Breast Surgery
Breast surgery has been a mainstay of Dr. Kirn's practice from the beginning. With extensive experience in augmentation, lift, reduction, revision, and reconstruction, your breast surgery needs can be met in our practice. Consultation is the first step in surgical planning. All consultation visits include a detailed discussion of the procedure options and their associated risks and benefits. Each patient is unique, so the plan is custom tailored to suit your needs and goals. There are no assembly line / cookie cutter operations in Dr. Kirn's practice.
Breast Augmentation
Breast augmentation has been one of Dr. Kirn's most popular procedures since the start of his private practice in 1998. Over the course of time, the technique has been gradually refined to minimize scars and recovery time for patients while maintaining high quality results. Many factors go into achieving these goals. No two patients are alike, so we strive to customize the operation to fit the patient's needs and goals.
Incision: Patients have their choice of incision: in the armpit, at the nipple, or under the breast. Sometimes, the patient's anatomy makes one of these options more favorable than the other. Based on these factors, and the patient's preference, the planned incision is determined during the consultation in advance of surgery. The armpit incision is advantageous since it avoids a visible scar on the breast. Dr. Kirn places both saline and gel implants through the armpit. Technological advancements over time have made this possible. For saline implants, Dr. Kirn developed a smaller surgical instrument to create the implant pocket thereby minimizing incision size. A larger incision is always necessary for silicone implants. But here again, technology has come to the rescue. The Keller Funnel was developed by one of Dr. Kirn's closest professional colleagues. Dr. Kirn participated in some of the early research on the device, as well as subsequent laboratory testing. The Funnel allows a gel implant to be safely inserted through a smaller incision than would otherwise be possible with a gel implant. Further, this device enhances performance of a "No Touch" technique.
Implant Selection: Dr. Kirn uses both saline-filled and silicone gel-filled implants. Most commonly, implants from the Mentor Corporation (www.mentorwwllc.com) are used. Gel implants were re-approved by the FDA in 2006. Dr. Kirn participated in one of the FDA clinical trials on gel implants giving him years of experience with them before their general re-approval. There are certain circumstances where saline or gel implants may have a particular advantage. Therefore, the choice of saline or gel implant is a decision made jointly between you and Dr. Kirn.
Implant size selection is one of the most important aspects of a successful breast augmentation procedure. The choice is highly personal but must remain within accepted safe surgical technology. During the consultation, you will have the opportunity to try on sizer implants to provide a simulation of breast volume. While there is no exact method to precisely select an implant size, these two methods have proven valuable over time in our practice and have minimized the need for size change operations.
The Operation: Nearly all of Dr. Kirn's breast augmentation procedures are performed at the SCA Lexington Surgery Center. The Surgery Center is an AAAASF accredited outpatient operating room which has been in Lexington since 1981. Patients benefit from attentive care by the staff and the safety advantages of a professionally managed, multispecialty facility. For patient comfort and safety, general anesthesia is provided by a Board-Certified Anesthesiology group.
The day of surgery includes arrival at the Surgery Center roughly one hour in advance of the operation. The procedure usually takes one and a half to two hours to complete, but surgical times can vary depending on many factors. After the procedure, patients will typically spend 30 minutes to 1 hour in the recovery room before leaving the facility.
A "No Touch" technique is utilized for all breast augmentation procedures. This designation, "no touch" is somewhat of a misnomer and a more accurate statement would be "one touch" or "limited touch." The technique involves keeping the implant away from any potential source of microscopic contamination. In Dr. Kirn's procedure, he is the only person in the operating room who will touch the implant. Further, the implant is only opened when it is ready to be inserted. If a gel implant is used, the implant is inserted through the Keller Funnel directly into the pocket and may truly not be touched by anyone including Dr. Kirn. Saline implants are inserted before filling. Then, they are inflated using sterile IV saline running through tubing connected directly to the implant. The saline is never exposed to air, just as would occur with an IV placed into a vein.
All patients are raised into a sitting position after the implants are in to confirm proper positioning and, for saline implants, make any fill volume adjustments to maximize symmetry.
Dr. Kirn has been offering the long-acting numbing medication, Exparel, to breast augmentation patients since early 2015. This medication is injected while the patient is under general anesthesia, just prior to start of the operation. It provides a significantly improved patient comfort for the first 72 hours or so, based on our observations thus far. Although the use of Exparel is an optional choice for patients, most patients find it to be extremely helpful and decrease the need for narcotic pain medication after surgery. Recovery: After surgery, most patients can expect soreness for a few days. This will be more significant when the implants are placed under the muscle. Dr. Kirn takes every precaution to minimize trauma to the tissues intraoperatively, so there are no movement restrictions immediately following surgery. Patients are advised to avoid activity which elevates the heart rate or blood pressure for at least five days after the procedure to minimize the possible risk of bleeding.
Patients are usually placed into an ACE wrap dressing in the operating room and will change to a sports bra on the third day after surgery. We do not routinely use special surgical bras. Patients should avoid the use of underwire bras for six weeks after surgery. Following that, patients may wear whatever they choose. If the implants are placed under the muscle, it usually takes several weeks for the muscle to stretch out over the implant and the breast shape to mature. The process is gradual. Dr. Kirn and his staff will guide the patient regarding use of any exercises to expedite breast shaping.
More general information about breast augmentation may be obtained at the American Society of Plastic Surgeons website: www.plasticsurgery.org. Or the American Society for Aesthetic Plastic Surgery website: www.surgery.org.
Mastopexy (Breast Lift)
Mastopexy operations always involve a trade. In exchange for a more pleasing, "perkier," breast shape, you also get some visible scars on the breast. Dr. Kirn performs many different types of mastopexy operation. So like all breast procedures, mastopexy is custom tailored to your needs. At the minimum, the scar is limited to an incision just around the nipple. For slightly more droopy breasts, an incision around the nipple and a vertical incision extending downward may be necessary. A full mastopexy involves an incision around the nipple, a vertical incision, and an incision along the crease at the bottom of the breast. Mastopexy can be performed as a stand-alone operation or in combination with placement of a breast implant.
A common misconception is that placing a breast implant will correct a droopy breast. Breast implants serve only to increase breast size. There are some circumstances where the breast can appear droopy due to lost volume. In those cases, placing an implant alone may restore a desirable breast shape. This is not always the case, however. Most patients with a droopy breast will require a lift or a combination of augmentation and lift to really improve breast shape. Determining the best procedure, or procedures, for your unique need is a key element of the consultation. Dr. Kirn makes every effort to keep the scars minimized.
A droopy breast indicates a natural laxity of the tissue. This means the breast is unable to properly support its own weight. The mastopexy operation works by using the skin like a bra to support the breast. If there is natural laxity however, the improved breast shape created by the operation will be subject to gravity and will change over time. Size of the breast may be adjusted with mastopexy operations. Sometimes the breast is made smaller while in other cases, the breast size is increased with an implant. If there is no desire for size change, no breast tissue will be removed, and no implant will be added. In that circumstance however, the breasts usually appear slightly smaller since skin has been removed during the process.
Due to the many surgical options, a detailed consultation is extremely important when considering a mastopexy. Most mastopexy procedures are performed at the Lexington Surgery Center using general anesthesia. Mastopexy is an outpatient procedure. Most patients are back to normal activities within a few days.
Augmentation - Mastopexy
Many patients desire an increase in breast fullness with a simultaneous improvement in breast shape. If the breast starts out droopy, a combination of breast augmentation and mastopexy is usually necessary to achieve this. There is a significant increase in complexity when the two operations are combined.
Incisions used for combination augmentation-mastopexy are the same as with mastopexy alone as described above. Sometimes, adding an implant will allow use of fewer or smaller incisions than would be needed for mastopexy alone. Usually, the implant is inserted through one of the mastopexy incisions, so that an extra scar is not needed just to place the implant. As with augmentation alone, the implant may be placed on top of or underneath the muscle and either a saline-filled or gel-filled implant may be used.
Because of the added complexity in the combined operation, there is a higher "touch-up" rate with augmentation-mastopexy procedures. A touch-up refers to the need to make an adjustment to the breast several weeks or months following the initial surgery. Most commonly, these procedures are very minor and are completed in the office under local anesthesia. From time to time, more major revisions are necessary. Why does this happen? The breast tissue and the implant will settle after surgery and the exact degree to which that will occur cannot always be adequately determined in the operating room at the time of the initial procedure. The forces of tissue stretch, muscle relaxation, and scar / capsule formation can vary from patient to patient and even breast to breast in the same patient. Further, most patients start out with some degree of asymmetry which further adds to the complexity.
As with mastopexy, there are many different options when planning an augmentation-mastopexy, so a detailed consultation is necessary. Augmentation-Mastopexy is performed at the Lexington Surgery Center under general anesthesia. It is an outpatient procedure.
Breast Implant Revision, Exchange or Removal
From time to time it is necessary to change or remove old breast implants. There are many reasons to do this including implant leaks, capsular contracture, or a desire for breast size change. Revisionary procedures are always specific to individual patient needs and goals. In some cases they are much more complicated than the original procedure and other times they are simpler. A variety of techniques are available to address specific concerns including the use of spacers or mesh to stabilize implant location. It is useful to have as much information about the previous surgery as possible at the time of consultation. Especially, it is useful to know the size and model number of the existing breast implants.
Breast Reduction
Breast Reduction is performed for both functional and cosmetic reasons. Many patients have physical problems due to the size and weight of their breasts including back pain, shoulder pain, shoulder grooving from bra straps, neck pain, a rash under the breasts, and occasionally numbness and tingling in the fingertips. While not a direct treatment for any of these problems, breast reduction frequently gives relief from many, if not all, of these symptoms. In addition, breast reduction brings the breast size in proportion to the rest of the body. Patients will frequently be asked if they have lost weight after the surgery. Finding properly fitting clothing is usually easier after breast reduction.
As with breast lift (mastopexy), breast reduction involves a trade. The patient gets smaller, less heavy, and generally shapelier breasts but also gets visible scars. Dr. Kirn performs most breast reductions using an inverted T (anchor shaped) incision. In most cases, he uses liposuction to address fullness in the area where the breast extends along the side of the chest into the armpit.
Breast reduction is an outpatient procedure performed under general anesthesia. Most breast reduction procedures are completed at the Lexington Surgery Center. Breast reduction may be combined with other operations. Most commonly, tummy tucks or liposuction are performed simultaneously. Breast reduction may be covered by your insurance carrier.
Gynecomastia
Male breast enlargement affects all age groups of men, although it is more common in the teenage years and at an advanced age. Sometimes it develops in the teenage years and persists over time. Although there may be several medical reasons this problem can occur, most of the time, the reason is unknown, and it is simply an undesired change. The first step in treatment is to have the area evaluated by a knowledgeable physician. If an underlying cause can be identified, then that problem must be addressed first. Then, steps may be taken to improve the appearance of the area.
Most cases of gynecomastia can be treated with liposuction. Dr. Kirn uses either Power Assisted Liposuction or Ultrasound Assisted Liposuction for the male chest. Many patients also have some element of breast glandular tissue which cannot be removed with liposuction. Residual glandular tissue may be removed at the time of surgery using an arthroscopic tool passed through the liposuction incision or sometimes, there is enough glandular tissue that an incision must be made along the border of the areola. Glandular tissue removal may be completed at the time of surgery or delayed for several weeks or months after surgery.
Some patients present with a combination of extra skin, extra glandular tissue, and extra fat in the chest area. For these more severe cases, a combination of skin removal, gland removal, and liposuction may be necessary. When skin removal is required, a scar will result which will be permanent. Therefore, every effort is made to avoid need of an incision when at all possible.
