I developed a sizing technique over 11 years ago and have used it successfully in hundreds of patients: a sizing technique that allows you to select the look you want with my help. This reduces the chance of any wish to adjust afterwards. Here it is:

At the initial consultation we meet, review videotapes and before and after pictures, and after an examination discuss recommended procedure and costs. [For patients not sure what procedure they need it is best to bring in some pictures at the initial consultation. Dr. Pertsch will be able to recommend the best procedure to achieve the breast appearance desired. Options to achieve the desired breast might include: implant only vs. breast lift only vs. lift with implant vs. breast reduction only vs.breast reduction with lift and add implants.]

Before any surgery you will return to the office for a comprehensive one-and-a-half to two hours to review our extensive breast augmentation information, what to do before and after for the best results, an overall check of your health, and for implant sizing. (Before the time scheduled for this extensive, second consultation you will need to have found your "sizing pictures" as described below.)

After we get all this 'work' done my nurse and I will review pictures you found beforehand, in and out of clothing, of women whose proportion you like. (You may have experienced some challenge finding the proper cup size for yourself so it is difficult for me to estimate cup size after surgery.) Obviously, I want you to be the proportion you wish to be after surgery. The best way I have found to accomplish this is for you to find pictures with the upper body look (proportion) you seek. Find pictures with and without clothes. The most helpful view is the oblique or 45 degree view, i.e. halfway between front view and side view. It gives me the best idea of how it is you want to look afterwards. Then, using a stretchy brassiere we have in the office you will try on the various implant sizers (between 155 to 600 cc) in front of the mirror. I check to be sure what you like in the pictures and in front of the mirror are consistent. Only then can I recommend an implant (size, style, manufacturer) for each side that will best accomplish what you want. Sizing doesn't end here, however. Before the end of your surgery, after the implants are in, I sit you up and compare how you look with the pictures you brought to make final sizing adjustment decisions. Most women have a broad range of size their anatomy can comfortably handle and remain in proportion.

[There are some magazine photographs of models without clothes available in our office for your use. All sizing photographs must be selected before the actual scheduled time of your extensive preoperative appointment.]

Having said all this you will be the one having these implants for a long time. I have used just about all the implants out there in one situation or another. If you really like the idea of adjustability after your surgery the Spectrum implant could be used.

I use anatomical-shaped breast implants but usually recommend them in certain patient situations. Most commonly I have recommended round smooth implants to give my patients the look they wish to achieve. Of course, if a patient has done their research and concluded anatomical implants will give them the look they want then that is what could be done. There is a higher risk of rotational problems inserting anatomical implants through the armpit (axilla) that using either the areolar or inframammary approach minimizes. Round implants do not have any risk of rotation / orientation problem.

There are many options and they need to be tailored to your specific anatomy, wishes, etc. In general I prefer to place the implant behind the pectoralis major muscle as it gives the best appearance and has other advantages. [These include: better ability to perform mammography, less visibility of the implant where the breast shows most (upper and/or inner surface), less palpability of the implant especially in a slender patients.]

Please contact us if you require additional information.

Breast lift and implants (augmentation mastopexy) may be the best procedure to transform deflated, sagging breasts to a more youthful, perky appearance. Many patients initially come seeking a lift with implants but settle for the improvement possible with implants alone to avoid the extra scarring that the lifting requires.

A breast lift (mastopexy) alone may leave the upper portion of the breast without much fullness. For larger, drooping breasts it is sometimes necessary to reduce the volume of breast tissue to minimize early reoccurrence of drooping, add an implant to give upper breast fullness, as well as performing the breast lift to restore lower breast shape and proper nipple/areolar position (nipple projects from the breast, areola is the flat, colored part of the breast skin around the nipple).

Breast augmentation is a procedure to make up for a natural process that fell short: left you smaller than you envisioned being. Breast augmentation is just the next best thing to a naturally developed breast.

In general the more breast tissue you have to start with and the smaller the size implant chosen the more likely the breast will appear like a naturally developed breast. The less breast tissue you have and the larger the implant size chosen more aspects of the result will be less like a naturally developed breast.

There is always a risk of losing some sensation in the nipple, areola (flat colored part around the nipple), or skin of the breast. The reason is that the nerves get to your breast skin as follows: brain -> spinal cord -> around the chest just under each rib -> up through breast to skin. During breast augmentation, room under the breast needs to be made and some of the nerves may be stretched and still work, stretched such that they stop working, or cut to make room for the implant. The biggest nerve to the breast skin is usually just lateral (i.e. away to the outside) to where the implant goes and thus most patients retain most sensation. Loss of sensation is always a major concern to patients going in for breast augmentation but rapidly becomes a 'non-issue' for my patients after surgery even if some sensation is lost.

Breast reduction can not only reduce your breast size and relieve any back, neck or shoulder discomfort due to large breasts but also increase the ease with which you can participate in physical activities. In addition the breast will assume a more lifted, perky look after the procedure. Most patients are very happy they had this procedure done and frequently wonder why they waited so long to do so. Most have an experience of freedom and relief following the procedure. I have had patients who wanted more children but wanted their breasts reduced to make future pregnancies and the associated breast size change more tolerable.

Often insurance will cover breast reduction surgery if certain criteria are met. The best way to check for insurance coverage is to come to our office for a consultation.

Removal of the buccal fat pad results in a thinner-looking face. After I have removed the buccal fat pad every patient (thus far) has received multiple compliments: "Have you lost weight?" Its removal makes a round or full face look much thinner and more angular . This fat pad is about the size of the last part of your thumb. The buccal fat is a special packet of fat in the middle of your cheek. To demonstrate where it is on yourself: clench your jaws, start at the corners of your mouth and inch your fingers toward your earlobes. When your index finger strikes a hard edge (the anterior part of the masseter muscle) stop! Your long finger is now over the center of the buccal fat pad. You can mimic the look of buccal fat pad removal by sucking your cheeks in a little bit. The fat pad can easily be removed under IV local anesthesia with the access inside your mouth. There is minimal down time after surgery of one to two days. Buccal fat pad removal can be performed alone or in combination with other procedures that make a round/full face look thinner and more angular: chin augmentation, rhinoplasty, and liposuction under the chin and/or the face. I perform this procedure frequently as it is relatively simple, there is little recovery time, and patients are pleased with the subtle but definite facial enhancement.

Liposuction can thin the entire cheek and area under the chin. Liposuction uses a very thin tubular instrument to sneak fat out of a broad area via a very tiny access point. Although many patients request thinner faces I perform facial liposuction less often than the procedures mentioned above.