News and Updates Archives - Andrew Trussler, MD, PLLC

Dr. Trussler Featured in Cosmetic Blog

Dr Trussler — Tue, 18 Apr 2017 18:11:03 +0000

Dr. Trussler was featured in Zwivel.com’s cosmetic surgery blog for his experience in treating Congenital Deformities with plastic surgery.

Nipple sparing mastectomy with Immediate Breast Reconstruction: Safe Options for the Breast Reconstruction

Dr Trussler — Sun, 11 Mar 2012 23:24:35 +0000

Mastectomy for removal of breast tissue for pre-malignant or malignant breast conditions can be done through multiple incisions. Factors that contribute to the placement of incisions on the breast include the position of the breast tumor on the chest and it’s proximity to the skin. Classically, a mastectomy incision was located across the middle of the breast to accommodate for nipple areolar complex removal and access for axillary lymph node dissection. This long incision is difficult to conceal and problematic when performing a reconstruction of the breast because it flattens the contour of the breast. Skin sparing and areolar sparing mastectomy have evolved with the advent of sentinel lymph node dissection limiting the need for axillary lymph node dissection, this has changed the ability to create a very natural appearing breast after reconstruction. In women who undergo prophylactic mastectomy or in early stage breast cancer nipple sparing mastectomy has become more popular. Initial studies did demonstrate oncologic safety in this procedure with the removal of breast ductal tissue while maintaining the areola and nipple skin. Nipple sparing mastectomy can be combined with an immediate breast reconstruction with either an implant or an autologous breast reconstruction. A nipple sparing mastectomy and breast reconstruction should be performed on breasts without a significant amount of sag or ptosis. It is impossible to lift the position of the nipple areolar complex after a mastectomy is performed because the blood supply to this area has been compromised. I only provide this option in a breast that has a low-grade oncologic stage that will not need radiation, and has a normal nipple height. That makes this option for breast treatment not always the right option, but it can be combined with an immediate placement of a breast implant, tissue expander or an autologous free flap such as a DIEP flap or free TRAM. The incision for this mastectomy is in the fold or a vertical incision. The beauty of the vertical incision is that is heals very well and it can provide a minor breast lift.

A consultation with Dr. Trussler will help define an individual plan for you. The ability to perform all of these breast reconstructive procedures gives you a choice that is individual and right for you. Dr. Trussler will make your reconstructive breast surgery a pleasant experience and will guide you at each step of this process. He will give you the option of surgical location and it will likely necessitate a one night overnight stay so that you are comfortable and confident during recovery after this type of surgery. Physical activity can be resumed after 2 weeks and scar care is started after 3 weeks with the goal of buying new bras in 6 weeks.

The post Nipple sparing mastectomy with Immediate Breast Reconstruction: Safe Options for the Breast Reconstruction appeared first on Andrew Trussler, MD, PLLC.

The Correction of the Inverted Nipple

Dr Trussler — Mon, 20 Feb 2012 06:09:10 +0000

Inversion of the nipple is a common congenital deformity of the breast, which can occur on both sides or just affect one side. It can be a source of embarrassment and shyness, but may go unnoticed to the female patient. An inverted nipple may have different degrees of inversion depending on the amount of tethering of the underlying breast ducts. The inversion can functionally impair the ability to breast feed secondary to the baby not being able to latch on to the flattened nipple. The degree of inversion relates to the ability of the nipple to become erect. In severe cases, the nipple does not evert at any point. In moderate to severe cases of nipple inversion, simple correction can solve the issue and improve function and the aesthetic of the nipple. Correction of the severely inverted nipple can alter the continuity of the breast ducts, which can lead to the impairment of breast-feeding. This impairment needs to be discussed with the patient as a risk of any nipple inversion correction. Typically, nipple inversion can be corrected with small dermal or fat grafts to the nipple to fill the nipple and hold the nipple out. This is performed through a small lower nipple incision and can be done just under local anesthesia. Severe inversion may require release of the underlying breast ducts, filling out the nipple with dermal grafts, and closing the base of the nipple with suture or small star flaps. This as well can be done under local anesthesia or combined with other breast procedures, such as breast augmentation, breast enhancement, or breast lifts (mastopexy). Correction of nipple inversion, or any other nipple deformities can be discussed with Dr. Trussler. These are small procedures, which can greatly improve patient self-confidence, as well as the aesthetics and the function of a woman’s breast.

The post The Correction of the Inverted Nipple appeared first on Andrew Trussler, MD, PLLC.

Why Breast Implants Get Hard: Reasons and remedy.

Dr Trussler — Tue, 31 Jan 2012 06:55:31 +0000

Breast implants are foreign bodies, which in general are inert and unreactive to the human body. Your body does recognize breast implants as foreign and does form a normal capsule around the implant, no matter if it is saline or silicone. The first generation silicone breast implants were designed to rupture early and relied on this natural capsule for the maintenance of shape of the implant. These days, the new generation silicone breast implants are more solid silicone gel without a liquid phase, which hold their shape if ruptured and decrease the amount of silicone dispersion to the local tissue. The body’s natural response to breast implants help to maintain implant position and consistency. A capsular contracture or scarring around the breast implant can be increased in intensity with bleeding, infection and leakage. Silicone leakage can be more inflammatory than saline, which is absorbed. This inflammation around the silicone breast implant can lead to scarring and a capsular contracture. A capsular contracture can cause hardening of the implant, as well as implant malposition and breast deformity. Capsular contracture can also be related to bleeding and low-grade infection around the implant. This makes the risk of scarring around the new generation silicone and saline breast implants equivalent and equals about 7 % after 10 years. The risk of implant rupture is relatively equal and is about 1% per year, but if a breast implant ruptures the scarring is more intense with silicone. A new or worsening capsular contracture can be a sign of a silicone breast implant rupture, but with saline breast implant rupture, the immediate loss of volume is the usual problem.
The remedy for a breast implant capsular contracture may include removing the breast capsule or breast capsulectomy, changing the breast implants, and possibly changing the implant shell to a textured breast implant. Most capsular contractures can be prevented with proper operative technique, including anti-biotic irrigation and a bloodless breast implant pocket. In general, breast implant rupture is rare and breast implants do not need to be changed every 10 years. Breast implants only need to changed when there is a problem, such as breast implant rupture or hardness, but more commonly for breast implant size.
Dr. Trussler will review the risks of breast implants and will review the benefits of breast implants and secondary breast implant surgery.

The post Why Breast Implants Get Hard: Reasons and remedy. appeared first on Andrew Trussler, MD, PLLC.

The Athletic Breast Enhancement: Breast augmentation for the active woman

Dr Trussler — Sun, 22 Jan 2012 14:36:12 +0000

The active woman who desires breast enhancement usually has a slender and lean chest. The goals of breast enhancement for this population is a very conservative increase in volume and a very natural appearing breast that fits her frame and looks great in athletic apparel. The goal of the natural appearing breast augmentation is coupled with the goal of returning to athletic training soon after the operation. The key to achieving the goals of the active and athletic woman seeking breast enhancement is a moderate profile implant placed under the muscle, usually in the 300 cc range, depending on the woman’s height and weight. A silicone gel breast implant is the most natural feeling breast implant, which is important in the woman with a very lean chest. A saline breast implant should be used in the woman who is under the age of 22 in the United States. One of the main concerns in the active woman who inquires about breast augmentation is the placement of the breast implant over or under the muscle. Placement of the breast implant over the muscle does shorten recovery and eliminates any animation deformity of the breast implant when the pectoral muscle contracts. The main disadvantage is that placement of the breast implant over the muscle can lead to an unnatural upper breast contour and rippling, which is noticeable in athletic clothing. Placement of a breast implant over the muscle does affect the sensitivity of mammogram screening of the breast. The breast implant should be placed under the pectoral muscle, which gives a natural contour to the upper aspect of the chest, limits rippling and scarring around the breast implant, and has almost no effect on mammogram screening. The placement of the breast implant under the chest muscle does contribute to a slight increase in the recovery and the settling of the implants, but this is a minor sacrifice for a long-lasting natural appearing breast in the athletic and active woman. I usually recommend two weeks lay-off until cardio activity to help prevent bruising and swelling, and then 4 weeks to heavy lifting to allow for the pectoral muscles to relax and the breast implants to drop into a natural position. The placement of the breast implant, under the muscle should have no effect on chest strength and the ability to do upper chest and arm exercises. The reason for allowing the chest muscles to relax is that the chest muscles will be in a contracted position after the placement of the breast implants which does press on the implants and hold them in a high position. Allowing for chest muscle relaxation enables the implants to drop into the natural breast position. Breast implant massage is usually started within one week, which helps to break the contraction of the chest muscle. After three weeks the breast implants should assume a natural position and then after three months they will be very soft and move with the chest. My goal is that the woman forgets that she has breast implants in place. In certain circumstances exercises such as push-ups and swimming can aggravate the pectoralis muscle and lead to temporary firmness in the breast. This is likened to a “Charlie-horse” and will improve with massage and anti-inflammatories. Upper chest exercises should have no effect on the breast implants over time. I encourage my breast implant patients to follow-up yearly to check the implant, but with the new generation silicone breast implants, the risk of problems such as scarring or capsular contracture, as well as rupture is very low. Breast implants do not need to be routinely changed after 10 years; they only need to be changed if there is a problem; such as firmness, but more commonly for implant size change.
Breast enhancement for the athletic woman does improve the body as well as improving self-esteem. The operation and recovery can easily be incorporated into an active woman’s lifestyle. Please schedule a consultation with Dr. Trussler to help define the right breast enhancement for you.

The post The Athletic Breast Enhancement: Breast augmentation for the active woman appeared first on Andrew Trussler, MD, PLLC.

Secondary Breast Augmentation: Correcting the “Bottomed-Out” Breast Implant.

Dr Trussler — Sat, 21 Jan 2012 14:35:19 +0000

Breast implants can drop too much. This is referred to as “bottoming-out” and usually gives the appearance of breast sagging. The difference between true breast sagging or ptosis versus bottoming-out, is that nipple position is usually preserved in the bottomed out implant where as in the sagging breast the nipple position is low. The reason why implants bottom out is because of gradual thinning of the supporting tissue of the lower breast. The weight of the implant stretches the skin and tissue between the nipple and the lower breast fold. The bottomed out breast appears to have a large amount of skin between the nipple and fold, which gives the sagging appearance. This can be associated with rippling on the side of the breast secondary to thinning of the breast tissue.
Bottoming out of the breast can be corrected by removing lower breast skin and adding an internal supporting sling made of collagen. Breast implants can be maintained or changed in size or to silicone breast implants or saline breast implants. Correction of the breast does add longer scars in the fold of the breast, but these fade over time and the body does grow into the collagen internal sling. The operation is an outpatient operation and is a very easy recovery. Secondary cosmetic breast surgery will help correct the negative effects of breast augmentation and help to improve the shape and feel of the enhanced breast.

The post Secondary Breast Augmentation: Correcting the “Bottomed-Out” Breast Implant. appeared first on Andrew Trussler, MD, PLLC.

Breast Lift or Mastopexy with or without a Breast Implant: What is the Right Breast Lift Procedure for Me?

Dr Trussler — Sun, 13 Nov 2011 16:38:33 +0000

Mastopexy or breast lift repositions the nipple for the sagging breast. It will reshape the breast and give it a lifted and refined look. Not every mastopexy patient needs a breast implant and some mastopexy patients even need removal of tissue. The patient who has a significant amount of skin with a small amount of breast tissue would definitely benefit from a breast implant to fashion a breast lift around. However, not every patient would like a breast implant and the most difficult operation is performing a breast lift on the deflated breast without much fullness. The breast is lifted to a certain height and the skin is tightened to a tension without creating deformity. The lift in these patients is difficult because the deflated breast can be overly tightened and a small breast implant can be used to provide a base to the breast to be tightened and lifted on. In the opposite sense, the woman with relatively large breasts who desire maintenance of fullness and a breast lift; the options would be to remove breast tissue and add an implant or use the existing breast tissue to shape it like a breast implant. Other options include fat grafting; which is at the infancy of use in cosmetic breast.
The auto augmentation in the mastopexy patient can limit the need for breast implants and eliminate the complication risk associated with breast implants including infection, scarring, and implant malposition. Outer and inner breast tissue is rotated centrally to form a round breast mound; which has the appearance of a breast implant. The breast tissue is elevated to a higher position along with the nipple. Inner sutures along the outer breast, as well as the top and central mound are used to support the auto-augmented breast. Breast lift with auto augmentation is an outpatient operation that usually requires a one-week recovery. It can be combined with other procedures, such as abdominal contouring to complete a mommy makeover.
Breast lifts with auto augmentation should be limited to the patients who need a breast lift with already a full breast volume, or for the patient who does not want or is not a candidate for a breast implant, such as in the post-bariatric patient who has a significant amount of breast sagging. For the woman without enough breast volume, or who wants to add volume, a breast implant should be considered. Breast implants can be placed at the time of the breast lift, which is referred to as a mastopexy augmentation. Breast implants can as well be placed in a staged procedure where the breast lift is performed first and then followed as early as 3 months later with a breast augmentation.
A consultation with Dr. Trussler will help define an individual plan for you. The ability to perform all of these cosmetic breast procedures gives you choice that is individual and right for you. Dr. Trussler will make your cosmetic breast surgery a pleasant experience and will guide you at each step of this process. He will give you the option of going home after the procedure or staying at least one night for observation in the Medallion Guest Suites so that you are comfortable and confident during recovery after this type of surgery. Physical activity can be resumed after 2 weeks and scar care is started after 3 weeks with the goal of buying new bras in 6 weeks.

The post Breast Lift or Mastopexy with or without a Breast Implant: What is the Right Breast Lift Procedure for Me? appeared first on Andrew Trussler, MD, PLLC.