Breast Reconstruction Surgery

Davinci plastic surgery | Washington dc | steven p. davison, md




Mastopexy (Breast Lift) – Breast Reduction – Breast Augmentation - Expander Implants  Breast Implants

The goal in any breast surgery is to achieve a natural looking, proportional, balanced outcome.  After a mastectomy, the majority of women choose one of several procedures for the other breast to achieve a natural looking, balanced outcome…

After a unilateral mastectomy women are faced with still more decisions to make about the remaining breast.  If reconstructive breast surgery is performed to rebuild the diseased breast after a mastectomy - this typically causes a symmetry problem with the unaffected breast.  The reconstructed breast is usually greater in volume and size with a different shape than the un-operated breast.  Clearly proportion – balance – symmetry and a natural look are gone.  With today’s wonderful advanced and refined procedures – Dr. Davison is able to balance these problems to restore the look you want and deserve.  Using Implants, Breast Lift(s) (Mastopexy), Breast Reduction, Breast Augmentation and Breast Implants – women come away from surgery often with better proportion and balance than they had before.  Dr. Davison believes that all surgeries should be functional and attractive – resulting in the most natural look possible. 


Mastopexy – Breast Lift
Mastopexy surgery reshapes a sagging breast(s) to a more naturally rounded shape and repositions the breast, nipple/areola to a higher – more youthful position and projection. Underlying breast tissue is tightened and sagging skin is reduced. If desired, the size of an enlarged areola can be reduced. Breast Lift does not change the amount of breast tissue – it changes the shape which can affect the overall size.  Often – a lift is done with an implant to achieve the desired size and shape. The technique used for your lift will be based upon your breast size and shape, the size and position of your nipple/areola complex, the degree of ptosis (sagging), skin elasticity and the amount of excess skin that will need to be removed.  Incision patterns may include one of the following:

  1. Incision placed around the areola
  2. Incision down from the areola to the breast crease
  3. Incision placed horizontally at the breast crease

The new shape and position are visible immediately after surgery but it takes several weeks for the new look to settle in.  Breast Lift is the only way to permanently restore youthful body contour to the breasts and one of the options to restore or create breast symmetry.

Breast Reduction
Breast reduction reduces the breast size to be more body proportionate for improved appearance and quality of life.  Many women with “too large” breasts suffer from back pain, shoulder pain/grooves, rashes and irritation and deteriorating posture as well as problems with clothing styles and proper fit. Some women suffer with poor self-esteem issues also.  After a mastectomy – the majority of women who need it – choose a breast reduction to achieve balance and symmetry – and get relief from all the above as well. Reduction involves removing excess tissue and fat and sculpting the breast into a smaller shape. Techniques have been improved and refined over recent years to lessen scars and improve shape so that some fullness is restored to the upper breast portion.  Incisions include all or a combination of the following:

  1. Concentric or donut-shaped incision around the areola
  2. Incision place vertically down from the areola to the breast crease
  3. A “T” shaped incision placed horizontally at the breast crease

Working through the incision, Dr. Davison removes excess fat and tissue (liposuction may be employed) and sculpts the breast into a smaller, more pleasing size and shape. The nipple is repositioned – while remaining attached to its nerve and blood supply – the overlying skin and the size of the areola is reduced (if needed) to match the shape, position and proportion of the new breast.  Results are seen and felt immediately – but plan on a few weeks for recovery.

Breast Augmentation
Breast augmentation is typically an out patient procedure performed under general or local anesthesia with sedation.  If augmentation is done the same time as breast reconstruction it will be done in hospital.  There are several options for placement of implant incisions as follows:

  1. Inframammary Incision is placed in the fold under the breast and is the most common method used.
  2. Axillary Incision can be made in the armpit and typically requires use of an endoscope for implant placement.
  3. Periareolar Incision  is placed at the lower perimeter of the areola and is usually well hidden.  Loss of nipple sensation is common with this placement.
  4. Umbilical Incision employs an endoscope to insert the implant through an incision made in the belly button.  Only Saline implants can be placed using this incision.

Your body type determines the actual placement of the implants.  This determination is made during your physical exam/consultation appointment.  Two placements are used:

  1. Subglandular involves implant placement over the pectoral muscle.  This is better for patients with only mild sagging and who have no plans to have a breast lift procedure in the future.
  2. Submuscular placement means the implant is placed below the pectoral muscle and the overlying breast tissue.  This involves a longer recovery time but is the best choice for certain patients.

Breast Implants
Implants are devices made of biocompatible material called silicone and are either filled with silicone or saline.  They have either a smooth or textured solid silicone shell, come in a host of sizes and shapes – round or contoured and can be custom fitted to meet your specific needs and goals. Today’s implants are so improved they actually mimic the shape and slope of a natural breast. A new type of implant has been developed for use in breast reconstructions.  It is similar to the tissue expander with an integrated port that allows for slow expansion over several weeks.  Once the desired size is reached, the port is removed and the expander becomes a permanent implant making the reconstruction closer to a one-stage procedure.  Based upon choice - implants can accomplish the following:

  • Breast Implants can enhance the overall width of the breast
  • Breast Implants can enhance breast projection
  • Breast Implants can enhance the size and shape of the breast
  • In some cases –  Breast Implants may help create cleavage

Today’s breast implants are much longer-lasting than older versions and the risk of rupture/leakage is rare.  They do not change with our body – we change with age, lifestyle etc – and so they may not be permanent depending upon your age at the time of placement.  

Silicone Implants
Silicone implants are back - they are safe and effective and are the best choice for certain breast procedures.  They are made from silicone- which is one of the earth’s natural elements – and are biocompatible with your body.  Silicone implants feel more natural – like your own breast tissue.

Saline Implants
These implants contain sterile saline (salt) water and can be pre-filled to a specific size or filled at the time of placement which allows for smaller incisions – such as when advanced through the umbilicus.  Saline can be absorbed by the body in case of leakage – which is rare with today’s new implants. 

Tissue Expander Implants
Tissue expansion is a process that stretches the skin - over several months - to create a space for permanent breast implant placement.  Depending upon whether you’re having an immediate or delayed breast reconstruction, the tissue expander is either placed at the time of the mastectomy or later in a second – stage procedure.  An expander is inserted into a pocket under the pectoral muscle and the overlying skin tissue the same as with a breast implant.  It is usually placed into position “collapsed” with fluid being injected about 2 weeks after surgery.  The fluid is either injected directly into the expander or through a distant port.  The filling process continues for several weeks until the expander is filled to an optimal volume, allowing time for the skin to slowly expand around the capsule. Once accomplished, a second surgery is performed to remove the expander and place a permanent breast implant.

After Breast Surgery – What to Expect:
You’ll wake up wearing a support bra and thin drainage tubes in the incisions which will be kept in place until Dr. Davison determines it’s safe to remove them. You’ll be stiff and sore along with breast tenderness, heightened or lack of nipple sensation, swelling and bruising, regional tightness/discomfort, redness and discomfort or itching at the incision sites. You will need to sleep with your head elevated for a week or two after surgery.  All surgery results in scarring – but Dr. Davison uses advanced techniques to minimize scarring – and scars do fade over time.  Your activity will be restricted for a few weeks and we’ll give you complete post-operative instructions to guide you through recovery. Healing takes time and final results may take up to a year to fully appreciate.

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Steven P. Davison, MD

Steven P Davison - board certified plastic surgeon

Breast Reconstruction
Plastic Surgeon
Washington, DC and Northern Virginia

Dr. Davison is board certified and fellowship trained with a special interest in breast cancer reconstruction.  His unique and desirable skillset places him in a special league of surgeons who can provide unequaled expertise in full-spectrum plastic and reconstructive surgery.  He is able to effectively deal with other cancers as well, including melanoma and successfully manages many  surgeries of the body, both cosmetic and reconstructive.  Dr. Davison’s interest in breast and body contouring facilitates in his creation of a natural, aesthetic breast that is pleasing to the patient and grants him hundreds of happy patients.