Cool Case of the Week

FtM Gender Affirmation Top surgery Before and After

This pleasant 35 year old trans man came to see Dr. Medalie in regards to FtM “top surgery”. He had too much loose skin for the peri-areolar approach and was scheduled for a double incision mastectomy with free nipple grafting and chest contouring by limited liposuction. His gender confirming surgery was performed as an outpatient and took approximately 90 minutes to perform. In his after picture he is shown 3 years post DI and is very pleased with his contour. He also embarked on an excellent exercise regimen and built up his body musculature to highlight his improved chest contour. The DI scars in the post op picture are hidden in the shadow of the enlarged pectoralis major muscle. *Results may vary

Below I have attached some information from my main web page that discussed the surgical options for top surgery. Here is a link to that page:

Top Surgery For Transgender Patients

The procedure is based on the following:

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

PERI: In general, patients who have smaller breasts can have the entire surgery performed by having a small incision at the outer edge of the areola from 12:00 to 6:00 o’clock. A lighted retractor and surgical scissors are used to perform a complete sub-cutaneous mastectomy. Liposuction of the chest is also performed as needed.This provides the most optimal results and can be almost invisible after it heals. If the skin appears a little looser at the start of the case then a complete peri-areolar incision is made. A small amount of skin is 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 areola. 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.

Double Incision: 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 (elliptical or double incision 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 sometimes the pigmentation), 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 always try and address the dog ears at the time of surgery but this may extend the length of the scar. Dog ears are more likely in patients who are heavier and have more tissue to start with. I always perform liposuction of the central and lateral chest (to flatten the dog ears) as well as the area in front of the armpit. I have been asked why a scar may meet in the center of the chest on some top surgery results but not on others. This is dependent on pre-existing anatomy. If the tissue meets in the middle (such as in the example right below) then the scar by necessity will meet in the middle (this can’t be seen in the example because of the patient’s chest hair.)

  • Posted on: Jul 25 2022
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Breast Augmentation with IDEAL Saline Filled Breast Implants

This pleasant 25 year old woman came to see Dr. Daniel A. Medalie of Cleveland Plastic Surgery at his Beachwood office to inquire about breast augmentation. She is 5’3″ and 105 lbs and wanted to go from A full A cup to a full C cup after surgery. She chose to proceed with the surgery in an outpatient setting and had a successful 1.0 hour procedure. The implants placed were IDEAL Structured Saline breast implants inflated to 330 cc. The patient is shown 3 months after her breast enhancement and  is very pleased with the results.   *Results may vary

 

      

 

 

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. Dr. Medalie prefers light general anesthesia with the patient breathing fully on her own.

Step 2 – The Incision

Incisions are made in inconspicuous areas to minimize visible scarring.We will discuss which incision options are appropriate for your desired outcome. Incision options include: along the areolar edge (peri-areolar incision), the fold under the breast (inframammary fold) and in the armpit (axillary incision). I prefer the IM fold approach because recent literature suggests that it is associated with a lower incidence of capsular contracture. Ths incision for a silicone implant is by necessity larger than one for a saline implant because the silicone implant is pre-filled and the saline implant starts empty.

breast augmentation incisions

Incisions vary based on the type of breast implant, degree of enlargement desired, your particular anatomy and patient-surgeon preference.

Step 3 – Inserting And Placing The Breast Implant

After the incision is made, a breast implant is inserted into a pocket either:

submuscular and subglandular breast implant placement

A. Under the pectoral muscle (a submuscular placement)

B. Directly behind the breast tissue, over the pectoral muscle (a submammary/ subglandular placement)

C. Dual-plane which is partly under the muscle (in the upper pole) and partly under the breast (lower pole). This procedure is more frequently used in women who have had children and have some droop to their breasts.

The method for inserting and positioning breast implants depends on the type of implant, degree of enlargement desired, your body type and your surgeon’s recommendations.

Step 4 – Closing The Incisions

Incisions are closed with layered sutures (that dissolve) in the breast tissue and with sutures, skin adhesive and surgical tape to close the skin.

breast augmentation incision locations

Over time the incision lines will fade. The quality of scar depends on many things, including your genetics, exposure of your body to nicotine and infection.

Step 5 – See The Results

The results of breast augmentation are immediately visible. Typically they start high and then over time settle to a lower and more natural appearance. I usually tell patients that what they see is not what they get until 3 months after the surgery.

*Plastic surgery results can vary from patient to patient and are not guaranteed

AN INNOVATIVE DESIGN USING TIME-TESTED MATERIALS

 

 

DESIGN

Years of research and testing led to this innovative design, developed to better meet the needs of women wanting a natural look and feel without concerns relating to rupture of silicone gel. A series of implant shells nested together and two separate chambers hold the saline filler. The unique internal structure controls movement of the saline for a more natural feel, while reducing wrinkling. On the outside, the edges have been lowered for a more natural contouring to the chest wall.

MATERIAL

IDEAL IMPLANT is a Structured Saline Implant made from safe and proven breast implant materials and time-tested manufacturing processes. It contains no silicone gel or new materials, yet offers a natural feel and beautiful shape due to its unique design and internal structure. And because the design is patented, no other breast implant company can manufacture or sell the IDEAL IMPLANT Structured Saline Implants.

EXPERIENCEThe IDEAL IMPLANT was approved by FDA and Health Canada in 2014, based on results from a multi-center US clinical trial with 502 women that started in 2009. The approved IDEAL IMPLANT is made in the United States using advanced robotics to achieve greater product consistency. Our FDA-inspected facility has been manufacturing silicone medical devices for more than 30 years. Quality is built-in and a limited warranty is included, so you can feel confident in your choice of the IDEAL IMPLANT.
  • Posted on: May 9 2022
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FtM peri-areolar top surgery for gender affirmation

   

FtM Peri before picture                                                                                   FtM peri after picture (2 years)

This pleasant 27 year old trans man came to see Dr. Medalie in regards to FtM “top surgery”. He had a fairly small chest and was a good candidate for the peir-areolar “keyhole” approach and chest contouring by limited liposuction. His gender confirming surgery was performed as an outpatient and took approximately 90 minutes to perform. In his after picture he is shown 2 years post peri and is very pleased with his contour. He also embarked on an excellent exercise regimen and built up his body musculature to highlight his improved chest contour. The peri scars in the post op picture are hidden at the outer edge of the areola. *Results may vary

Below I have attached some information from my main web page that discussed the surgical options for top surgery. Here is a link to that page:

Top Surgery For Transgender Patients

The procedure is based on the following:

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

PERI: In general, patients who have smaller breasts can have the entire surgery performed by having a small incision at the outer edge of the areola from 12:00 to 6:00 o’clock. A lighted retractor and surgical scissors are used to perform a complete sub-cutaneous mastectomy. Liposuction of the chest is also performed as needed.This provides the most optimal results and can be almost invisible after it heals. If the skin appears a little looser at the start of the case then a complete peri-areolar incision is made. A small amount of skin is 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 areola. 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.

Double Incision: 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 (elliptical or double incision 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 sometimes the pigmentation), 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 always try and address the dog ears at the time of surgery but this may extend the length of the scar. Dog ears are more likely in patients who are heavier and have more tissue to start with. I always perform liposuction of the central and lateral chest (to flatten the dog ears) as well as the area in front of the armpit. I have been asked why a scar may meet in the center of the chest on some top surgery results but not on others. This is dependent on pre-existing anatomy. If the tissue meets in the middle (such as in the example right below) then the scar by necessity will meet in the middle (this can’t be seen in the example because of the patient’s chest hair.)

  • Posted on: Apr 18 2022
  • By:

Breast Augmentation with IDEAL Saline Breast Implants

This pleasant 27 year old woman came to see Dr. Daniel A. Medalie of Cleveland Plastic Surgery at his Beachwood office to inquire about breast augmentation. She is 5’2″ and 115 lbs and wanted to be a C-D cup after surgery. She chose to proceed with the surgery in an outpatient setting and had a successful 1.0 hour procedure. The implants placed were IDEAL Structured Saline breast implants inflated to 320 cc. The patient is shown 3 months after her breast enhancement and  is very pleased with the results.

 

 

     

breast augmentation procedure includes the following steps:

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. Dr. Medalie prefers light general anesthesia with the patient breathing fully on her own.

Step 2 – The Incision

Incisions are made in inconspicuous areas to minimize visible scarring.We will discuss which incision options are appropriate for your desired outcome. Incision options include: along the areolar edge (peri-areolar incision), the fold under the breast (inframammary fold) and in the armpit (axillary incision). I prefer the IM fold approach because recent literature suggests that it is associated with a lower incidence of capsular contracture. Ths incision for a silicone implant is by necessity larger than one for a saline implant because the silicone implant is pre-filled and the saline implant starts empty.

breast augmentation incisions

Incisions vary based on the type of breast implant, degree of enlargement desired, your particular anatomy and patient-surgeon preference.

Step 3 – Inserting And Placing The Breast Implant

After the incision is made, a breast implant is inserted into a pocket either:

submuscular and subglandular breast implant placement

A. Under the pectoral muscle (a submuscular placement)

B. Directly behind the breast tissue, over the pectoral muscle (a submammary/ subglandular placement)

C. Dual-plane which is partly under the muscle (in the upper pole) and partly under the breast (lower pole). This procedure is more frequently used in women who have had children and have some droop to their breasts.

The method for inserting and positioning breast implants depends on the type of implant, degree of enlargement desired, your body type and your surgeon’s recommendations.

Step 4 – Closing The Incisions

Incisions are closed with layered sutures (that dissolve) in the breast tissue and with sutures, skin adhesive and surgical tape to close the skin.

breast augmentation incision locations

Over time the incision lines will fade. The quality of scar depends on many things, including your genetics, exposure of your body to nicotine and infection.

Step 5 – See The Results

The results of breast augmentation are immediately visible. Typically they start high and then over time settle to a lower and more natural appearance. I usually tell patients that what they see is not what they get until 3 months after the surgery.

*Plastic surgery results can vary from patient to patient and are not guaranteed

AN INNOVATIVE DESIGN USING TIME-TESTED MATERIALS

 

 

DESIGN

Years of research and testing led to this innovative design, developed to better meet the needs of women wanting a natural look and feel without concerns relating to rupture of silicone gel. A series of implant shells nested together and two separate chambers hold the saline filler. The unique internal structure controls movement of the saline for a more natural feel, while reducing wrinkling. On the outside, the edges have been lowered for a more natural contouring to the chest wall.

MATERIAL

IDEAL IMPLANT is a Structured Saline Implant made from safe and proven breast implant materials and time-tested manufacturing processes. It contains no silicone gel or new materials, yet offers a natural feel and beautiful shape due to its unique design and internal structure. And because the design is patented, no other breast implant company can manufacture or sell the IDEAL IMPLANT Structured Saline Implants.

EXPERIENCE 

The IDEAL IMPLANT was approved by FDA and Health Canada in 2014, based on results from a multi-center US clinical trial with 502 women that started in 2009. The approved IDEAL IMPLANT is made in the United States using advanced robotics to achieve greater product consistency. Our FDA-inspected facility has been manufacturing silicone medical devices for more than 30 years. Quality is built-in and a limited warranty is included, so you can feel confident in your choice of the IDEAL IMPLANT.

  • Posted on: Mar 28 2022
  • By:

Gynecomastia Surgery before and after case study

     

 

       

Gynecomastia before and after photos (front and side)

 

 

This pleasant 33 year old man came to see Dr. Medalie at his Beachwood, Ohio office to discuss gynecomastia reduction (left greater than right). He had evidence of breast tissue on his chest since adolescence and even with losing weight had not noticed a big difference. After careful consultation he decided to undergo a male breast reduction surgery (gynecomastia procedure) as an outpatient at the Brainard Surgery center where Dr. Medalie performs most of his operations. The surgery lasted around 1.5 hours and was an outpatient procedure. It involved a combination of liposuction and direct excision of the sub-areolar glandular tissue. The patient is now shown 4 months after his gynecomastia surgery and has an excellent post-operative contour. He is very pleased with his result. Plastic surgery results can vary. Below is information from the American Society of Plastic Surgery concerning gynecomastia and male breast reduction surgery.

What Is Gynecomastia Surgery?

Gynecomastia surgery reduces breast size in men, flattening and enhancing the chest contours.

In severe cases of gynecomastia, the weight of excess breast tissue may cause the breasts to sag and stretch the areola (the dark skin surrounding the nipple). In these cases the position and size of the areola can be surgically improved and excess skin may be reduced.

Plastic surgery to correct gynecomastia is technically called reduction mammaplasty.

What Is Gynecomastia?

Gynecomastia is a condition of overdeveloped or enlarged breasts in men that can occur at any age. The condition can be the result of hormonal changes, heredity, obesity or the use of certain drugs.

Gynecomastia can cause emotional discomfort and impair your self-confidence. Some men may even avoid certain physical activities and intimacy simply to hide their condition.

Gynecomastia is characterized by:

  • Excess localized fat
  • Excess glandular tissue development
  • Sometimes excess breast skin
  • Presence unilaterally (one breast) or bilaterally (both breasts)

    What Are The Steps Of A Gynecomastia Procedure?

    gynecomastia procedure includes the following steps:

    Anesthesia

    Medications are administered for your comfort during the surgical procedures. The options include intravenous sedation and general anesthesia. Your doctor will recommend the best option for you.

    Liposuction Technique

    male breast reduction

    In cases where gynecomastia is primarily the result of excess fatty tissue, liposuction techniques alone may be used. This requires insertion of a cannula, a thin hollow tube, through several small incisions.

    The cannula is moved back and forth in a controlled motion to loosen the excess fat, which is then removed from the body by vacuum suction.

    There are various liposuction techniques that may be used; the technique most appropriate in your case will be defined prior to your procedure.

    Excision Technique

    male breast reduction

    Excision techniques are recommended where glandular breast tissue or excess skin must be removed to correct gynecomastia. Excision also is necessary if the areola will be reduced or the nipple will be repositioned to a more natural male contour. Incision patterns vary depending on the specific conditions and surgical preference.

    Combination Of Liposuction & Excision Techniques

    male breast reduction

    Sometimes gynecomastia is treated with both liposuction and excision.

  • Posted on: Jan 24 2022
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Labiaplasty Before and After

Labiaplasty Before photo showing enlarged labia minora protruding beyond the edges of the labia majora

Labiaplasty After photo showing reduced labia minora now recessed below the edges of the labia majora

 

This patient came to see Dr. Medalie at his Beachwood office asking about labiaplasty which is also known as labia minora reduction. The labia minora are the inner labial lips and can be irritating if they protrude beyond the labia majora (the outer labial lips). The patient had extra tissue which was making it uncomfortable for her to perform normal daily activities. Her goal was to have the protruding labia trimmed so that no tissue projected beyond the edges of the labia majora. The procedure was done in Dr. Medalie’s office under local anesthesia with mild oral sedation (Ativan) and she is shown 3 months after surgery. This demonstrates how well and quickly the labia heal. Below is information from the American Society of Plastic Surgery that I have added some notes to as well.

 

What Is A Labiaplasty?

The term labiaplasty refers to a procedure that reduces the length of the labia minora. It is the most commonly performed vaginal rejuvenation procedure and it can relieve symptoms women experience from twisting and tugging of the labia.

Reasons Patients Want A Labiaplasty

Women opt for surgery for a variety of reasons, including pain from twisting and tugging of the labia when riding a bike or during intercourse, itching, irritation and self-consciousness.

What Does A Labiaplasty Do?

The goal of the procedure is to reduce the labia minora so that they don’t hang below the hair-bearing labia majora. A labiaplasty may be performed to reduce asymmetry when one is longer than the other, or, more commonly, to reduce the length of both labia so that the labia no longer twist, tug or fall out of a bathing suit.

Anesthesia For A Labiapasty

Labiaplasty is a procedure that can be done under either local anesthesia with oral sedation or under general anesthesia.

Labiaplasty Procedure

The most common type of labiaplasty is the trim procedure, in which the extra tissue is removed and sewn up directly. I personally believe that this is an inferior procedure compared to the wedge resection and almost always perform some type of wedge resection. Next in popularity is the wedge procedure, which maintains a natural border after a pie-shaped piece of tissue has been removed. Extra folds of the clitoral hood can also be reduced at the same time. Closure is usually done with absorbable sutures.

What Are The Risks Of A Labiaplasty?

The risks associated with labiaplasty include those of most surgical procedures, including bleeding, hematoma and infection. The most common complication is over-resection (this can occur with trim procedures more than wedge procedures). While some women desire an aggressive reduction, this can result in chronic dryness, scarring at or near the vaginal opening and pain with intercourse. Healing problems are more likely to occur with a wedge procedure, particularly if the patient is exposed to substances that cause blood vessels to shrink (such as smoking).

Recovering From A Labiaplasty

Most patients take a week off from work, during which they can reduce swelling and pain by icing with a cold pack sandwiched between the patient’s underpants and an elastic garment, like Spanx. This can be done “twenty minutes on, twenty minutes off.” The patient can also lie with her bottom elevated to reduce swelling.

Patients can resume wearing tampons or having intercourse after four to six weeks.

While the most distorting swelling is gone by 6 weeks, residual swelling may take several months to disappear.

What Are The Results Of A Labiaplasty?

Labiaplasty typically results in shorter labia that no longer hang down below the level of the hair-bearing labia majora. Most patients who experienced symptoms from twisting and tugging of their labia generally find relief after surgery. According to multiple studies, labiaplasty surgery is associated with a high satisfaction rate of over 90 percent.

  • Posted on: Jan 6 2022
  • By:

Labiaplasty Before and After Photos and Case Report

 

Labia minora reduction before photo

 

Labia minora reduction after photo

This patient came to see Dr. Medalie at his Beachwood office asking about labiaplasty which is also known as labia minora reduction. The labia minora are the inner labial lips and can be irritating if they protrude beyond the labia majora (the outer labial lips). The patient had extra tissue which was making it uncomfortable for her to perform normal daily activities. Her goal was to have the protruding labia trimmed so that no tissue projected beyond the edges of the labia majora. The procedure was done in Dr. Medalie’s office under local anesthesia with mild oral sedation (Ativan) and she is shown 3 months after surgery. This demonstrates how well and quickly the labia heal. Below is information from the American Society of Plastic Surgery that I have added some notes to as well.

 

What Is A Labiaplasty?

The term labiaplasty refers to a procedure that reduces the length of the labia minora. It is the most commonly performed vaginal rejuvenation procedure and it can relieve symptoms women experience from twisting and tugging of the labia.

Reasons Patients Want A Labiaplasty

Women opt for surgery for a variety of reasons, including pain from twisting and tugging of the labia when riding a bike or during intercourse, itching, irritation and self-consciousness.

What Does A Labiaplasty Do?

The goal of the procedure is to reduce the labia minora so that they don’t hang below the hair-bearing labia majora. A labiaplasty may be performed to reduce asymmetry when one is longer than the other, or, more commonly, to reduce the length of both labia so that the labia no longer twist, tug or fall out of a bathing suit.

Anesthesia For A Labiapasty

Labiaplasty is a procedure that can be done under either local anesthesia with oral sedation or under general anesthesia.

Labiaplasty Procedure

The most common type of labiaplasty is the trim procedure, in which the extra tissue is removed and sewn up directly. I personally believe that this is an inferior procedure compared to the wedge resection and almost always perform some type of wedge resection. Next in popularity is the wedge procedure, which maintains a natural border after a pie-shaped piece of tissue has been removed. Extra folds of the clitoral hood can also be reduced at the same time. Closure is usually done with absorbable sutures.

What Are The Risks Of A Labiaplasty?

The risks associated with labiaplasty include those of most surgical procedures, including bleeding, hematoma and infection. The most common complication is over-resection (this can occur with trim procedures more than wedge procedures). While some women desire an aggressive reduction, this can result in chronic dryness, scarring at or near the vaginal opening and pain with intercourse. Healing problems are more likely to occur with a wedge procedure, particularly if the patient is exposed to substances that cause blood vessels to shrink (such as smoking).

Recovering From A Labiaplasty

Most patients take a week off from work, during which they can reduce swelling and pain by icing with a cold pack sandwiched between the patient’s underpants and an elastic garment, like Spanx. This can be done “twenty minutes on, twenty minutes off.” The patient can also lie with her bottom elevated to reduce swelling.

Patients can resume wearing tampons or having intercourse after four to six weeks.

While the most distorting swelling is gone by 6 weeks, residual swelling may take several months to disappear.

What Are The Results Of A Labiaplasty?

Labiaplasty typically results in shorter labia that no longer hang down below the level of the hair-bearing labia majora. Most patients who experienced symptoms from twisting and tugging of their labia generally find relief after surgery. According to multiple studies, labiaplasty surgery is associated with a high satisfaction rate of over 90 percent.

  • Posted on: Jan 3 2022
  • By:

Breast Augmentation with silicone implants and peri-areolar mastopexy

Breast Augmentation and lift Before picture

This pleasant 22 year old woman came to see Dr. Daniel A. Medalie of Cleveland Plastic Surgery at his Beachwood office to inquire about breast augmentation and correction of protuberant areolae. She is 5’4″ and 135 lbs and wanted to be a full C cup after surgery. She was interested in reducing the size and protuberance of her areolae and elected to also have peri-areolar mastopexy (lifting). She chose to proceed with the surgery in an outpatient setting and had a successful 2.0 hour procedure. The implants placed were Allergan silicone 330 cc silicone breast implants. The patient is shown 6 months after her breast enhancement and areolar reduction and flattening procedure and is very pleased with the results.

breast augmentation procedure includes the following steps:

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. Dr. Medalie prefers light general anesthesia with the patient breathing fully on her own.

Step 2 – The Incision

Incisions are made in inconspicuous areas to minimize visible scarring.We will discuss which incision options are appropriate for your desired outcome. Incision options include: along the areolar edge (peri-areolar incision), the fold under the breast (inframammary fold) and in the armpit (axillary incision). I prefer the IM fold approach because recent literature suggests that it is associated with a lower incidence of capsular contracture. Ths incision for a silicone implant is by necessity larger than one for a saline implant because the silicone implant is pre-filled and the saline implant starts empty.

breast augmentation incisions

Incisions vary based on the type of breast implant, degree of enlargement desired, your particular anatomy and patient-surgeon preference.

Step 3 – Inserting And Placing The Breast Implant

After the incision is made, a breast implant is inserted into a pocket either:

submuscular and subglandular breast implant placement

A. Under the pectoral muscle (a submuscular placement)

B. Directly behind the breast tissue, over the pectoral muscle (a submammary/ subglandular placement)

C. Dual-plane which is partly under the muscle (in the upper pole) and partly under the breast (lower pole). This procedure is more frequently used in women who have had children and have some droop to their breasts.

The method for inserting and positioning breast implants depends on the type of implant, degree of enlargement desired, your body type and your surgeon’s recommendations.

Step 4 – Closing The Incisions

Incisions are closed with layered sutures (that dissolve) in the breast tissue and with sutures, skin adhesive and surgical tape to close the skin.

breast augmentation incision locations

Over time the incision lines will fade. The quality of scar depends on many things, including your genetics, exposure of your body to nicotine and infection.

Step 5 – See The Results

The results of breast augmentation are immediately visible. Typically they start high and then over time settle to a lower and more natural appearance. I usually tell patients that what they see is not what they get until 3 months after the surgery.

*Plastic surgery results can vary from patient to patient and are not guaranteed

  • Posted on: Dec 13 2021
  • By:

FtM Top surgery by Double Incision Mastectomy and Nipple Grafting

       

This pleasant 33 year old trans man came to see Dr. Medalie in regards to FtM “top surgery”. He had too much tissue for the peri-areolar approach and was scheduled for a double incision mastectomy with free nipple grafting and chest contouring by limited liposuction. His gender confirming surgery was performed as an outpatient and took approximately 90 minutes to perform. In his after picture he is shown 5 years post DI and is very pleased with his contour. He also embarked on an excellent exercise regimen and built up his body musculature to highlight his improved chest contour. The DI scars in the post op picture are hidden in the shadow of the enlarged pectoralis major muscle. *Results may vary

Below I have attached some information from my main web page that discussed the surgical options for top surgery. Here is a link to that page:

Top Surgery For Transgender Patients

The procedure is based on the following:

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

PERI: In general, patients who have smaller breasts can have the entire surgery performed by having a small incision at the outer edge of the areola from 12:00 to 6:00 o’clock. A lighted retractor and surgical scissors are used to perform a complete sub-cutaneous mastectomy. Liposuction of the chest is also performed as needed.This provides the most optimal results and can be almost invisible after it heals. If the skin appears a little looser at the start of the case then a complete peri-areolar incision is made. A small amount of skin is 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 areola. 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.

Double Incision: 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 (elliptical or double incision 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 sometimes the pigmentation), 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 always try and address the dog ears at the time of surgery but this may extend the length of the scar. Dog ears are more likely in patients who are heavier and have more tissue to start with. I always perform liposuction of the central and lateral chest (to flatten the dog ears) as well as the area in front of the armpit. I have been asked why a scar may meet in the center of the chest on some top surgery results but not on others. This is dependent on pre-existing anatomy. If the tissue meets in the middle (such as in the example right below) then the scar by necessity will meet in the middle (this can’t be seen in the example because of the patient’s chest hair.)

  • Posted on: Jun 17 2021
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Gender Affirmation top surgery FtM

This gender affirmation patient contacted Dr. Medalie for a top surgery procedure. He was scheduled for a peri-areolar incision double mastectomy. The procedure was performed through a keyhole incision and the patient is shown 6 months post op. He is very pleased with his FtM top surgery results.

  • Posted on: May 13 2021
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