Breast Procedures

Choosing a breast surgeon involves many considerations. Whether you desire cosmetic breast surgery or breast reconstruction surgery, one of the most important decisions you will have is choosing your plastic surgeon. The best option is to select one who is Board Certified by the American Board of Plastic Surgery, and a Member of the American Society of Plastic Surgeons. Dr. Saied Asfa has these qualifications, and is one of the region’s most experienced and qualified plastic and reconstructive surgeons.


Breast Augmentation

Breast augmentation is one of the most frequently performed cosmetic surgery procedures in the U.S. It can give women with small or unevenly-sized breasts a fuller, firmer, better-proportioned look through the placement of saline or silicone implants in the breast. Women may elect to undergo breast augmentation for many different medical and aesthetic motivations, including balancing breast size and compensating for reduced breast mass after pregnancy, weight loss or surgery. The procedure may be combined with others such as a breast lift (mastopexy) for more satisfying results.

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Breast Asymmetry

Breast Asymmetry is a condition where one breast is larger than the other. Most people have slightly different-sized — or asymmetrical — breasts. However, in some cases the difference in size is pronounced. There are options on how to correct this condition. You may want to augment (enlarge) the smaller breast to look like the larger one, or reduce the size of the larger breast to match the smaller one.

Breast implants can be used to augment one breast, making it similar to the other one. Breast reduction can be performed to reduce the larger of the two breasts. This involves removal of excess breast tissue, fat and skin. Either procedure results in breasts that are more similar in size. Correcting breast asymmetry has not only helped women improve upon their appearance, but it can also provide a boost to their self-esteem and self-confidence.

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Breast Implant Revision

Each year, many women undergo breast augmentation. It has become one of the procedures most frequently performed on women today. Breast implant revision is a surgical procedure designed to replace older silicone implants with new saline-filled implants (or in certain patients, with newer silicone-filled implants). As with most medical devices, breast implants are not designed to last forever, and eventually many patients need to undergo at least one or more operations for routine implant replacement.

There are various reasons women have for choosing to undergo breast implant revision. One of the main reasons is deflation of the breast implant. Another reason is that some women want to have bigger or smaller breasts and would like an implant exchange. There are also women who were not happy with the original results of their first operation and would like to have breast implant revision to gain an appearance they can be happy with. Breast implant hardening or encapsulation is another reason why women may seek correction or revision. Even though the majority of implants remain acceptably soft, some do experience more firmness. Some may even have visible distortion or discomfort and feel that it should be addressed.

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Breast Lift

A breast lift, or mastopexy, is performed to return youthful shape and lift to breasts that have sagged as a result of weight loss, pregnancy, loss of the skin’s natural elasticity or simply the effects of aging and gravity. The procedure can also reduce areolar size (the dark skin surrounding the nipple), and it can be combined with breast reduction for added firmness. This procedure is usually done under general anesthesia, and lasts from one to three hours.

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Breast Reduction

Large breasts can cause pain, improper posture, rashes, breathing problems, skeletal deformities, and low self-esteem. Breast reduction surgery is usually done to provide relief from these symptoms. Performed under general anesthesia, the two- to four-hour procedure removes fat and glandular tissue and tightens skin to produce smaller, lighter breasts that are in a healthier proportion to the rest of the body.

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Gynecomastia Surgery

Gynecomastia surgery, also known as reduction mammaplasty or male breast reduction surgery, is a procedure to correct gynecomastia, which is a condition of over developed or enlarged breasts in men. Gynecomastia can occur at any age, and can be the result of hormonal changes, heredity, obesity or the use of certain drugs. This condition can be highly embarrassing as well as physically uncomfortable. In cases where gynocomastia is primarily the result of excess fatty tissue, there are various liposuction techniques that can be used. Excision techniques are used when glandular tissue or excess skin must be removed, and if the aureola will be reduced or the nipple needs to be repositioned to a more natural male contour. Sometimes a combination of liposuction and excision techniques are used.

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Pectoral Implant

Pectoral implant surgery is a procedure to improve a man’s chest definition. Some men have underdeveloped pectoral muscles, or have an asymmetrical chest or a deformity from birth or an accident. This procedure is also a popular option for men who are athletic and desire a more sculpted, masculine looking chest.

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Breast Reconstruction

Breast reconstruction is achieved with a variety of procedures to attempt to restore and improve the shape of the breast after mastectomy (removal of a breast), or lumpectomy (removal of part of the breast). One in eight women will be diagnosed with Breast Cancer during their lifetime, and sometimes, even men are diagnosed with breast cancer. When mastectomy is a part of the treatment plan, many important decisions need to be made, including when and if reconstructive surgery is desired, as well as what type of reconstructive procedure to have. One of the foremost fears is often that of permanent disfigurement. Thankfully, recent advances in breast reconstruction have addressed many of these issues with sophisticated procedures that allow for restoration of the body and sense of wholeness.

Dr. Asfa performs a variety of breast reconstruction techniques, and he will work with your breast cancer surgeon to help determine which procedures are best for you. He performs a high volume of breast reconstruction surgeries, and in some cases, has modified and developed new reconstruction techniques to preserve and/or rebuild the most natural looking and feeling breasts possible.

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Simultaneous Breast Reconstruction

Some women have the option to have reconstruction of the breasts immediately following the removal (mastectomy) of their breasts. Also known as immediate one-stage breast reconstruction, this is a good option for women who do not need breast irradiation. Dr. Asfa works in tandem with the breast surgeon during the mastectomy, and immediately following that procedure, reconstructs the breast with implants, tissue expanders or fat grafting/transfer. Another option for reconstruction may be autologous (reconstruction using your own tissue and muscle) with a TRAM flap or latissimus dorsi flap procedure.

  • Breast Reconstruction with Implants – Implants are made out of silicone or saline, or a combination of both, and can be inserted during or after a mastectomy. They are placed underneath the chest muscle versus on top of it, as in the case of breast augmentation.
  • Fat Grafting/Transfer – this reconstruction technique uses liposuction to remove fat from other parts of your body and inject it into your breasts. This is also the most common reconstruction procedure for men who want breast reconstruction after mastectomy. This is also a breast augmentation option for women who are looking for a relatively small increase in breast size and would prefer natural looking and feeling results.
  • TRAM or Latisiumus Dorsi Flaps – During flap reconstruction, a breast is created by transferring tissue (skin, fat and muscle) from the lower abdomen or upper back area to the mastectomy site and creating a breast mound. This technique could be done as an immediate procedure after mastectomy or as a delayed procedure for patients who had a mastectomy (with or without radiation) in the past, but now desires reconstruction.
  • Skin Preserving and Nipple & Areola Sparing – During a traditional mastectomy, all of the breast glandular tissue and central breast skin are removed. This can result in a prominent scar across the breast, making reconstruction more challenging. But sometimes some skin, and the nipple and areola can be preserved. Prior to your mastectomy, Dr. Asfa will work closely with your breast surgeon to develop a reconstruction plan to utilize these innovative reconstruction techniques whenever possible.

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Staged Breast Reconstruction

For women who need radiation therapy to treat their breast cancer, staged or delayed breast reconstruction is advised vs. simultaneous breast reconstruction. If radiation is done on a newly constructed breast, it could cause the reconstructed breast with implant to become hard, or painful, and it can also cause the cosmetic appearance of the breast be altered or deformed. So after radiation therapy has been completed, the reconstruction can begin.

Staged or delayed breast reconstruction is also an option if the plastic surgeon was not present during the mastectomy, or if there was not enough skin available to do immediate reconstruction. In this case, a temporary tissue expander is placed at the time of mastectomy, and then the process of the expansion begins, and usually takes two to three months. Once the process of the expansion has been completed, the tissue expander will be switched with permanent implants. Dr. Asfa will coordinate with your breast surgeon to determine the best approach for you.

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Secondary Surgical Procedures

Sometimes secondary surgical procedures may be necessary following the initial mastectomy and reconstruction. Among these are implant exchange and revision procedures on the breast, as well as revisionary procedures designed to improve the appearance of flap reconstructions. Contour abnormalities in a reconstructed breast may be addressed using a variety of surgical approaches. Some patients may require surgery to address complications from prior surgery.

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