Why Plastic Surgery Artistry Matters
Patients who come to the office of Chicago plastic surgeon John Q. Cook for breast enlargement, breast lift (mastopexy), and breast reduction are well-served by Dr. Cook’s extensive experience in breast reconstruction surgery. Breast reconstruction forces the plastic surgeon to ever broaden his array of techniques to meet the specific challenges of breast shape and form. “It also deepens the surgeon’s vision,” says Dr. Cook. “You become aware of the many varieties of breast shape and develop specific techniques to account for these.”
Dr. Cook was selected as a clinical investigator for the national studies involving saline implants that were designed by the FDA. He also has served as the principal investigator for the studies involving saline implants and silicone gel implants for breast reconstruction at Rush Presbyterian-St. Luke’s Medical Center.
The fundamental challenge in breast surgery is similar to that faced in other areas where Dr. Cook works – how to obtain as natural a result as possible. “The best surgery,” says Dr. Cook, “should not look surgical.” This is particularly true for the patient considering breast augmentation. “I often use the term breast enhancement when I describe this type of surgery,” says Dr. Cook. “Although volume may be an important consideration, the surgery is really about so much more than just making breasts larger. It is often a more complex and subtle question of shape and visual balance. The key is to avoid having the implant overwhelm the breast. If this occurs, the surgical result will disappoint the more sophisticated patient and surgeon alike.”
Dr. Cook’s detailed study of this field has led to his development of several operations which address specific breast shapes and configurations. Patients interested in breast reconstruction, breast reduction, or breast enlargement or lift procedures at our Chicago centers will meet with Dr. Cook for a thorough evaluation. During this time, Dr. Cook will review potential surgical options with you to determine the best treatment plan to meet your needs.
“It is truly gratifying to see how patients benefit from breast reduction surgery,” says Dr. Cook. Often these individuals suffer in silence. They develop habits of dress and posture to hide their breast size. They may also feel self-conscious in social situations and feel limited in the way that they can exercise. Unfortunately, ‘well-meaning’ family members and even doctors will frequently discourage patients from seeking surgical help due to a lack of understanding of the fundamental mechanics.”
“When the breasts reach a certain size, a number of undesirable things will occur,” says Dr. Cook. “The patients often suffer from a band of pain arching across the back, neck and shoulders. Some patients have told me they even have gained weight to try to hide the size of their breasts by bringing the proportions of the rest of the body up to their scale. One of the most frequent comments we hear from patients who undergo this surgery is that their only regret is that they did not carry it out years ago.”
“This is an exciting time to be involved in breast reduction surgery,” says Dr. Cook. “I am much happier with the results that I can obtain with my patients now than what I obtained five or ten years ago.” Several years ago Dr. Cook modified his technique so that it departed in significant ways from the most common technique of breast reduction. “I did this because I was unsatisfied with the lack of control that the standard technique was giving me, especially in patients whose breasts were asymmetric or which had complex shapes.” Dr. Cook has also worked extensively with the newer techniques which, in select patients, allow for shorter scars than in traditional breast reduction surgery. Examples of these techniques include vertical and periareolar breast reduction.
Dr. Cook’s most significant contribution to the field of breast surgery is his development of the technique of structural breast surgery. This is an approach that he offers many patients who come to him for breast lift, breast reduction, or augmentation-mastopexy. With this technique Dr. Cook restores natural fullness to the upper portion of the breast without the use of implants. The breast is anchored in its new position at a variety of levels in order to reduce the amount of stretching out that occurs in breast that have been lifted only at the skin level. Scars are reduced from what is found in the classical technique of breast reduction and breast lift.
Breast lift, or mastopexy, is performed to counteract the effects of gravity or pregnancy on breast shape and volume distribution. Sometimes individuals go through cycles of weight gain and weight loss which will also stretch out the breasts. As the skin is stretched, the breasts will settle into an abnormally low configuration. This can produce an undesirable hollowing, or lack of fullness, in the upper portion of the breast, where there may be very little breast tissue left.
It was the challenge of balancing the shape and contour of the reconstructed breast that led Dr. Cook to search for better techniques of breast lift surgery. “Many patients would gladly undergo breast lift were it not for the scars that accompany the traditional operation,” says Dr. Cook. The traditional operation places a scar around the border of the areola as well as in the fold under the breast and a vertical scar connecting the lower border of the areola. Newer techniques of short scar mastopexy and reduction are appropriate for many patients. In the periareolar variant, the scar can be confined just to the border around the areola. In another variant there will be an extension from the lower border of the areola to the fold under the breast, but no scar running around the lower border of the breast. These newer operations, although highly beneficial, are not for all patients. When the classical operation is the appropriate choice, you will benefit from Dr. Cook’s extensive experience and meticulous attention to detail. Experience and judgment are critical in order for the right technique to be matched with the right patient. “I have seen a number of patients who have had surgery that perhaps resulted in more extensive scarring than necessary,” says Dr. Cook. “But even worse than this is the situation where an inexperienced surgeon tries to push the technique of short scar surgery on a person who can really not benefit from it. In that case, the result will either be inadequate correction or significant distortions of breast shape.”
The operation known as augmentation/mastopexy can be a good choice for patients where the issue is a combination of settling of the breast and volume loss. “I view this as restorative, or rejuvenative, surgery,” says Dr. Cook. “In this sense, the goals that I set for myself are similar to what I do with a facelift. That is to restore the beautiful contours of youth but do so in a way that minimizes artificiality.” This surgery is designed to counterbalance certain natural forces which act upon the breasts including pregnancy, weight fluctuation and gravitational settling.
“I am able to offer my patients a nice variety of choices when it comes to the augmentation/mastopexy operation,” says Dr. Cook. As part of the detailed evaluation he performs on each patient Dr. Cook discusses the advantages and disadvantages of different types of silicone gel and saline-filled implants. Patients who undergo the augmentation/mastopexy procedure are particularly well suited to the shorter scar techniques of breast lift. This includes such variants as the periareolar mastopexy, in which the scar is confined to the border around the areola.
Dr. Cook performs breast lift, breast enlargement, breast reduction, and selected techniques of breast reconstruction on an outpatient basis. Dr. Cook offers his patients at his Chicaco centers a variety of quality outpatient settings including Rush University Medical Center and a fully-accredited private surgery center near his office in the Gold Coast.
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