Excessive or uneven development of a woman’s labia minora (the “inner lips� of the female genitalia) can be a great source of embarrassment, functional hygiene problems and even discomfort in some women.

Enlarged or hypertrophic labia can result in local irritation, problems of personal hygiene during menses or after bowel movements, interference with sexual intercourse, and discomfort during cycling, walking, or sitting.  In addition, excessively large labia minora or an uneven development between the two sides can cause significant embarrassment.

As our plastic surgical techniques to correct these problems have improved over time, aesthetic surgery of the female genitalia has become an increasingly common procedure performed by plastic surgeons.

Labium minora reduction (or “labiaplasty�) has been most commonly performed by simple and straight amputation of the protuberant segment and oversewing the edge.  This technique may still benefit some patients, especially those with very large labia or those with a pronounced asymmetry between the two sides.  Downsides of this technique revolve around the long vertical suture line that can be associated with local irritation and even discomfort while walking or during intercourse.  Moreover, because the inner mucosa of the vagina is very different in colour, texture and lubrication when compared to the outer skin of the labia, this technique can remove the natural contour of the labia minora and replace it with a straight suture line which can result in an obviously operated look.

Recently, to prevent these potential unfavorable outcomes, increased attention has been focused on the cosmetic results and surgical techniques for labia minora reduction.  For small or moderate labia reductions, I have been using a more modern technique, which involves removing a central wedge of protuberant tissue (like a “piece of pie�).  This results in a barely visible and short horizontal scar and does not interfere with the delicate transition from inner vaginal mucosa to outer labial skin.

Below are some photos preop, immediately postop and 6 weeks postop.

 

This procedure is performed on an outpatient basis (i.e., day surgery) and is most commonly performed under a local anaesthetic (although the option for a general anaesthetic is available). It commonly takes less than an hour and the recovery from this surgery to regular activities is within a few days (but one must refrain from sexual intercourse for at least six weeks).

Operations using breast implants, whether for breast augmentation or reconstruction, account for a large proportion of my cases.  How a particular implant is chosen for each individual patient may be surprisingly simple or complex. 

When choosing an implant, I have no agenda, other than having a happy patient when I have completed the operation.  I do have constraints, however, such as chest width and tissue quality.  These factors may give each woman few or many choices to meet her goals.  In general terms, there are 3 main considerations: 

One of the first decisions is to choose between saline and silicone breast implants.  Main advantages of saline implants are that they are slightly cheaper and if they were to rupture, the saline filler is easily and safely reabsorbed by your body.  They do however not feel as much like a breast when compared to the silicone implants and patients can often feel and sometimes see the edges of the implant.  More patients are choosing silicone implants these days because they do feel much more like their breast.  They are much less palpable and visible, especially in women with thinner tissues.  The safety of these implants is well researched and they are approved by both the FDA in the US and Health Canada here.  If you would like more detailed information, we have extensive literature provided by Allergan, the implant manufacturer.

The next decision is whether we (the patient and myself together) prefer a round or an anatomic/�tear drop� shaped implant.  I am currently using about 2/3 round implants and 1/3 anatomic implants.  Where I believe the anatomic device can be very helpful is in the following scenarios:  moderate ptosis (droop) of the breast which could be corrected with an implant alone, developmental conditions (eg, tuberous breasts) whereby patients would benefit from the extra shape provided by the tear drop shaped device, patients who do not want to have a round upper pole (a potential tell tale sign of an augmented breast), and I almost exclusively use these implants in reconstructive cases (after mastectomy). 

Next, we decide together on the size of the implant.  The main constraints to size are the width of the current breast and the overlying soft tissue cover.  Therefore, a woman’s frame and anatomy may dictate that choose between a certain range of sizes.  Luckily, today’s breast implants come in a variety different diameters, heights and profiles.  Together, taking into consideration the patient’s desires for a certain size, their inherent current anatomy, and the matrix of implant sizes and shapes, we can find an excellent implant for every patient’s particular frame. 

In order to come to that final decision of size, I often recommend that patients play with some rice and 2 Ziploc bags.  The number of cc’s or mL’s on a measuring cup in your kitchen cabinet is the same as what we think of in terms of breast implant sizes.  If you use a non padded bra, you can “stuff� the bra with the rice and get a rough idea of the size you like.  In the office, we also use a range of silicone sizers to achieve the same effect. 

These are some thoughts on choosing the perfect breast implant for you.  In my office, I do the consultation and help with sizing myself as opposed to using a nurse or other assistant.  That way, the process and final decision are mutually agreed on and your questions can be answered as they come up.  I have found this method gives my patients what they want in a safe manner while minimizing complications and the need for implant exchanges.  I hope this was helpful and I look forward to speaking to you in person.

Welcome to my new Blog.

As the original website is now a few years old, I was looking for a way to “freshen up� the site and also try a new way to communicate better with new and old patients.

I endeavour to post a new article at least once a month. I will start with a few brief topics, to hopefully answer a few of the questions that I commonly get asked in the office.

I hope that these articles will help answer some of your questions and help you with your decision on whether or not to embark on a consultation with me or any of my plastic surgery colleagues.

Best Wishes,

Kyle Wanzel  MD, Med FRCS(C)