Every person is unique and not all breasts are the same. For that reason, as a plastic surgeon, the goal of Dr. Couto is to improve the size and shape of your breasts and to satisfy your aesthetic desires by accentuating your natural beauty with balance.
See more LessThe breast can play a significant role in how a woman perceives of herself. If a patient is unhappy with her breast size, either because she was born with small breasts, wants to restore volume following pregnancy/breastfeeding, or is interested in further enhancing her cleavage and fullness, a breast augmentation may be the solution.
A breast augmentation is a safe, outpatient procedure that is performed to enhance the volume, size, and shape of the breasts. Breast augmentation can be achieved by using breast implants (silicone or saline), fat transfer, or by combining breast implants and fat transfer, which is also known as a composite breast augmentation . In addition, Dr. Couto implements the “24-hour breast augmentation fast track recovery”, created by his mentor Dr. William P. Adams. This consists of advanced perioperative techniques that minimize breast tissue manipulation which help expedite post-operative recovery.
Dr. Couto is a Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine.
During his training, Dr. Couto had the privilege to have mentors that are considered top leaders in the field of cosmetic breast surgery. This includes, Dr. William P. Adams, one of the describers of the dual-plane breast augmentation technique and the creator of the 24-hour breast augmentation fast track recovery and Dr. Louis L. Strock, a pillar in the field of transaxillary breast augmentation.
Dr. Couto has also authored book chapters and publications in peer-reviewed journals related to breast implants, breast augmentation, and breast cosmetic surgery.
The consultation is divided into five parts:
1) Health and Medical History Evaluation
A comprehensive evaluation of the patient’s health and medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the surgery. Fortunately, most of these can be easily modified with lifestyle changes. Although this procedure is short and relatively low risk, our patient’s health and safety will always be our main priority. We like to set the patient for success, not for failure; therefore, modifying any potential risks is essential.
2) Discuss with the Patient About Surgical Goals
Dr. Couto has a deep discussion with the patient to learn about their concerns and goals. Here, we explore the patient’s desired breast cup sizes and appearance. Listening to our patient’s interest is crucial, since it is our priority to determine if we can meet their expectations.
3) Breast Analysis & Surgical Recommendations
A comprehensive breast analysis is performed. In this part of the consultation, our objective is to determine whether the patient is a candidate for breast augmentation only or if the patient will benefit from a combined breast augmentation and lift. This question is answered using objective measurements of the breast and a 3D-imaging simulation system that enables us to show the patient how she could look with different types of breast implants.
We examine their size, shape, descent and identify any existing breast or chest asymmetries. We also evaluate the contour and proportion of the breasts in relation to the body. After this examination, Dr. Couto discusses with the patient his recommendation and explains in detail everything that is involved with the procedure and its recovery.
4) Breast Implant Selection
This is the most crucial part of the consultation, since the breast implant should fit as perfect as fitting a hand in a glove. Choosing the incorrect breast implant could result in a suboptimal aesthetic result or even lead to complications. Therefore, using the information obtained from the breast analysis and taking in consideration the patient’s desired size and aesthetic goal, we guide the patient to select the correct implant. Furthermore, we use 3D-imaging technology to select breast implants. This 3D simulation system enables us to determine the correct breast implant size/shape and show the patient how the breasts could look with the selected implants.
5) Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized quote that is tailored to the procedures discussed during the consultation and review the steps involved to book the procedure with us.
Nor all breasts are equal and not all implants are a “one size fits all.” Dr. Couto’s philosophy is not to impose a breast implant on a patient, but instead to guide them in selecting with him the implant that will be most beneficial to the patient’s body. To do so, we take in consideration the patient’s breast dimensions, chest anatomy, and desired size and projection. Lastly, we utilize 3D-imaging simulation to show the patient how she could look with different types of breast implants.
Three-dimensional imaging is a simulation system that produces high resolution images of how the patient could look with different breast implant shapes and sizes. After performing a detailed breast analysis, Dr. Couto uses this technology to guide the patient in selecting the correct implant and help them visualize how they may look with specific implants.
Breast implants are divided into two major groups: silicone gel and saline water. It is important to know that both are made of an outer silicone shell. The main difference between them is the material that fills the shell, which can be silicone gel or saline water. Here we enlisted the advantages and disadvantages of each implant type:
Silicone:
Saline:
Implant Position: Subglandular vs Submuscular vs Dual Plane
Historically, breast implants were either placed below the breast gland (subglandular) or below the chest muscles (submuscular). However, these approaches had their disadvantages. While subglandular breast augmentation had a higher risk of capsular contracture and implant palpability, placing the implant submuscularly exhibited greater movement of the implant with chest muscle contraction (breast hyper animation) and prevented a natural breast enhancement. In order to capture the benefits of these two approaches, the dual-plane breast augmentation was created. This technique, which was perfected and popularized by one of Dr. Couto’s mentor, Dr. William P. Adams Jr, consists of placing the superior aspect of the implant below the chest muscle (submuscular) and the inferior portion of the implant below the breast gland (subglandular). Having the muscle cover the superior portion of the implants creates a natural transition between the chest and the breast, while reducing the risk of capsular contracture and implant palpability. The benefit of having the inferior part of the implant subglandular is that it provides adequate volume and projection of the breast.
Skin Incisions:
There are three types of skin incisions used in a breast augmentation:
Composite Breast Augmentation (Breast Implant & Fat Transfer)
If a composite breast augmentation (breast implant and fat transfer) is planned, we would proceed with the fat transfer after inserting the breast implant. In this part of the procedure, fat is harvested from the abdomen or thigh using liposuction techniques (hyperlink). After properly processing the fat, it is injected mainly in the upper pole of the breast. Using this technique we can further enhance the breast cleavage.
Patient with
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan, review the 3-D simulation and confirmed the selected breast implants, and clarify any questions involving the surgery. Furthermore, we thoroughly review with the patient the preoperative/postoperative instructions and the medication regimen and schedule your future post-operative appointments.
We always emphasize to our patients that medication (e.g. aspirin, ibuprofen), vitamins and herbal supplements (e.g. Fish oil, Omega-3, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 3 weeks before surgery, as this increases the risk of bleeding. Nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake and avoid foods high in salt/sodium after any surgical procedure. This could be easily achieved with supplements available in our practice.
We provide the patient with a detailed postoperative protocol to ensure a comfortable and quick recovery. Following surgery, it is common to feel soreness and sensitivity around the surgical site; however, this is easily manageable with our postoperative pain regimen medication. Furthermore, we start all our patients in a scar therapy to optimize the healing process and obtain the best scar results. We recommend our patient to take 2 days of work (less if working from home) and avoid lifting anything heavier than 7-10 pounds for 4 weeks. Patients can resume their aerobic exercise (e.g. running, walking, spinning) 2 weeks after surgery. However, you will be able to restart your gym exercises and full activities 4 weeks after surgery.
Our practice offers 24-hour fast track recovery breast augmentation, which is a protocol that consists of surgical techniques that minimizes breast tissue manipulation and reduces postoperative pain, swelling, and bruising. It also involves a postoperative pain regimen that does not include narcotic medications and ensures that the patient has a comfortable and quick recovery. We constantly hear our patients say that they don’t feel pain, and that they only feel some pressure in the chest that quickly goes away as the body gets used to the new breast implants. This protocol enables most of the patients to return to their activities of daily living in 24-48 hours. We also establish a scar therapy regime to optimize the healing process and obtain the best scar results.
When an implant is inserted in the body, scar tissue automatically forms around it; we call this a “capsule.” This is a normal healing response, as it attempts to isolate the implant inside the body by creating a barrier of tissue. This occurs not only in breast implants, but in every single prosthesis inserted in the body, whether orthopedic, neurological, facial, buttock, cardiac, etc. In terms of breast surgery, this capsule is typically a good thing, since it becomes the home of the implant and maintains it in place. However, in certain patients, this capsule becomes unusually hard and can alter the postoperative appearance of the breast. When this occurs, it is called capsular contracture. It is important to note that this is not harmful to the body.
Although the exact cause of capsular contracture is not entirely determined, studies suggest that this condition is mainly caused by implant contamination, presence of blood around the implant, and/or genetic predisposition.
So, how do we reduce the risk of capsular contracture? Dr. Couto follows the 14-point plan, which was developed by Dr. Couto’s mentor, Dr. William P. Adams Jr. This protocol consists of 14 steps that have scientifically shown to minimize the risk of capsular contracture and other complications. Additionally, Dr. Couto uses povidone iodine-triple antibiotic irrigation that has been scientifically studied to reduce bacterial contamination of the breast pocket. Lastly, Dr. Couto utilizes the Keller Funnel ®, a device designed to insert the breast implant without the need of touching or handling it. Thus, further reducing risk of implant contamination, and capsular contracture.
This is a particular area of interest for Dr. Couto. Together with Dr. William P. Adams Jr, Dr. Couto has received a scientific research grant from the Aesthetic Research and Education Research Foundation (ASERF) to study the role of bacteria contamination in the breast capsule and analyze the effectiveness of povidone iodine-triple antibiotic irrigation in decreasing the bacterial load of capsular tissue.
A breast augmentation of any kind will not affect your ability to breastfeed. During this procedure we are not compromising any of your mammary glands and ducts. In fact, one of the main objectives of this procedure is to minimize the contact between the breast implant and the lactating breast structures to reduce risk of capsular contracture.
As we get older, our skin loses its elasticity and becomes lax. These aging changes, along with factors such as pregnancy, breastfeeding, and weight changes, cause the breasts to lose their firmness, shape, and position. If you're interested in repositioning your nipples and addressing the sagginess of your breasts, a breast lift may be the correct procedure.
Dr. Couto is a Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine.
During his training, Dr. Couto had the privilege to have mentors that are considered top leaders in the field of cosmetic breast surgery. This includes, Dr. William P. Adams, creator of the Tissue Based Triad Augmentation-Mastopexy technique, dual-plane breast augmentation, and pioneer in the use of biological mesh support in cosmetic breast surgery.
Dr. Couto has also authored book chapters and publications in peer-reviewed journals related to breast implants, breast augmentation, breast cosmetic surgery.
A breast lift, also known as a mastopexy, is a procedure designed to rejuvenate the breasts by restoring their position and form. Furthermore, it also reduces the size and the aesthetic shape of the nipple areola complex. In this procedure, loose skin and soft tissue around the breast and areola are removed and tightened to lift and reshape the breast into a natural and aesthetically pleasing look. A breast lift does not increase the volume of the breasts, since no implant or fat is added. If you are interested in increasing your breast size and/or accentuating your breast cleavage, a breast augmentation with a lift may be indicated.
The consultation is divided into 4 parts:
1) Health and Medical History Evaluation
During this part of the consultation, we focus on identifying any potential risk factors for the surgery. Fortunately, most of these can be easily modified with lifestyle changes. Although this procedure is short and relatively low risk, your health and safety will always be our main priority. We like to set the patient for success, not for failure; therefore, modifying any potential risks must be essential.
2)Discuss with the Patient About Surgical Goals
Dr. Couto has a deep discussion with the patient to learn about their concerns and goals. Listening to our patient’s interest is crucial, since it is our priority to determine if we can meet our patient’s expectations. We focus on learning whether the patient is interested in just lifting the breast or if she is also interested in adding volume with an implant or fat . We always like to emphasize to the patient that a breast lift does not increase the volume of the breasts, it just strictly lifts and reshapes the breast and nipple-areola complex. If in addition to lifting the breast, the patient is interested in volumizing and enhancing the cleavage, then a combined breast augmentation with a lift (hyperlink) may be required.
3) Breast Analysis & Surgical Recommendations
A comprehensive breast analysis is performed. In this part of the consultation, our goal is to determine whether the patient is a candidate for a breast lift, a breast augmentation, or a combined breast augmentation and lift. We examine the size, shape, and descent of the breasts, identify any existing breast or chest asymmetries, and evaluate the contour and proportion of the breasts in relation to the body. After the examination, Dr. Couto discusses with the patient his recommendation and explains in detail everything involved with the procedure and its recovery. If the patient is also interested in volumizing her breast with an implant, then we use 3D-imaging technology (hyperlink) to determine the correct breast implant. This 3D simulation system enables us to determine the correct breast implant size/shape and show the patient how the breasts could look with the selected implants.
4) Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized quote that is tailored to the procedures discussed during the consultation and review the steps involved to book the procedure with us.
Skin Incisions:
A common concern of a patient seeking a breast lift is the location and size of the scar. The principal cause of a droopy breast is the presence of excess lax skin. Therefore, in order to lift the breast and nipple, that loose skin needs to be removed and tightened. That means an incision needs to be made and a scar will be produced. The tradeoff of restoring the shape and position of the breast is having a scar. This scar typically heals properly, is well concealed, and most importantly, outweighs the benefit of a rounder, fuller and younger breasts.
There are three types of skin incision tecniques that Dr. Couto uses to perform a breast lift:
Breast Lift with Mesh Support:
A breast lift with mesh support is a variation of a traditional breast lift, where soft tissue support is added to slow down the aging changes that will naturally occur after surgery.
Following any breast surgery, the skin will continue to age and the breasts will continue to be exposed to gravity. Therefore, with time, the breasts will take their natural course and will descend. An effective way to delay this effect is by adding a soft tissue support to the breast. This is achieved with the use of a biological mesh (Galaflex Ⓡ) that is placed in the breast at the time of surgery, serving as an internal bra. With time the body absorbs this mesh and leaves in place a reinforced layer of collagen.
Patient with:
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan again, and clarify any questions involving the surgery. Furthermore, we thoroughly review the patient preoperative/postoperative instructions and the medication regimen. We also schedule post-operative appointments.
We always emphasize to our patients that medication (e.g. aspirin, ibuprofen), vitamins and herbal supplements (e.g. Fish oil, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 3 weeks before surgery, as this increases the risk of bleeding. Furthermore, we remind them that smoking, vaping, or using any nicotine products can affect the results and recovery. There are numerous scientific studies demonstrating that the use of nicotine (eg. cigarettes, vaping, chewing, etc) disturb a person’s capacity for healing, and thus increases risk of complications. During the initial consultation, Dr. Couto will ask the patient to stop smoking at least 6-8 weeks before the operation to reduce the risk of complications. Patients with a history of diabetes mellitus must have a glycosylated hemoglobin (HbA1c) of 7 or less to be able proceed with surgery. If the HbA1c is above this level, Dr. Couto will refer the patient to their primary care physician or endocrinologist to optimize medication regime or diet and help lower the HbA1c levels. Lastly, nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake and avoid foods high in salt/sodium after any surgical procedure. This could be easily achieved with supplements available in our practice.
We have a detailed postoperative protocol to ensure that the patient has a comfortable and quick recovery. Following surgery, it is common to feel soreness and sensitivity around the surgical site; however, this is easily manageable without the need of narcotic medications. Furthermore, we start all our patients in a scar therapy regimen to optimize the healing process and obtain the best scar results. We recommend our patient to take 5 days of work (less if working from home) and avoid lifting anything heavier than 10 pounds. Patients can resume their aerobic exercise (e.g. running, walking, spinning, biking) 2 weeks after surgery. However, you will be able to begin your gym exercises and full activities 6 weeks after surgery. Although the final results of the breast lift can be seen within 3 months from surgery, the final appearance of your scars will be observed 1 year after surgery.
A breast reduction is indicated for patients experiencing symptoms associated with a heavy breast, such as neck/back pain, skin rash, etc. Consequently, in a breast reduction we remove excess mammary tissue to make it smaller and lighter, but also we lift the breast and nipple/areola to an aesthetic pleasing position.
On the other hand, a breast lift is performed on patients that are strictly bothered by the saggy and droopy appearance of their breast, not the size or weight. In this procedure we are just lifting the breast and nipple and making it perkier. Breast tissue is not removed in a breast lift; therefore, the breast size and weight continues to be the same.
Surgical drains are rarely used for this procedure. If surgical drains are placed, they are usually removed 3-5 days after surgery.
Uncontrolled diabetes can affect the ability of the body to heal wounds properly and increase risk of infection. Therefore, it is crucial for diabetic patients to have their blood sugar levels under control for this procedure. Patients with an HgbA1c of less than 7 are candidates for this procedure.
There are numerous scientific studies showing that smoking cigarettes and/or using nicotine products increase your risk of postoperative complications. Nicotine affects the vascularity, and thus prevents the body from healing wounds properly following surgery. We recommend patients to stop smoking or use nicotine products at least 6-8 weeks before surgery.
There are numerous reasons why the breasts lose their youthful appearance, including pregnancy, breastfeeding, weight loss, or aging. The breasts become saggy, lose volume, and the nipples descend. An effective way to rejuvenate the breast is to perform a breast lift, which tightens the skin and lifts the breast and nipple in an aesthetic position. However, the breast lift does not help restore lost breast volume, especially in the upper breast pole. In order to increase upper pole fullness, a concomitant breast augmentation with an implant or fat is performed to provide volume and cleavage. If you are interested in optimizing the shape and volume of your breast, a breast augmentation with a lift may be the indicated procedure.
This procedure intends to improve the overall appearance of the breast by enhancing the shape, volume, and position of the breast. In this procedure, excess skin is removed, and then the tissue is tightened to reshape and lift the breast and nipple-areola complex. Then the breast upper pole and cleavage is volumized and enhanced by either inserting a breast implant or injecting fat from your own body.
The consultation is divided into 5 parts:
1) Health and Medical History Evaluation
A comprehensive evaluation of your medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the surgery. Dr. Couto will emphasize the importance of avoiding nicotine products (e.g cigarette, nicotine patch, vape, etc), having blood sugar levels well controlled if the patient has a history of diabetes, and the importance of adequate body weight. These are common risk factors that can be easily modified with lifestyle changes and can affect your surgical results. Although this procedure is low risk, your health and safety will always be our main priority. We like to set the patient for success, not for failure; therefore, modifying any potential risks is essential to obtain the best possible result.
2) Discuss with the Patient About Surgical Goals
Dr. Couto has a deep discussion with the patient to learn about their concerns and goals. Listening to our patient’s interest is crucial, since it is our priority to determine if we can meet our patient’s expectations. We focus on learning whether the patient is interested in just lifting the breast or if she is also interested in adding volume with an implant or fat transfer. We always like to emphasize to the patient that a breast lift does not increase volume, it just strictly lifts and reshapes the breast and nipple-areola complex. If in addition to lifting the breast, the patient is interested in volumizing the breast and enhancing the cleavage, then a breast augmentation with a lift is required.
3) Breast Analysis, Surgical Recommendations
A comprehensive breast analysis is performed. In this part of the consultation, our goal is to determine if the procedure can be performed in a single operation or if it needs to be divided into two operations: breast lift followed by a breast augmentation 2-3 months later. In order to answer that question, we examine the size, skin quality, and most importantly, the degree of droppiness of your breasts. Furthemore, we identify any existing breast or chest asymmetries, and evaluate the contour and proportion of the breasts in relation to the body. After the examination, Dr. Couto discusses with the patient his recommendation and explains in detail everything involved with the procedure and its recovery.
4) Breast Implant Selection
In this type of surgery it is crucial to select a size and type of breast implant that is precise for your anatomy. Choosing the incorrect implant could result in a suboptimal aesthetic result or even lead to complications. Therefore, using the information obtained from the breast analysis and taking in consideration the patient’s desired breast size and aesthetic goal, we guide the patient to select the correct implant. Furthermore, we use 3D-imaging technology to select breast implants. This 3D simulation system enables us to determine the correct breast implant size/shape and show the patient how the breasts could look with the selected implants.
5) Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized quote that is tailored to the procedure(s) discussed during the consultation and also discuss the steps involved to book the procedure with us.
As the name suggests, the breast augmentation and lift is a two-part procedure: breast augmentation is performed first, followed by the breast lift. This procedure can be performed either as a single or two stage approach.
Part I: Breast Augmentation
In a breast augmentation with a lift, Dr. Couto typically performs a dual-plane breast augmentation (hyperlink), a technique popularized by his mentor, Dr. William P. Adams Jr. An approach that has been shown to provide consistent results and the lowest complication rate. Using this technique, the superior aspect of the implant is placed behind the pectoralis muscle, and the lower part of the implant directly behind the breast.
Part II: Breast Lift
Skin Incisions:
A common concern of a patient seeking a breast lift is the location and size of the scar. The principal cause of a droopy breast is the presence of excess lax skin. In order to reshape and lift the breast and nipple in optimal position, that loose skin needs to be removed and tighten. This will produce a scar that is typically well concealed, and most importantly, outweighs the benefit of a rejuvenated breasts appearance. Once the skin incisions are made and the excess skin is excised, Dr. Couto will restore the shape and position of the breast to one that is rounder, fuller, and younger.
There are three types of skin incision techniques that Dr. Couto uses to perform a breast lift:
A breast augmentation and lift with mesh support is a modified technique, where soft tissue support is added to slow down the aging changes that will naturally occur after surgery. Following any breast surgery, the skin will continue to age and the breasts will continue to be exposed to gravity; therefore, with time, the breasts will take their natural course and will descend. An effective way to delay that effect is by adding soft tissue support to the breast. This is achieved with the use of a biological mesh (Galaflex®) that is placed in the breast at the time of surgery.With time the body absorbs this mesh and leaves in place a reinforced layer of collagen that serves as an internal bra.
Patient with:
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan again, and clarify any questions involving the surgery. Furthermore, we thoroughly review the preoperative/postoperative instructions and the medication regimen with the patient and confirm schedule your post-operative appointments.
We always emphasize to our patients that medication (e.g. aspirin, ibuprofen), vitamins and herbal supplements (e.g. Fish oil, Omega-3, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 3 weeks before surgery, as this increases the risk of bleeding. Furthermore, we remind them that smoking, vaping, or using any nicotine products can affect the results and recovery. There are numerous scientific studies demonstrating that the use of nicotine (eg. cigarettes, vaping, chewing, etc) disturb a person’s capacity for healing, and thus increases risk of complications. During the initial consultation, Dr. Couto will ask the patient to stop smoking at least 12 weeks before the operation to reduce the risk of complications. Patients with a history of diabetes mellitus must have a glycosylated hemoglobin (HbA1c) of 7 or less to be able proceed with surgery. If the HbA1c is above this level, Dr. Couto will refer the patient to their primary care physician or endocrinologist to optimize medication regime or diet and help lower the HbA1c levels. Lastly, nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake and avoid foods high in salt/sodium after any surgical procedure. This could be easily achieved with supplements available in our practice.
We provide the patient with a detailed postoperative protocol to ensure a comfortable and quick recovery. Following surgery, it is common to feel soreness and sensitivity around the surgical site; however, this is easily manageable with our postoperative pain regimen medication. Furthermore, we start all our patients in a scar therapy to optimize your scar healing process and obtain the best results. We recommend our patient to take 5 days of work (less if working remotely) from home) and avoid lifting anything heavier than 7-10 pounds for 4 weeks. Patients can resume their aerobic exercise (e.g. running, walking, spinning) 2 weeks after surgery. However, you will be able to restart your gym exercises and full activities 6 weeks after surgery. The final appearance of your scars will be observed in 1 year after surgery.
Surgical drains are rarely used for this procedure. If surgical drains need to be placed, this are usually removed 3-5 days after surgery.
Uncontrolled diabetes can affect the ability of the body to heal wounds properly. Therefore, it is crucial for diabetic patients to have their blood sugar levels under control for this procedure. Patients with an HgbA1c of less than 7 are candidates for this procedure.
There are numerous scientific studies showing that smoking cigarettes and/or using nicotine products increase your risk of postoperative complications. Nicotine affects the vascularity, and thus prevents the body from healing wounds properly following surgery. We recommend patients to stop smoking or use nicotine products at least 6 -8 weeks before surgery.
Enlarged breast is a condition commonly seen in the adult population; however, it can also occur during adolescence. This condition can create an overweight and older appearance, but also affect the quality of life of a person by interrupting daily living activities. Chronically, it can cause irritation of the skin and produce neck and back pain resistant to analgesics. Breast reduction surgery could be the effective way to eliminate or reduce these symptoms, improve your appearance, and restore your functionality. Patients following breast reduction are among the most satisfied patients in the field of plastic surgery. It is very common to hear the patient say how they wish they had this procedure done earlier, since it makes their daily life easier and more bearable.
Dr. Couto is a Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine.
During his training, Dr. Couto had the privilege to have mentors that are considered top leaders in the field of cosmetic breast surgery, such as Dr. William P. Adams and Dr. Louis Strock.
Dr. Couto has also authored book chapters and publications in peer-reviewed journals related to breast surgery.
This surgery is designed to reduce the breast to a size that is proportional to the body and lift the breast and nipple to its ideal position. This is achieved by removing excess glandular tissue, fat, and skin to create a smaller, firmer, and more symmetrical breasts. At the same time the nipple areola complex is rejuvenated by lifting it and reducing its size.
The consultation is divided into 4 parts:
1)Health History Evaluation
2)Discuss with the Patient About Surgical Goals
3)Breast Analysis & Surgical Recommendations
4)Pricing and Scheduling Information
Skin Incisions:
The tradeoff of breast reduction surgery is a well concealed scar on the breast. These skin incisions are used to resect excess breast tissue, fat, and skin, and reshape/lift the breast and nipple-areola complex.
Dr. Couto utilizes two type of skin incisions techniques for the breast reduction:
A breast reduction with mesh support is a variation of a traditional breast reduction, where soft tissue support is added to slow down the breast descent that occurs post-surgically as we continue to age. After any breast surgery, the skin continues to age and the breasts continue to be exposed to gravity; therefore, with time the breasts will take their natural course and descend. An effective way to delay this descent is by adding soft tissue support to the breast. This is achieved with the use of a biological mesh (Galaflex Ⓡ) that is placed in the breast at the time of surgery, serving as an internal bra. With time the body absorbs this mesh and leaves in place a reinforced layer of collagen.
Patient with:
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan again, and clarify any questions involving the surgery. Furthermore, we will thoroughly review with the patient the preoperative/postoperative instructions and the medication regimen with the patient. We also schedule the post-operative appointments.
We always emphasize to our patients that medication (e.g. aspirin, ibuprofen), vitamins and herbal supplements (e.g. Fish oil, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 3 weeks before surgery, as this increases the risk of bleeding. Furthermore, we remind them that smoking, vaping, or using any nicotine products can affect the results and recovery. There are numerous scientific studies demonstrating that the use of nicotine (eg. cigarettes, vaping, chewing, etc) disturb a person’s capacity for healing, and thus increases risk of complications. During the initial consultation, Dr. Couto will ask the patient to stop smoking at least 6-8 weeks before the operation to reduce the risk of complications. Patients with a history of diabetes mellitus must have a glycosylated hemoglobin (HbA1c) of 7 or less to be able proceed with surgery. If the HbA1c is above this level, Dr. Couto will refer the patient to their primary care physician or endocrinologist to optimize medication regime or diet and help lower the HbA1c levels. Lastly, nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake and avoid foods high in salt/sodium after any surgical procedure. This could be easily achieved with supplements available in our practice.
We provide the patient with a detailed postoperative protocol to ensure a comfortable and quick recovery. Following surgery, it is common to feel soreness and sensitivity around the surgical site; however, this is easily manageable with our postoperative pain regimen medication. Furthermore, we start all our patients in a scar therapy to optimize your scar healing process and results. We recommend our patient to take 5-7 days of work (less if working from home) and avoid lifting anything heavier than 10 pounds for 4-6 weeks. Patients can resume their aerobic exercise (e.g. running, walking, spinning) 2 weeks after surgery. However, you will be able to resume your gym exercises and full activities 4-6 weeks after surgery. Although the final results of the breast reduction can be seen within 3 months from surgery, the final appearance of your scars will be observed in 1 year after surgery.
A breast reduction is indicated for patients experiencing symptoms associated with a heavy breast, such as neck/back pain, skin rash, etc. Consequently, in a breast reduction we remove excess mammary tissue to make it smaller and lighter, but also we lift the breast and nipple/areola to an aesthetic pleasing position.
On the other hand, a breast lift is performed on patients that are strictly bothered by the saggy and droopy appearance of their breast, not the size or weight. In this procedure we are just lifting the breast and nipple and making it perkier. Breast tissue is not removed in a breast lift; therefore, the breast size and weight continues to be the same.
Surgical drains are rarely used for this procedure. If surgical drains need to be placed, they are usually removed 3-5 days after surgery.
Uncontrolled diabetes can affect the ability of the body to heal wounds properly and increase risk of infection. Therefore, it is crucial for diabetic patients to have their blood sugar levels under control for this procedure. Patients with an HgbA1c of less than 7 are candidates for this procedure.
There are numerous scientific studies showing that smoking cigarettes and/or using nicotine products increase your risk of postoperative complications. Nicotine affects the vascularity, and thus prevents the body from healing wounds properly following surgery. We recommend patients to stop smoking or use nicotine products at least 6 -8 weeks before surgery.
