David M. Monacelli, MD
board certified plastic surgeon
Breast Surgery In Ithaca, NY
Dr. Monacelli has extensive experience in cosmetic and reconstructive procedures of the breast. He has been in practice in Ithaca, NY for over 15 years, and during that time, the majority of cosmetic surgeries that he has done have been breast procedures.
Breast Augmentation
Breast augmentation is the most common major cosmetic procedure that Dr. Monacelli performs. Breast augmentation can be a tremendous confidence builder in many women who either never developed full breasts, or have had decrease in size of their breasts following pregnancy or weight loss. Breast augmentation can safely fill out the breasts and allow these women to wear clothing that they may not otherwise feel comfortable wearing. Dr. Monacelli’s philosophy on breast augmentation stresses natural looking results. An overdone or artificial look is never the goal.
Both saline and silicone breast implants are used in Dr. Monacelli’s practice when appropriate. Most women are candidates for either type of implant, and Dr. Monacelli counsels his patients to help them choose the implant that is the best for their unique situation.
Saline Implants
Saline implants have been readily available for many years and have a very long history of safety and effectiveness. Saline implants do have an increased tendency to wrinkle compared to silicone gel implants. However, saline implants continue to give consistently good results in many patients, particularly patients that have adequate breast tissue and body fat present to cover the implant and thus minimize the chance for noticeable wrinkling. Saline implants are easier to handle, should they rupture. The saline is absorbed by the body and the implant deflates, making the detection of leakage much easier than with silicone implants.
Silicone Gel Implants
Silicone gel implants have had a great deal of media coverage, and controversy over the past decade. The Food and Drug Administration (FDA) has reviewed extensive research and studies during this time and have deemed silicone gel implants to be safe and effective.
LINKS: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108790.htm and http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/
ucm063743.htm.
The main disadvantage of silicone implants, in Dr. Monacelli’s opinion, is that, should silicone gel implants rupture, silicone is not absorbed by the body to any great degree, and therefore the breast size does not usually change noticeably. Thus, a ruptured silicone gel implant can go undetected for some period of time. For this reason, the FDA recommends a periodic MRI scan to assess silicone gel implants for rupture.
Silicone implants will feel more natural and wrinkle less than saline implants in some patients. Very thin women are more likely to have problems with saline implants wrinkling, and thus, these are the patients that Dr. Monacelli often recommends considering silicone gel implants, to obtain a more natural appearing result. Ultimately, it is always left up to the patient to make the final decision on the type of implant used, based on what they feel most comfortable with. Likewise, the size of implant used, is always left ultimately up to the patient. Although Dr. Monacelli counsels his patients, and uses sizing exams, where patients try on different size implants inside a bra, to help guide them to the ideal size for obtaining the result that each patient is looking for.
The most common incisions used for breast augmentation are the inferior periareolar incision (around the lower edge of the areola, where the darker skin surrounding the nipple meets the lighter skin of the breast), and the inframammary incision (in the fold where the bottom edge of the breast meets the chest). Saline implants can be placed through either type of incision. Silicone implants often require a larger incision and therefore are more commonly placed through an inframammary incision.
Breast Lifting/Mastopexy
Mastopexy, also known as a breast lift, is also a very common procedure in Dr. Monacelli’s practice. Breast lifts are frequently done as an isolated procedure, but also as a frequent adjunct to breast augmentation surgeries. The main goals of a breast lifting procedure are to raise and reshape the breast mound and move the nipple and areola to a higher, more ideal position.
Many women who complain of a lack of fullness in the breasts, simply need an implant placed through a standard breast augmentation. Other women, however, have a condition known a breast ptosis, where the nipple and areola are positioned too low on the chest. If the low nipple position is not corrected in an augmentation patient, they may have an unsatisfactory result, where the nipple is positioned too low in relation to the implant and the nipple is pointing down instead of pointing forward on the breast. While some surgeons recommend correcting the nipple position in a second surgery, Dr. Monacelli prefers a combined augmentation and lifting procedure known as an augmentation mastopexy, thus correcting the lack of fullness and the low nipple position in the same surgery.
There are multiple techniques available for performing a breast lift, all of which result in some degree of scarring. A major goal has been to reduce the size and number of surgical incisions used in mastopexy surgeries, and thus reduce the extent of scarring. Dr. Monacelli will carefully evaluate each patient and make recommendations based on his extensive experience performing these surgeries. In Dr. Monacelli’s opinion, it is only the patients with severe ptosis of the breasts that require the traditional “inverted T” scars with a circular scar around the areola, a vertical scar below the areola, and a long curved horizontal scar in the inframammary fold at the bottom edge of the breast. Some patients only needing a small lift can have a procedure done solely through a periareolar incision, a circular incision all the way around the areola. This leaves only a circular scar around the edge of the areola, and typically leaves the least noticeable scar. The most common procedure, however, used in patients who need moderate to large amounts of lifting, is done through a combined periareolar incision and a vertical incision below the areola, on the lower half of the breast. In Dr. Monacelli’s experience the vertical scar generally heals well in most patients, and the improvement in breast shape and position is greatly enhanced with this procedure.
Designed for Dr. Monacelli by the American Society of Plastic Surgeons