Nippin’ Out
July 9th, 2009
I just do not know how else to describe the recent article in Allure Magazine. Quoting a London Daily Mail article about Victoria Beckham, they show a photo of her is a fitted top. The photo prominently displays the shape of her nipples and areola. The article claims surgical enhancement to create this appearance is becoming more popular.
The breast can be separated into three profile components. First is the breast mound, which accounts for the majority of the breast size. Traditional breast enlargement surgery enhances this through placement of an implant beneath the breast and/or muscle. The center portion of the breast is highlighted by the nipple and areola. This is the eye point or where a person looks when they look at another person’s (man or woman) chest. The nipple is the central portion of this area. It projects out from the breast normally. The nipple represents the termination of the breast milk ducts allowing breast feeding. The darker skin around the nipple is known as the areola. Its color varies widely with genetic background and past pregnancy history. The areola is usually flat in relation to the surrounding breast mound. Sometimes this projects above the breast mound to add another contour to the breast. This is apparent in the Allure photo.
There are a variety of cosmetic nipple surgeries. The most common procedure in the past has been correction of inverted nipples. In this condition, the normal milk ducts are too short and cause the central part of the nipple to be drawn inward thus reducing the nipple projection. Correction of inverted nipples eliminates the ability to breast feed and can interfere with nipple sensation. It is important to understand nipple inversion can be a sign of breast cancer. The internal mass can cause scarring of the milk ducts which draw in the nipple. If a patient experiences this inward movement after having normally projecting nipples, they must be evaluated for a possible breast tumor.
Some women are self conscious of nipple prominence. It embarrasses them when they wear clothing. For those women I suggest the use of clear plastic adhesive dressings which flatten the nipples. The dressings are imperceptible beneath clothing.
Other women are requesting increased nipple and sometimes areola projection. There are implants available but these are generally reserved for nipple reconstruction after breast cancer surgery. In addition, there are many reconstructive nipple procedures which use the remaining skin and fat after the cancer surgery to make a new nipple. The potential scarring resulting from these procedures require that they generally keep those surgeries in the realm of reconstruction surgery.
Women considering increased nipple and areola projection might consider temporary fillers like Restylane ® or Juvederm ®. These will be reabsorbed after six to nine months. If there are any reservations regarding the appearance, nothing need be done. A more permanent solution is fat graft injections. Fat taken from another area of the body is transferred with injections to the areola and/or nipple. The result can be permanent but some of the initial improvement will be lost as the body absorbs some of the transferred fat.
Just like clothing and hair styles, this fashionable trend may only be popular only for a season or two. I think temporary solutions to increase nipple and areola projection are the best choices. Any surgery is serious business and it should not be considered frivolously.
Top Ten Poor Results
July 8th, 2009
Poor results are different from complications, although they can be related. A poor result after cosmetic surgery has an unacceptable physical appearance. It detracts from the visual or functional goal of the patient and surgeon. A complication is a negative event which occurs adversely affecting the recovery. Some complications like skin loss can lead to unacceptable scarring, a poor result.
- Breast Too Small Some 80% of women feel their breasts are too small after breast enlargement surgery. About 10% of these women act on their concerns and have a second and sometimes third surgery to increase their implants size.
- Unacceptable Scar As noted above, an unacceptable scar can be the result of skin loss and slow healing of the skin. Unfortunately, poor placement of a cosmetic surgery scar will make it unacceptable, as well. This is particularly true when clothing, hair style or makeup are unable to conceal the scar.
- Asymmetry All of us are different from one side of our bodies to the other. This is the normal human condition. Some argue this is an integral part of beauty. Cosmetic surgery can reduce differences that are more significant, but never eliminate them completely. After cosmetic surgery, some asymmetry usually remains.
- Skin Lightening Skin responds to scarring with changes in color. Color changes are a result of a disruption of the color producing and color containing cells in the skin. Some procedures have a high risk of skin lightening. The most notable of these procedures is skin resurfacing. The treatments which superficially burn or damage the skin can also bleach the color of the skin.
- Irregularities Beneath The Skin Much of cosmetic and reconstructive surgery involves rearranging skin and the underlying fat. Liposuction involves only removing fat. Scarring beneath the skin does lead to lumpiness which can be felt and sometimes seen.
- Skin Sagging Skin stretching procedures tighten the skin at first. During surgery every effort is made to remove as much skin as possible safely. Depending on how much the skin has been stretched in the past, sun damage, and genetics may contribute to skin can sagging after surgery.
- Unnatural Appearance I believe all plastic surgery results should look natural. My philosophy is not widely held by other surgeons or patients. The unusual results witnessed in celebrities bears this out. If a patient looks like they have had surgery, such that you look so different or comments range from what happened, or worse, who are you? The result may not be as natural as you had hoped.
- Functional Changes Cosmetic surgery is usually done to improve physical appearance. Every effort is made to allow normal body function after surgery. However, anatomical variability can change the way a body part will work. Inability to close the eyes after upper eyelid surgery, genital distortion after inner thigh lift surgery and inability to breast feed after breast surgery are all examples of functional changes.
- Poor Implant Position Implants are a part of cosmetic surgery. Breast implants are the best known but facial implants and injectable materials are also used. Each implant has to be placed according to the specific patient anatomy to yield the desired effect. Breast implants placed too high look like “porn star” breasts. We’ve all seen poorly placed cheek implants, where the patient looks more like a chipmunk.
- Insufficient Improvement Surgeons have an understanding of what may be accomplished through surgery. It is important for a patient to have a good understanding of what can be done and what realistic change might be expected. Patients with unrealistic or misunderstood expectations can express feelings of insufficient improvement after cosmetic surgery.
All of the poor results that I have mentioned may lead to correction with secondary surgeries. Many times these procedures are successful. Unfortunately, after each revision surgery is completed, some additional scar tissue is added. This subsequent scar tissue reduces the chances of success with each additional revision surgery.
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