chest. The surgical plan is highly individualized to each patient, based on their presenting anatomy and their postoperative goals and desires. Recommendations depend primarily on what the patient’s initial appearance is, and how large the breasts are, upon presentation. The most commonly performed technique is the double incision technique, often combined with the free nipple graft, or areolar resizing and repositioning. A few patients may be candidates for liposuction of the chest area alone, but this is unusual, as breast tissue itself cannot be removed with the liposuction cannula. Occasionally, with significantly larger breasts, a keyhole type of incision, or an anchor shaped pattern, may result in overall improved chest contour. The male chest contouring procedure is not the same as a mastectomy, which is a procedure typically performed by general surgeons to treat breast cancer. Male chest contouring is a significantly more evolved surgical technique involving removal of the majority, but not all of the breast tissue, and specific tailoring of the breast soft tissue flaps and creating appropriate definition in the inframammary fold region. Additional contouring of the chest is also performed, utilizing liposuction to contour the excess fatty tissue in the upper portion of the breast, and along the “subaxillary fat” along the sides of the chest. The nipple areolar complex is also addressed in male chest contouring, either by performing a free nipple graft, or reducing the size of the areolar complex, or even the nipple itself. Dr. Nygaard will recommend the technique that will deliver the most natural appearing male chest contour possible.

Male to female breast enhancement:

While most male to female patients may experience some degree of breast tissue development after a period of time on hormone therapy, many patient still desire to achieve fuller, rounder, and more balanced and proportional breasts, to better match their body size. A breast augmentation procedure involves surgically placing a silicone gel or a saline implant beneath the chest muscle to create a more feminine breast appearance. Dr. Nygaard frequently recommends using softer, more natural feeling, silicone implants to minimize implant palpability, especially where there is often a lack of adequate soft tissue padding in the breasts of transgender patients. There are a number of different implant sizes and styles options available, and Dr. Nygaard will help the patient decide what implant type will best meet each individual patient’s goals. The various implant types and surgical options will be discussed in detail at your initial consultation. There are multiple inherent differences between the male and the female breast, most typically a lack of adequate lower pole breast dimension, which can limit the size of implant that can be placed. Options such as fat grafting may help to feminize the breasts as well. For more information on breast augmentation, visit the breast augmentation section of this website.

What to expect:

  • Moderate discomfort, usually controlled by medications.
  • Mild bruising and swelling most of which is gone after a month, although the final results may not be apparent for up to 6 months or longer.
  • Transient numbness which should gradually resolve completely.
  • Usually scars are quite inconspicuous although they may take months to fully fade.
  • If a free nipple graft is performed in top surgery, the nipple complex will be permanently numb.
  • A compressive vest is worn under clothing for 4 to 6 weeks to minimize swelling and help the skin re-drape smoothly, in female to male chest contouring.
  • A sports bra is worn for 6 weeks postoperatively in male to female breast enhancement.
  • Typically patients are off of work about 1 week.
  • Arm use restrictions and avoidance of heavy lifting and aggressive physical exercises is necessary for 6 weeks postoperatively.

GYNECOMASTIA CORRECTION

Gynecomastia is a term that refers to enlargement of the male breasts. Sometimes this condition may be related to the use of certain medications, or to medical conditions, including obesity, however the underlying cause is often not known. Enlarged breasts in a male can cause problems with self-esteem and self-confidence and can cause physical problems and social anxiety.

The goals of gynecomastia surgery are to remove the excessive breast tissue and create a more natural-appearing male chest contour. This can also help to better reveal the pectoralis muscle definition and contour, although exercise and weight lifting is required to maximize definition of the pectoralis muscles.

The best candidates for this surgery are men fairly close to their ideal body weight, with good quality elastic skin. Good skin quality will allow for smooth re-draping of skin over the improved contour of the chest. For overweight patients, weight loss prior to surgery can improve the final result. If there are stretch marks present on the chest, these will typically remain following surgery.

Gynecomastia surgery typically involves a combination of liposuction of the fatty tissue of the breast and chest, as well as direct tissue excision in the sub-areolar region. Occasionally if the male breast is excessively large, or if there is a substantial amount of loose skin, such as that which may occur with significant weight loss, longer incisions may be required to remove excess tissue and skin. This may lead to longer and more visible scars. Surgical intervention is typically very satisfying and effective, and can significantly improve the overall appearance of the male breast, which will in turn boost self-esteem and self-confidence.

What to expect:

  • Moderate discomfort, usually controlled by medications.
  • Mild bruising and swelling most of which is gone after a month, although the final results may not be apparent for up to 6 months or longer.
  • Transient numbness which should gradually resolve completely.
  • Usually scars are quite inconspicuous although they may take months to fully fade.
  • A compressive vest is worn under clothing for 4 to 6 weeks to minimize swelling and help the skin re-drape smoothly.
  • Typically patients are off of work about 1 week.
  • Arm use restrictions and avoidance of heavy lifting and aggressive physical exercises is necessary for 6 weeks postoperatively.

NIPPLE REDUCTION

Overly prominent nipples may occur in both female and male patients and can cause embarrassment as well as awkwardness in bathing suits or certain types of clothing. Sometimes just the nipple itself is enlarged, and sometimes the areolar complex is enlarged as well. Overly prominent nipples can be reduced by a variety of different techniques, depending on the size, length, base width, and other presenting factors of the nipples themselves. Most typically the lower portion of the nipple can be excised, with the superior portion of the nipple then being folded over upon itself, to create a smaller nipple with minimal visible scarring. For larger nipples, a central wedge resection can be undertaken, approximating the two reduced halves of the nipples together. For broad based nipples, an additional triangular wedge resection can be performed at the base of the nipple, to reduce the overall base diameter of the nipple. The goal of the procedure is to create a more harmonious balance between the nipple, the areola, and the breast itself.

Typically, patients retain a significant degree of nipple sensation, although patchy numbness may occur. Some patients have been able to successfully breast-feed after this procedure, but more typically patients should expect to have difficulty in breast feeding, and no guarantees can be given as to potential for future breast feeding. Minor asymmetries in the nipples themselves may occur, and on occasion there may be minor issues with pigmentation changes, although this is not typical.

What to expect:

  • A scar that becomes very imperceptible over time.
  • Very little pain, typically lasting only a day or two.
  • Results are usually permanent.
  • Sensation is typically normal, although occasionally may be slightly reduced.
  • Minimize aggressive physical activity for 4 to 6 weeks.

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