Breast augmentation with Ideal saline implants, before photoBreast augmentation with Ideal saline implants, after photo
This pleasant 35 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 116 lbs and wanted to be a C cup to small D after surgery. She chose to proceed with the surgery in an outpatient setting and had a successful 1 hour procedure. The implants placed were IDEAL saline 330 cc breast implants. The patient is shown 1 year after her breast enhancement and is very pleased with the results.
A 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.
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:
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.
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
FtM Double Incision Top Surgery Before PictureFtM Double Incision Top Surgery After Picture
This pleasant 23 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 1 year post DI and is very pleased with his contour. *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.)
This pleasant 33 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 158 lbs and wanted to be a full D after surgery cup. She chose to proceed with the surgery in an outpatient setting and had a successful 1 hour procedure. The implants placed were Allergan, smooth, round, moderate profile plus 415 cc silicone breast implants. The patient is shown 4 months after her breast enhancement and is very pleased with the results.
A 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.
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:
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.
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
FtM top surgery before peri procedureFtM top surgery after peri procedure
This 19 year old transgender patient contacted my office seeking FtM top surgery. He was scheduled for a peri-areolar approach to his double mastectomy. This is also known as the keyhole approach or partial peri procedure. He is now shown 14 months after the procedure. He has excellent symmetry and contour and barely visible scars and is very pleased with the aesthetic result.
Top Surgery double incision pre-op photoFtM top surgery double incision post-op photo
This very pleasant trans man contacted Dr. Medalie of Cleveland Plastic Surgery seeking FtM top surgery. Because of his starting chest size and skin excess it was decided that he would be a better candidate for the double incision mastectomy with nipple grafting procedure versus the peri- areolar surgery. Chest contouring with liposuction was also performed. The DI took place on an outpatient basis at Brainard Surgery center in Beachwood , Ohio. It lasted 1.5 hours and the patient did very well post-operatively. He is shown 9 months out from his double mastectomy and has an excellent contour with good nipple placement and sizing. He is fully active and working on his chest musculature.
Breast augmentation before surgeryBreast augmentation after surgery
This 35 year old mother of two came to see Dr. Medalie at his Beachwood office to discuss breast augmentation surgery. She is 5’8″ and 135 lbs. She was interested in the IDEAL saline type breast implants and after careful consultation decided to proceed with 390 cc IDEAL breast implants during her surgery. She is shown three months after the insertion of the breast implants (which was done in a small 1 hour outpatient procedure at the Brainard surgery center). She is delighted with the results of her breast enhancement.
A 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.
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:
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.
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 guarantee
Labiaplasty patient pre-op with central labial hypertrophyLabiaplasty patient 3 month post-op with excellent reduction in her central labial hypertophy
This pleaseant 41 year old came to see Dr. Medalie in his Beachwood office. She complained of difficulty with exercise and sexual activity due to the large size of her inner labia and desired vaginal rejuvenation by reducing her labia minora . She underwent the labiaplasty under local anesthesia and mild oral sedation at Dr. Medalie’s Beachwood office, and the pictures show her three month after her labiapasty surgery. She has excellent reduction in the size of her labia minora with no protrusion of the labial tissue beyond the labia majora. She is very pleased with her outcome.
Dr. Medalie of Cleveland Plastic Surgery is an expert in labia minora reduction and vagina rejuvenation. He also performs clitoral hood reduction and fat injection to the labia majora. He has presented his techniques and results at national meetings and in book chapters. His labiaplasty and vaginoplasty patients travel from all over Ohio, the midwest and east coast. Please visit his photo gallery to see examples of his work!
This 40 year old woman came to Dr. Medalie seeking breast augmentation. She is 5’1″ and 120 lbs and was an “a” cup, and was interested in being a “c” cup after the surgery. After careful consultation she chose 345 cc smooth round silicone inspira breast implants (allergan). She is shown 6 months after her breast augmentation surgery and is very happy with her natural appearance.
Breast Augmentation BeforeBreast Augmentation 6 Months After
Steps for Breast Augmentation (from the American Society of Plastic Surgery)
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.
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:
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.
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.
This patient came to see Dr. Medalie at his Beachwood office to discuss breast augmentation surgery. She was interested in the IDEAL saline type breast implants and after careful consultation decided to proceed with 360 cc IDEAL breast implants during her surgery. She is shown three months after the insertion of the breast implants (which was done in a small 1 hour outpatient procedure). She is delighted with the results of her breast augmentation.
A 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.
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:
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.
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 guarantee
This 26 year old patient came to see Dr. Medalie of Cleveland Plastic Surgery at his Beachwood office. She had a chief complaint of large areolae and slightly drooping breasts. Dr. Medalie proposed a peri-areolar mastopexy which could be done as an outpatient under local anesthesia. The surgery was confined to the peri-areolar skin so that the scar rested at the junction of the pigmented skin and normal color skin.The patient agreed to the surgery, and is shown 8 months after her procedure. The surgery was very successful and the patient was pleased with her smaller areolae and perkier breasts.
peri-areolar mastopexy beforeperi-areolar mastopexy after
What are the steps of a breast lift procedure?
Your breast lift procedure can be achieved through a variety of incision patterns and techniques.
The appropriate technique for you will be determined based on:
Breast size and shape
The size and position of your areolas
The degree of breast sagging
Skin quality and elasticity as well as the amount of extra skin
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
Step 2 – The incision
There are three common incision patterns:
Around the areola
Around the areola and vertically down from the areola to the breast crease
Around the areola, vertically down from the breast crease and horizontally along the breast crease
Step 3 – Reshaping your breasts
After your doctor makes the incisions:
The underlying breast tissue is lifted and reshaped to improve breast contour and firmness.
The nipple and areola are repositioned to a natural, more youthful height.
If necessary, enlarged areolas are reduced by excising skin at the perimeter.
Excess breast skin is removed to compensate for a loss of elasticity.
Step 4 – Closing the incisions
After your breasts are reshaped and excess skin is removed, the remaining skin is tightened as the incisions are closed.
Some incision lines resulting from breast lift are concealed in the natural breast contours; however, others are visible on the breast surface. Incision lines are permanent, but in most cases will fade and significantly improve over time.
Many women desire the smallest scar possible. However, your plastic surgeon will recommend the incisions which best suit your anatomy.
Listen to your surgeon and do not diminish your result by demanding an incision that will not be appropriate for you.
Sutures are layered deep within the breast tissue to create and support the newly shaped breasts. Sutures, skin adhesives and/or surgical tape may be used to close the skin.
