About Thomas M. DeWire Sr., MD
Breast Enlargement, Breast Lift, and Breast Reduction, Gynecomastia treatment, Tummy-Tuck, Liposuction, Post-Pregnancy Contouring, Thigh Lift and Arm Lift are among the most commonly desired Body Contouring techniques. Each is designed to specifically address developmental or acquired deformities of the chest, trunk, and extremities.
Most can be safely performed on healthy patients on an outpatient basis, and most are actually performed in our state-of-the-art Office Surgery Suite. Specific procedures with before and after photo illustrations are presented on the pages linked at right.
Dr. DeWire and his experienced staff of nurses and aestheticians look forward to meeting you to discuss a coordinated program of body refinement or facial rejuvenation. We will treat you as a guest in an attractive and modern surrounding while catering to your need for discreet and personalized care. We provide a full range of Cosmetic Plastic Surgery services, as well as Non-surgical treatments to optimize Skin Care, smooth Cellulite, and maximize your self-confidence.
Patients frequently visit us from out-of-town and we will work hard to be sure that your travel here is very timely, informative, and rewarding. Most of your surgical procedures can be safely performed in our fully equipped Surgical Suite, and Computer Imaging is utilized to help you achieve a better three-dimensional understanding of the anticipated goals of your surgical procedure. Many actual before and after photos are displayed as well to help you visualize the concepts that are presented.
Important Information about Breast Augmentation with Saline Implants and Silicone Implants :
Among the most frequently performed procedures by Dr. DeWire, Implant Breast Enlargement or Augmentation Mammaplasty requires careful pre-op consideration and decision making. This process begins with a careful Consultation, concentrating on the history of any breast process, including pregnancies, breast-feeding, breast surgeries, and any family history of breast disease or breast cancer. Mammography is also an important consideration for prospective candidates over age 40, in accordance with the guidelines of the American Cancer Society.
Careful physical examination is also very important since physical characteristics of the individuals’ breasts, such as shape, size, volume, symmetry, skin characteristics, inframammary fold and nipple position have a great bearing on the achievable result.
Also, chest wall size, shape, and symmetry, and patient height and weight have a significant impact on the achievable result as well. Since Breast Augmentation is a completely discretional, elective cosmetic surgery procedure, there is a special burden to avoid any intervention that may impair future breast exam or diagnostic testing, including mammography. For this reason, I prefer submuscular placement of breast implants, which fortunately has no negative impact on breast self-examination, and using proper Eklund breast implant displacement technique, little if any impact on Mammography quality.
Patients with very small breasts may actually be able to obtain better mammography after augmentation, since the implants have lifted breast tissue and pectoral muscles away from the chest wall, allowing better positioning of the breasts on the mammogram machine. Important details concerning the decision-making process leading up to breast augmentation are presented on the following linked pages, along with many before and after photos and pictures of representative patients.
Breast Enlargement with Breast Lift or Augmentation Mastopexy:
Breast Augmentation in the presence of breast ptosis or skin droop requires correction of the excess of skin and the breast disproportion, in addition to enlargement of the breast volume. True ptosis of the breast is seen when the level of the nipple falls to a point at, or below, the level of the fold beneath the breast.
There is usually too much breast skin and too little breast tissue volume in this situation, leading to the appearance of elongated and flattened breasts. A variant is seen where there is adequate breast volume, but a high positioning of the lower breast folds, and the resultant appearance of low – positioned nipple areolae.
In either instance, upward relocation of the nipples, and tightening of the skin is needed, along with adjustment of the position of the lower and lateral breast folds. I always prefer placement of implants beneath the pectoral chest muscles, to prevent mammogram interference, and to prevent surface wrinkling of the breasts that is often seen with implants above the muscle (directly behind the breast gland tissues).
By approaching breast implant placement via the Trans-Axillary technique (via the armpit), I am also able to prevent potential contamination of the breast implants with germs that are known to reside in the breast tissue ducts, and are probably responsible for the frequent finding of firm scar formation around implants that are placed above the muscle. Also, the axillary route to the submuscular plane will preserve the intact muscular fascial envelope from the chest muscles to the abdominal muscles, maintaining “internal bra – like” support.
Breast Lift in concert with Breast Augmentation Mammaplasty is a more complex procedure than breast enlargement alone, and thus will require a longer period of skin adjustment until the absolute final result is apparent. Mastopexy or Breast Lift at the time of Breast Augmentation always requires some type of incision, or incisions, in the breast skin, and thus there is a trade-off in achieving improved breast shape and breast size, in exchange for some scars.
Depending upon the degree of sag present, several different mastopexy approaches may be used to tailor the skin, while placing the least number of scars on the surface of the breast. Mastopexy seldom leads to loss of nipple sensation by the techniques that I favor. Fortunately, breast scars, if necessary, will fade and flatten out with the passage of time. Examples of several techniques are shown below and on the linked pages.
Breast Augmentation Frequently Asked Questions:
Where is the Surgery Performed?:
Because placement of implants in the submuscular position requires complete muscle relaxation, particularly via the trans-axillary route, outpatient general anesthesia is used. We have recently moved to new offices with a fully-equipped ambulatory surgery center, employing Anesthesiologists (MDs) who are certified by the American Board of Anesthesiology to perform anesthesia services.
To maximize patient comfort and safety, our new Outpatient Cosmetic Surgery Center has two operating rooms fully Class C (all depths of anesthesia) certified by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). A link to the AAAASF website is found here. Virtually all of our surgical procedures are now being done in this state-of-the-art surgery facility.
What is the cost of Trans-Axillary Breast Augmentation Mammaplasty?:
The surgery fee for Breast Augmentation is currently $3000 for primary breast enlargement, and the OR and anesthesiology fee (which is offered as a special procedure package rate) is an additional $2750 in our ambulatory surgery center.
Some procedures, such as exchange of existing breast implants, complex revisions for problems in surgeries done elsewhere, or when breast skin lift (mastopexy) is needed, will entail higher fees. A separate consultation fee of $50 is charged, and brings the total cost to $5800 for a straightforward primary breast augmentation. Fees for augmentation with mastopexy, and for revision surgeries must be quoted based on findings at consultation, or photo and questionnaire data provided via mail or e-mail
What preparations are necessary for General Anesthesia?:
Patients should arrive for surgery having had nothing to eat or drink for at least 8 hours. Patients who take certain medicines, such as blood pressure medication, are usually instructed to take their morning dose with a sip of water.
Someone must be available to drive you home after the surgery, and stay with you at home the day of surgery. We always advise all patients who smoke to quit for several weeks to months before surgery, since poisonous carbon monoxide gas and many of the chemicals in tobacco smoke, including nicotine, cause circulatory compromise to healing wounds, leading to poor healing and excessive scar formation.
Smoking also leads to significantly higher pain levels after surgery because of the nicotine irritation of the injured nerve endings at the surgery site. Patients who smoke generally have a higher risk of complications than non-smokers. This risk is reduced, but not completely relieved by quitting smoking well before surgery, and resolving not to resume post-op. Lab tests or EKG tracings may be necessary depending upon your age and risk factors. A recent mammogram is necessary if you are over 40 or have a strong family history of breast cancer.
What should I do to prepare for Breast Enlargement Surgery?:
To limit the risk of bleeding, patients should avoid drugs that interfere with clotting, including aspirin and anti-inflammatory drugs (such as ibuprofen (Advil, Motrin) or napoxen sodium (Naprosyn, Alleve)) for at least 7 days before surgery.
Vit. E should be stopped for at least 3-4 weeks before surgery (since it inhibits clotting protein production by the liver), as should all homeopathic remedies, such as St. John’s Wort. Alcohol should be eliminated for 24 hours before surgery.
To limit the risks of infection or germ contamination that could lead to implant scar capsule formation, you should not shave for 10-14 days before surgery (to prevent shaving nicks and ingrown hairs that could harbor germs), until the morning of surgery when you should shower thoroughly with soap, and then shave your armpits in the shower, just before coming to the hospital.
Birth Place: Reading, Pennsylvania, USA; May 11, 1952
Wife: Sandra Sue DeWire, RN
Children: Thomas, Jr. age 20; Geoffrey, age 23
University: Bucknell University 1970- 197, Albright College 1972-1974 B.S. Biology 1975
Medical School: Jefferson Medical College (Philadelphia, PA) 1975-1979 M.D. 1979
Internship: Medical College of Virginia (Richmond, VA) 1979-1980
Residency: Medical College of Virginia ( General Surgery) 1980-1984 Chairman: Lazar Greenfield, MD
Fellowship: Medical College of Virginia (Plastic Surgery) 1984-1986 Chairman: I. Kelman Cohen, MD
American Board of Plastic Surgery: November 1988-present
American Board of Surgery: 1985-1995
Practice History: Private Practice in Richmond, Virginia: July 1986-present
Hospital Staff Appointments:
Henrico Doctors Hospital
St. Mary’s Hospital
Medical College of VA : Instructor in Plastic Surgery
Hanover Medical Center
Johnston Willis Hospital
Chippenham Medical Center