If you are considering liposuction in Southern California including Beverly Hills, Santa Monica and Long Beach from a Board Certified Female Plastic Surgeon continue reading …

What is liposuction? Suction Assisted Lipectomy (SAL) or liposuction is a surgical technique in which the removal of fat deposits reshapes a specific part of the body, such as the face, neck, arms, abdomen, hips or thighs. Liposuction, which was actively practiced in Europe during the mid 1970′s, was not popularized in the United States until the early 1980′s. Since then it has become the most requested aesthetic surgical procedure. The popularity of this operation is based on its relative simplicity which requires only a small incision usually well-hidden in a normal skin fold.

Frequently, patients seek liposuction to reduce their weight and general obesity. Unfortunately, liposuction is not indicated to treat these problems. Standard methods of weight reduction are required for these patients. Liposuction is intended to resculpt isolated collections of body fat that would not generally respond to diet and exercise: it is a method of body contouring to reduce inches, not pounds. The good news is that the suctioned fat cells are permanently removed. If the patient gains weight later on, the new fat will be distributed in a more proportioned manner.

Who should have liposuction? Patients with average weight, localized fat collections, and healthy elastic skin are the best candidates for liposuction. Obesity, cellulite, or loose, sagging, inelastic skin are several problems that would tend toward poor results. In fact, these problems may be worsened by liposuction. Unfortunately, many individuals performing liposuction are not trained in other techniques of body contouring and may not have the experience to recognize that a different procedure (such as a tummy tuck) may provide a better result for the patient. SAL may be used in conjunction with other body contouring procedures, such as breast reduction, tummy tuck, thigh lift or face lift.

How is the operation performed? Liposuction can be performed in an outpatient setting such as the surgeon’s office or surgicenter; less frequently a short hospitalization will be required. The procedure can last from 30 minutes to several hours depending on how many body areas are being operated upon. The type of anesthesia will also vary. Local anesthetic with sedation can be used for small areas; however, more extensive procedures usually require general anesthesia. Through a small incision, usually less than one-half inch, a blunt-tipped instrument called a cannula is passed back and forth essentially vacuuming out the fat. The cannula is connected to rubber tubing which in turn attaches to a machine that generates high vacuum pressure. Following surgery, a firm elasticized garment is used to provide compression and reduce swelling and discoloration at the surgical site.

During larger volume surgery, IV fluids are given to replace losses that occur with the procedure. Very rarely, transfusion is required, but this can usually be anticipated prior to surgery so that the patient can receive his/her own blood (aurologous donation).

What can I expect after the operation? As in all operations, pain and discomfort varies greatly from patient to patient. Generally, pain medication would be required for the first several days. Continuing discomfort can last varying amounts of time. Much of the swelling and bruising will be improved by two weeks; however, some will persist for six to eight weeks. It is often difficult to see significant changes in the body shape before this time. It is frequently useful to wear an elastic garment for four to six weeks to help with skin shrinkage. Your doctor will tell you how long you should wear your elastic garment. Normal activity may be resumed at one to two weeks and exercise at two to four weeks. Your doctor will give you specific time periods during a post-operative visit. Persistent swelling and irregularities may be present for several months. If antibiotics are prescribed, they should be taken as directed.

Is hospitalization necessary? Usually hospitalization is not necessary but it depends on the volume of liposuction and any other additional surgery. Many of these operations are performed under general anesthesia and may be done at a surgicenter as outpatient surgery.

Is there an age limit for this operation? People under 40 years of age usually get the very best results because their skin is tighter. However, the state of the skin remains the determining factor, regardless of age.

Are bandages applied? As discussed earlier, compression garments are worn after the operation to assist in the retraction of the skin and to prevent swelling. Light massage is started on the 10th day. After the operation, exercises are recommended beginning on the 14th day in order to minimize the adhesions between the skin and the deeper tissues. Early results are seen 10-14 days after surgery but improvement continues for 4-6 months.

When can you return to work? In general, 3-5 days after the operation for office work, and 14 days for more active employment. This will depend on the amount of liposuction and the type of work.

When can you do exercises? Usually 2 weeks after the operation you may exercise in order to modify and diminish the adhesions between the skin and the tissue. Walking, swimming or a stationary bicycle can usually begin a few days after surgery.

Should you follow a special diet? In order to have the best results, it is good to have a well-balanced diet including carbohydrates, fruits, vegetables and proteins, and not to overeat salty or fatty foods.

When can you get out in the sun again? When all the bruises have disappeared. this takes about 2-3 weeks. Use a sunscreen with a SPF of at least 15. Decreased sensation in the first few months after surgery may result in an accidental sunburn. Be careful.

Are the results permanent? In general, yes. In you gain weight, however, the operated area will also increase but not as much as would have occurred before the operation. Rippling may also occur with large weight gain.

Can the operation be repeated? Yes in certain cases. It is preferable to operate in stages on heavier people.

What about scars? Following surgery, your surgical scars will go through a maturation process. For the first few months, they will be red and possible raised, firm or unsightly. As the scar matures, after 6-12 months, it becomes soft, pale, and flat and much less noticeable. You may experience numbness, tingling, burning, “crawling” or other peculiar sensations around the surgical area. This is a result of the healing of tiny fibers which are trapped in the scar. These symptoms will disappear. Some people are prone to keloids which is an abnormal scar that becomes prominent and unsightly with time. If you or a blood relative have a tendency to keloid formation, please inform the surgeon.

What happens to the excess skin? Depending upon the age of the patient, the skin (because of its elasticity and retraction), will shrink over the reduced area of the body. Older or excess skin may require subsequent surgery to obtain the desired result.

Why is it important to have pre-operative pictures taken? Pictures help in the analysis of the problem in pre-operative planing, as a guide during surgery and in evaluation results. Consequently, they are necessary prior to all plastic surgery procedures.

If you are considering a non-surgical treatment in Southern California including Beverly Hills, Santa Monica and Long Beach from a Board Certified Female Plastic Surgeon continue reading …

LASER PEEL AND OTHER FACIAL PROCEDURES

Who is a candidate?
• If you have fine or coarse wrinkles of the skin – usually on the face.
• If you have an uneven skin surface as a result of scarring, acne, or small skin growths.
• If you have areas of hyperpigmentation (age spots).

Intended Result
• Smoother, youthful-appearing skin of more uniform color.

Procedure Description
• The superficial layers of the skin are removed by the pulse laser. The advantage of the laser is that the depth of treatment is controlled and predictable.
• The laser treatment also tightens the skin, but it is not a substitute for a face lift.

Recuperation and Healing
• You will be sent home with specific written instructions. The treated areas are covered with a tape-like covering or with ointment.
• The treatment postoperatively will prevent formation of a crust or scab. Healing will be complete in 7-10 days.
• Redness will usually last 7-10 days. Pink color continues to resolve but may last up to three or more months, depending on the skin type.
• Make-up can be worn once healing is complete (7-10 days).

Other Options
• Other facial procedures such as blepharoplasty (eyelid lift), face-lift, rhinoplasty, cheek implants, etc., can be performed at the same time.
Note
• The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation. All procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are rare.

LIP ENHANCEMENT, WRINKLE SOFTENING, AND OTHER FACIAL PROCEDURES
Thin and aging lips are common concerns of our patients. Collagen injections are the most commonly known treatment for these problems. There are actually many different options to improve the appearance of your lips and smile. The most common treatments involve the use of fillers, like collagen or fat. Other treatments include softening wrinkles with laser peels, dermabrasion, or chemical peels. Still another method to improve your appearance is surgery, to lift, shorten, or thicken lips more permanently. Finally, the ultimate beautiful smile can be achieved with the addition of cosmetic dentistry and oral surgery to improve the appearance of your teeth. Whitening solutions or the use of new lasers can provide dramatic results. Dental implants, tooth bonding, and veneers are just a few of the newer methods available to obtain your best possible smile. As plastic surgeons, we do not provide these dental services, but we do work closely with dentists and oral surgeons who are experienced and skilled with these techniques.

Below is a brief outline of most methods and materials available to achieve the best possible result. Further information is available on each specific technique. Let us give you something to smile about!!!

FILLERS: These are materials which can selectively fill various parts of your lips creating more ”pouting” or “Paris Lips” which enhances the white roll or outer edge of the lips.

Collagen, made from bovine (cow) protein, is temporary lasting 2-4 months. It is simple and quick to use with excellent results for many patients. Collagen requires one and sometimes two skin tests 30 days prior to treatment to test for sensitivity or an allergic response.

Cosmoplast, can be used to treat facial wrinkles on the forehead, crow’s feet, oral commissures, scars, and soft tissue defects.

Cosmoderm, can be used to treat facial wrinkles on the forehead, crow’s feet, oral commissures, scars, and soft tissue defects.

Restylane, is an effective tissue filler for lip enhancement and treatment of wrinkles. Made of Hyaluronic acid, a naturally occurring component of the skin.

Hylaform, is an effective tissue filler for lip enhancement and treatment of wrinkles. Made of Hyaluronic acid, a naturally occurring component of the skin.

Fat may be more permanent than collagen. It can give excellent results in most parts of the face but seems to be the least reliable in the lips. As with most “fillers,” more than one treatment is usually required.

Alloderm is cadaver dermis that is medically prepared for insertion as a filler. It is placed under the skin much like Gore-Tex or Softform but is not synthetic, and it is replaced by the body’s own collagen over time.

Cymetra is injectable micronized Alloderm. It requires several treatments for best results, especially in the nasolabial folds.

SURGERY can create permanent improvements in the appearance of your lips. These procedures are usually brief with quick recovery, although some swelling may persist for several weeks. The overall cost may be less than repeated collagen or fat injections. As with all surgery, some scars may be visible depending on the technique and placement of incisions.

Lip lifts use a small incision at the lip line, raising the lip to show more red. This can create a fuller red upper lip.

Lip shortening employs small incisions placed at the base of the nose under the nostrils. This shortens the distance between the nose and the upper lip and may also allow the lip to “roll out” creating a more pouty look.

Lip Augmentation (with Alloderm), can be created with small incisions placed inside the lip and Alloderm is then rolled and inserted into the lip to create a fuller and more youthful looking mouth.

Lip thickening can be created with small incisions placed inside of the lip to roll out the lip. This thickens the lip and also creates more pouting. Healing may take a number of weeks, and sometimes the sensation of the lips is altered, although the changes are temporary for most patients.

WRINKLES may occur around the upper lip and sometimes around the chin (the perioral area). Smoking, sun damage, and aging can contribute to these changes. These areas do not respond to face lifts and need one of the treatments listed below to achieve an improvement.

Micro-dermabrasion (“lunchtime peel”) is the latest technique for gentle but definitive “sanding” down lines, irregular skin texture, or pigmentation. For the best results, a series of six sessions is required along with adjuvant skin care. However, there is no recovery time necessary. You can go back to the office or out for the evening the same day!

Chemical Peels have also been used commonly for years to peel off the outer layers of skin. The peels can be superficial or deeper. Aggressive peeling has been associated with permanent color changes of the skin; however, many patients have been satisfied with the improved smoothness of their skin.

Laser Peels may currently provide the safest, most consistent results in achieving smooth skin. Prolonged redness has been a problem for some patients in the past; however, new lasers and post treatment skin care are also providing quicker, better results. Lasers have largely replaced the other methods of smoothing skin and reducing fine wrinkles.

If you are considering an eyelid lift in Southern California including Beverly Hills, Santa Monica and Long Beach from a Board Certified Female Plastic Surgeon continue reading …

One of the first signs of early aging is bagginess or puffiness around the eyes, often associated with wrinkling of the eyelid skin. Blepharoplasty is designed to correct this condition and to restore the youthful, alert appearance of your eyes. This condition may be present in the upper eyelids, lower eyelids or both. It also may be associated with looseness of the skin of the eyebrows or temple region.

Normally, everyone has a small amount of fat around the eyeball. If the quantity of fat increases, or the local tissues stretch and weaken, the fat begins to bulge, producing “bags”. Occasionally this bulging is seen in young patients and is an inherited family trait and not a result of aging. The laxity and wrinkling of eyelid skin may be seen alone or in conjunction with excess fat. These changes have a striking effect on one’s appearance. An attractive face with these early signs of aging can affect a patient’s self image, attitude and sense of well-being.

What is a blepharoplasty? Blepharoplasty is an operation designed to remove sagging skin and muscle from the eyelids, and to remove “bags” by trimming away excess fat bulges. In some cases the upper or lower lids can be treated alone. If indicated, all four lids may be treated at the same time. At times, a forehead lift and/or a face lift is done along with the eyelid surgery. Excess drooping of the eyebrows and corners of the upper eyelids may require a forehead lift to correct the area.

Where are the incisions? The incision in the upper lid usually lies in the lid crease. The incision in the lower lid lies just below the eyelashes and parallel to the lid edge. Both incisions may extend for a short distance beyond the eyelids, toward the temple. In certain cases, lower lid incisions may be made inside the lid.(transconjuctival incision). Excellent healing is characteristic of the eyelid skin, and once the wounds are mature, they usually become quite inconspicuous. The outer part of the incision – the part extending toward the temple – is the slowest to mature, and is sometimes noticeably pink for some months after the operation. The stitches are removed in 3-7 days after surgery.

What kind of anesthesia is used? A local anesthetic is used. The patient also receives sedation so that the operation will be a relaxed and comfortable experience. A general anesthetic may be indicated in some cases.

How fast is recovery? Swelling, discoloration, and bruising is to be expected. It is not unusual to have some difficulty seeing during the first day or two after surgery because of the swelling. Patients vary a great deal in their recovery rate, but usually can resume normal light activity or work 3-4 days after surgery using dark glasses and make-up to camouflage the swelling and discoloration. The patient will usually be presentable without dark glasses in 10 days. A small amount of residual swelling persists for many weeks but gradually disappears.

Will the bags and wrinkles come back? Sagging skin or wrinkles may recur as the years go by, but it is unusual for “bags” to recur. The operation can be repeated as necessary. “Crows feet” (skin wrinkling at the corner of the eye near the temple) is not greatly affected by this procedure; they may be helped with an ancillary procedure such as a dermabrasion or chemical peel.

Where is the operation done? The operation is usually done in a surgicenter as an outpatient. A friend or relative should be available to take you home and stay with you for at least the first 24 hours after surgery. Some patients may be done in a hospital operating room if other medical conditions are present.

Will insurance pay for eyelid surgery? Patients who have functional or visual problems caused by excessive upper eyelid skin may have coverage by their insurance policy. This usually requires documentation by an opthalmologist regarding the medical necessity of surgery.

If you are considering breast reconstruction in Southern California including Beverly Hills, Santa Monica and Long Beach from a Board Certified Female Plastic Surgeon continue reading …

Breast Reconstruction: What Can Be Done?

If a woman is a good candidate for reconstruction, she can usually expect a breast mound that will fill a bra cup to her desired volume, along with a nipple and areola, if desired. The opposite breast can be made to match by augmentation, reduction or lifting. These procedures are covered by insurance, as mandated by law. In addition, significant breast symmetry as a result of lumpectomy/radiation or multiple biopsies can be corrected with reconstructive surgery.

The word “can” is used because breast reconstruction is a matter of choice. Some women choose to wear a breast prosthesis with their bra. Others may choose reconstruction, which is not limited to one’s age. The overall health condition and status of the cancer are the issues that determine feasibility.

Consultation with a plastic surgeon prior to mastectomy is part of a comprehensive breast care center program. The patient should be fully informed of her options for immediate versus delayed breast reconstruction. The technique(s) recommended are based upon her anatomy, medical background and anticipated future cancer treatments.

Decision-making in breast reconstruction begins with the simple question of whether breast reconstruction will be part of the woman’s recovery process.

Some women know the answer immediately; others need days or weeks to decide.

Once the decision is made to go ahead with the procedure, the next question is which technique to select. In each case, the decision is based upon surgical preference and which technique will be better in the face of any anticipated treatments of chemotherapy and/or radiation therapy.

The two most common types of breast reconstruction are the tissue expander/implant technique and the transverse abdominus musculoctaneous (TRAM) flap. A third technique is the latissimus dorsi musculocutaneous flap with a breast implant. The table shown here summarizes and compares these techniques.

With the plastic surgeon’s guidance, the most appropriate technique can be selected for breast reconstruction, taking into account the desires, health status and unique anatomy of the individual woman.

The expander/implant technique requires two stages. The first stage of this breast reconstruction is placement of the tissue expander below the pectoralis chest muscle. This procedure adds less than one hour to the mastectomy time with the same overnight hospital stay.

The second stage is the exchange of the tissue expander for the permanent saline or silicone gel filled breast implant. This stage requires general ane sthesia, but is usually less than one hour in duration unless a procedure on the opposite breast is added.

Breast implants are confirmed safe by multiple medical studies. Both saline and gel filled breast implants were released years ago by the Food and Drug Administration (FDA) to be used for breast reconstruction and for replacement of older or present gel implants.

The TRAM flap technique uses autogenous, or one’s own tissue to create a breast mound. This surgery takes an average of five hours in addition to mastectomy completion with the average hospital stay of five days and an average recovery time of five weeks. The abdominal skin above the belly button is lifted off the abdominal fascia and sutured down to the pubic area skin with replantation of the belly button. The four to five week recovery period is necessary to straighten and strengthen the abdominal walls and muscles. Activity levels usually return to the normal, pre-operative status.
The latissimus dorsi flap with implant is usually used as a salvage

technique in the face of previous radiation or surgery. The flap consists of the latissimus muscle with an overlying skin paddle from the back. It usually requires a breast implant to obtain the desired breast shape and volume. The implant is placed below the latissimus muscle after the muscle is passed onto the chest wall through a tunnel at the base of the axilla (underarm). It is a useful reconstructive technique in the face of irradiated breast skin with deformity after lumpectomy and a lack of an adequate volume of abdominal fat.

Nipple areolar reconstruction can be performed at the time of the second stage reconstruction. Or, it can be done as a separate procedure as an outpatient under local anesthesia. The skin on the breast mound is the source of the nipple reconstruction with a full thickness skin graft, usually from the inner, upper thigh skin used for the areolar reconstruction. This skin is usually textured and pigmented resulting in a realistic appearing areola.

An extensive and detailed consultation with the plastic surgeon is mandatory for a patient to be truly informed and guided to make the best decision about breast reconstruction in conjunction with the treatment recommendations from the breast surgeon and oncologist

FREQUENTLY ASKED QUESTIONS:
Removal or deformity of a woman’s breast following cancer treatment, injury or developmental abnormalities may severely impact one’s body image and self-esteem. The removal of any body part, male or female can evoke a sense of loss. Breast reconstruction can be a great benefit in overcoming the emotional and physical consequences of a mastectomy or breast deformity.

How is breast reconstruction done? There are two general techniques of reconstruction. One technique uses a breast implant which is made of silicone and contains silicone gel, saline, or a combination of both. The second uses the patient’s own skin, fat, and muscle to recreate the breast mound (flap reconstruction).

How is the implant method done? Following mastectomy the surgeon places a tissue expander beneath the skin and muscle. This is a balloon made of silicone which will gradually be inflated over several weeks or months with saline (salt water). This expander placement requires about one hour under general anesthesia and one or two days of hospitalization.

When the desired expansion is achieved , a second stage is required to remove the expander and replace it with the permanent implant. In some cases, a type of expander may be used which remains as the final implant. The second operation usually takes one or two hours and most often is performed as an outpatient or short hospital stay.

This technique is the simplest and shortest method of breast reconstruction, although it may ultimately take longer to achieve the final result. The recovery time for each stage is relatively short. On the other hand, it usually requires many office visits, additional surgeries and several months to complete the reconstruction. All of the possible complications of breast implants must be considered. (i.e. capsular contracture, wrinkles, infection, etc.) This method also has a high complication rate when the chest has had previous radiation therapy.

How are flap reconstructions done? Currently, the most common flap reconstruction is the TRAM (transverse rectus abdominus myocutaneous flap). This method uses the skin, fat, and muscle of the abdomen to reform the breast. The muscle “carries” the blood supply to the overlying skin and fat. The abdomen is repaired much the way a cosmetic “tummy-tuck” is performed. On occasion, two muscles of the abdomen can be used to “carry” larger amounts of skin. Another variation removes the “tissue” completely, transplanting the skin and fat to the chest using “microvascular” techniques to establish circulation. When the abdominal area is scarred from other surgeries or too thin to create a breast, tissue from the buttock or thigh can be transplanted to the chest using microsurgery. These operations generally require more than four hours but essentially create the breast mound in one operation. The hospitalization is usually four to seven days.

TRAM abdominal closure usually includes a synthetic mesh placed in the abdominal wall to add strength and prevent hernias or weakness where the muscle is removed. Blood transfusions may be required and autodonation (autologous blood) of the patient’s own blood or donor directed blood is recommended when time allows. Smokers must stop smoking four weeks before and after surgery to reduce possible circulation problems and complications.

Although this operation can provide a very natural appearing breast, the patient must accept the longer surgery and recovery time, as well as the additional scars where the flap is taken from (donor site)

What is the Latissimus Flap? This is a flap of skin, fat and muscle (latissimus dorsi) from the back which can be molded into the form and shape of a modest breast (A/B cup) without the use of an implant. Much of the previous discussion applies to this technique as well. The scar on the back is transverse or oblique and attempted to be kept within the brassiere or clothing lines. There may also be some contour deformity where the fat is taken from. Commonly, the flap is used with an implant to create a larger breast in one stage.

Are other operations required? To achieve symmetry, many women choose to alter the other breast either by enlargement, reduction, or lift (mastopexy). Frequently, this can be done at the second stage (in the expander method or along with nipple areola reconstruction. These operations leave additional scars.

How is nipple areola reconstruction done? Generally, this operation is done several weeks to months after the breast is reconstructed. The nipple is created from local “flaps of skin and fat.” The areola can be made from darker skin taken from the groin or by tattooing pigment into the skin. This is generally an outpatient operation and often is done with local anesthesia.

What are the potential risks of implants? Additional materials are enclosed which review this information in depth. Women who choose implants are required to participate in the FDA study which tracks and evaluates the outcome of participant’s risks, benefits, and patient’s responsibilities are outlined in separate consent forms for the study. Relevant information regarding saline implants can be provided in the information packets on Breast Augmentation.

If you are considering a breast lift in Southern California including Beverly Hills, Santa Monica and Long Beach from a Board Certified Female Plastic Surgeon continue reading …

FREQUENTLY ASKED QUESTIONS:

What is a breast reduction? Also known as reduction mammaplasty, this is an operation intended to reduce the size of a woman’s breasts and improve their shape and position. Frequently, the areola (dark skin around the nipple) is also made smaller. Functional symptoms (medical disorders) caused by excessive breast weight may be relieved or improved by this operation.

What is a breast lift? A breast lift, or mastopexy, is designed to improve the shape and position of the breasts without reducing their size. It is used for breasts which sag but are not large. Sagging of the breasts may occur with normal development for some women or as part of aging. Pregnancy, breastfeeding and weight loss are other conditions which increase breast ptosis (sagging). Some patients will have a better shape to their breast if an implant is used at the time of mastopexy. This procedure is not covered by insurance.

Where are the incisions? There are a variety of techniques for these operations. Most commonly there is an incision around the areola, another between the areola and breast crease, and the third within the crease under the breast. This is an “anchor –shape” or inverted “T” incision. Occasionally, especially with mastopexy, these incisions may be modified and more limited. Some operations may require only the incision around the areola.

Will insurance pay for my surgery? Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). When the excessive size causes functional problems, insurance will generally pay for the operations. These problems may include neck pain, back or shoulder pain, hygiene difficulty and breast pain. Other problems that are less likely to be covered by insurance include: skin irritation, skeletal deformity, breathing problems, psychological/emotional problems and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.

Special note on reduction of extraordinarily large breasts: In extraordinarily large or bulky breasts, for technical reasons, we sometimes remove the nipples completely and put them back as “free grafts”. The sensory nerves are all cut, and even though a certain amount of sensation returns after healing, it will never be normal and erotic sensation is lost completely. The milk ducts are interrupted in this operation, so nursing would be impossible. You will be informed in advance if your breasts are in this category.

How long is the patient hospitalized? For a reduction mammaplasty, one day of hospitalization is usually needed if there are no complications. A mastopexy can be done as an outpatient procedure, requiring no hospitalization. Usually suction drains (plastic tubes) are left in place after surgery with breast reduction, and possibly with a mastopexy.

What kind of anesthesia is used? A general anesthetic is used on all reduction mammaplasties and some mastopexies. Some mastopexies can be performed using local anesthesia and intravenous sedation.

Who is on the surgical team? Generally, two board certified surgeons will perform the operation. There may be a separate bill for the assistant surgeon’s fee.

What can I expect post-operatively? Discomfort, swelling and discoloration of the breasts are to be expected for several weeks. Usually, our patients return to almost normal activity within two weeks. The scars at the incision lines typically become reddish, raised and firm a few weeks after surgery, but after many months become pale and soft. After 8-12 months, the scars are relatively inconspicuous. The nipples and some areas of the skin may be numb or sensitive after surgery. Sensation frequently returns within a few weeks or months but may be diminished or overly sensitive.

Will the breasts start to sag again? Gravity continues to have its effect, and there is a tendency for the skin of the breast to stretch over long period of time. Women vary a great deal in this respect. In general, the smaller the breasts, the less tendency for sagging to recur. If the breasts sag further, excision of the skin on an outpatient basis can be used to correct the problem. If we try to lift heavy breasts without making them smaller at the same time, sagging will return soon. One key to a satisfying result is realistic expectations – a wide based large breast will not look like a smaller, but firm narrow based breast.

What are the alternatives to surgery? Occasionally patients respond to weight loss. Some patients can be improved with liposuction or liposuction and surgery. Patients with small amount of sagging may do well with breast implants alone.

If you are considering breast augmentation in Southern California including Beverly Hills, Santa Monica and Long Beach from a Board Certified Female Plastic Surgeon continue reading …

FREQUENTLY ASKED QUESTIONS:

What are the benefits of breast augmentation with implants? This operation is performed to enhance or restore the size and shape of a woman’s breasts. Breasts may be small because of lack of development or changes following pregnancy, weight loss or congenital abnormalities. Sometimes a woman’s breasts are very asymmetric. This operation can improve a woman’s self esteem and quality of life. Studies have shown over 90% of women are satisfied with their results. Currently, saline implants (silastic bags filled with salt water ) are placed either behind the pectoral muscle and breast tissue or in front of the muscle. This is done through an incision 1-1/2 ” – 2″ long placed either under the breast, around the areola.

What do breasts look like after augmentation mammaplasty? Saline-filled prostheses are the best means now available to enlarge the breasts by surgery. However, the prospective patient should know that the final appearance, shape and texture are not exactly the same as normal breasts. The surgically enlarged breasts do not move in the same way as normal breasts. They tend to be more firm. The contours are usually somewhat different than normal breasts. In some patients, these discrepancies may be rather noticeable. Although every effort is made to place the implants symmetrically, complete symmetry is rarely achieved. Immediately after surgery, the breasts may appear swollen and firmer; the final shape and size is seen after several weeks. Please note that silicone gel implants are now available for elective new breast augmentations since FDA approval late last year.

Are the prostheses safe? Can they cause cancer? To the best of our present knowledge, these prostheses are made of non-reactive, safe material. Thus, there is no way to say positively that they won’t cause trouble 20 years from now, but it is unlikely. The incidence of cancer in augmented breasts is the same as in normal breasts, actually less in some studies. Additionally, the incidence of collagen vascular disease is the same or less in studies of women with breast implants.

What kind of anesthetic is used? A general anesthetic is most common when the implant is placed under the pectoral muscle.

What are my limitations in activity post-operatively? You should plan to avoid activities which require much raising of the arms above the level of the head for 10 days after surgery. With great care, you can drive about 3 days after surgery. Patients can usually return to work in a few days unless their occupation requires particularly strenuous movements and lifting. In such cases, 2-3 weeks should be allowed.

What are the risks of surgery?

Initial

1. GENERAL RISKS of surgery include infection, pain, delayed wound healing, hematoma (a collection of blood at the surgical site), bleeding or reactions to anesthetic.

2. COSMETIC COMPLICATIONS: You may not be satisfied with the appearance of your implant(s). Incorrect implant size, inappropriate scar location or appearance, and misplacement of implants may interfere with a satisfactory appearance. Asymmetry (unequal breast size or shape) may occur. The implanted breast may sag or droop (ptosis) over time, much like a natural breast. Very rarely the implant may change position or break through the skin, particularly if you have very thin breast tissue covering it. This is more common with saline implant(s).

3. BLEEDING: When blood collects beneath the skin, it causes excessive discoloration. Sometimes lumps which last many months may occur. If blood collection is discovered, it is usually removed by taking out a few stitches and squeezing the clot out, or inserting a needle and aspirating it. If bleeding continues, it is sometimes necessary to return to the operating room to stitch the bleeding vessels. This risk increases in people who take aspirin or who bruise easily. Let your doctor know if this is the case. Do not use aspirin or aspirin-containing products for two weeks before and two weeks after surgery. (See list of medications that may increase bleeding.)

4. WRINKLING AND RIPPLING: Some wrinkling of the implant shell is normal and expected. If your breast tissue is very thin, these wrinkles can show up as visible ripples, especially when you lean forward without wearing a brassiere. The wrinkling can also produce little corners on the implants that can sometimes be felt with your finger if the breast tissue is very thin. This is less likely to occur with silicone gel implants.

5. CAPSULAR CONTRACTURE: The scar tissue that forms around the implant can tighten and squeeze the implant as a natural response to a foreign object implanted in the body. This firmness can range from slight to very firm. The firmest ones can cause varying degrees of discomfort or pain. Capsular contracture can occur on one breast or both. Implants under the muscle may result in less contracture.

6. RUPTURE/DEFLATION: Breast implants may not last a lifetime. The silastic shell can break due to normal wear over time, injury , valve malfunction, breast manipulation (mammograms), or unknown reasons. The usual sign is loss of breast size over days or weeks. The saline (salt water) will be absorbed by the body without any harm. Surgical replacement will be needed to restore the breast size. Replacement will involve additional costs.

7. NUMBNESS: Sensory changes are expected to some degree immediately after surgery but loss of nipple and breast sensation may be permanent. Increased sensitivity is less common but does occur. These changes can interfere with comfort, sexuality and nursing (lactation).

8. PAIN: Can be related to the surgery itself or a later response to problems such as tight capsule formation.

9. INFECTION: When severe , may require removal of the implant if it is not controlled with antibiotics. Rarely, this can occur any time after surgery. Consideration should be given to taking prophylactic antibiotics with dental work or other surgeries. If an implant is removed, replacement may be delayed for three months.

10. HEMATOMA: May require surgery to remove the collection of blood. Sudden swelling of the breast after surgery should be immediately reported to the doctor.

11. SCARS: Generally do well with all breast incisions. However, healing is unpredictable and occasionally patients may form thickened or red hypertrophic/keloid scars. Additional surgery may be required. Wound healing complications are higher is smokers therefore, you must stop smoking at lease 2 weeks before and 2 weeks following surgery.

12. INTERFERENCE WITH MAMMOGRAPHY: An implant can interfere with the detection of early breast cancer because it may “hide” suspicious lesions in the breast during an X-ray exam. It is especially important for women who are at high risk of developing breast cancer to consider this before having implants. Additional views are required for routine mammography in patients with implants. Mammography is more effective with implants under the muscle.

13. CALCIUM DEPOSITS: Can develop in the breast tissue at any time after surgery. These are benign but may be confused on an X-ray with breast cancer calcium deposits and require a biopsy.

14. ALTERATION IN BREAST FEEDING: For women who have not had children, this surgery may alter your ability to nurture children in the future. Spontaneous lactation may occur after this surgery but is usually self-limited.

15. LIFETIME OF IMPLANT: Implants will not last forever. The FDA currently estimates implants will last about 10 years. This is an estimate. The FDA has not reviewed all the data about saline implants (1994).

16. UNKNOWN RISKS: In addition to these known risks, there are unanswered questions about saline-filled breast implants. For example, questions have been raised about whether these devices might cause autoimmune diseases such as lupus, scleroderma and rheumatoid arthritis in some women, or whether they might increase the risk of cancer. There is no scientific evidence at present that women with either silicone gel-filled or saline-filled breast implants have increased risk of these diseases, but the possibility cannot be ruled out.

17. PHOTOGRAPHY: Photographing, filming, or videotaping of the treatment or procedure, for educational or diagnostic use, is a standard and required part of patient care.

18. NO GUARANTEE: The practice of medicine and surgery is not an exact science. Although good results are expected, there cannot be any guarantee, nor warranty, expressed or implied, by anyone as to the results that may be obtained.

19. COMPLICATIONS AND ADDITIONAL SURGERY: Any of these problems noted above may require additional surgery, hospitalization, and time away from work. If this occurs, there will be additional costs for surgical fees, supplies, anesthesia, etc., depending upon the required operation. Complications of cosmetic surgery generally will not be covered by medical insurance.