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!!

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!!!!!

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

Is it possible to have a lift and augmentation at the same time?  This is a question I am asked all the time.  There are many cosmetic surgeons that feel a simultaneous procedure is not possible.  Others feel it is not safe and should not be done.  In the recent issue of Cosmetic Surgery Times, the lead article and most of the discussion was centered on this question.  In my opinion, there are very few instances when they cannot be done together. 

Why would you not want to do them both at the same time?  Good question!  The reason is multi-faceted.  First, the lift.  When we do a lift or reduction we are doing a number of things to the breast.  We are, most importantly, repositioning the nipple to a more youthful and appropriate position.  As the breast ages and is used for nursing, it looses its support and begins to sag.  The nipple falls below the fold under the breast and the upper part of the chest takes on the shape of a ski slope. We can lift the breast in this instance but it will not make the upper part of the chest full.  Once the nipple has been repositioned into a more appropriate spot, we have all the skin left below it.  This skin must be removed and the skin envelope tightened.  We now have a breast that is much perkier with a nipple position that is elevated. As you can see, there is a great improvement in shape and nipple position.  However, from this 45 degree view, the upper aspect of the breast is very sloped.  Many women don't mind this and that is fine but if upper breast fullness is desired an augmentation is required with an implant.  That's where the problem comes in.  The second problem is this; now that we have a tighter breast skin envelope we are now going to place an implant that will stretch what we have now tightened.  This can easily be done and since we have lifted the nipple we put the implant below the muscle.  What this does is fill in the upper pole of the breast and helps you regain that youthful breast that was lost.As you can see from the picture, on the lateral view and 45 degree view the upper pole is now full with good cleavage...nice result.

The third problem...do it twice and make it as identical as possible!!

That is why doing a combined lift with augmentation is challenging to many Cosmetic Surgeons.  At Total Body Surgical we do them daily with great results.  This procedure can make a tremendous change in how you look in clothes and out of them.  Come see us today for a complimentary consultation...call 918-786-7780.  Don't forget our other procedures that we have special pricing on...liposuction, breast augmentation, laser hair removal and many others.

Like us and be our friend on facebook too....please!!

Do I need a lift?? Todays blog is in response to a question I was asked on Facebook.  This is a question I hear almost daily.  It's a question many women are scared to ask.  The four most common cosmetic breast procedures are:

1.  Augmentation.

2.  Breast reduction.

3.  Breast lift.

4.  Breast lift with Augmentation.

So how do you decide what you need??  First, reduction.  Breast reductions are done cosmetically for women who have breasts that are too large for their frame.  They are so big that they interfere with life in general.  Clothing doesn't fit, bras are difficult to find, they can be embarassing.  They become a medical issue when neck pain, back pain, rashes, strap marks, etc. start to occur.  This is when insurances start to kick in and may cover the procedure.  They usually require certain criteria to be met and a certain volume must be removed for them to pay.  A reduction is done to reduce volume and make the breast smaller.  A lift is done to reposition the nipple.

Lift vs. augmentation vs. lift and augmentation.

The choice of procedure is at times a judgement call and also depends on what the patient is looking for.  It all depends on the position of the nipple relative to the infra-mammary fold. (the fold below the breast where the breast stops and the chest wall begins)  If the nipple is well below this fold then a lift will usually be necessary.  If this breast is augmented, the nipple will still hang and the "Snoopy Nose" breast occurs, nice implant with a drooping breast over it.  The nipple must be raised and centered either in the breast or placed where it will be in the center of the implant.  If the nipple is above the infra-mammary fold then usually only an augmentation is done.  When the nipple is at the fold is when good judgement and figuring out what the patient is after, managing expectations, and all the other unmeasureables come into play.  For a lift, you will have scars.  They usually heal very well and after a little time are fairly inconspicuous, but they are there.(nipple above the fold-augmentation)

If a lift alone is done, the upper pole of the breast has a slope to it and may lack fullness.  Many women don't like that look and for them, an implant gives the breast a fullness that recreates the youthfull breast.

Notice the lateral view where the upper pole is sloped after a lift/reduction only.

Notice the fullness in the upper pole after a lift and augmentation.

I hope this helps clear some things up about what procedure is right for you if one is desired.  If you have a question, facebook me and I will address it.  Next week I will discuss liposuction.  Don't forget to check out our specials!!