Select Your Procedure

If You’re Considering Breast Augmentation

Why do women choose to have breast augmentation? Are you the right candidate?

Many people wonder what exactly breast augmentation is. Breast augmentation, also known as augmentation mammoplasty, is a procedure in which a woman’s breasts are altered through size and shape. Many people want this surgery because:

• it can improve the body shape of a woman who feels her breasts are too small
• it can bring back the lost volume in the breast due to weight loss or pregnancy
• it can help bring proportion to breasts that are asymmetrical in shape and size
• it can help sagging breasts regain shape and firmness often used in association with a breast lift procedure

To receive an improvement in bust line, a surgeon must insert an implant behind each breast. If you are considering breast augmentation, a basic understanding could help answer many questions. If you still feel like your questions have not been answered, please feel free to ask me.

What is a breast implant?

A breast implant is a silicone shell which is filled either with saline solution (sterilized salt water), or an elastic silicone gel. After being researched, tested, and reviewed by a panel of physicians for safety, they have both been approved by the U.S. Food and Drug Administration (FDA).

Types of Implants:

Based on a woman’s breast anatomy, type of body, and your preferred size increase, I can determine what choice of implant filler, implant size and shape. Other aspects are based on your lifestyle, goals and personal preferences, as well as my recommendations. Many new styles and types of implants are made and are also available to you.

New Post Op Adjustable saline implants:

If you are afraid that your breasts may be too large or still small after your augmentation you are not alone. Most patients are concerned about this. Medical studies clearly document that the most common request for patients following breast augmentation is an increase in size of their breasts.

It is not unusual for patients to love the size and shape of their breasts in the first few weeks after surgery. But as the swelling settles, the breasts decrease in size. Patients wish that they had the enlarged size and shape immediately following the surgery. But to change the size requires an additional surgery and additional cost.

New post operative adjustable implants give you and your surgeon the ability to change the size and the shape of your breasts to your satisfaction even three to six months after surgery.

Some women also dislike the sharp edge look of the breasts following breast augmentation. The new post operative adjustable implants can be over filled and then reduced in size after the surgery. This allows the breasts to have a softer and a natural look.

Here is how it works. The saline implants have a small connecting tube and a small size injection port that is left under the skin close to your incision. Following surgery, additional fluid can be injected through the injection port. This allows correction of the asymmetry if you have any after the surgery too. One/ two additional fluid injections or removals may allow you to achieve the size and shape you are wishing for. After you are happy and satisfied with the final size and shape of your breasts the injection port is removed in the office by a minor ten minute procedure. No additional incisions are necessary.

New FDA approved Silicone Implants

In November 2006 FDA approved the use of silicone breast implants for all patients requesting breast augmentation over the age of 22 and for breast reconstruction. The silicone breast implants have been in use for the last 20 years and over a million women have used them all around the world. They are now available to you in the US.

More Styles. More Choices.

Round gel-filled implants come in three different profiles (Moderate, Moderate Plus, and High Profile), and in both smooth and textured surfaces. Mentor has been making breast implants for over 20 years. Over two decades has given Mentor enormous experience, and a global reputation for integrity and continuity.

MemoryGel™ Implants: A More Evolved Breast Implant

• Multi-layered barrier inhibits silicone gel bleed
• Highly compliant shell for ease of placement through standard incision
• A proprietary formula for a feel that is similar to actual breast tissue
• Lifetime replacement guarantee
• Moderate, moderate plus, and high profile options offer a wide selection of projection per base width in round gel implants
• Highest quality materials used to optimize implant integrity

Over a million women around the world have had breast augmentation with the Mentor Memory Gel, so if you are considering breast augmentation or breast lift call us for more information.

Memory Gel (gummy bear) Implant cut into half and turned upside down showing that the gel does stick to itself

What is the right size for me?

The size of a breast implant is measured in cubic centimeters (cc’s) based on the volume of the saline or silicone filler. It is not difficult to choose the right size of the implant. It is based first on your breast width. Choosing an implant wider than our chest will result in the implant rubbing against your arm. Choosing and implant narrower than your breast makes it look very unnatural. Once the implant width is determined it is easy to find out the right profile for you based in the amount of breast you already have and what you want to achieve with your surgery. If you choose to have the saline post op adjustable implant you can have the breast size to fit your favorite bra six weeks after your surgery. You will be in complete control. If you choose to have silicone implant then you can choose from three different profiles. During your consultation you will also be given a chance to see in the mirror with the implant inside a tight tank top, so you will have fair idea how it will look after the surgery.

Where will the implant be placed?

Implants can be placed behind the breast or behind the breast or a combination of both (dual plane technique).

There is enough medical evidence that placing the implant behind the breast significantly increases the risks of formation of scar tissue or capsular contracture. This has been shown in numerous medical studies and in different countries over a decade. The implant edge can be visible and the implant rippling is more visible if the implant is placed behind the breast.

Placing the implant completely behind the muscle makes the implant higher and give an unnatural appearance. It however has a very low incidence of capsular contracture and the implant edges are not visible.

A combination technique (dual plane) allows the vast majority of the implant to be placed behind the muscle reducing the chances of the capsular contracture but the lower edge muscle is divided so that implant does not appear to be higher and the breast has a more natural appearance. This is the technique I have used for many years and has resulted in the best outcome.

What are the risks following breast augmentation?

Rarely bleeding follows a surgery and may cause swelling and pain. To control persistent bleeding, a surgery might be needed to manage the bleeding and remove the build up of blood.

If an infection occurs around the implant, which is very rare, the implant might be removed for several months until the infection goes away. A new implant can be reinserted afterwards. An infection can occur at any time, but is often noticed within a week after surgery.

Once an implant has been placed your body will form some scar tissue around it. If excessive scar tissue is deposited this may lead to capsular contracture. To minimize the chances of this happening implants are placed behind the muscle (submuscular). Some women have residual asymmetry after this surgery. After all, minor asymmetry is present in most women prior to any surgery. Implants generally have a warranty for approximately 10 years and they may need to be replaced at that time. Regular monitoring is essential. Routine mammograms should be performed. Current medical literature does not support any evidence of any link between breast implants and cancer of the breast nor does it support any link between breast implants and autoimmune diseases. Many potential mothers wonder if breast implants obstruct their ability to breast feed. Although pregnancy and similar changes to a woman’s body may change the outcome of any breast surgery, there is generally not an interference with the ability to breast feed. It is very important to discuss your choices of breast implant surgery with your surgeon if you are considering becoming pregnant and breast feed in the future.

Where Your Surgery Will Be Performed?

I will perform the operation in a hospital outpatient facility.

Types of Anesthesia

Breast augmentation can be performed with a general anesthesia, so you’ll sleep through the entire operation.

The Surgery

The method of inserting and positioning your implant will depend on your anatomy. There are three locations where incisions can be made. The first is under the underarms, the second around the areola and the third under the breasts. Each incision has its advantages and disadvantages and I will discuss and recommend what is best for you during the consultation. In the vast majority of the patients the final incision is barely visible after six months to a year following the surgery.

Once the incision has been made I will lift the breast and muscle and place the implant in the space created. The saline implant will be inflated and the incision will be closed in multiple layers.

The surgery usually takes one to two hours to complete.

After Your Surgery

After your surgery, you will likely feel tired and sore for a few days. You will most likely be up and about in one to two days. Medication will be prescribed by me so most of your discomfort can be controlled.

Soon after your surgery, your gauze dressings will be taken out and you will use a surgical bra. For about two weeks, your will feel a burning sensation in your nipples, but it will settle down. Swelling will take three to five weeks to disappear.

How long is it until you are back to your typical self?

Most people return to work within a few days. It mostly depends on the amount of activity required for your job.

Make sure you follow my advice on when to begin normal activities or exercise. You should avoid physical contact with your breasts because they will be sensitive to direct stimulation for two to three weeks. Usually three to four weeks after surgery, your breasts will no longer feel sore.

For women in the appropriate age group, mammograms should be continued even after the surgery. Please let the mammogram technician know that you have implant so they can use special techniques to perform the mammogram.

Your New Self

Your result after your surgery can be satisfying as you learn to love your new self.

You should still have follow-ups even after your surgery. You should also have a monthly breast self-exam and schedule a regular diagnostic breast screening.
Once your goals are met you can enjoy your new look.

If you’re considering Breast Reduction

If you have very large, pendulous breasts, you have probably experienced a dragging sensation at the end of the day. You may have low neck pain or a upper back pain. You are unable to sit upright and do a variety of activities in sports or at home. Your bra straps may indent your shoulder and you may have excessive sweating underneath your breasts. Breast size can be reduced to help you with these symptoms. Some teenagers also experience this problem and surgery can be done to improve their self image.

Breast reduction, or mammoplasty, helps women who have these problems. This procedure helps remove fat, skin, and glandular tissue to make breasts smaller, tighter, and firmer. It also helps reduce the size of the areola, which is the darker skin around the nipple. By giving you a smaller, better-shaped breasts, the goal of breast reduction is reached.

Who are the best candidates for this surgery?

Performed mainly for physical relief than cosmetic improvement, this surgery helps women who have sagging breasts that stop a woman from activities.

The surgery is performed when a woman’s breasts are fully developed but they can also be performed earlier if the breasts cause serious physical pain. Women who are mature enough to comprehend the procedure and have realistic goals are great candidates for this surgery. You should not have this surgery if you plan to breast-feed.

Prepare For Your Surgery

A mammogram may be essential prior to the surgery. You may have to purchase a garment or a support bra prior to the surgery. You will need for someone to take care of you for the first few days after the surgery.

Type of Anesthesia

Breast reduction is nearly always performed under general anesthesia. You’ll be asleep through the entire operation.

The Surgery

I tend to remove just enough breast tissue and create a breast that looks full and tear drop in shape giving it a natural appearance. This is achieved by doing a superior pedicle technique which is the latest and newest technique currently used by nationally recognized plastic surgeons around the country. The incision is the shape of a Popsicle and rarely extends horizontally under the breast crease thereby minimizing your incision and scarring.

Skin and breast tissue is removed and the nipple is relocated (but not completely detached) and stitched in the new position. All incisions are closed in multiple layers and all sutures are left underneath the skin.

Immediately after surgery

You will be in a surgical compression bra following the surgery for four to six weeks. Pain is there for the first couple of days especially if you cough or move around. I will give you pain medications to decrease your pain following the procedure.

Downtime?

Your breast may hurt for the first few days but this will improve over the next few weeks. The incisions will continue to heal and you may find a few sutures may come up to the surface and few areas may drain as small amount of fluid. Keeping the bra on will reduce the dragging sensation at the end of the day. You should be able to do brisk walking in a few weeks and aerobic exercises can be started in six weeks.

Your new image

Even after six months to a year, your breasts will still need time to settle into their new shape. Breast reduction scars are permanent, but your surgeon will try to conceal them as much as possible. The scars will remain lumpy and red for months and then gradually become less obvious. Eventually you will only have thin white lines for scars. Scars will be placed so you can still wear low-cut tops.

You will find that the back pain will reduce almost immediately following the surgery. You will feel lighter and enjoy doing sport activities and exercises.

You will need time to adjust to the new changes of your body. Be patient and keep in mind why you had surgery. You will then be pleased with your new results like most women are.

Breast Mastopexy and Augmentation

If You are Considering a Breast Lift . . .

As we age we lose the elasticity in our skin and breasts that were once youthful start sagging. This also happens following excessive weight loss and is not unusual after pregnancy. The surgery for lifting breast tissue is called Mastopexy or a breast lift. A breast lift can also:

• Reduce the size of the areola, which is the dark skin around the nipple
• If your breasts are too small or have lost volume, breast implants can be inserted as well as a breast lift. This can increase both their firmness and size.

If you plan to have children it is best to postpone surgery until later as your breasts will change in size and shape during your pregnancy. The best results are obtained if you have adequate cup size but your breasts have sagged over time.

Planning Your Surgery

During your initial consultation I will examine your breasts, take measurements and check for any asymmetry. Having done that I will discuss with you whether you will need any implants or not in conjunction with the breast lift surgery. This will depend on the size and shape you breasts, your weight, your expectations and finally on your initial breast volume. I will also discuss with you the size of the nipple areola and whether they need to be reduced during the surgery or not, I will also describe to you how the surgery is done and tell you where you have the incisions following the surgery. In your initial consultation, it’s important to discuss your expectations frankly with me. Every patient has a different view of what is a desirable size and shape for breasts. I will also explain the anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved.

I tend to remove minimal breast tissue and create a breast that looks full and tear drop in shape giving it a natural appearance. This is achieved by doing a superior pedicle technique which is the latest and newest technique currently used by nationally recognized plastic surgeons around the country.

Where Your Surgery Will Be Performed

Your breast lift may be performed in an outpatient surgery center.

Types of Anesthesia

Breast lifts are usually performed under general anesthesia, so that you will not be awake during the procedure.

The Surgery

Mastopexy usually takes one and a half hours to perform. If implants are placed there is an additional hour added to the time. The incision for a Mastopexy (breast lift) and the augmentation is the shape of a Popsicle. It is placed around the nipple and a vertical part that extends from the nipple to the inframammary fold. The incision outlines the area from which breast skin will be removed and defines the new location for the nipple. When the excess skin has been removed, the nipple and areola are moved to the higher position. The skin surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around the areola, in a vertical line extending downwards from the nipple area, and sometimes along the lower crease of the breast.

If you’re having an implant inserted along with your breast lift, it will be placed in a pocket directly under the muscle of the chest wall. Please refer to Breast Enlargement / Breast Augmentation on this web site for more information.

After Your Surgery

After surgery, you’ll wear an elastic bandage or a surgical bra over gauze dressings. Your breasts will be bruised, swollen, and uncomfortable for a day or two, but the pain shouldn’t be severe. Any discomfort you do feel can be relieved with medications prescribed by your surgeon. There are no drains.

Within a few days, the bandages or surgical bra will be replaced by a soft support bra. You’ll need to wear this bra around the clock for three to four weeks, over a layer of gauze. The stitches are under the skin and therefore do not need to be removed.

If your breast skin is very dry following surgery, you can apply a moisturizer several times a day. Be careful not to tug at your skin in the process, and keep the moisturizer away from the suture areas.

You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This numbness usually fades as the swelling subsides over the next six weeks or so.

What happens after surgery?

You will be in a surgical compression bra for extra support. I will be giving you pain medications and within a few days your pain will be manageable. You will wear the bra for six weeks to prevent any dragging sensation. Your stitches will be underneath the skin and will not need to be removed. There will no drains following the surgery. You may lose some sensation over your nipples for a few weeks but this will return in the vast majority of the patients.

How long until I will be back to my normal self?

You will be able to walk briskly after three weeks and do aerobic exercises in six weeks. You will feel some pain when you lift heavy objects and sometimes lifting toddlers may be difficult. You will need to wear a bra for around six weeks following surgery.

If you are considering Male Breast Surgery

Male breast surgery or surgery for enlarged male breast (Gynecomastia) is a very popular procedure with males who are embarrassed with visibly large breasts. to remove fat from unwanted area. Male breasts can commonly become enlarged due to reasons that are primarily unknown. Rarely, abnormalities in the testicles, alteration in hormone levels, application of steroids for weight training or some drugs can all be responsible. Rarely, a tumor can also grow within the male breast resulting a lump that can be felt. These tend to on one side whereas those due to medications, abnormality of the testicles tend to be bilateral.

Many men are embarrassed due to the large breasts they become visible in clothes or when you wear swimwear or simply an embarrassment caused due to inability to change in a locker room. As we all know it is not just the women who have to have great image but men too get embarrassed due to the large size of the breasts. Rarely, they can become painful too.

Due to all these reasons men seek help to reduce the size of the breasts

The following information will help answer your questions. There might be more questions that were not answered but please do not hesitate to ask me.

Plan for Your Surgery

During your initial consultation I will examine the areas where you want to have male breast surgery performed. I will also discuss with you where the male breast surgery will be performed, the location of the incisions and the final outcome that can be expected. Essentially there are two types of surgery that can be performed on male breasts. First and most common is liposuction and second is removal of the breast tissue surgically. If you have hard lump that can be felt underneath the nipples sometimes an incision and surgical removal of this hard tissue is necessary. If however, there is no hard tissue and your breasts are enlarged due to a soft tissue all around the breast liposuction is all you will need.

Where Your Surgery Will Be Performed

The procedure will be performed in an outpatient surgery center or in the office depending on the size and the amount of tissue that will need to be removed. If a larger amount of tissue needs to be removed then you may require general anesthesia.

Anesthesia For Male breast surgery

Small volume male breast surgery can be performed under local anesthesia but moderate to large volumes of male breast surgery need to be performed under general anesthesia.

The Surgery

It is difficult to predict the time required to perform this surgery. Small area male breast surgery can be performed in less than an hour but a longer time is needed when a larger amount of tissue needs to removed.

The techniques vary depending on what is the best procedure for you.

Liposuction: A small incision is made a fluid I injected into the site undergoing male breast surgery . This fluid makes it easier to remove the fat and at the same time reduces the amount of bleeding and bruising. A tumescent technique or a super wet technique will be used for injecting the amount of fluid. After waiting for five a very small cannula measuring 3-4 mm (size of a pencil) will be inserted and connected to a strong medical suction. The cannula is moved back and for the till all the fat has been taken out. Sometimes a mechanical vibrating cannula is used and sometimes a ultrasonic probe is used to help the process of removal of the fat. Once the necessary amount of contouring is done the very small incisions are closed and pressure garment is applied.

Surgical Removal: Rarely there may be excessive hard tissue underneath the nipple. An incision is therefore placed from 3 O’ Clock to 9 O’ Clock position at the junction of the nipple and the surrounding breast skin. Through this small incision the hard tissue is removed from underneath the nipple and the incision is closed with dissolving stitches.

Drains are very rarely left after the surgery.

How does Dr Panchal differ from other surgeons?

Dr. Panchal uses Power Assisted Male breast surgery ® (PAL) technique to perform large volume male breast surgery . This unique and latest technique allows him to use a male breast surgery cannula (hollow tube) to vibrate very rapidly. The MicroAire Power Assisted Lipoplasty Device uses a 2-mm reciprocating movement at 4000 cycles per minute to facilitate the movement of the cannula in tissue. This vibrating movement allows the fat cells to break very easily making it easier for the fat to be removed. PowerLiposuciton technique allows larger quantity of fat to be removed quickly making your surgery quicker and causes less mechanical trauma and bruising to the surrounding tissue. To learn more about this product please visit this website: http://www.microaire.com/pal/index.html

After male breast surgery many surgeons leave a breast that looks hollow and concave. A youthful male breast always has some areas that are convex (bulging) and some areas that are flat. Typically the area around the nipple protrudes just a little. There is decreasing amount of thickness from this central location to areas over the periphery.

Dr Panchal strives very hard to give you a very natural look. He uses very special cannulas to prevent rippling in your skin which can occur after male breast surgery.

Risk of the Surgery

Male breast surgery is a very safe surgery if it is performed by a trained surgeon Some patients may notice some irregularity in their skin surface and some may have some temporary swelling. The swelling generally disappears in a few weeks but rarely it may be slow to disappear and last for six weeks. Very rarely there may be collection of blood. Infection is extremely rare after this surgery. There could be some asymmetry of the breasts after the surgery.

Getting Back to Normal

Healing progresses slowly and your patience will be essential. There will some firmness at the site of male breast surgery that will gradually soften and feel normal. Generally patients can go back to work within a few days if male breast surgery. The stitches will dissolve in a 10 days to two weeks. There will be some fluid drainage form the site of the incision at for the first one to two days. I will be monitoring you closely and will be available if you have any questions or concerns.

Your New Look