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Breast Procedures


Breast Reconstruction in Palo Alto

Modern surgical technology makes it possible to reconstruct a natural-looking breast after mastectomy (breast removal) for cancer or other diseases. Breast Reconstruction is commonly performed immediately, simultaneous with the mastectomy procedure, so that the patient wakes from surgery with a new breast mound following the mastectomy procedure. This allows for patients to perceive the mastectomy procedure as a new beginning, rather than simply a loss. Alternatively, the patient may choose to begin reconstruction years after mastectomy. It is not a requirement to start the process immediately following mastectomy, rather a choice that saves time and additional procedures.

As with most plastic surgery procedures, there are several choices available for Breast Reconstruction. Some of the reconstruction procedures involving implants are relatively simple and easy to recover from without any damage to other areas of the body. Alternative, more involved techniques, which require using tissue from other body areas to reconstruct a breast, are sometimes chosen or required for multiple reasons. Nationally, most women choose breast reconstruction using implant techniques. Identifying which procedure is most appropriate for you is best determined by having a consultation at The Plastic Surgery Center on Woodside with Dr. Papalian, who has performed hundreds of breast reconstruction procedures.

As part of the breast reconstruction process, recent state and federal legislation has allowed for treatment of the opposite breast for symmetry purposes of the breast reconstruction, as a covered benefit under health insurance plans. This can involve breast reduction, breast lift, or even breast augmentation procedures to create the best symmetry possible with the reconstructed breast.

The most common technique for Breast Reconstruction involves replacing the tissue lost from mastectomy, by initial tissue expansion followed by an implant and nipple reconstruction. Flap techniques to reconstruct the breast by moving tissue from other areas of the body to the chest, are either performed as a pedicle (tunneled technique) or as a “free flap” which requires a micro-vascular team at specialized hospitals. Determining which procedure is most appropriate for you is best determined by a consultation with Dr. Papalian, who will present your options and provide you with an experienced discussion. Tissue expansion and implant techniques, as well as pedicled or tunneled flaps, are commonly performed by Dr Papalian. Having performed hundreds of breast reconstructions in his 20 years of experience, Dr Papalian is uniquely suited to discuss your options with you. When necessary or requested, Dr. Papalian will assist you in referral to a micro-vascular center, if a free flap is ultimately selected. Not infrequently, patients will travel to centers in other states, which specialize in certain techniques that are not commonly performed. Dr Papalian offers to follow patients who have made such choices and need post operative care locally as a service to patients and the community. During the consultation, Dr. Papalian’s focus is ensuring that the patient is fully informed, understands all of their options and makes the right choice for their particular situation.

The most commonly performed technique for Breast Reconstruction using Tissue Expansion is typically initiated in combination with the mastectomy. The initial procedure is followed by serial expansions of the reconstructed breast, as an office procedure, until the appropriate breast size is achieved. Following any postoperative cancer treatment that might be required, a second procedure is performed to replace the tissue expander with a reconstructive implant and nipple reconstruction. These procedures produce a newly reconstructed breast with symmetry being achieved by treating the opposite breast when needed.

Having a comprehensive and trusted consultation by Dr. Papalian will ensure that are you going to have all of the options presented in a thoughtful manner. You will have all the information needed to make the right decision for you. At the time of Your Consultation, a personalized treatment plan will be developed.


Correction of Breast Reconstruction and Post Lumpectomy irregularities.

Following Breast Reconstruction, with implants or flaps, or Lumpectomy, irregularities often persist. With the latest techniques in Autologous Fat Transfer/Fat Micro Grafting (link to Fat transfer page), improvement in the appearance of Breast Reconstruction is now possible.

Often, performing liposuction in problem areas and transferring/micro grafting the fat into irregular areas of the reconstructed breast, can add a finishing touch that softens the reconstruction, or improves a deformity in patients who have undergone Lumpectomy.

Breast Reconstruction revision and fat micro grafting to improve the appearance of the reconstructed breast or a Lumpectomy defect is a covered benefit by insurance plans. In addition, treatment of the opposite breast for symmetry in reconstruction is also a covered benefit.


Gynecomastia (Male Breast Enlargement) in Palo Alto

While much is written regarding enlargement of the female breast, rarely discussed is the common problem of enlargement of the male breast, known as Gynecomastia.

Gynecomastia can be a result of actual breast gland growth or fatty infiltration of the male breast area. There is often no known cause for gynecomastia, although there have been some correlations with various drugs and medical conditions. Transient gynecomastia is also a common phenomenon during puberty.

Men who feel self-conscious about their appearance can be helped with breast reduction surgery. The options for treatment are multiple and it is important to have a comprehensive consultation with an experienced Plastic Surgeon to reach the right treatment decision for you.

Liposuction only, breast gland excision and full breast reduction with skin removal are all possible treatment options depending on the degree of tissue enlargement and the amount of excess skin. The result is a more contoured chest that is flatter and firmer. Treatment decisions are best individualized as each case presents different findings.

During your consultation at The Plastic Surgery Center on Woodside with Dr. Papalian, a discussion will take place regarding your particular anatomy, degree of excess skin and desired outcome. A treatment decision will be made with you to best match your desired outcome and scar limitations.