Category Archives: breast surgery

When Does Breast Reduction Become a “Medical Necessity?”

shutterstock_71283385“Medically necessary” is a term used by the insurance industry to classify a procedure they will cover. There is a certain set of criteria used by each individual insurer to determine whether they pay for surgery. If a patient does not meet these criteria, then the operation is categorized as cosmetic and elective, and therefore ineligible for insurance coverage.

Although the specific requirements of a medically necessary breast reduction vary by company, many are similar. Here, Mountain View plastic surgeons Drs. Samuel Pearl and Alexander Ereso explain some of the requirements that a breast reduction candidate must meet (and that her doctor must document) in order to qualify for insurance coverage. Continue reading

Do I Need a Breast Lift with My Breast Implants?

Perhaps you are unhappy with breasts that have become saggy as a result of having children, breast lift with implantsbreastfeeding, weight fluctuations or the aging process. You may wish to have a breast lift, but wonder if that procedure alone will give you the breasts you desire. At Pearl Plastic Surgery, Dr. Samuel Pearl offers breast lift both with implants and without. In this blog post, he will help you to determine which procedure is right for your needs.

Good Candidates for a Breast Lift without Implants

If your breasts are droopy and your nipples fall below your breast fold, but you are still happy with the size of your breasts, then breast lift surgery alone is sufficient for lifting your breasts to a higher and more youthful position. Dr. Pearl accomplishes this by removing excess, sagging skin and tissue from the breast, reshaping the remaining breast tissue higher on the chest and then shifting the areola and nipple to a higher position on the breast mound.

When a Breast Lift with Implants is Right for You

For women who not only wish to lift their breasts but who have also lost volume (often as a result of breastfeeding and significant fluctuations in weight), a breast lift surgery with implants may better suit their needs. With this procedure, not only is the excess breast skin and tissue removed from the breast, but an implant is placed in order to add fullness to the breast, particularly in the upper pole area. Women who wish to have breast implants can choose from saline, silicone and highly cohesive silicone gel implants. Silicone implants retain their shape within the breast pocket and are associated with a lower risk of capsular contracture and rippling.

Other Factors to Determine Candidacy

Generally, candidates for breast lift with or without implants also:

  • Are physically healthy overall (with no serious medical conditions)
  • Have fully developed breasts
  • Have realistic expectations of surgery
  • Have downward-pointing nipples
  • Have breast skin that is stretched out
  • Have elongated nipples
  • Have one breast that is lower than the other

Do you have more questions about your breast surgery options? Schedule a private consultation with Dr. Pearl and he can answer your questions about implant placement options, what to expect from recovery and any other concerns you may have. Call Pearl Plastic Surgery Center today at (650) 964-6600.

How to Get Your Body Back after Baby

Post-Pregnancy Cosmetic SurgeryRecently, celebrity moms like Mila Kunis and Blake Lively have been lavished with praise for losing their baby weight seemingly overnight and hitting the red carpet looking as svelte as ever. This is just the latest example of the rabid coverage of Hollywood moms snapping back after baby, which sets an impossible standard for the average woman.

If you are a new mother concerned with losing baby weight, Drs. Samuel Pearl and Alexander Ereso encourage you to relax and spend the first few months to a year concentrating on your child’s needs. Follow your obstetrician’s guidelines for gradually returning to exercise. Breastfeeding, eating and sleeping well will also help you shed baby weight.

But what about post-baby body issues that aren’t weight-related? For example, you may reach your pre-pregnancy weight but still have lax looking abdominal skin and sagging breasts. Drs. Pearl and Ereso caution that some pregnancy-related issues will not resolve naturally. Sadly, no amount of diet or exercise will repair lax skin and saggy tissue after giving birth. Surgical correction is the best solution.

Tummy Tuck for a Flatter, Firmer Abdomen

Tummy tuck is designed to address several common post-pregnancy issues in the abdomen. The goal is a firmer, flatter abdomen.

During tummy tuck, excess abdominal skin under the navel is removed, and the remaining skin is tightened. This often minimizes or removes stretch marks on the skin below the navel. Abdominal muscles that have weakened or separated during pregnancy (causing abdominal protrusion) are repaired. And, if needed, excess abdominal fat is removed by incorporating liposuction techniques into the operation.

Breast Lift for Perky, Youthful-Looking Breasts

Breast lift corrects breast sagging after pregnancy and nursing and improves the overall shape and position of the breasts (and nipples).

During breast lift, the breast tissue is sculpted to create the breast mound higher on the chest wall. Excess skin is removed and the remaining skin is tightened. Downward-pointing nipples are corrected, and enlarged areolas are reduced. Very frequently, breast implants are added to the breast lift. This improves upper pole fullness as well as enhances the size of the breasts.

Breast Augmentation for Bigger, Fuller Breasts

If nursing has left the breasts looking small and “deflated,” saline or silicone breast implants can be used to add volume and boost cleavage. Breast augmentation may be combined with breast lift to improve the size, shape and position of the breasts.

Want a natural alternative to breast implants? Drs. Pearl and Ereso can perform breast augmentation with fat transfer, which uses donor fat from another area of the body to add breast volume and cleavage. Fat transfer can be combined with breast implant placement to soften and narrow the cleavage area, or it can be performed as a separate procedure at a later time.

Learn More about Post-Pregnancy Plastic Surgery

If your post-baby body isn’t what it used to be, Drs. Pearl and Ereso can help. Schedule a private consultation with the surgeons to discuss your treatment needs and goals. Call (650) 964-6600 today to make an appointment.

The Use of Acellular Dermal Matrix and Biologic Scaffolds in Difficult Cosmetic Breast Surgery Revisions

What is acellular dermal matrix?Over the past 30 years, millions of women have had breast implants for cosmetic augmentation and lifting, as well as reconstruction after breast cancer excision. Difficult problems can arise that sometimes require sophisticated solutions that were not available previously. Breast revision has become a true sub-specialty in plastic surgery and, with more than 25 years of experience, Dr. Pearl has developed a keen interest and talent in the art of breast revision. Dr. Ereso’s recent modern training has had an additive effect on Dr. Pearl’s experience, helping to produce some outstanding results. Many patients are referred to Dr. Pearl and Dr. Ereso to treat these difficult problems, as well as treating their own patients that have developed complications.

When a breast augmentation patient develops a complication such as recurring capsular contracture, implant rippling, implant malposition, severe asymmetry or loss of either superior or inferior pole support, Dr. Pearl and Dr. Ereso will perform cosmetic breast surgery revision. In many cases, they can manage the problem with a very innovative solution: the use of a biomaterial called acellular dermal matrix.

What Is Acellular Dermal Matrix?

Acellular dermal matrix (ADM) is a skin graft from which the cells have been removed. Think of it like a lattice or scaffolding of sterile tissue that supports the natural breast tissue. Once placed, the patient’s own cells grow into the framework and in some instances, eventually replace the graft.

ADM has been used for more than a decade, and has yielded many favorable results with a low complication rate. Usually it is used for breast revision operations, although occasionally, ADM may be used in primary breast surgery (if Dr. Pearl or Dr. Ereso feels it would be medically appropriate).

How the Doctors Use These Biomaterials

Drs. Pearl and Ereso use Strattice® and AlloDerm® biomaterials (as well as Allergan’s SERI® Surgical Scaffold) to support the natural breast tissue, and improve the appearance of breast implants. They can use ADM to do any of the following:

  • Correct the inframammary fold (crease underneath the breast) when an implant has “bottomed out”
  • Stabilize the pocket of an implant
  • Provide support for the lower portion of the implant in augmentation or implant-based reconstruction cases
  • Decrease the appearance of implant wrinkling or rippling
  • Camouflage implant visibility in thin patients (particularly reconstruction patients)

ADM is particularly helpful in cases of capsular contracture, when scar tissue forms around the implant, squeezing it and distorting the shape/feel of the breasts. In these cases, Dr. Pearl or Dr. Ereso will place ADM over a portion of the implant to prevent the return of capsular contracture. The intention is that by covering the implant with ADM, the body won’t produce more scar tissue in that location. SERI® surgical scaffold, which is made of silk, is the latest innovation that can be used to treat these problems. SERI® has the unique property of allowing your own tissue to grow into the silk scaffold. After one to two years, your tissue entirely replaces the silk!

Learn More about Acellular Dermal Matrix

For more information about ADM, and how the biomaterial can be used to improve the results of breast implant surgery, please contact Dr. Pearl and Dr. Ereso today by calling (650) 964-6600.