BEFORE	AFTER

Breast augmentation is a very popular procedure for women and among the most commonly performed cosmetic surgery procedures. Either a silicone or saline-filled implant is placed under the breast tissue or beneath the chest wall muscle.  After surgery, breasts will appear fuller and more shapely in contour.  Incision scars can be placed in the armpit, around the areola, or under the breast. 

Dr. Medalie typically performs breast augmentation as an outpatient procedure.

For more of Dr. Medalie's patient photos, please visit his photo gallery and his other breast web sites listed below.

For more information about Breast Augmentation, please visit the American Society of Plastic Surgery site, by clicking on  this link.

		BEFORE	AFTER

Over time, the effects of gravity along with the loss of the skin's natural elasticity begins to have an effect on the appearance of a woman's breasts.  These factors, combined with pregnancies and nursing will often cause the breasts to lose their youthful shape and firmness.

A breastlift, or mastopexy, is a surgical procedure to raise and reshape sagging breasts.  The procedure can also reduce the size of the areola (the darker skin surrounding the nipple).  Breast implants inserted in conjunction with a mastopexy procedure can increase both firmness and size.

Dr. Medalie typically performs breast lift as an outpatient procedure. 

For more of Dr. Medalie's patient photos, please visit his web site. 

For more information about Breast Lift, please visit the American Society of Plastic Surgery site, by clicking on  this link.

BEFORE	AFTER

Large, pendulous breasts may cause a woman to potentially experience various medical problems caused by the excessive weight of the breast tissue.  Problems with posture, skeletal deformities, back and neck pain, skin irritations and nerve irritations of the fingers are common with this condition.  Bra straps often leave indentations in the shoulder area.  Many women, especially teenage girls, are very self-conscious if they have unusually large breasts.  With breast reduction surgery, women of all ages are able to have breasts that are better shaped and in proportion. 

Breast reduction (reduction mammoplasty) removes fat, glandular tissue, and excessive skin, resulting in smaller, lighter and firmer breasts that are better-shaped in proportion to rest of the body.

For more information about Breast Reduction, please visit the American Society of Plastic Surgery site, by clicking on  this link.

For more of Dr. Medalie's patient photos, please visit his web site. 

		BEFORE	AFTER

Reconstruction of the breast after a mastectomy due to cancer or other disease is quite possible with today's surgical procedures.  It is now a Federal law that after Breast Cancer surgery, all insurance companies are required to cover Breast Reconstruction as well as opposite side breast symmetry procedures.   Using the newest medical techniques, a plastic surgeon is often able to create a breast that is similar in form and appearance to that of the natural breast.  A consultation will provide you with information on the many available options for post-mastectomy breast reconstruction.

For more information about Breast Reconstruction, please visit the American Society of Plastic Surgery site, by clicking on  this link.

For more of Dr. Medalie's patient photos, please visit his web site. 

BEFORE	AFTER

Dr. Medalie is a specialist in the surgical treatment of gynecomastia or male breast enlargement. Although rarely discussed, male breast enlargement is a common condition. There is no specific cause for gynecomastia, although there has been some correlation with various medical conditions or drugs (anabolic steroids, some heart medications, marijuana, etc.).
Men who feel self-conscious about their appearance are helped with breast-reduction surgery. The procedure removes fat and/or glandular tissue from the breasts, and in extreme cases removes excess skin, resulting in a contoured chest that is flatter and firmer.
If excess glandular tissue is the primary cause of the breast enlargement, it typically requires sharp excision. The excision may be performed alone or in conjunction with liposuction. Dr. Medalie prefers ultrasonic liposuction because it has greater efficacy in the dense fibrous tissue under the nipple. In a typical procedure, an incision is made at the skin -areola junction in the 4-8 o'clock position. Working through the incision, Dr. Medalie removes the excess glandular and fatty tissue from beneath and around the nipple. The remaining excess tissue is contoured via liposuction to blend smoothly with the rest of the chest wall. Major reductions that involve the removal of a significant amount of tissue and skin may require larger incisions that result in more conspicuous scars. When liposuction is used to remove excess fat, the cannula is usually inserted through the existing incisions or in an inconspicuous location under the arm.

Dr. Medalie typically performs male breast reduction as an outpatient procedure. 

For more information about Male Breast Reduction, please visit the American Society of Plastic Surgery site, by clicking on  this link.

Due to the private nature of these surgeries, Dr. Medalie has chosen to limit the extent of the discussion on his web site. Please contact him for more information which can be e-mailed to you. He would also be more than happy to provide a free online evaluation of photos e-mailed to him.

Dr. Medalie adheres to the same guidelines and principles of the Harry Benjamin International Gender Dysphoria Association. Prior to any surgical procedure, the prospective patients must fulfill the criteria established by the Benjamin Society and have letters of referral from a therapist (psychiatrist, psychologist or psychiatric social worker) who has had a long-term relationship with the patient.

FtM Chest Surgery

The procedure is based on the following:

• Size and shape of breast
• Elasticity of skin
• Patient's needs and preferences

BEFORE	AFTER
This is an example of ultrasonic liposuction and small subcutaneous mastectomy with purse-string closure.e.
BEFORE	AFTER
This is an example of elliptical excision and grafting

In general, patients who have smaller breasts can have the entire surgery performed by having a small amount of skin removed (in a doughnut pattern , also known as-“peri-areolar or “purse-string” mastopexy”). A subcutaneous mastectomy is performed and then the outer edge of the skin is closed with a purse-string to the newly down-sized nipple. By necessity the edges of the incision around the nipple will be  “scalloped” or bunched up initially. This settles down to a great degree over time. If the patient understands that scar revision may be necessary,  this is a very reasonable approach. The nipple may experience compromise of its blood supply and also have sensation or erectile capacity changes.

In those patients with a large amount of breast tissue with excessive skin of poor quality and droop, it is usually recommend to remove the excess skin and breast tissue in the crease of the pectoralis muscles (ellliptical or double skin excision mastectomy) and put the nipples and areolae back on as grafts. This surgery has the advantage of immediate and predictable results. I can contour the skin flaps and place the nipples where I want to. It has the disadvantage of permanently altering the sensation and erectile capacity of the nipples, and it leaves larger scars on the chest. Over time they fade and flatten out. At each end of the scar, ‘”dog-ears” may form. These are small bunches of tissue created by the closing of the ellipse as a straight line. They tend to settle down over time, but may need to be revised. I can try and address the dog ears at the time of surgery but this can extend the length of the scar.

For more detailed information about FtM mastectomy surgery and how to proceed with scheduling, please download Dr. Medalie\'s informational PDF by clicking on this link.

If you have just had FtM "top" surgery and need post-operative instructions, please click on this link.

If you have had FtM "top" surgery a week or more ago and need long term care instructions, please click on this link.

MtF Chest Surgery

	BEFORE	AFTER

In those male patients who desire female breasts the first treatment that can be of benefit is the female hormone, estrogen. The results are extremely variable, but almost all patients have some growth of breast tissues. The more definitive and predictable way to achieve female breasts is through implant surgery. This surgery is no different for genetically male patients than genetically female patients. I encourage readers to see my breast augmentation section as well as examine the information at the American Society of Plastic Surgery at www.plasticsurgery.org.