“Do you have to detach my nipple?”

In my 19 years of practice I have heard this question a lot and I always wonder where this information comes from. At our consultations my patients tell me that they heard or usually read when they consulted Dr. Google, that during a breast lift or a breast reduction the nipples have to be removed from the breasts.

This is unequivocally WRONG. Totally False. Untrue!!

I know you are never supposed to use “always” and “never”, but in this case I’m gonna break that rule and then comes my disclaimer. I “never” detach a nipple during a breast lift and I “never” detach a nipple during a breast reduction. I “always” leave them attached. There, I just broke both rules.

Disclaimer time: There actually is a time when we DO have to detach the nipple. The operation is called a Free Nipple Graft, but we ONLY do this when the breasts are EXTREMELY droopy. What does ‘extremely droopy’ mean. Well, get a tape measure and measure from the top of your breast bone diagonally down to the nipple. That distance should ideally be between 19 and 21 cm. For most patients who need a lift or a reduction the number will be more in the 27-30 cm range. It is only when the number exceeds the 41-42 cm mark that we even discuss detaching the nipple. The other measurement to look at is from the crease under the breast back up to the nipple. Lift the breast and place the tape measure at the crease and then measure back up to the nipple. Ideally that number is 5-7 cm. It’s not until 21-23 cm we that we even start to discuss detaching the nipple.

So, for 99% of women considering a lift or a reduction, detaching the nipples isn’t even remotely a consideration. It just never happens. When we see the kind of numbers I mentioned above, then, and only then, do we discuss the need to detach. Stated another way, in 19 years of practice and having done literally thousands of these procedures, I have never, ever detached a nipple that I didn’t plan on detaching from the get go to extreme breast size and extreme droop.

Lee E Corbett, MD

Corbett Cosmetic Aesthetic Surgery and Med Spa

 

What’s a Mommy Makeover?

At Corbett Cosmetic, a Mommy Makeover is one of our most requested operations. A ‘mommy makeover’ is a generic term for some combination of breast procedure and tummy procedure.

The breast portion can be a lift, a reduction, an augmentation, or a lot of times an implant and a lift are combined. This allows me to restore the fullness to the top of the breast and reposition the natural breast tissue so that is doesn’t droop below the crease that is below the breast.

For the tummy portion, we typically will do a tummy tuck with liposuction, but sometimes Liposuction alone is all that is needed. The decision is based on how much loose skin you have, how much your muscles were stretched by the pregnancies, and how much fatty tissue we are dealing with.

These decisions are pretty simple to make after your consultation. It’s really just a matter of you stating your goals and then I can match the operation best suited for your particular problem.

If you are interested just give us a call at (502) 721-0330 or by e mail at Misty@corbettcosmeticsurgery.com

Lee E Corbett, MD

Medical Director: Corbett Cosmetic Aesthetic Surgery and Med Spa

 

What’s a Mommy Makeover?

I’m preaching to the choir here, but pregnancy takes its’ toll on Mom’s figure. Sometimes it’s minor, but sometimes its not. Your breasts take a hit, especially if you breast fed. Obviously your tummy is forever changed, particularly with twins or triplets. And, in a lot of cases, even after you get back to your pre-pregnancy weight, your shape just isn’t the same.

Here are a few truths that a lot of my patients are surprised to hear. 1) Your skin will not respond to exercise 2) There is a sheath that wraps your stomach muscles called fascia. It gets stretched with pregnancy and it will not respond to exercise. Thus the laxity 3) Your breasts will not get more perky if you exercise your chest muscles. 4) Your shape will be different no matter what your weight.

So…there are Mommy Makeovers. A Mommy Makeover is not a specific operation though. It involves some combination of a breast augmentation or breast lift or both. For your tummy/flanks/hips a tummy tuck or liposuction or both are used. Some combination of these procedures adds up to a mommy makeover.

Mommy makeovers are usually done in a hospital setting because they tend to be longer cases, around 3 to 4 hours. I prefer that my patients take advantage of an over night stay after surgery but this decision depends on the scope of the procedure.

After surgery you should plan on about 3-4 days of downtime, back to work is about 7-10 days, and a return to full activity in about 6 weeks.

Lee Corbett, MD

Nipple Sensation after breast augmentation

I saw a new patient just yesterday who is going to have a breast augmentation and she had a good question. Her nipples are overly sensitive and she was hoping that after her breast implants were placed her nipples might be less sensitive. She asked if this was likely.

The answer is that it is possible but not likely. With any breast surgery, whether we are doing a lift, a reduction, or an implant, the nerve that give the nipple are its feeling is at risk. As a rule the ‘deeper’ into the breast we go the more this becomes a possibility because the nerve in question enters the breast from its under surface and then branches come up to the skin level. So, if we are just on the surface, as in a lift, yes some of the tiny nerve branches will be cut resulting in some temporary sensory loss but the dominant nerve supply is intact and full sensation should return within a few weeks. That’s why when we make a circular incision around the nipple it doesn’t mean you will be numb afterwards. With a breast reduction, as this is a bit more invasive than a lift, the chances for sensory changes are higher and thus more common. It’s simply a matter of the surgeon being deeper into the breast to remove the excess tissue. Now with implants the risk is highest as we are placing the implant right at the level of the nerve, which is called the 4th Intercostal nerve. This nerve enters the breast from the side and moves towards the midline (your breast bone). Now as your surgeon, I know where this nerve lives and so when I get into that area I change how I develop the pocket for the implant in an effort to preserve full sensation. That being said, if you look at the implant manufacturers data, the rate of sensory disturbance after an augmentation is about 8% and when this happens it tends to be an all or none deal. So, my answer to the patient referenced above is that “No, your nipple sensation probably wont change and if it does lessen I have no way to control how much or how little.

Lee E. Corbett, MD

Medical Director, Corbett Cosmetic Aesthetic Surgery and MediSpa