Other Procedures

Release of Inverted Nipple

Congenital inverted nipples are a common problem. They can easily be corrected under local anesthesia and can also be treated in time of breast surgery, reduction augmentation and lift. In order to release the nipples, a small incision is made at the base of the nipple and the breast ducts wish tethered the inverted nipple are released. Because release of the nipple involves release of the underlying ducts breast-feeding can be affected. If an inverted nipple is a new finding it must be evaluated to make sure that there is no underlying breast cancer before surgery.

Nipple Reduction

For patients with overly prominent nipples, nipple reduction can be performed under local anesthesia or at the same time as other breast surgeries such as augmentation or lift. The prominent nipple is tucked back into the breast to give a smaller diameter and less projection. This is occasionally performed as well for male patients.

Areolar diameter reduction

Areolar reduction generally occurs as part of a full breast lift or breast reduction. In certain circumstances, Patients can undergo areolar reduction under local anesthesia or as part of a breast augmentation and lift. This is called in purse string mastopexy where the tissues are gathered around smaller areola like tightening the string on a purse. Because this type of lift with areolar reduction can be more variable in the quality of the scar that produces I try to use it selectively.

Reducing the puffy aeola

Some men and women have discrete fullness or puffiness of the areola. Under local anesthesia tissue can be removed from under the entire aeola to make it flatter. This procedure will generally result in some loss of sensation to the nipple and will certainly diminish the ability to breast feed.

Crescent lift

In some patients a small elevation of the nipple and give you more youthful appearance. A crescent lift involves a small elevation of the nipple by taking out a crescent of skin above the areola. Depending upon the degree of elevation of the nipple may take on a slightly oval shape. This can be done at the time out breast augmentation if needed or as a separate procedure under local anesthesia.

Scars Revision

Despite our best efforts sometimes scars can be thick or widen over time. Regardless of race, color, or nationality the techniques used for surgery always endeavor to make the finest scar possible. A genetic predisposition to thicker scars can sometimes be seen in the Asian, African American or Middle Eastern population.

Even in this population scar revision will sometimes improve results because scar revision involves the removal of only a small amount of tissue. In breast lift, reduction, and even sometimes augmentation scars can widen because of tension on the skin. Scar revision is generally performed about one year after surgery when the tissues have relaxed and tension is minimal . In this situation reapproximating the scar can sometimes give a better result. For small scars this can be done on the local anesthesia.

Exchange of a saline implant after leakage or rupture

For a healthy patient with a recently deflated saline implant, the implant can sometimes be exchanged or replaced under local anesthesia. This is evaluated on a case-by-case basis. For patients who have had a long-standing deflation, wish to change to a larger implant or want a gel implant implant exchange, these procedures are generally performed under a light general anesthesia because in this situation the implant pocket may need to the adjusted or enlarged.

Release of capsular contracture

In some patients breast implants, either silicone or saline, will become firm with excess scar tissue around the implant. This is known as capsular contracture. In some cases the scar tissue will be removed in its entirety and in others the scar tissue will simply be released. This procedure is generally performed under a general anesthesia.

Changing the sub glandular to sub muscular

I generally prefer breast implants underneath the chest wall muscle. They look more natural, mammography is better, infection rate appears to be lower and capsular contracture rate appears to be lower. When the implant is under the muscle there is a more gentle transition from the chest wall to the breast. When you see a sharp line of demarcation, e.g., like half a coconut stuck on the chest wall, it is usually a sub glandular breast augmentation. When patients elect to change the position of the implant from sub glandular to sub muscular sometimes a larger implant or a breast lift may be required . This is evaluated on a case-by-case basis.

Trans Abdominoplasty (Tummy tuck) Breast Augmentation

For the patient who is having abdominoplasty (tummy tuck) at the same time as breast augmentation hollow or trends abdominoplasty breast augmentation can be performed in some cases. This involves the placement of sub muscular breast implants through the abdominal plasty incision. I offer this procedure selectively to appropriate candidates. It can only be performed with saline implants because the approach is more difficult there can be a higher risk of bleeding asymmetry with this procedure.

Correction of Asymmetry

There are many approaches that I use to correct breast asymmetry:
- breast lift and or breast reduction alone without implants
- breast augmentation with different implants
- a combination of both of the above
The only thing I try to avoid is using just one implant for the purposes of symmetry. I find that augmenting just one breast never looks good. I would rather see two natural breasts with no

implants or two augmented breasts. Patients with just one breast implant to correct for volume always looks asymmetric because the natural breast will always have more droop than breast with the implant. Each patient I evaluate for breast asymmetry is different. Utimately, when reasonable, I prefer to have similar breast implants and a similar amount of natural breast tissue.

Labioplasty:

What is labioplasty and why talk about it on a breast surgery site?

Labioplasty is the trimming or removal excess vaginal labial tissue (the vaginal lips). Some women with excesss labial tissue experience difficulty or discomfort with sexual intercourse others simply wish to change the appearance of the external vaginal lips. Some women feel more comfortable in clothing or during exercise. The reason I include labioplasty in this site is that I have had a number of patients who did not know that labioplasty was available to them. Had they know, they would have had the procedure performed while they were already asleep for breast enhancement. For the purposes of decorum I have not included photos of this procedure there but i review examples are in consultation.

While I'm asleep...

is a very popular phrase. Multiple procedures can be considered and are common as long as they can be done safely. Each patient's plan is individualized. The most common "while your at it" combination is breast enhancement with Liposuction of other areas or a tummy tuck. For a more complete listing of the other procedures I perform please visit www.atcosmetics.com

Some of the smaller more common requests while already asleep…

Botox
facial fillers
mole or skin tag removal
tatoo excision
earlobe repair
lip augmentation
labioplasty
carpal tunnel release

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Thank you Dr. Tattelbaum for my surgery, I cannot thank you enough. Thank you for being patient. Thank you for the work you did on me, I no longer have to wear those uncomfortable enhancers I used to stuff in my bra. Thank you!! You and your staff and the nurses at the center where I had the surgery performed are the most professional and friendly people I have ever met. I was made very comfortable and happy at all times. Thank you Dr. Tattelbaum for what you did for me. May God bless you. Thank you for your care.