Aesthetic Breast Surgery @ Amaze MedSpa

1. Aesthetic
&
Reconstructive
Breast Surgery
Dr Sumita Shankar
M.Ch (Plastic Surgery) FICS (USA, Barcelona)
Carl Zeiss Fellow in Hand & Microsurgery
MD Amaze MedSpa
Laser & Cosmetic Surgery Center ( Guntur)

2. Art of Breast Sculpting2

3. Common Aesthetic Breast Problems
• Amastia- Congenital (Poland Syndrome)
Post Mastectomy
• Hypomastia
• Hypermastia
• Sagging Breasts
• Asymmetric Breasts
• Axillary Breasts
• Gynaecomastia

4. A Brief Overview
• Breast Augmentation
• Breast Reduction
• Breast Reconstruction

5. Indications of Breast Augmentation
Unilateral Breast
• Amastia
• Breast Asymmetry
• Post Mastectomy
Bilateral Breasts
• Bilateral Hypomastia
• Post Mastectomy & Lumpectomy
• Gender Reassignment
• Volume Loss after Pregnancy or Massive Weight loss

6. Bilateral Augmentation/ Enlargement

7. Gender Reassignment

8. Breast Enhancement- Methods
• Implants
• Autologous Fat Transfer
• Tissue Expansion + Implants
• BRAVA + Implants
• Reconstruction with Flaps +/- Implants /AFT

9. Implants
Types
• Silicon Gel / Saline Implants
• Round / Anatomical
• Textured / Smooth

10. Round Textured & Smooth Implants

11. Round / Anatomical Implants

12. Why Silicon?
• The chemical stability of the silicone structure.
• Silicone’s ability to readily sterilize without
the physical properties being destroyed.
• Silicone’s flexibility due to its structure is very
high.
• Silicone’s mechanical endurance. Silicone’s
are found to last for a long period of time

13. Incision Types

14. Placement of Implants

15. Size of the Implants
3D Vectra Imaging
• With the Sizers
• Measurement of
Base Diameter
• 3D Vectra

16. Breast Augmentation:
Cohesive Gel Silicon Implants

17. Breast Augmentation

18. Breast Augmentation

19. Bilateral Hypomastia

21. Challenges in Augmentation
• SRS surgery
• Tubular breast
• Post Mastectomy
• Unilateral Breasts
• Poland Syndrome

22. Tubular Breast

23. Breast Asymmetry

24. Unilateral Amastia ? Poland
Syndrome

25. Post Mastectomy Reconstruction
Options

26. Post Mastectomy
Breast Reconstruction: AFT
Before After

27. Complications
• Capsular Contracture
• Implant Rupture
• Implant Displacement
• Breast Asymmetry
• Hematoma
• Infection
• Immunological disease
• Interference with Cancer Detection
• Anaplastic Large Cell Lymphoma

28. Autologous Fat Transfer

29. Liposuction for Fat Aspirate

30. Fat Aspirate for Breast
Augmentation

31. Breast Augmentation : AFT

32. Breast Augmentation

33. Breast Augmentation

36. Advantages of AFT
• Autologous tissue / Natural
• Painless
• Scarless
• Post mastectomy cases / Transgender
• Breast Asymmetry
• SImple
• Day care procedure
• Local anaesthesia
• Very less Downtime
• Dual Benefit of removing fat from Unwanted places
39

37. Disadvantages
• Multiple sittings
• Fat absorption and Cyst formation
• Donor Scarcity
• Micro calcifications – may mimic malignancy
on mammogram
• Tubular breast
• Fat Necrosis

38. Breast Reduction / Reduction
Mammoplasty
Removes some of the tissue and skin to reshape and
reduce the size of the breast
Methods
Liposuction
Diff. Surgical Techniques

39. Causes of Hypermastia
• General Obesity
• Endocrinological
• PCO’s
• Constitutional ? Hereditary

41. Surgical Technique

42. Standard Wise Pattern

43. Other Common Techniques
• Superior Pedicle
• Supero medial Pedical (EHF)
• Central Mound
• Inferior Pedicle

44. Breast Reduction & Abdominal
Liposuction

45. Breast Reduction & Abdominal
Liposuction

47. Reduction Mammoplasty

48. Reduction Mammoplasty

49. Gigantomastia

50. Reduction Mammoplasty in
Asymmetry Breast

51. Challenges in Br. Reduction
• Age @ which to operate
• Nipple Areola preservation
• Sensation to NAC Complex
• Lactation
• Scars

52. Combination Procedures
• Mastopexy with Implants
• Reduction with Implants
• Implants / Reduction with Liposuction
• Implants / Reduction with Abdominoplasty

53. Conclusion
• Breast Surgery is complex as it involves 3 D
Conceptualisation of tissues.
• Surgery is done in supine position and results
are required in standing position
• Once mastered the technique, Outcomes are
most Gratifying.

54. Thank You…

55. Amaze MedSpa
Laser and Cosmetic Surgery Centre
Dr Sumita Shankar
MCh ( Plastic Surgery)