Blog — Notes of a Plastic Surgeon

Welcome to my blog. I am a plastic surgeon in Seattle and have been in private practice since 1991. I've seen more than a few interesting faces and cases through my years spent in the exam room, the operating room and the emergency room. And I have an opinion on just about everything relating to plastic surgery (and a lot of unrelated stuff). If you like my blog, let me know. Thanks for reading! Lisa

Category: Nipples

Nipple reduction and a breast lift can make the breasts look fuller.

September 27th, 2017 — 11:55am

Check out this case.

This lady initially came in for breast augmentation.  She wanted to look a little fuller but was a worried about the impact of larger breasts on her competitive tennis game.  After chatting with her and examining her, I came up with the plan of a lift and a nipple reduction.  These procedures would give the illusion of fuller breasts without actually increasing the volume.

A small and saggy breast with a long stretched-out nipple looks – I’m gonna say it – a little pathetic.  Once the breast skin is tightened up and the nipple shortened, the breast looks almost the way it did before babies, breast feeding, gravity, general aging, etc.  And a procedure like this is maintenance free.  It should last a lifetime.  But remember to wear a bra most of the time when upright.  Gravity never sleeps.

Thanks for reading!  Dr. Lisa Lynn Sowder

Follow me on Instagram @sowdermd and @breastimplantsanity.

Breast Contouring, Breast Lift, Mommy Makeover, Nipples

Introducing the Nipple Areolar Complex

August 22nd, 2012 — 10:29am

Seattle Plastic Surgeon reviews nipple anatomy and nomenclature.

The NAC a.k.a the nipple areolar complex.

 I recently saw a patient who wanted a breast lift and also  a “nipple reduction.”  Her actual nipples were quite small and what she really wanted was anareola reduction” which is often part of a breast lift or breast reduction.  

Areola is a very common word in the plastic surgery lexicon but play it in a Scrabble game and it will likely be challenged. 

So…………….. here is a little tutorial this mammary structure, the nipple areolar complex, which defines us as mammals. 

The nipple is in the center of the areola which is usually pinker or darker than the surrounding breast skin.  The nipple contains the milk ducts, which are little tubes that bring milk from the breast gland to the baby.   The areola has little muscles in it which explain how the nipple and areola can contract and relax.  The little bumps on the areola are called Montgomery’s Tubercles  They can be really prominent or almost nonexistent.   I do not know if these little bumps have anything to do with British Field Marshal Montgomery but it’s fun to think about. 

Patients, men included, can have issues with any part of their nipple areolar complex  and usually those issues can be addressed with surgery.

Thanks for reading and isn’t it great being a mammal?  I love it!  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Lift, Breast Reduction, Nipples

Tuberous breast deformity

January 26th, 2012 — 11:15pm

Seattle Plastic Surgeon blogs about the psychological burden of tuberous breast deformity.

Tuberous breats - Seattle Plastic Surgeon has a lot of experience.
The tuberous breast is characterized by “puffy” and enlarged areolas, a pointy shape with a constricted breast base. They can come in any size, from extra small to really large. Also, breast asymmetry is very common in patients with tuberous breasts.

I do a lot of breast surgery and I spend a better part of my day looking at breasts.  Just like my patients, breasts come in all shapes and sizes.

One breast issue that I see from time to time is called tuberous breast deformity.  I have also heard it called tubular breast deformity.  This problem does not become apparent until a girl starts developing with puberty.  It is not uncommon for pubertal girls to be very, very modest and embarrassed with their development, even with sisters, friends and mothers.  So many young women with tuberous breasts haven’t shared their problem with anyone and have just managed to choose clothing, bras and swimsuits that hide their tuberous breasts.  I have seen young women in their 20’s and even 30’s with this “secret” and I have seen the psychological damage that tuberous breasts can cause.

Tuberous breasts is a problem that gets very little attention in the popular culture or even the medical culture and often patients with tuberous breasts feel very isolated and think that they are the “only one” with this deformity.  That is until they come in and see me and I can tell them that I see this condition many times a year and that they are, in fact, not alone.

Treatment of this condition is always surgical and treatment varies depending on the severity of the deformity, the size of the breasts and the patient’s desires.  I have never seen a tuberous breast that I could not make a lot better.  Not perfect, but a lot better.

The surgery usually consists of treating the deficient base of the breast with an implant or fat transfer and then addressing the pointy and droopy shape and the puffy areola with some type of breast lift.  In some cases, only a lift is needed to rearrange the breast tissue and reshape the nipple.

My tuberous breat patients are some of my most gratifying patients.  It is so wonderful to see these women actually enjoy shopping for a bra or swim suit.  I have seen some young women go from being very, very shy and self conscience to being confident and happy with their bodies.

I just wish that this problem would get a lot more attention.  Maybe this blog will go viral?  Who knows.  Spread the word and thanks for reading.  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Lift, Nipples

I promise I won’t drop your nipple on the floor. I couldn’t if I tried!

January 17th, 2012 — 12:40am

Seattle Plastic Surgeon assures her breast lift patients that the nipple never leaves the breast.  It would be impossible to drop it on the floor.

I saw a patient today who was worried about what could happen to her nipple during a breast lift.  She thought we actually removed the nipple from the breast and then sutured it back into a higher position.  This is a very common misunderstanding of how a breast lift works.  Take a look at these illustrations that show how the nipple (actually the nipple areaola complex or NAC) stays attached to the breast tissue.


Preoperative markings for a vertical breast lift.

The outer layer of skin around and below the NAC (nipple areolar complex) is removed.

The breast tissue is loosened up from the overlying skin. The NAC stays attached to the breast tissue.

This is the "Stuff" step in what I call my "Stuff and Tuck" breast lift. The NAC is still happily attached to the breast.

This is the tuck part of the "Stuff and Tuck" Vertical Breast Lift

The incisions are closed and the nipple is inset with stitches. The skin has shifted and the breast tissue has shifted carrying the NAC with it. The NAC has stayed attached to the breast tissue the entire time. Most of the nerves and blood vessels to the NAC are undisturbed.

 So there you have it; the “Stuff and Tuck” Vertical Breast Lift.  So no more worries about the nipple being dropped, thrown away by mistake, mixed up with the other nipple, etc.  It never leaves the breast just like my fingers never leave my hands.  I know these illustrations make it look kind of easy but I don’t advise that you try this procedure at home.

Kudos to Dr. Michael J. Brown of Virginia for these awesome illustrations.  They are the best I have seen.

Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Lift, Nipples, Now That's Cool, Plastic Surgery

Does this mean my nipples could fall off??????

September 1st, 2011 — 11:15pm

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder has good news for you and your nipples.

I did a breast lift today on a lady who had waited years and years before having the procedure because she was afraid to have her “nipples cut off” and then “put back on”. This is a rather common misunderstanding about breast lift (and breast reduction) and I want to set the record straight.

Repeat after me:  “Your nipples never leave your breasts”.  The nipples are shifted up into a higher position with breast lifts and reductions but they stay attached to the underlying breast tissue and in most cases, sensation is preserved.

It is only in a rare, gigantic breast reduction that I do a procedure called a “free nipple graft” breast reduction.  In those cases, the nipple has to be raised so much that it is not possible to keep it attached.

Sooooooo, unless you are having a ginormous breast reduction, fear not your nipples falling off.

Thanks for reading!   Dr. Lisa Lynn Sowder

Breast Contouring, Nipples

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