Breast


Women choose to undergo breast surgery for a variety of very personal reasons. Gravity, pregnancy, breast-feeding and weight loss affect the shape, size, and firmness of the breasts. Patients desiring more youthful breasts with greater projection can benefit from a breast surgery.

At Harbour Plastic Surgery we offer a variety of breast procedures such as breast augmentation, breast lifts, breast reduction as well as breast reconstruction surgery.

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Breast Augmentation / Enlargement / Enhancement

Under-developed breasts can have a deleterious effect on a woman’s self-esteem. After pregnancy the glandular tissue may shrink considerably or cause an unwanted change in the shape of the breasts. A silicone or saline breast implant can be used to achieve the shape and size of breasts that a patient desires.

There are several different incisions possible in breast augmentation surgery. An incision under the breast, called the infra-mammary incision, is hidden along the natural skin crease under the breast. This incision allows Dr. Geppert excellent visibility during surgery, aiding precise symmetric placement of the implants. Risks of infection are lowest with this incision and Dr. Geppert’s sutures heal inconspicuously.

At Harbour Plastic Surgery in Houston we perform breast augmentation on an outpatient basis, under general anesthesia. During breast enhancement surgery a small incision (about an inch and a half) is made in the fold of skin under the breast. Depending on the circumstances and after discussing the options with you, Dr. Geppert inserts the implant (silicone or saline) under the mammary gland or under the pectoral muscle. A pocket is created just large enough to accommodate the implant and positioned to give the best aesthetic result. Breast augmentation could also be performed through an incision around the nipple also known as peri-areolar incision. Dr. Geppert will make a half-circle incision at the edge of the areola. The natural color transition around the nipple camouflages the scar; however, this incision poses a slightly higher risk of nipple numbness and infection. Women with small areolas or large silicone implants may not be candidates for this incision, as placement of the implants may be technically impossible. This is a good choice, however, for women undergoing a breast lift with breast augmentation surgery.

After breast augmentation surgery, the body forms a fine capsule of connective tissue around the implant. Very rarely, thickening of this capsule leads to capsular contraction. Bleeding and infection are also possible, but utmost care is taken to avoid them. Steri-strips are placed along the incisions and the patient may shower after a couple of days after breast augmentation. She can wear a bra after couple of weeks. We also recommend that the breasts be massaged starting at two weeks after breast augmentation surgery to prevent a capsular contracture.

Breast augmentation helps women obtain the breasts that they have always desired and feel more sensuous and confident.

Alternate Breast Augmentation Incisions (not used by Dr. Geppert)

An incision placed under the arm, the Trans-Axillary incision is possible by use of an endoscope. This incision is less desirable because it is far from the central location of the implant, resulting in wider cleavage and difficult implant placement. The scar is well hidden when your arms are at your sides, but can be noticeable in sleeveless tanks and especially in women with olive or darker skin tones.

The Trans-Umbilical incision for breast augmentation involves making a one inch incision at the edge of your belly button. A long metallic tube is then forced to the breasts through the incision. Then the empty saline implant is folded and pushed through the tube into position, and then filled. This approach is not ideal because it is limited to saline implants and it is a challenge for precise, symmetric placement of the implants.

Implant Selection

If you are looking for breast augmentation in Houston, you will have to choose between saline or silicone, a variety of sizes and shapes and several different manufacturers which might make your selection difficult. At Harbour Plastic Surgery we will explain the available options and help you choose the implant that is right for you.

The main decision that a patient has to make is between saline and silicone gel implant. The incision used for saline-filled implants is slightly smaller because they are filled after insertion. Some women feel more comfortable with the harmless saline solution in case of rupture. However, saline implants are associated with more rippling and higher visibility. Silicone gel implants, on the other hand feel more natural, but to monitor for ruptures, MRI needs to be performed. Also silicone gel implants are only recommended in women 22 years of age or older. Currently more form stable silicone implants have been approved by the FDA also known as “gummy bear” implants. These implants retain their shape in any position and do not exhibit rippling, but feel fairly firm to the touch.

When deciding on the size, shape and projection of the implant, Dr. Geppert will guide you so that you can select the implant that will meet your expectations, but also fit your body and breast type. The implant’s profile or projection signifies how far the implant protrudes from the chest wall. Implants also come in round and anatomic shape. The round implants provide upper pole fullness while the anatomic implants look a little bit more natural and are fuller on the bottom. Because anatomic implants could look asymmetric if they rotate, they have a textured cover to increase tissue ingrowth and keep them in place. Round implants are more commonly used and with proper surgical technique in Dr. Geppert’s hands produce a very natural and attractive post-operative results.

Breast Augmentation Revision

Women choose to undergo breast augmentation for a variety of very personal reasons. Breast augmentation is a very safe procedure with minimal down-time and high satisfaction rate. For women who are displeased with the outcome of their original breast augmentation Dr. Geppert can perform breast augmentation revision to achieve aesthetically pleasing and attractive breasts.

Choosing Breast Implant Revision in Houston

There are a number of reasons why women choose breast augmentation revision:

Unsatisfactory Cosmetic Result 

 Some women are not happy with the cosmetic outcome of their original surgery and need implant correction. Others desire to exchange old saline implants with cohesive gel silicone or gummy bear implants. A woman might also desire a different size implant.

Capsular Contracture 

 Occasionally the thin scar around a breast implant can thicken and tighten. The breasts can become hard and painful, with an unnatural appearance. Breast implant redo in Houston is the solution to capsular contracture.

Implant Deflation and Rupture 

 Implant rupture is a rare event, but it does occasionally occur in a small percentage of women. Saline and silicone breast implants behave very differently when they rupture. A saline breast implant deflation becomes evident almost immediately after rupture because the body absorbs the saline, and the ruptured side is visibly smaller. Silicone breast implant rupture on the other hand can only be detected by MRI and occasionally by ultrasound. The breast itself does not change in size because the body cannot absorb the silicone.

Breast Implant Revision is a technically challenging procedure and requires a greater surgical skill than primary breast augmentation. Revision of the breast implant pocket might require moving the pocket from subglandular to submuscular plane, placing internal stitching to modify the breast implant pocket or creating an internal bra using Stratice surgical matrix. Dr. Geppert is well versed in all types of breast implant revisions and has performed a large number of revisions for both cosmetic and reconstructive breast implant surgery.

Breast Reconstruction

The joy of surviving breast cancer can often be overshadowed by the loss of breasts through lumpectomy, double or single mastectomy. Breast reconstruction in the Houston and Clear Lake area helps women feel “whole” again, achieve a balanced body shape and regain their confidence and beauty. For women interested in reconstruction an immediate breast reconstruction might be an option (i.e. the breast reconstructive process begins at the same surgical setting as the mastectomy). The reconstruction could also be performed in a delayed fashion.

Deciding on breast reconstruction is a personal choice which depends not only on the woman’s breast shape and size, but also on her general medical condition, life style, and emotional state. At Harbour Plastic Surgery in the Houston area the type of reconstruction to be undertaken is mutually decided between Dr. Geppert and the patient, and various factors are taken into consideration. Dr. Geppert creates a customized surgical plan that takes into account each patient’s breast anatomy, medical condition and aesthetic desires.

Approaches to Breast Reconstruction 

Tissue Expansion

Breast Reconstruction with tissue expander and regenerative tissue matrix such as Alloderm is the most frequently used method for breast reconstruction. The expander is placed under the chest muscle and the skin gradually stretched until sufficient space is created for an implant. This type of reconstruction requires a number of office-visits, however the recovery is faster and easier than with flap reconstruction.

Flap Surgery

During flap reconstruction the breast mound is recreated using a woman’s own muscle, fat and skin usually from the abdomen or back. The donor tissue often remains attached to its original blood supply and is tunneled to the mastectomy defect.

Implant Reconstruction

Implants are most commonly used for reconstruction after tissue expansion, but they could also be used for immediate reconstruction if the patient has sufficient tissue and does not desire large breasts. Larger breasted women may require a breast reconstruction with both autologous tissue flap and an implant.

For improved symmetry the uninvolved breast might have to be lifted or reduced (reduction mammaplasty). If the patient does not desire surgery to the unaffected breast, alternate methods of breast reconstruction could be considered. Dr. Geppert has performed a large number of breast reconstructions and has the artistic eye and surgical skill to make your newly reconstructed breast feel natural and look aesthetically pleasing.

Breast Lift / Mastopexy

Gravity, pregnancy, breast-feeding and weight loss affect the shape, size, and firmness of the breasts. Patients desiring more youthful breasts with greater projection, without increase in size will benefit from a breast lift. When a woman desires a larger breast volume, the breast lift could be combined with breast augmentation, also known as augmentation mastopexy.

A breast lift procedure is usually recommended after a woman has had children, since pregnancy and breast-feeding affect the size and shape of a woman’s breasts. Most commonly a breast lift procedure is performed through three incisions: one around the areola, another vertical incision from the nipple to the crease under the breast and a third horizontal incision hidden in the fold under the breast fold. At Harbour Plastic Surgery in the Houston area Dr. Geppert tries to minimize or avoid the infra-mammary incision so that no scars are seen when the patient is wearing revealing clothing. A breast lift procedure should not affect a woman’s ability to breast-feed. Overall, the mastopexy procedure gives the mature breast a more youthful, firm, and attractive shape. The breast lift procedure can be performed as part of the mommy make-over when combined with a tummy tuck or abdominoplasty procedure during the same surgical setting.

Breast Reduction

Women who seek breast reduction surgery usually complain of back and neck pain from the excessive weight of the breasts, as well as, shoulder-grooving and skin irritation under the breasts. Breast reduction surgery usually provides a relief to many of these complaints, and also significantly improves the shape of the breasts giving them a smaller, firmer and more youthful contour.

There is no particular age at which breast reduction surgery should be performed. Patients undergoing breast reduction before child-bearing should be informed that the procedure may interfere with the ability to breast-feed, and future pregnancies might have an unpredictable effect on the size and shape of a woman’s breasts. Three incisions most commonly used for breast reduction: one around the areola, a vertical incision from the nipple to the breast fold, and a horizontal incision in the crease under the breast. Possible complications of reduction mammaplasty, although rare include: bleeding, infection, scars, and change of sensation around the nipples. The breasts are supported with a sports bra for several weeks post-operatively. The patient may return to work after one week and to full physical activity after six weeks. Breast reduction enables patients to have a more balanced and harmonious figure and allows their breasts fit better in clothes.

Many insurances cover breast reduction surgery, but usually require that a certain amount of weight to be excised from each breast which might result in smaller than desirable breasts. Breast reduction could also be combined with tummy tuck to be performed in the same surgical setting as part of the mommy make-over.

Nipple Repair

Proportionate, attractive and well-positioned nipples are extremely important in achieving beautiful looking breasts. At our Houston cosmetic surgery practice we correct a variety of nipple and areola problems.

Inverted Nipple Correction 

Inverted nipples are not only cosmetic, but also a functional problem. Women with inverted nipples are not able to breast feed or enjoy stimulation because their nipples are retracted within the breast. Surgical correction of the inverted nipples is possible and can be combined with other breast procedures.

Nipple Reduction 

Some women are unhappy and uncomfortable with their large nipples and feel self-conscious when wearing thin shirts or bras. Nipple reduction is a surgical procedure which can be performed under local anesthesia or combined with other cosmetic breast surgery procedures.

Areolar Reduction and Treatment for Puffy Areolas 

When women are unhappy with their large areolas (the dark skin that surrounds the nipple) areolar reduction surgery can reduce the diameter of the areolas and decrease also their puffiness. Areolar reduction is usually a part of most mastopexy and breast reduction procedures.