Total Body Surgical Blog

That is the question we hear daily.  Do I NEED a breast lift??  With this being one of the last installments on breast for a while, I thought a little knowledge in this area would be helpful. 

Before we start, let me remind you that we have 20 days left on the spring time breast augmentation special pricing....click below to see how you can get breast augmentation surgery, ALL INCLUSIVE, for as little as $3500.00!!

Now for the burning question...do I need a breast lift??  The answer to that question is, in some cases, a little fuzzy.  There are instances where the decision is easy.  If you have no breast tissue, or very little, and the nipple position is high, obviously, you do not need anything to enhance the breast except volume, i.e. implants. 

 In this picture, the nipple position is great, the skin is tight, and only an implant is necessary.  After implant placement, the skin will stretch to accomidate the implant and the breast will take on a nice and natural shape.  This is the perfect patient for implants alone.  As discussed in earlier blogs, the incision placement options, size, and type of implants are variable according to taste. At your consult, all of this will be discussed and you can decide.

The second presentation that is fairly easy is the patient that has significant drop in the nipple position

If the nipple has fallen below the fold under the breast (inframammary fold) then a lift is always needed.  Some select an implant and some do not.  That is a personal choice, but if fullness is desired in the upper chest, it is difficult to create, and maintain, without an implant.

This picture depicts one of the "easy" decisions.  Obvious drooping of the breast and nipple complex below the lower fold of the breast where it attaches to the chest.  If we were to just place an implant in this situation, there would be a nice implant present with a sagging breast hanging off with the nipple still pointing at the floor.  Several procedures are used to lift the breast.  We usually use the Weiss pattern lift (anchor incision) for larger lifts and the vertical (lolly pop) lift.  Both types of lift raise the nipple into a more normal position, remove excess skin below the breast and move remaining breast tissue into a higher position.  In the picture above, we call this the "rocks in socks" breast.  There is some breast tissue hanging around the nipple (rocks), and skin (socks).  If lifted only, this will be a very small and flat breast.  This is when an implant can really be beneficial to give the breast some volume.  Others have a sagging nipple and breast but still have a good amount of volume.  A lift alone, or with implants are both choices.

This is a photo of a breast lift alone. The shape is nice and nipple position is good, however, the upper pole remains flat.  This can only be fixed, long term, with an implant.  Implants, however, can be placed after a lift so you can decide later if you want them or not.

As you can see, a lift with an augmentation can be done simultaneously with good results.  This gives good fullness to the upper pole of the breast with the added benefit of only one procedure.

Now for the harder ones.  Many women have breasts that have fallen some but not to the extent we have discussed.  When the nipple is just above the lower breast fold or even with it...now what??  When the nipple is above the fold but there is significant breast tissue below, this is called pseudo-ptosis or false droop.  We have more than one option at this point.  One is to put large implants above the muscle, preferably silicone.  This is actually not a bad option for the right person.  The breast will still remain a little low, not filling the upper pole as much as if a lift were also done. Also, need for a lift later is still a real possibility. This is good for those who do not want scars on the breast and are willing to accept a breast that is not quite as "perky".  The other option for this group is to go ahead and bite the bullet and do the lift with or without implants.  This will generally fix the problem long term, give you a nice fullness to the upper breast and move the nipple into a more normal position.

Breast pseudoptosis with implants.  Looks pretty good, but upper pole is somewhat flat.  If this is acceptable, it is a great choice.

Well that about does it for this week.  I will try to move on to something else next time.  Remember our breast special pricing and call today....918-786-7780 or 1-866-weight0.  Cosmetic consults are complimentary!!

Hard to tell by the weather, but Spring IS here, not only by dates, but soon the warmer weather too.  In keeping with our Spring $3500 breast augmentation offer, we will discuss breasts.  There are a little over 3 weeks left to take advantage, so click on the button below to get details and fill out the contact form.  We'll get back with you.  Or call 918-786-7780 or 1-866-weight0 to schedule an appointment that will be complimentary.

I think we have about beat this subject to death but wanted to go into a little more detail about approaches to implant placement and some of our thoughts.  This will help YOU decide.  You deciding seems to be a recurring theme here, but you need to happy with your choice of implants and how they are placed.  Understand that we are happy if you are happy!!  The size you choose, the insertion approach you choose is all about you, not us.  We are here to help guide you in making your decisions.  Dr Miller and I have a great deal of experience with these choices and can help guide you.  Trish, Janet, Rachel, and Wendy also have experience, some have had this type of surgery and they are here to help too.  They are also WOMEN, this gives them a leg up, as politically incorrect as that statement is!!

A couple of things that have been glossed over you need to know about....

1.  Sizing:  When it comes to the size of implant you want or need, there are several factors involved.  Your height and weight.  Your build, thin, athletic, or larger build, your current breast size, and your desired size after augmentation.  We always hear comments on implant size based on what the internet says or friends comments, or the size someone else received.  You can usually throw all of these comments and suggestions out of the window.  Why??  You are unique.  The amount of breast tissue you are starting out with is not exactly the same as everyone else.  The size of your chest is not the same as everyone else.  You are taller or shorter, thinner or fluffier than everyone else.....one size DOES NOT fit all in this situation.  We start off by talking to you to get an idea what you want.  We then measure your current breast location, how big the current breast is, and the size of your chest. This helps us to figure out a range of implants that will be right for you.  If you have 100cc of natural breast tissue and want to increase to a 400cc breast, we need to look at implants around 300cc.  If your friend started out with 300cc of natural tissue and ended up with a 200cc implant, she may think your 300 is "large" when if you consider where you both started....it is about the same...right?.....right.  We will allow you to try different sizes on, in your clothes, so you can get an idea what you will look like.  We will also help you choose the style of implant you want.

There is a new higher profile not pictured here.

2.  Placement approach:  How do you want the implant placed??  Also an important question.  The options for saline are, armpit (transaxillary), below the breast (inframammary), through the nipple (peri-areolar), or through the belly button (TUBA).

 Arm pit incision-saline or silicone.

The incision is only 2-4cm, not this big!! Saline or silicone.

incision around the nipple. Saline or silicone.

Silicone cannot be placed through the belly button.

We all have our preferences but we are here to help you decide what YOUR preference is.  Here are the ones I don't like.  Peri-areolar approach is less ideal because it can cause sensation changes around the nipple and leaves a scar on the breast.  I also am not too fond of the TUBA.  It has a higher incidence of assymetry and can also cause unsightly scarring around the belly button.  My first choice is trans-axillary (through the arm pit), Dr Miller's is under the breast.  There are several reasons why I like the arm pit...one is that there is no scar on the breast.  I choose a small crease in the arm pit that is there in everyone and use it to make my incision.  This usually heals well within 6-12 months and you can barely find it....no scars on the breast and the scar that is there is concealed.  My second choice is the infra-mammary incision.  This incision is probably the easiest one to use as it is the least remote from where the implants are placed.  It is also a commonly used incision later if implants are replaced or any other work on the capsule is necessary.  The down side....an incision on the breast, even though they usually heal very well.

So don't forget to call 918-786-7780 or 1-866-weight0 to make your appointment.  With only a little over 3 weeks left, the time is now.  As long as you book before April 31, you can pick any date after and still get the special pricing.  Call TODAY!!

HAPPY EASTER FROM TOTAL BODY SURGICAL AND GREEN COUNTRY BARIATRICS

With our breast implant spring deals going on, we felt like we better talk about breast implants and enhancement.  What spring deal, you might ask??  Click on the button below to get all the details....

When you come to Total Body Surgical for a breast consult, the first thing that will happen is a discussion about implants.  We cover about every positive AND negative to having implants and contrast and compare the saline with the silicone gel implants that are currently available.  We feel it is very important for you to have all of the knowledge. 

First is saline.  Saline implants were made popular when the silicone implant scare started in the 90's.  These implants are a bag that is placed empty and filled with saline.  They can be placed through an incision under the breast, through the arm pit, through an incision around the nipple, or through the belly button. If a lift is required, then we use the same incisions.  We usually discourage using the nipple access for obvious reasons.  When placed throught the belly button, the incidence of assymetry is reportedly higher.  We generally use the arm pit or an incision under the breast.

The pros to the saline implant are several.  One thing that we can do with them is over fill them.  This makes them look like implants.  Some women want this.  Another advantage is if they rupture.  If this happens, the saline is absorbed and the implant goes flat.  We simply replace the implant and you go on your way.  Because saline implants are put in flat, they can be placed through a smaller incision whichever approach you decide upon.  Most studies support a lower capsular contracture rate with saline implants (this is when the implant is distorted by a thicker and tighter capsule that makes the implant feel hard and can cause distortion).

 Capsular contracture on right with implant thightening and displacement.  It would feel very hard if you could feel it.

Lastly, and in many cases most importantly, saline implants are cheaper.  They are about $1200 cheaper than silicone implants.

Now the cons.  Some people think that saline implants don't feel as "natural" as silicone implants.  Secondly, saline implants are generally placed under the muscle to avoid some of the limitations of the implant.  Thirdly, saline implants have a higher incidence of "rippling".  Ripples are creases that can form in the implant.  They are more prevalent in women who are very thin and get larger implants.  This can occur with silicone implants as well but less so.

  implant "rippling"

Now for pro's of silicone gel implants.  Some women think they feel more "natural" than saline.  Some women think they have a more "natural" shape.  I think, in the moderate profile shape, they both can look great.  In the high profile shapes, it is my opinion that the silicone gel is the implant of choice and looks better.  It is also my opinion that when implants are placed above the muscle, silicone is the implant of choice due to its lower pressure.  It ripples less and looks better.  Below is a video of what a silicone gel implant looks like when you cut it open.

http://youtu.be/kceaEMmi7pA

The con's.  You must be 22 (the infamous FDA) to get them.  Silicone gel implants are full when we put them in, therefore, the incision must be slightly larger than with saline.  Studies show that the capsular contracture rate is slightly higher than with saline.  Silicone gel implants are more expensive than saline. Implants made of silicone cannot be placed through the belly button. 

So there you have it!  We feel that implant selection, size and content, is a personal choice and should be made by you.  If you are unsure, we will help guide you in the selection process.  Our office staff is also very good at sharing their experiences with you and giving the "woman's touch" helping you decide.  Dr Miller and I share most of our opinions with only slight variations.

Call us at 1-877-weight0 or 1-918-786-7780 today to schedule your complimentary Cosmetic consultation.  Remember, to take advantage of the 2013 Spring Special Pricing, you must book your surgery by April 30 so don't put it off!!

We look forward to seeing you!!

I started working in the yard last weekend.  It was warm and sunny.  While I worked, I noticed that the trees are budding out, and there were even a few with some juvenile leaves showing up...guess what...the warm days of summer are nearly here!!  While we talk about hair and skin, don't forget about our breast augmention special, hit the button below to get the details.

This week I wanted to cover a couple of old subjects...skin and hair.  With summer rapidly approaching, these are two of the things that you can improve quickly and get ready for summer.  So what can you do??

1.  Hair.  Most women (and some men) don't like hair in certain places.  This includes the bikini area, underarms, face, and legs in women, and chest, back, and underarms in men.  What can we do about this?  Have you ever shaved in any of these sensative areas and wished you didn't have to? Or, at the pool, notice that you SHOULD have?  That hair is hard to tuck in!!  What about getting waxed, and with tears in your eyes, thinking, there has got to be a better way than this to get rid of this hair!!  At Total Body Surgical we can rid you of this problem for the rest of your life....AND....with unbeatable pricing, not break the bank.

We use the Cutera system to do our laser hair removal.  It is one of the few systems that is FDA approved to treat all skin types and it is very effective.  We expect to get rid of 80-90% of the hair completely and what is left is spindly, light, and weak if there is anything.  Of course the hair has to be darker for us to treat it because that is how the laser works...the dark hair transmits the light energy as heat into the follicle, killing the hair stem cells.

As the population of these cells decreases, the hair becomes thinner and thinner until eventually, it is gone. Body hair generally takes about 6 treatments and facial hair, because it is thinner and transmits less energy, about 9 treatments.  The darker and coarser the hair, the quicker it goes.  The treatments are spaced about 6 weeks apart and generally take about 30-40 minutes.  We use numbing cream and let it set about 20 to 30 minutes before the treatment.  If you do not want to numb it takes less time of course.  Everyone is different so some like the numbing and some don't.  We use the Zimmer cooling system so the discomfort is minimal even if you don't numb.

Remember, hair has to be there for the laser to work.  This means you must wait six weeks after waxing or using a cream hair remover.  You can trim or shave the areas being treated so it does not have to be long and embarrassing.

The way we do areas is like this....the face is considered an area, the underarms is considered an area, the bikini is considered an area.  The legs are considered 4 areas due to the large size so lower leg front and back is 2 areas, thigh front and back is 2 areas.  The abdomen upper and lower is 2 areas and the chest, upper and lower, is 2 areas.  The back, upper and lower is condered 4 areas as well, divided as the abdomen and chest are.

Be sure to click on the hair removal button above to see how affordable hair removal really is!

2.  Skin.  Most skin issues, i.e., pigment changes, are due to UV (sun or tanning bed) exposure.  In women, hormonal changes also contribute.  These changes have many names....

melasma 

poikiloderma 

Of course, they occur on the sun exposed areas of the face, chest, neck, and arms.  If you have these areas, they will usually NOT resolve by doing nothing.  What do we advise??  First, sun protection.  No matter what we do, if sun exposure continues, these areas will return.  Sun screens, hats, and cover ups are critical to the success of any therapy and once you have that covered, we can start addressing the problem.  Basic skin care is critical and the product we recommend is Obagi.  Created by a Dermatologist the line is medical grade and is VERY imitated.  It contains medical concentrations of tretinoin and a lightner.  The kit we recommend also contains the products to manage the pH of the skin, making the medicines work better.  Compared to other products, it is very affordable.  After a few months you will see the skin looking healthier and the discolorations decreasing.  For faster results, or for areas that are a problem, we use Pulsed light treatments.  These treatments target areas of pigment and cause them to peel off quicker and also help turn off the cells that are creating the pigment.  It usually takes a series of treatments along with the basic skin care.  I feel like the best sun screens come from the Skinceutical line of products.  They were also created by Dermatologists and come in many strengths and even in a water proof formula. 

So, get your skin in shape for the coming summer, AND, get rid of your razor!!

Call today to book your treatment or consult 1-877weight0 or 918-786-7780.  There are about 40 days left in our breast augmentation spring special so don't delay...ACT NOW!!

What does Bravo have to do with gastro-esophageal reflux disease??  Well, let's investigate it a little.

What is GERD (gastro-esophageal reflux disease)?? Here is a good definition: 

GERD is characterized by symptoms and/or tissue damage that results from repeated or prolonged exposure of the lining of the esophagus to acidic contents from the stomach and occurs when the lower esophageal sphincter (LES) does not seal off the esophagus from the stomach.

The two most frequently reported symptoms of GERD are heartburn, which can be described as a burning discomfort that begins behind the breastbone and radiates to the neck and throat, and acid regurgitation, which is characterized as a bitter, sour tasting fluid. One out of five people experience heartburn or acid regurgitation on a weekly basis and two out of five people experience heartburn or acid regurgitation at least once a month.

This is a good depiction of how reflux occurs.  The esophagus is not prepared to handle the exposure to acid that the stomach is.  The "heartburn" that can occur is normal on occasion, but if it occurs frequently, it can cause changes in the lining of the esophagus... esophagitis. Besides the symptoms this can cause, I.E. heartburn, chest pain, hoarseness, coughing, bad breath, inability to sleep, it can cause strictures in the esophagus, difficulty swallowing, and changes in the cellular lining that can be dangerous.

Fortunately, today, we have medicines that are very effective in reducing the acid and the symptoms that it causes.  These medications are readily available, even over the counter, but, they are not meant to be used for a long time.  They also have a dark side.  PPI (proton pump inhibitors) like prilosec, nexium, etc., when taken for the long term can cause calcium leaching from the bone leading to osteoporosis or thinning of the bones.  They can also cause changes in the lining of the stomach leading to polyp formation.  They can also be very expensive!!

So, what can be done about this!!  When I see a patient with symptoms of reflux, the first thing we like to do is document any changes to the baseline by looking with a scope...an EGD.  This allows us to look and biopsy to establish any changes.  The procedure takes about 15 minutes under sedation...pretty easy.  We then start a trial of medication which usually works.  It is recommended that the trial is relatively short...a few months...  If symptoms persist we will then schedule for a BRAVO pH monitoring test after being off of the meds for about a week.  This allows us to rule out other causes for the symptoms you are experiencing.  The Bravo is a small monitor that adheres to the esophagus for a few days and monitors the acidity.  You keep a journal of symptoms while we monitor...symptoms and acid=a positive test. 

With a positive test, changes in the esophagus, and symptoms on the medication, we recommend a laparoscopic repair.  This is called a Nissen Fundoplication (hiatal hernias are also repaired at the same time).  If the medications alleviate the symptoms, and you have been on them a long time....we have to decide if surgery is appropriate.  Considering the fact that the medications can cause problems, if you are healthy, patients usually opt for fixing the problem to get off of them medication.

The success rate for the Nissen is about 90%, as reported in the literature....there are not many treatments that have statistics that good!!  You will usually spend one night in the hospital and are back to normal in a couple of weeks with only small (1/4 inch) incisions.

So, the Bravo is a great test to help us figure out if the symptoms you are having are actually caused by your GERD....that's important.  The worst thing we can do is fix your reflux and later find out your symptoms are from something else!!

Come see us today if you have reflux that does not respond to medications, or, if you have been on the meds for some time and cannot live without them...WE can help.  We do EGD, Bravo pH testing, AND Nissen Fundoplication, Total Body Surgical!

Call 918-786-7780 or toll free 877-weight0 today for an appointment!!

Don't forget our special pricing on breast enhancement surgery until April 30..what a deal!! Just click on the breast button to see what it's all about.  AND our liposuction special pricing too, look great for summer!!  Cosmetic consultations are always complimentary!!

Thought ya'll might like a break from the breast this week!  I guess you can have too much of a good thing, BUT, don't forget about our spring breast deal...hit the button above to check out our offer, it's a good one!

After a cold winter of intermittent goody indulgences (think Christmas and New year) and less sporadic exercise, the question is..... are you going to be ready for Summer?  Would you like a jump start to a new and healthy lifestyle?  Are there areas on your body that despite all the exercise and dieting in the world, simply will not go away?  You can blame that on your genetics, baby.  Unfortunately, we can't pick our parents, so what options does that leave us?

Thin girl with "saddle bags"...genetics in action.

The answer to that question is liposuction.  You may also hear the term "body contouring" , the terms are interchangeable.  Many of our patients who undergo liposuction body contouring improve not just their confidence, self esteem, and overall quality of life; but also comment on their new and increased volition to exercise and maintain their body in a positive fashion. At a far more drastic end of the spectrum, we have had others comment that a simple body contouring liposuction procedure has allowed them to experience and achieve goals that their appearance or body shape has prevented them from achieving in the past. 

love handles...spare tire

Men often collect and store their fat over their abdomen, breasts, and neck, whereas women will collect it in their waist (the dreaded muffin top), their abdomen, arms, and thighs.

"Muffin top"...funny but true.

So you're asking, what does this entail?  "I've seen it on TV and it looks soooo rough and painful."  Guess, what?  Things have changed.  Drastically. At Total Body Surgical, we use a technique that was popularized around 2005 on the West Coast called, laser lipo, lunchtime lipo, smartlipo, etc.

CoolTouch laser used at our facility.

Essentially, the process involves three steps.  The first part is the hardest step and takes the longest time.  What happens is numbing medicine (lidocaine with saline mixed) is placed into your areas of concern.  Once you are numb, the next portion involves using a laser to go in and melt the fat.  The laser also serves another really beneficial purpose... it helps to shrink down the skin.  Ok, that being said, we need to take a side trip and discuss this whole saggy and loose skin thing.  Picture a  10 pound sack of potatoes.  If you took 9 pounds of potatoes out of the bag, you'd have a heck of a lot of sack left over, right?  This is the same concept with your body and liposuction.  If we go in and remove a batch of fat from an area, it's inevitable that you're going to have some extra skin.  Now, whether or not that skin is going to snap back depends, once again, on your  genetics.  We only have so much elasticity to our skin.  As we get older, have babies, and yo-yo diet, all these factors act to decrease the amount of give and elasticity to our skin.  It's kind of like your favorite pair of socks that ends up around your ankles at noon time because the elastic has given up.   The laser helps to counteract this somewhat.  As I stated already, the overwhelming factor of whether your skin will shrink down or not completely depends on your genetics, but the laser certainly helps to optomize the situation.  Lastly, the third and final step to the procedure is the fun part.  This is where we insert a tiny tube underneath your skin and suck out all the melted fat.  This is where you lose your inches and get rid of that darn fat deposit.

Now, take into account that you will retain water and be swollen enough to not allow you to see your final appearance for about 12 weeks.  That means, getting ready for Summer and planning ahead is essential.  Make no mistake, Spring is peaking its head above the covers, and Summer is just around the corner!

Beside the breast augmentation special we have going this spring...we always have great deals on liposuction!  Check it out by hitting the lipo button.  Remember that Cosmetic Consultations are complimentary, so what have you got to lose???  Call 918-786-7780 TODAY.  Financing also available.

Tired of hearing about the breast???  This week I want to talk about the less than perfect breast that some women develop.  I know many of you women are tired of hearing about the perfect breast that is just a little small and can be made better by implants.  What about the breast, due to genetics, or abnormal development, cannot be helped by implants alone??  Let's talk about that today to give you a break!  However, I don't want you to forget about our breast enhancement special...it only lasts until April 30 so you have to act quickly.  Click the button below to get the details!!

Let's see how the breast develops normally, then we'll have a better appreciation for how these deformities can occur.  Then we will cover how we fix them to make the breast look more normal.  The normal breast is stimulated to form by female hormones that begin production at menarche or the start of menstruation. The picture below shows the normal progression of the breast as it grows from a bud that men AND women have.  Again, it is the female hormonal soup that causes them to form.

Of course it is very rare for both breast to form exactly the same.  Perfect symmetry in the body is rare, so each breast is different, even in the same person.  This is why some women have difficulty finding a properly fitting bra.  There may be a half cup difference between sides.....this is not abnormal....just aggravating!  Here is a picture of different breast shapes and sizes.  This does not include all types of course, but it gives you an idea of how many variations of normal there are and also includes some of the abnormal breast shapes.

 (the "perfect" breast shape is a misnomer of course)

As you can see from the first picture, the breast bud starts first and develops concentrically, widening to form the breast mound.  If this concentric expansion is retarded, the breast forms as a tube, making the very constricted and abnormal looking.  The function of the breast is also retarded and in most cases, breast feeding later in life is not possible.

 This picture is a depiction of tubular breasts of different severities.  It is the mound of the breast that is constricted and does not spread out, therefore, the tubular shape of the breast. 

The other feature of the tubular breast deformity is a herniation of the nipple.  Normally, as the nipple and areola develop, they are "puffy".  The nipple is puffy until the breast mound spreads out.  As this happens, the nipple-areolar complex flattens to create the more "normal" appearing breast as a whole.

 Herniated "puffy" nipple.

So now that we know what a tubular breast deformity is.....what can be done about it?  To fix this problem properly, we must address several issues.  First, is the nipple herniation.  Fortunately, fixing the nipple also gives us access to the rest of the problem and allows the entire fix to be done through one incision.  We use the peri-areolar incision to make the nipple smaller and to allow access to the tubular, constricted, breast tissue below.

 This incision allows us to reduce the nipple size and when closed it flattens the nipple and areola into a more normal appearance.  The constricted breast is broken up below so that it is no longer in a tube shape and lays flatter. 

The last step is augmentation.  Since the breast only formed centrally, there is generally very little volume.  This can only be corrected by adding volume with an implant.  We place the implant below the muscle and through the same incision.  Saline implants or silicone implants are used as there is no difference in the result...again...it is personal preference.

The results are generally very good.  It does take some time for the skin to stretch and accomidate the new volume.  There also may be some creasing of the skin, usually the lower part of the breast, due to its tight adherence to the chest wall, that may take some time to stretch.  This skin may never stretch fully.  The goal is to get as near a normal appearing breast as possible.  This is not always achievable but any improvement is usually greatly appreciated.  The incisions heal nicely and the recovery time is about that of a breast augmentation.

 Good representation of tubular breast deformity repair.

Come see us today for all of your Cosmetic surgery, Vein surgery, Obesity surgery, and General surgery needs.  All Cosmetic Surgery Consults are complimentary, call 918-786-7780 or call toll free 1-877-weight0.  Be sure to take advantage of our breast augmentation special through April 30!!!!!

Boobs and Boats!!  Crass?  Shocking?  Well, it's not meant to be, but I sure got your attention, didn't I?  Here in Grove, we are welcoming the Bass Masters Classic this week, essentially the Super Bowl of fishing. With that, we are also having our annual boat show in town.  To many, boats means the lake, and the lake means sun and fun. 

 Summer fun!!

It seems that even though there was snow last week, Memorial Day is just around the corner.  Boats mean swimwear, sun tan lotion, strapless dresses and other summer wear.  This is the time many women think about breast enhancement.  That leads me to discuss our focus for the next 2 months: breast augmentation, AKA boob jobs.  Why are we focusing on this, you might ask??  If you didn't know, spring time is our breast enhancement special time.  Of course we are pretty affordable year round but in the spring, we pull out all the stops and try to make breast enhancement as affordable as possible. Hit the button below to get the details....

With a summer spirit in my mind, if you are considering breast enhancement, here are some things to think about. There are generally three categories women want to fall into after augmentation: 1) One that only the woman and her significant other notice. A very small change.  In this situation the desire is only improved shape and not necessarily size. 2) The second type is one where a difference is noticable but not over the top, enough to turn a few heads.  Essentially, enough to fill out a bathing suit, accentuate a nice summer top, or just make shirts fit better.  3) The third type is one that stops traffic.  Typically uncommon, we certainly try to  accomodate all wishes.  The bottom line, we want YOU to pick the size and shape that you feel most comfortable with.  Sure, we'll make suggestions, but ultimately, it is your body.  

The process is fairly straightforward.  After discussing with you what it is you are looking for, we will have you use a sizing bra, and place actual implants within it.  Bring your favorite top to try on over this bra if you like.  Take as much time as you need.  Once a size is found, we then discuss what incisions you'd prefer.  There are four types: through the nipple, through the armpit, through the bellybutton, and underneath the breast.  The nipple or peri areolar incision is not something that we recommend, as the scar is visible plainly when viewing the breast from the front.  Making the incision through the armpit hides the scar, but it can be a bit more painful than the other types on incisions.

 transaxillary incision

Placing the implant through the bellybutton has really fallen out of favor because the higher likelihood of abnormal implant placement, and the fact that silicone implants cannot be placed this way.  The incision made underneath the breast is well hidden, and the least painful.

  inframammary incision

We like placement through incisions under the breast or through the armpit but we can place them through any approach.  If an implant ever needs to be replaced in the future, it is always done through an incision at the bottom of the breast. Next, we discuss placing the implants above or below the pectoralis muscle.  When possible we like to place them below the pectoralis muscle.  It gives the implant more support, and looks more natural.  The best way to think about it is like a natural bra.  Placing the implant above the muscle has less support, and gives more of a "stuck on" appearance.  We place implants above the muscle when a breast is borderline needing a lift. Next, our consultation will turn to the type of implants.  We offer two types: saline and silicone.  Both have their positives and negatives which we will discuss with you at your consult.  It really boils down to personal choice.  The saline implants are a little bit cheaper in price than the silicone.  The feel of the two types is distinctly different. The saline feels a bit more like a water balloon, which is essentially what it is.  It's a bag filled with salt water.  The silicone feels a bit more like actual breast tissue. 

http://youtu.be/kceaEMmi7pA (video showing the inside of a silicone breast implant)

The leak rate of saline implants are a little higher than the silicone implants- there is a 2% chance per year collective risk of having a leaking implant.  That means, at 2% a year, over 50 years, there would be a 100% chance that your saline implant would leak (50 yrs x 2%= 100%).  If a saline implant leaks, it is obvious.  It's a bit like having a flat tire on your car.  The saline that leaks out is easily absorbed by the body (55-60% of the body consists of saline already!). 

 http://youtu.be/ILWdCJNSTeI (here is a discussion about silicone implants)

If you wake up with a deflated saline implant, you call us, and within a very short period of time, it is replaced and you are back to normal.  If the implant leaks due to a defect, it is replaced under a warranty.  Silicone leaks can be a bit more difficult to diagnose. Wrinkling or rippling that can be seen on the sides of the breast has a higher incidence with saline implants.  What do I mean by rippling? 

 breast implant rippling

Have you ever been to the beach or swimming pool and seen a woman lean over, and the sides of her breasts have ripples in them?  That is from the native breast tissue thinning out, and the ability to see more of the actual implant.  This problem is a little more common with saline implants but can occur with either type.  It occurs more frequently in very thin patients with low body fat and large implants. 

We will be talking about implants for the next few weeks so stay tuned.  Remember that if you are coming from out of town you can email us through the contact form and we can do a great deal of the work, getting you ready here.  You come to the office close to the day of your surgery and it saves you time.  Remember this special only lasts until April 30 so you must act now!!  Call 918-786-7780 today to reserve YOUR time!!

It's VERY close to spring (thank God) and summer is right around the corner.  I wanted to blog today about something very special.  If you have ever considered breast enhancement surgery, you MUST pay attention.  Dr Miller and I have a special offer for you and it is limited, so you will need to act quickly if you want to take advantage of it.  Click on the button below to see the offer, then continue.

Breast enhancement is a very personal choice.  Many women, who are not well endowed, have breast augmentation, in the back of their mind, but due to life in general, or cost, they put it off.  Our goal is to remove the cost issue.  If you can get around the "life in general" part, we can help with the rest.

Here is the thing about the cost....in many cases, when you get a quote for an augmentation, they neglect to inform you of the facility fee, anesthesia fee, and in some cases, the cost of the implant.  Our quotes have no hidden fees, it is all out there so you know what you are going to spend.

Here is what you get.  First, you set up your appointment, you can request either Dr Miller or Dr Swetnam.  (If you are healthy and live further away, much of the preparation can be done by email. Just send an email and we can talk there) The consult is complimentary of course.  We talk about what you want, size, implant selection, saline vs. silicone, etc.  The consult will take about 30-40 minutes.  We want you to bring shirts that you want to fill out and when you try on implants, you will have an idea of what you will look like.  We will also discuss the approach (how the implants will be placed).  Of course the size and approach are personal choices but we will help guide you.  Lastly, we will review before and after pictures so you can see our work. We don't play the "trust me" game where you are not involved in the selection process.  You will then get a quote that includes everything.  The fees we charge include the facility fee, professional fee, anesthesia, and implants.  The only other fees will be for the post operative bra, post operative medications which are generally less than $100.

We then pick your surgery day.  You show up, the procedure is performed...takes less than an hour.  With recovery and pre op, about 3-4 hours total time.  When you wake up you will have your post op bra on and you will wear it for about a week.  Of course you can take breaks from the bra, shower, walk around, do most of your normal activity, within limits.  We like to see you soon after the procedure, within the first week (if far away, we have you send some pictures by email) to make sure everything is OK.  We then usually see you at a month and at about 3 months to get pictures for YOUR before and afters.  We will email them to you if you like.  The post operative visits are also included in the fee.

So there you have it.  At Total Body Surgical we are trying to remove the barriers.  All of us worry about cost these days (except Washington..ha) and we understand that.  This is a rock bottom offer that you will find hard to beat so take advantage.  There is only so much operating time between now and April 30 so make sure you get yours!

Call 918-786-7780 TODAY to book YOUR time for YOUR enhancement.  Don't live with regret, this offer may not happen again 918-786-7780, CALL TODAY!!

This is a great article that was written for a magazine in NW Arkansas.  I also wanted to mention our 2013 spring time special on Breast enhancement.  You must act now though as it is on only until April 30.  Click on the button below to see the great pricing!!

Green Country Bariatrics: There IS a Light at the End of the Tunnel!

By Nathan G. Miller, M.D., board-certified general surgeon, fellowship trained bariatric surgeon and cosmetic surgeon

“Please help me. I’ve tried every diet out there, I exercise, I can’t get rid of my weight, and it’s literally killing me.” These are the words I hear all too often from my patients. You see, obesity has become a problem in the United States, and it’s not going away – not even close.

I often see patients at their wits’ ends. They have tried everything to lose weight, and nothing works. Rest assured, there IS light at the end of the tunnel! The surgical solutions of today are unparalleled to those of the past. The complications and problems of old have been minimized, and weight loss is now maximized. And in addition to pounds lost, many patients see up to an 85% resolution rate of their diabetes issues and 50% resolution of high blood pressure problems. Several are able to get off medications altogether.

At Green Country Bariatrics, we work very closely with another fellowship-trained bariatric surgeon in the region, Dr. Josh Roller. We consult frequently about patient care and our areas of expertise. I specialize in sleeve gastrectomy and lap band, whereas Dr. Roller concentrates on gastric bypass.

What is possible?

Lap Band - A fully adjustable collar that is placed around the top of your stomach, the lap band causes you to eat less and feel fuller, faster. It is nonpermanent, and is typically done on an outpatient basis. Patients return to our clinic to tighten or loosen the band as needed, depending on weight loss and hunger. With this technique, we often see a 50 percent maximum excess weight loss, meaning, if the patient was carrying an extra 100 pounds, he or she would typically lose nearly 50. Most patients are able to return to work within a week. 

Gastric Sleeve - The gastric sleeve is an operation where 80 percent of the stomach is removed, including the hormone center for hunger. In addition, this surgery also removes the part of the stomach where food is stored, sometimes referred to as the reservoir. While this is a permanent procedure, the patient’s anatomy is not rearranged as it is in the gastric bypass or mini gastric bypass. With this technique, we often see a 70 to 80 percent excess weight loss, meaning, if the patient was carrying an 100 extra pounds, he or she would typically lose around 80. Normally, this procedure requires one to two nights in the hospital. It is less associated with malnutrition, dumping syndrome, ulcers, and internal hernias than other bariatric procedures, and it is usually performed through six tiny holes in the abdomen. Return to work is often within two weeks, and many insurance companies now cover this procedure (including Medicare).

Gastric Bypass - This is an operation that removes a significant amount of native  stomach.  Typically, it also bypasses anywhere from 90-120 cm of the native small bowel. This causes the body to absorb fewer calories and fats. It is a permanent procedure wherein the patient often loses 80% of his or her excess weight. Many times, this is a prime procedure for brittle diabetics, or those with diabetes requiring insulin for more than five years. It is also an excellent procedure for those with extensive reflux problems and a related need for weight loss.

What happens after the weight loss?  Let’s pretend we have a 10-pound sack of potatoes.  Now, let’s also imagine that we’ve taken 9 pounds out of that sack. There’s quite a bit of sack left over, right? Such is the case with weight loss. Skin has only a certain amount of elasticity. Age, yo-yo dieting and childbearing all work to degrade that elastic property. For many on a weight loss journey, removal of excess skin is often the final destination. Men and women alike often opt for tummy tucks, and also add arm lifts, neck lifts, breast lifts or thigh lifts. Essentially, these procedures are the polishing step in the complete rejuvenation of the patient. 

Tummy Tuck - A tummy tuck is performed through an incision in the lower abdomen a few centimeters above the pubic region. The incision goes from hip bone to hip bone and also around the stalk of the belly button. The skin is raised off of the underlying connective tissue and muscle up to the ribs. Next, the loose muscle and underlying connective tissue is tightened to make the abdomen flat. The skin is then pulled down and the excess is removed. A new opening for the belly button is created. The smooth, firm skin from above the belly button is pulled down, and stretch-marked tissue and scars are removed. The result? Voila: a flat abdomen.

  Typical loose skin after weight loss surgery.

Arm Lift - An arm lift, or brachioplasty, reduces excess skin and fat between the underarm and the elbow, reshapes your arm to result in smoother skin and contours, and results in a more toned and proportioned appearance.

Sagging arm skin after weight loss.

Breast Lift - A breast lift, or mastopexy, raises the nipples and firms the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour. Implants can also be placed to fill out the deflated breast.

Loss of breast volume after weight loss.

At Green Country Bariatrics and Total Body Surgical Cosmetic Surgery, our cosmetic consultations are always complimentary. If you’ve been considering these options, call us today for an appointment at 918-786-7780.  For more information, we welcome you to visit our websites and “like” us on Facebook!  Be sure to check the breast special!!!

www.greencountrybariatrics.com

www.totalbodysurgical.net