Correcting Breast Asymmetry with Surgery

No woman’s breasts are identical. In many cases, the differences in size or shape are hardly noticeable. However, to some women the asymmetry is not only noticeable but upsetting. If you have uneven breasts, you may feel extremely self-conscious to the point where you don’t like going out in public or wearing certain styles of clothing because of the asymmetry.

Breast asymmetry can be corrected with the help of a trusted, experienced plastic surgeon like Dr. Alexander Ereso. Read on as the plastic surgeons discuss how they commonly fix breast asymmetry. Continue reading “Correcting Breast Asymmetry with Surgery”

Commonly Asked Questions about Breast Reduction


Breast reduction has the potential to change a woman’s life. By reducing oversized, heavy breasts, the surgery can improve appearance, personal comfort and self-confidence. To help educate women interested in breast reduction, Dr. Alexander Ereso answers commonly asked questions about the procedure below. Continue reading “Commonly Asked Questions about Breast Reduction”

When Does Breast Reduction Become a “Medical Necessity?”

“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.

Chronic Back/Neck/Shoulder Pain

Most insurance companies provide coverage to women whose breasts cause chronic and significant back or neck pain, due to the mass and weight of the breasts or the bra straps cutting into the shoulders. A finding of grooving along the shoulders from the shoulder straps of the bra demonstrates this. Chronic pain can roughly be defined as lasting for at least one year, and significant pain can be loosely interpreted to mean interfering with daily activities. It is important that the pain one is suffering be attributed to having large, pendulous breasts and not due to some other prior trauma. Some insurance companies will require documentation from another physician attesting to this. Regardless, all insurance companies require photographs of the breasts to be taken and sent for examination by the medical director of the insurance company.

Rashes under the Breasts

Another complication that could help classify a breast reduction as medically necessary is if the candidate regularly develops rashes, infection, inflammation or irritation on the skin under the breasts due to their weight and mass. Because of the large size, maintaining good hygiene may be difficult with rashes leading to skin breakdown.

Abnormal Curvature in the Spine

Some women’s breasts are so large and heavy that they develop painful kyphosis, which is an abnormal curvature in the spine. As a result, a woman may walk hunched over instead of standing tall, and suffer from related back pain and stiffness.

Tingling or Numbness in the Upper Extremities

The weight of oversized breasts can, in some cases, cause a condition called paresthesias in the upper extremities; this means that the limbs start to tingle or go numb.

Understanding Insurance Rules and Regulations

Typically, when an insurance company designates breast reduction as a medical necessity, they have some special rules and regulations. They can dictate a rough estimate of how much breast tissue must be removed during the operation. For example, some insurance policies dictate that any breast reduction that removes 500 grams (a bit more than a pound) of breast tissue is covered. In an attempt to correlate differences in body sizes and the amount of breast tissue to be remove,  a formula, which includes the patient’s body surface area and weight, can be used to determine the minimum amount to be used.

Learn More about Breast Reduction

This information is for educational purposes only and should not be construed as fact. It is best to check with your individual insurance company for more information about your plan and what it does and does not cover. The team at Pearl-Ereso Plastic Surgery Center would be happy to give you more information if needed. Please contact us with any questions.

How to Get Your Body Back after Baby

Recently, 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, Dr. 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. Dr. Ereso cautions 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? Dr. 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, Dr. Ereso can help. Schedule a private consultation with the surgeon 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

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. Many patients are referred to 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. Ereso will perform cosmetic breast surgery revision. In many cases, he 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. Ereso feels it would be medically appropriate).

How the Doctors Use These Biomaterials

Dr. Ereso uses 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. 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. Ereso today by calling (650) 964-6600.