Although the desire for breast reconstruction can arise from many situations, such as congenital breast issues, the vast majority of women seeking breast reconstruction have been given a diagnosis of breast cancer.  The diagnosis of breast cancer represents an incredibly difficult time in a woman’s life as well as her family’s. Breast cancer can occur in males but with less frequency. Considering breast reconstruction during this volatile period takes time, understanding and a gentle approach.  We strive to make the acquisition of information and choices as easy as possible thru multiple visits and open communication.

The options for reconstruction depend on the nature of the surgery required to treat the breast cancer, your individual anatomy and any additional therapy to that may be required following surgery.  Ultimately the new breast will be completely covered by your own skin. The volume however can come from several places and/or choices. The volume can be replaced with your own tissue by complete surgical removal from one location and reattached in the region of the breast to be rebuilt (DIEP flap).  Alternatively your breast can be rebuilt with your own tissue by direct movement maintaining the connections from one location to the next (TRAM flap). Each of these two examples have their own risks and benefits.

The volume can also be replaced with an implant (saline or silicone).  A tissue expander is a temporary implant that is placed in surgery and filled with saline to a safe volume. Subsequent increases in volume are done in the office  This technique requires a subsequent operation to change the temporary tissue expander to a permanent implant. Depending on many factors, a permanent implant may be able to be placed as a single stage.

Breast reconstruction is a process.  The number of operations or procedures varies based on your own tissue available for reconstruction and other treatment requirements (chemotherapy, radiation, hormonal therapy).  Reconstruction can be done at the same time as your primary surgery to remove the breast cancer, or can be delayed. Some choose to delay reconstruction until a later date for many reasons.  Any and all procedures are covered by insurance, regardless of timing (immediate vs delayed). The process can be individualized and may require a more complex coordination between your treating physicians.

Your team of doctors, nurses and support staff all have the same goal in mind, your wellbeing and success through this difficult time.   Although an immediate reconstruction can have provide significant emotional assistance with processing the changes to your body, the reconstruction can not interfere with the treatment of the breast cancer.  You will be given all the information you and your loved ones need to decide if reconstruction is right for you and the options available.

A breast reduction decreases the size of the breasts and inherently provides a breast lift.  Although the amount of breast tissue to be removed is frequently the primary indicator for insurance companies to assess medical necessity, the location of the excess breast tissue relative to the inframammary fold also contributes to the typical symptom complex of neck and back pain.  The procedure reduces not only the internal excess breast tissue, it reduces the overall amount of skin surrounding the large breasts. The typical design produces an effect similar a breast lift. The breast sit higher on the chest wall in addition to being smaller. A breast reduction can’t promise complete resolution of symptoms, but typically offers substantial reduction if not complete relief.  The procedure is designed to be functional but can dramatically improve the aesthetic appearance of the breast resulting in improved self esteem and comfort with activities & clothing.

Botox is a trade name for a product that minimizes wrinkles by temporarily paralyzing the muscle associated with a particular wrinkle or wrinkle pattern.  Limiting the particular muscle results in decreasing the action that is causing or at least contributing to the formation and maintenance of the wrinkle. The muscles in the face tend to occur in groups that provide opposite actions.  One group may pull up while the contrary group may pull down. Limiting the function of one group can improve the function of the other thus affecting the appearance of the face. You should be aware of two concepts when altering muscle function with agents like Botox or similar products.  First some muscle functions are essential to normal daily facial functions. Smiling is important in social interactions and thus should not be altered even if primarily responsible for a given wrinkle. Special circumstances do exist but must be approached very carefully. Second, muscle groups that produce opposite effects may each produce certain wrinkle patterns.  The muscles in the forehead that produce forehead wrinkles also lift the eyebrows. If the placement of product limits the forehead muscles resulting in less forehead wrinkles, the brow may drop making you look tired. The perfect combination may not exist to achieve your desired goal. Defining which muscle or groups of muscles that are contributing to your particular concerns requires careful attention and observation.  A solution will be designed to maximize your expectations and minimize unwanted corollary results.

The eyelids and eyebrows are a functional unit.  Depending on the findings at the time of examination, as well as your specific goals and expectations, a brow lift may be offered as a part of a particular eyelid procedure.  If a brow lift is truly indicated, a more extensive eyelid surgery can not provide the benefits of a combined brow and eyelid surgery. A more extensive eyelid surgery, or blepharoplasty, without a needed brow lift can actually create more problems without achieving the aesthetic goals.

Techniques have been developed and refined to address changes in the face and surrounding areas.  Multiple techniques exist now to deal with changes associated aging. Volume restoration can be achieved with the choice of multiple fillers. Wrinkles can be directly minimized thru reduction of muscles responsible for a particular wrinkle or wrinkle complex.  The quality of the skin (including texture, hydration, color, tone) can be improved with a combination of products and/or laser and light emitting devices. Although tightening technologies exist, at some point the amount of loose skin requires excision or removal to achieve a desired effect.

The face proper does not live in isolation.  The surrounding areas (forehead, neck, brows) all contribute to the overall impression one has of themselves.  A comprehensive evaluation is required to determine which procedure or product will enhance your appearance while maintaining the natural harmony the face has with the person as a whole.  The changes of aging are subtle from one decade to the next. Correcting the subtle changes from aging requires a careful and thoughtful approach to regain a more youthful, healthy appearance.  The degree of correction may be more subtle than you think. Overcorrection to try and achieve a “younger” appearance my produce unnatural results. Dr. Louis has adapted his unique knowledge of light and shadow acquired while studying architecture to help explain and define the changes associated with aging.   Your consultation with Dr. Louis will determine the combination of techniques, products and/or surgery to ensure preservation and restoration of facial harmony while providing a more youthful and rejuvenated appearance.

Facial rejuvenation can be divided into areas as well as different techniques to achieve the desired goal.  Areas can be broken down into the eyes & brows, the forehead, the face and the neck. Techniques and concepts include volume restoration, altering the formation and persistence of wrinkles by administering Botox, and products designed to improve the tone, texture and quality of your skin.

Although each component can be discussed in isolation, a complete evaluation helps direct treatment options to achieve the desired degree of improvement.  Additionally a complete approach can help prioritize which areas if treated in isolation will give the most improvement for a given cost while maintaining as much harmony as possible.

A traditional facelift removes excess skin while providing a tighter, smoother look.  Multiple techniques have been described and are used to achieve a specific aesthetic outcome.  The decision to have a facelift must be balanced against the relationships with surrounding regions (neck, forehead, general appearance, skin quality and tone).

The degree or extent of a facelift requires coordination with treatment of other factors such as volume, quality of the skin and its contribution to the appearance of an aging face.  A face lift alone may not achieve the results that a combined or customized approach addressing all the variables that affect facial aesthetics.

Multiple forms of fat reduction exist.  Traditional liposuction requires a small incision to be made in the skin so that a small cannula can be introduced to remove unwanted fat.  Small focal areas may be able to be done in an office setting but frequently traditional liposuction requires anesthesia (sedation vs deeper anesthesia).  Newer technologies have been introduced to either “freeze” the excess fat or use different forms of energy such as a laser to reduce the number of actual fat cells.  All of the current options have a role. As the amount of fat cells required to achieve your specific goal, increases, certain techniques provide more predictable results.  As a general rule, liposuction is intended to sculpt focal areas of excess fatty deposits. Larger amounts can be removed but needs to be done so with caution. The choice of techniques or procedures is the most important predictor of a successful outcome as judged by your happiness.  If one choice offers a lower percent improvement over another, then the money paid for the lower percent improvement would certainly be better spent on a more effective technique. A thorough and honest approach is required to ensure you have the information needed to decide which is best for you.

The neck plays a crucial role in overall facial aesthetics.  The perceived appearance should be in harmony with the face. Any discrepancies are easily perceivable and can limit the success of any plan to restore the face to a more youthful, healthy appearance.  Although nonsurgical options do exist, significant restoration usually requires a procedure. Initially Botox can be used to help with platysmal bands and restore the normal angle between the neck and jawline.  Excess fatty areas can be carefully liposuctioned to create the same result. Once the changes have created permanent loss of neck skin support, surgical procedures are available to improve the contour and look of your neck.

Volume provides a more youthful appearance.  The progressive loss of volume is one of the major reasons we begin to look aged.  In addition to the direct effect of decreased prominences and support, the skin appears be looser as the volume decreases.  Sometimes the perception of loose skin is falsely attributed to skin excess. Volume can play a role in restoring a youthful appearance without surgical excision of skin.  In carefully selected patients, volume can push back the need for excisional surgery. The correction may not provide full restoration in such patients. The level of restoration may however provide enough improvement to make the additional costs and/or risks associated with surgery less desirable at a given point in time.  The current choices for volume restoration have increased in number and will be discussed at your consultation

Weight loss surgery and/or management represents a unique scenario in Plastic Surgery.  The outcome of weight loss (minimal, moderate or massive) can be variable from person to person as well as body areas in the same patient.  The changes from weight loss can be affected by extent of weight loss, the rate of weight loss, the dominant area of weight loss within a given individual’s body and genetics. Many other factors exist. Skin that has been stretched secondary to weight loss can lose elasticity.  The loss of elasticity has significant consequences on any future procedure to deal with loose skin. If an individual has excess skin excised to improve contour and appearance, the remaining skin used to resurface a given area is also stretched and potentially damaged. The expectations of the individual needs to be balanced with what is possible given the amount of excess skin as well as the quality of the skin and elasticity.  Significant improvement can be obtained with a variety of surgical techniques. The ultimate happiness from any procedure depends on ones preoperative expectation. Careful preoperative evaluation and an honest discussion with the surgeon regarding most likely outcomes is essential to postoperative happiness.