15
April
2009
Patients who are faced with breast cancer and require a mastectomy, have many options for reconstruction. Our techniques continue to improve. One of the newest techniques is the use of alloderm or strattice dermal sheets of prepared tissue. By using these materials at the time of mastectomy with tissue expanders, a more natural breast shape and contour can be achieved. Immediate expansion of the overlying breast skin is accomplished. In patients that are candidates for skin sparring and nipple/areola preservation, a breast implant may be placed immediately and avoid the need for prolonged expansion.
These regenerative tissues help mask implant palpability and visibility and bottoming out of the implant. In my experience, I have found these new tissues to be beneficial and improve my results in breast reconstruction.
Dr. Robert Wald
Posted: Breast, Breast Reconstruction, Home
15
April
2009
The Miracles of Breast Reduction
In our society, large breasts are quite fashionable and emotionally uplifting to the patient. However, breasts can be too large causing multiple problems. The problems include shoulder strap grooving, back, neck and shoulder pain, headaches and occasionally shortness of breath. Some patients complain of poor posture and an inability to exercise because of the pain in their chest areas.
With breast reduction surgery, most of the symptoms disappear or are markedly diminished. This surgery is covered by most insurance companies when there is evidence of these problems. This surgery is performed as an outpatient and the patient is back to work within two weeks.
The patient must must accept scars on her breasts but these scars fade nicely over one year. I am amazed how much this surgery changes a woman life. These patients are now able to exercise, fit in normal size bras, and live their daily life without pain. It is for this reason, that I have found this surgery to be one of my most gratifying procedures.
Dr. Robert Wald
Posted: Breast, Home
14
April
2009
Women following childbirth develop aesthetic problems in their breasts, abdomen, and thighs. With pregnancy, women’s bodies stretch causing thinning of tissue, sagginess and stretch marks. Unfortunately, despite diet and exercise, the stretched and loose skin can only be corrected with surgery. Breasts also deflate following nursing which causes a decrease in breast size.
In order to correct these problems, breast augmentation, tummy tuck and liposuction may be indicated. All of these procedures may be done at the same time minimizing recovery time and cost.
Recovery time for all these procedures is approximately 2 weeks. Exercise may be resumed at 4 weeks. Women with young children should have help for one week. After this surgery, women are back to their pre pregnancy appearance.
Dr. Wald
Posted: Abdominoplasty (Tummy Tuck), Breast, Home
12
February
2009
A lot of women are candidates for breast lifts. Overtime and following childbirth, the breast envelope stretches causing breast ptosis or droopiness. Most women complain of the lack of upper pole fullness and the change in breast shape.
To correct these problems, a breast lift is required. The women must accept scars, either around the areola or in a lollipop or T-shape. In most cases, an implant is required to enhance the fullness in the upper breast. Textured implants are usually placed to help support the overlying breast tissue. Placing an implant without a lift will only cause larger, droopy breast. Overtime, as we age, the breast will continue to stretch. This may require a secondary procedure to re-tighten the breast skin.
Dr. Wald
Posted: Breast
7
November
2008
Breast reduction surgery is generally recommended for woman experiencing health problems associated with very large heavy breasts. Several medical conditions have been associated with large breasts including back and neck pain, skin rashes, breathing problems, shoulder indentations from tight bra straps and poor posture. It is also associated with a decrease sense of attractiveness and self confidence.
Breast reduction is usually performed to relieve physical symptoms and may be covered by insurance. Insurance companies usually require photographs and a letter from the plastic surgeon prior to any surgical intervention. If it can be shown the medical necessity is indicated, then the surgical procedure would be covered.
Many techniques are available for breast reduction. Traditionally and inverted “T” approach is used. This includes incisions around the areola down the center of the breast and in the infra mammary crease. Today much smaller incisions are available. Depending on the patients breast shape, size and amount of sagginess, a donut shaped vertical scar technique may be used. In my practice, almost all incisions have healed beautifully with minimal scarring.
Robert M Wald Jr. M.D.
Posted: Breast
7
November
2008
Breast Augmentation is performed to enhance the size and shape of the breasts. Today silicone has been approved for all woman. In my practice, it is very important to explain the differences between silicone and saline implants. Silicone is softer and more natural then saline implants. There is also less rippling with silicone implants. A woman must realize that if she chooses a silicone implant, that MRI’s must be performed periodically to look for a rupture. The rupture rate for implants is approximately 3% within the first ten years. All the studies have indicated that silicone is safe with no established systemic effects. Even though silicone implants are modestly more expensive, from my observations, women believe the extra price is worth the advantages.
Robert Wald M.D.
Posted: Breast
7
November
2008
Everyday I spend a lot of time discussing implant size with patients. Bra cup sizes vary according to the manufacture. Patients need to know that implant size that they see on the Internet or on another patient may not achieve the same result for them. There are many variables including preexisting breast volume, chest wall shape and tissue elasticity. I use a dimensional method to determine optimal implant size which considers the patients height, weight and body frame. I measure the diameter of the breasts, thickness of the tissue and the tissue mobility. By doing this properative analysis, I am able to achieve the most optimal results.
Robert M Wald Jr. MD
Posted: Breast
6
November
2008
Following breast augmentation or breast mastopexies (breast lift), revisional surgery may be necessary in a few cases. The patients tissue elasticity and the amount of stretching that can occur after these procedures is variable and may necessitate a minor revision. A period of six months is required for all the swelling and tissue stretching to occur. At this time, further adjustments to the breast can be performed. Sometimes the infra mammary crease may need to be elevated in order to correct a double bubble appearance. This occurs when the infra mammary crease is too low allowing the implant to fall and cause distortion of the breast. In mastopexies, the scars may need to be revised and the tissue envelope tightened. Even though these complications occur infrequently, the patient must realize that these problems can occur and may need to be corrected.
In my practice, I spend a lot of time with the patient showing photographs of patients with the types of scars following mastopexies. I also show surgical results following revisions. In almost all cases, revisional breast surgery is met with satisfaction and the scars and shape of the breasts are markedly improved.
Come in to my practice I would love to talk with you.
Dr. Robert M. Wald Jr.
Posted: Breast
