Breast Augmentation & Reduction (BAR)
Age: 44 Breast Augmentation Reduction (BAR)
This is a 44 year old mother of one who was interested in my BAR procedure. What attracted her to this procedure is the final result of “higher and tighter” breasts. She says that her breasts are quite saggy and situated low on her chest (actually encroaching on her upper abdomen!) She has a history of a 100 pound weight loss!
Indeed, her breasts are quite saggy and low. Most patients who experience a loss of 100 pounds will have loose skin and saggy breasts. She is seen here after a bilateral breast augmentation with 250cc high profile silicone implants and a 50 gram tissue reduction from both breasts. I had to revise her left breast twice under local anesthesia to deal with some skin excess and implant malposition.
She is seen here about two years out from her procedure. I also did a full abdominoplasty to deal with excess skin of her abdomen. Surly you can appreciate that her breasts are much higher and better shaped. She is quite pleased, and I am glad that she was patient with me while I was adjusting her left breast to make it as good as it could be. She is from out of town and traveled to the office while doing business in Austin.
This is the patient’s response to an email I sent congratulating her on the beautiful outcome:
“Heck, I may just have to get something else lifted or tightened, just to have an excuse to keep dropping in to see all you swell folk! I have been marketing you to some Spokane folk. They’re not as trusting of the mountain-ites and their knives, anesthesia ;-D
I’m gonna miss your team. Good people, make me feel safe, like a person. Same with you. Not a common thing in healthcare/physician offices. You’ve made a difference in my life that can’t be put into words.
God bless!”
Age: 41 Breast Augmentation Reduction (BAR)
This is a 41 year old mother of two, 5’1″ and 114 pounds, who desired a breast enhancement. Her breast had fallen from their original position after kids. Her breasts were of two different sizes. She had significant asymmetries of her chest wall which contributed to the different appearance of her breasts.
She elected for a BAR procedure. Through a vertical incision, I removed 63 grams of tissue on the right and 93 grams on the left. I used 275cc moderate profile silicone breast implants placed beneath the muscle with the preservation of the origin of the muscle along the rib at the breast fold in order to support the weight of her implants.
She is seen here about one year after surgery. You can clearly appreciate the “lift” associated with this procedure. We both noticed that the left implant had not completely settled to a level even with the right side. In the near future, I plan to move the left implant down and a bit laterally to optimize her result. This is a simple procedure that will be performed under local anesthesia. She is very pleased with her outcome, we are just going to tweak the implant for optimal results.
Age: 37 Breast Augmentation Reduction (BAR)
This is a 37 year old mother of four, 5’7″ and 122 pounds, interested in some work after she finished her family (or they finished her!). Her main focus was her breasts. They lost volume and superior fullness and they sagged quite a bit. She felt they were not particularly flattering and that the kids “sucked the life out of them!”
She is seen here after my typical BAR procedure (Breast Augmentation and Reduction). I placed 275cc moderate profile implants beneath the chest muscle and reduced about 35 grams of hanging tissue on each side. She has healed quite well with symmetrical breasts and fine scars. Take a look at some of her moles so that you can see how much of an improvement or “lift” she has experienced. The top of her breast is much higher making the upper chest shorter and more youthful in appearance. Her breasts are perky and project forward from her body beautifully, nothing “hangs.”
Patients like her are ideal candidates for a BAR procedure. Some patients request a BAR procedure but their breasts are simply too large. The more my patients learn about the BAR procedure the more they understand what it accomplishes and why I approach the breast by reducing it and augmenting it. However, there are limits, and until I have more experience with larger sized breasts I will always err on the side of conservatism.
Age: 18 Breast Augmentation Reduction (BAR)
This is an 18 year old who presented to my office complaining to me that her breasts never quite developed normally. She thought it was because she didn’t wear a bra.
You can clearly see that she has uneven saggy breasts with enlarged areolas. She is seen here after a bilateral BAR procedure (Breast Augmentation and Reduction). I removed 377 grams of tissue on the right and 259 grams on the left side. I placed 350cc moderate profile smooth walled round silicone implants beneath the muscle on each side. This was all performed with a vertical incision and a final lollipop shaped scar.
There is a remarkable improvement with very nice symmetry. She has soft, natural looking breasts. She still doesn’t wear a bra which isn’t going to help her at all (support equals a better long term shape).
This is a challenging procedure in general, but in this case more so because of the breast unevenness, the size of the reduction needed, and the expanse of her areolas.
Age: 32 Breast Augmentation Reduction (BAR)
This is a 32 year old mother of three, 130 pounds and 5’8″ tall who came to my office complaining about her breasts. You can clearly see in her pre-operative photos that her breasts were deflated, asymmetrical, and not particularly appealing. We discussed the five mammaplasty alternatives–breast augmentation, breast reduction, mastopexy, mastopexy-augmentation, and an augmentation and reduction procedure (BAR). After careful consideration of the benefits and risks of the various alternatives, she felt the BAR procedure offered her the most benefit (higher, perkier, fuller breasts).
She is seen here after a bilateral breast augmentation and reduction, using 325 cc moderate profile smooth silicone implants placed beneath the muscle without cutting the muscle at the bottom of the breast. About 90 grams of breast tissue was removed from each breast. The “lift” was accomplished through a vertical incision, with the final scar shaped in a lollipop pattern.
Her photos are taken at one year. Her breast measurements compared to her pre op breasts prove tremendous elevation of her breasts on her ribs, far more breast projection and NO PTOSIS (drooping or sagging). When standing, there is no part of her breast that falls below the breast crease. This is a tremendous achievement considering what she started with and this attests to the benefit and power of the BAR procedure in these difficult cases.
Age: 23 Breast Augmentation and Reduction (BAR)
This is a mother of two who is 5’3″ and 106 pounds interested in a breast enhancement. When she first met me in consultation she told me she did not want a “breast lift.” As you can see from her photos, she has extreme pregnancy related breast changes. Her breasts are involuted, collapsed, saggy and deflated (lots of stuff!). There is no elasticity to her skin whatsoever. When she raises her arms, you can see the fine wrinkling of the skin which is evidence there is no elasticity left.
When I saw her back I was impressed with the outcome, particularly considering what she started with. Look at some of the moles on her chest and you can see how much I was able to elevate her breasts.
It has been my experience that when a patient tells me that she “doesn’t want a lift,” this generally means that they need a lift, they know this, but they want me to tell them it is needed to achieve our goals. There is no way this breast can be adequately managed without a lift. Sure you can put in a huge implant but then it will destroy her skin, stretch her tissues, and cause complications like bottoming out and rippling. It will look unnatural and she will look like “boobs on a stick.” There is nothing to fear with a scar on the breast. Would you prefer a Ferrari with a scratch or a beat up old car? Your choice indeed, but most people prefer the Ferrari. What both men and women see is the “big picture:” breasts that are positioned well with nice skin and nipples that are pointing forward and not at the floor. Breasts that project and have superior fullness and cleavage. Note too that there is some difference in the positioning of the nipples on the left and right breasts. Rarely does any woman have perfect breasts and in the case of an augmentation and “lift” there will be asymmetry.
Age: 25 Breast Augmentation and Reduction (BAR)
This is a mother of one who is 152 pounds and 5’7″ tall. She wants fuller, larger, and perkier breasts. She is seen here after a bilateral BAR procedure (Breast Augmentation and Reduction). She had 400cc smooth round silicone implants placed beneath the muscle through a vertical lifting approach. I removed about 65 grams of breast tissue on each side. These photos were taken about a year and a half after her procedure. It’s apparent that she has gained some weight.
Before surgery she had typical post partum breasts (after kids), which lose overall fullness (particularly in the upper part of the breasts) and sag. You can clearly see the increase in fullness, particularly in the upper part of the breast. This attribute of superior breast fullness as well as an elevation of the breasts on the chest wall is relatively unique to the BAR procedure. Look at the projection of the breast on the lateral picture–how far her breast extends out from her chest. The loose tissue at the bottom of the breast is reduced and the new breast is built around a breast implant that is placed under the pectoral muscle that has not been “cut” as is not uncommon in breast enhancement procedures. The intact muscle helps to support the breast implant and keep it up high on the chest wall.
Note the rectangle on the bottom set of photographs. This was created using set points on both before and after photographs to illustrate the fact that the breast is filling out the rectangle much more after the procedure, there is much more projection of the breast, there is much less “sag” to the breast and most of the fullness has been created in the upper portion of the breast (the area that most patients find pleasing). Note also that when I speak of “superior breast fullness” I am not referring to the “step off” look created with subglandular, overinflated saline implants. The fullness created by this procedure is natural in appearance; it looks only unnatural when you consider that few women older than seventeen have such desired fullness!
It’s unfortunate that most patients don’t remember what they used to have until they have been shown their pre and post operative photos side by side. Pictures don’t lie and patients don’t remember. It takes over two years for the scars to look their best.
Age: 48 Breast Augmentation and Reduction (BAR)
This is a female who is 5’8″ and 148 pounds and had laparoscopic surgery for obesity. She lost over 100 pounds and told me she was interested in doing something about her breasts as they have fallen and they are very loose and unattractive to her.
She is seen here after a BAR procedure (Breast Augmentation and Reduction). She was augmented with 350cc smooth round silicone implants placed beneath the muscle. About 60 grams of hanging loose breast tissue was removed. This was performed through a vertical approach with a “lollipop” shaped final scar.
One can clearly see the overall improvement. Her flat, pancake like breasts are now fuller, higher, and tighter. There has been a big elevation of her breasts on her chest wall. She did have a small problem with the right implant after her surgery as it didn’t completely drop and required a minor procedure under local anesthesia to move it down. The arrow on the oblique view points to the area of increased superior fullness.
When observing the changes in her breasts over time with photographic analysis, it was apparent to me that her breasts dropped a bit lower and laterally. She does not wear a bra at night but wears a very supportive one during the day. I told her that it’s also very important to wear a supportive bra at night (one that does not have an under wire though), to keep her breasts positioned up front. The female breast will naturally want to move down and to the side over time. Women with larger breasts are more likely to experience this than those with smaller ones. The weight of a breast implant will stretch and thin the tissue over time so it is very important to supply external support with a quality bra. Think of it as a way of preserving your investment. It’s not the end of the world if you don’t but it sure does make sense.
Age: 20 Breast Augmentation and Reduction (BAR)
This young woman is 6′ and 139 pounds. She is seen before her BAR (Breast Augmentation andReduction) procedure and at five months and finally at 20 months post-operative. She was augmented with 300cc smooth walled silicone implants placed beneath the muscle with a vertical approach leaving a lollipop shaped final scar.
At four months you can clearly see the redder scar and the fact that the implants sit up quite high (the procedure is a powerful “lifter” of the breast). At 20 months the scars have faded nicely and the breasts have settled a bit (the implant has moved down a centimeter or so). Although the scars from a lifting procedure are permanent and real they generally fade well over time most patients feel that the scars were a very acceptable trade-off for the overall improvement in the appearance of their breasts.
It has been my experience that the BAR procedure is the most powerful technique to firm, lift, and shape the female breast. No matter what technique used by your surgeon, however, all breasts will settle to some extent. The possible benefit of the BAR procedure is that the tissue most likely to fall is actually removed at the time of the procedure–it can’t fall if it’s not there.
Age: 40 Breast Augmentation and Reduction (BAR)
This mom who is 5’4″ and 126 pounds says she likes the size of her breasts but wants them “lifted.” She wants more superior fullness with the nipples pointing in a forward direction. She doesn’t like the downward sloping appearance of her breasts.
She is seen here after a BAR procedure (Breast Augmentation and Reduction). She was augmented with 300cc smooth moderate plus profile saline implants placed beneath the muscle through a vertical incision with a final lollipop shaped scar. She had 83 grams of tissue removed on the right and 18 grams removed on the left.
She is seen here after four months. There is no doubt about the “lift” that she has received. Her breasts are sitting higher on her ribs, they are far more projecting, there is an enormous amount of superior fullness, and the nipples are certainly facing forward.
Look at the elevated station of her breasts by comparing the area of the rectangles that were drawn from her clavicle to her lateral breast and the “take off” of her breasts.
Age: 40 Breast Augmentation and Reduction (BAR)
This is a mother of four who is 5’9″ and 150 pounds. She was interested in breast enhancement since she was done with her family. You can see from her pre operative photos that the left breast was more ptotic (saggy) than the right and it was larger. She lost any superior breast fullness that she had and the areola’s of her breasts have increased in size significantly.
After discussing her options in detail, she elected for a BAR procedure (Breast Augmentation and Reduction). The implant is used to replace the saggy tissue volume that I plan on removing as well as to increasesuperior breast fullness. The tissue reduction will be greater on the right than the smaller left side and I will use the same sized implants. This will be done with a vertical approach that will result in a lollipop shaped scar (scar around the areola and down to the breast crease with the possibility of an extension of the scar in the breast crease if needed).
She is seen here a little over two years from her procedure. She was enhanced with 350cc smooth silicone implants placed under the muscle. There was 59 grams of tissue removed on the right and 119 grams on the left.
Note the improved shape and symmetry. Her breasts are higher on her chest wall than they were before her procedure. The scars have faded nicely and she is wearing an excellent bra that supports them well. I can’t stress enough the need for a proper fitting bra long term to support and shape the breast for a long lasting result. It is not possible to perform this complex procedure and obtain two perfectly symmetrical breasts.
