12-05-10 | Posted by Dorene Kaplan

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 Meet the US/UK Breast Surgeon

British-born Laurence Kirwan covers a wide field of cosmetic surgery and non-surgical techniques but is best known for his pioneering work in breast surgery, particularly to modify the “ptotic” – aka drooping – breast.  He practices in Manhattan and Norwalk, CT, and in London, where he has consulting rooms on Harley Street.  In the US, Dr. Kirwan is a Board Certified Plastic Surgeon.  He is on the Specialist Register for Plastic Surgery in Ireland and Finland.

Dr. Kirwan introduced his first breast innovation – named SAMBA (meaning, Simultaneous Areolar Mastopexy/Breast Augmentation) – in 1998, at the Congress of the European Academy of Cosmetic Surgery in London.  Over the years, he has been invited to give a SAMBA teaching course in the USA at numerous Annual Meetings of both the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS).

Since the late ’90s, Dr. Kirwan has added several more pioneering techniques to his portfolio, including Auto-Augmentation, a radical new approach to breast augmentation that uses the patient’s own breast tissue instead of an implant; his nipple reduction technique, which he calls Mercedes; and, most recently, axilla-plasty, which is designed to correct the excess skin and fat in the armpit that prevents women from wearing strapless or cut-away dresses.

Last year, UK celebrity Ulrika Jonsson took the unusual step of naming Dr. Kirwan as her surgeon when, having had four children and reached a ptotic 36i cup, she had a dramatic breast reconstruction involving reduction and uplift.  Jonsson’s new shape was featured in the popular British tabloid, the Daily Mail, and in a 10-page exclusive interview and photo-spread in Hello! magazine.

In April this year, Dr. Kirwan’s expertise in pioneering breast surgery was applauded by ASAPS at its Annual Meeting in Washington, DC. The course he was invited to give – Adjunctive Procedures in Aesthetic Breast Surgery – can be found on the website, www.cosmeticplasticsurgery.uk.org, along with a PDF of the published scientific paper.

www.drkirwan.com

What percentage of your work involves breast augmentation/breast lifting?

Around 35% all together. This breaks down into 30% breast augmentation with a silicone implant; 35% breast-lifting with either SAMBA or using my Auto-Augmentation technique – and this is growing substantially as more women learn about it, and the remaining 35% involves breast reduction surgery.

Why did you begin to focus on the “ptotic” breast in the mid-1990s?

I became conscious of the fact that conventional breast augmentation was not appropriate for women with pendulous breasts.  Significant loss of breast volume and sagging skin usually occurs through childbirth, breastfeeding, weight loss or ageing and I estimate that it affects about 50% of women in these categories.  I made it my mission to develop techniques that would give these women the more youthful shape and uplift they desire. 

My more recent breast Auto-Augmentation ** procedure is much more physically sound than conventional techniques in that it places a central segment of the breast into the upper pole.  Unlike standard procedures, which involve the so-called “inferior pedicle” technique, my development does not have an anchor shaped scar and there is no bulky pedicle of tissue bulging in the lower part of the breast, with a tendency for the breast to drop later and for the nipple to point upwards.

What does SAMBA involve?

SAMBA combines a breast lift with augmentation using a silicone-filled implant and involves the removal of skin around the nipple areolar complex.  The implant is placed below the muscle – a technique that reduces rippling, reduces the incidence of capsular contraction and protects the implant; and by making an incision around the nipple, rather than using the more traditional T-shaped cut, the excess skin is redistributed.  SAMBA therefore avoids a breast lift procedure that would involve additional scars on and around the breast as well as the “double bubble” effect that can occur with an implant below the muscle in a breast that is ptotic.  These are both still common techniques in the UK.  SAMBA can also be used to correct previous breast surgery that has resulted in continued skin laxity and a sagging breast.

When a breast sags too much to allow the “minimal scar” just around the areola that is achievable with my SAMBA technique, the alternative is usually considered to be an “anchor scar.”  This involves a scar around the nipple with a vertical scar from the areola to the crease under the breast, plus a horizontal scar in the crease itself. The horizontal scar usually extends from one side of the breast to the other and may be visible in the cleavage area and at the side of the chest. Scars in these locations may be visible and may heal with an increased width, which restricts the type of clothing a patient can then wear.  Hence a reason to opt for a vertical mastopexy, which has a better shape and tends not to droop over time and has the added benefit of just a short horizontal scar, which is hidden under the breast.

What percentage of your patients have breast reduction and what does this involve?

On average, about 30% each year, with about equal proportions of women in the US and the UK opting for this procedure.

My philosophy is that nipples are not meant to hide a woman’s navel. Too-large breasts are uncomfortable and unsightly. Surgery to reduce them gives an attractive shape that can improve posture and a woman’s own personal sense of well being. By revealing the contours of the stomach it will make a woman appear more long-waisted and therefore slimmer.

Breast reduction lifts the breasts and removes excess breast tissue, creating a breast shape that fits the rest of the body.  It should not be performed on teenagers until breast growth has been stable for at least 12 months.

In surgery on very large breasts, the nipple and areola may be removed and replaced as a free nipple graft after reducing the size of the breast. This prevents fat necrosis (or hardening) of the breast afterwards and gives a very secure shape with fewer tendencies to “bottom out” following surgery. However this is uncommon since most women can have this problem corrected with the “inferior pedicle” technique, which keeps the nipple attached and preserves its shape and texture and may preserve its sensation.

An inferior pedicle technique involves the use of the tissue below the nipple to maintain its blood supply – whereas a “superior pedicle” uses the tissue above the nipple, removing the tissue directly below and avoiding the problem of the inferior pedicle falling down later, and contributing to a droopy breast with the nipple pointing upwards.

It is now my preference in the mid to moderate breast enlargement to favour the superior pedicle technique because I believe it provides a durable lift and a better breast shape; but it is definitely more limited in reducing breast size and in narrowing the breast width.

You have developed other procedures to improve the look and shape of the breast.  What are they?

They are nipple reduction – which I call Mercedes, due to the shape of the incisions, which are similar to the car’s famous logo, and axilla-plasty.

Protruding nipples can be an embarrassment for a woman and my Mercedes procedure involves segmenting the nipple but using a method that preserves sensation.

Axilla-plasty is a procedure that corrects the overhang of fat and skin above the bra at the armpit – something that frequently prevents women from wearing sleeveless tops. Fat is suctioned away and excess skin removed to create a neat, thin, linear scar which is hidden in the crease of the axilla. The wound is closed with a buried stitch, which aids in the healing. 

Ulrika Jonsson opted for axilla-plasty when I did her breast reconstruction last year.

I find that axilla-plasty is becoming increasingly popular as fashion decrees that chic women should go strapless, or wear tops with cut-away armholes. 

What new breast techniques do you offer? 

Because there is such a current focus on breasts again – from revealing clothes on the catwalk to the TV series Mad Men – I find many women are wanting a more youthful cleavage, and this has become a key focus.

To rejuvenate the décolletage, I offer several non-surgical treatments.

In the UK, I use new Juvéderm Hydrate to smooth out wrinkles and Botox to alleviate vertical lines as well as Thermage to tighten the skin.  In the US, where I have my own surgical suite in Norwalk, I can also offer Fraxel and IPL therapy to treat lines and pigmentation.

Some UK patients opt for treatment with me in the US so that afterwards, they can enjoy shopping and a sojourn in Manhattan or a stay by the ocean in nearby upmarket Westport.

What else are you working on now?

For several years I have been concentrating on faces – both surgically and with non-surgical treatments. 

My aim is to reduce trauma during facial surgery so that there is less visible evidence of work having been done and – by diminishing swelling and bruising – to cut downtime for patients.  Therefore, when doing facial surgery, I use Tisseel tissue ‘glue’ to stick down connective tissue and absorbable ‘thread’ to eliminate stitch removal. Tisseel shortens recovery time for facelifts by 4 to 5 days.  It acts like a natural blood clot and quickly prevents bleeding, so surgery is less complicated.

When performing a brow lift I reduce surgical time, scarring and patient recovery time by using an endoscope – a type of small ‘telescope’ – for the procedure, along with Endotine Forehead devices. These are absorbable fixing devices that support the brow lift whilst it is healing and are highly effective. I also add a small suction drain to further reduce swelling

For many patients who are too young for, or not ready for, surgery, I mostly recommend a combination of Sculptra®, Thermage® and Botox®. They will be, I believe, be The Fountain of Youth for the next decade.

** Kirwan’s breast Auto-Augmentation technique was published in the Canadian Journal of Plastic Surgery in 2007.