Total Body Surgical Blog

As surgeons that wear many different hats during the week (Cosmetic Surgery, Reconstructive Surgery, Bariatric Surgery, and General Surgery), Dr. Swetnam and I are faced with constant challenges; and it is a significant challenge to keep everyone satisfied.  As one of my favorite subjects, today I'll discuss post weight loss cosmetic surgery.

Typically, bariatric surgery patients first and foremost have decided to take the plunge in changing their lives.   I heard it best this week from a patient who told me, "Dr. Miller, I am sick and tired of being sick and tired." It's a lifetime of habits that they must break: the way they eat, the way they exercise, even just the way they think. The positive repercussions of weight loss are legion.  It truly is an entire lifestyle change.  It is amazing for me to see how one positive change by a bariatric patient effects those around them.  I recently saw a patient that was 12 weeks out from a sleeve gastrectomy.

To both of our satisfaction, he had already lost 70 pounds.  On top of that, his wife had also lost 30 pounds just by following the same diet that I'd ask him to impart postoperatively.  The little cherry on top of all this icing post surgery was that their daughter had also decided to begin to make healthy food choices, resulting in weight loss as well.  It's amazing how one positive decision begets another positive decision.  Unfortunately, one of the few anticipated post weight loss "problems" (besides having to purchase a new "skinny" wardrobe), is what to do with all the extra skin that sometimes results from losing excess weight...? The thing is, not everyone ends up with excess skin.  Really, it depends on multiple factors: the patient's age (no, I didn't just call you old); how many children a patient may have had; excess roller coaster weight loss and gain over the year; and the personal skin elasticity of a patient.  The latter really making the majority of the difference.  Quite honestly, it really comes down to how you picked your parents when it comes to skin elasticity.  Genetics is key to just about everything under the sun, and skin elasticity certainly falls into that category.  So why does this matter? Think of it this way: if you have a 10 pound sack of potatoes and take out 9 pounds of those potatoes, you've got a lot of sack left over, right?  Sometimes this sack shrinks down, and other times it does not.  Again, all as a result (or lack thereof) of the degree of skin elasticity someone may or may not have.   I am often asked if exercise will help to tighten up the skin. Unfortunately, I can assure you that all the situps and jogging in the world will not help that excess skin to shrink.  So, what is the answer then?  What do I do now that I've lost this weight and my skin gets rashes between the folds?  And sure, I've lost a significant amount of weight, but my clothes still don't fit right lugging this extra skin around!  This is where the post weight loss recontouring comes into play. 

     Though not every post weight loss patient needs them, there are multiple  body contouring options for those that do post weight loss: tummy tucks, liposuction, arm lifts, breast lifts, thigh lifts, and body lifts. Typically, one or a combination of these procedures have been successfully used after weight loss surgery to refine patients’ bodies, and help them enjoy everyday activities as they envisioned at the beginning of their journey.  The most common procedure that Dr. swetnam and I do is the tummy tuck.  Essentially, that entails not just removing the excess skin present, but also tightening up the actual abdominal muscles.  We basically create an internal corset that results in a waist that many people had not seen for many, many years.  Following the tummy tuck, I would say that breast lifts are our next most common procedure post weight loss.  It's amazing to see how people's attitudes change as they continue along their weight loss journey.  Specifically, people who had become shy wall flowers virtually become alive again. Their inner personality that had been stifled for so long is reawakened.  No longer just satisfied to wear bulky sweaters and oversized tshirts to hide their insecurities, they sometimes pursue breast lifts.  Breasts that were once being tucked into their front pockets are now perky and full on the top of their chest- right where they should be.  Following breast lifts, arm lifts (sometimes termed brachioplasty in doctor-ese) would be the next most common procedure that Dr. swetnam and I perform.  It is essentially just removing extra skin and remaining fat to create a nicely contoured arm again.  Thigh lifts are much like arm lifts, except just a bit further south.  I would say that thighs are the most challenging to operate on, as God didn't create us in anticipation of having incisions in our groins (location required to lift up those thighs again).  I should mention here that the great thing about having two fellowship trained cosmetic surgeons together in a group means that more procedures can be done at the same time.  Why does that make any difference? First and foremeost, the operative time is more than halved.  This is not just better for the patient's health, but also is more cost friendly for the patient in the long run. 

     So when should a post weight loss patient consider having body contouring procedures done?  Typically, I suggest that a patient be within 80% of their weight loss goal.  Typically, this is at sometime between 12 and 18 months.  As I said, body contouring is not something that is essential from a health perspective, but rather as the end result of a long journey.  It's basically seeing the final end point result come to fruition.  It has been said more than once that we are flattered to be a part of this whole process, both as the wearing the weight loss surgeon's hat, as well as that of  the body recontouring surgeon's.  We literally know our patients inside and out!   

Come see us today for your complimentary Cosmetic consultation!!  918-786-7780 or 1-877-weight-0. 

Re-do what?  I have lots of patients that ask about how long a cosmetic procedure will hold up or "last".  I think that is a fair question in most instances.

First, the face.  When people ask me the question before a facial procedure, the analogy I like to use is daylight savings time.  When you have a facial procedure, basically, we are resetting the clock on your appearance.  You will continue to age, just like time continues to tick away in daylight savings time.  In other words, the change is permanent, but aging continues to change your appearance.  The procedure most often repeated is eyelid surgery.  Eyelids move constantly, the skin is very thin, and the eyelid skin is exposed to a great deal of sun.  The nature of the skin is to stretch and when used a great deal, it will stretch more.  Upper and lower eyelid surgery, the second time, is usually less traumatic than the first time because the fatty tissue has already been removed.  That means that only the skin is removed in the second procedure.  The second procedure most often repeated is the facelift.  Again, after the first procedure, as we continue to mature, the skin continues to stretch and the floppy neck or jowel may return after 15-20 years.  A second face lift is easier because of scar tissue that forms gives us more tissue to work with so sutures hold better and dissection is less involved.  The procedure that holds up the best is the endoscopic brow lift.  Since the low brow is usually heredity related, once the brow is lifted it tends to stay put.

Second to discuss are body procedures.  Tummy tucks seldom need re-doing unless you have severe changes in weight or have a pregnancy after the initial procedure.  That is why we encourage women to be done reproducing before considering a tummy tuck.

The same is true of most other body procedures, thigh or butt lifts, arm reductions, etc.  Liposuction is seldom repeated in the same area except for touch-up prodedures since most of the fat cells in that area have been removed.  Of course, if you do gain weight, it will appear in other areas and the repeat procedure will be in that area instead of the old site.  In other words, if you have your abdomen done then gain 20 pounds, you may notice that your arms or thighs are where the weight is going.  The reason is, the fat cells that used to store fat in the abdominal wall are gone or greatly diminished in number and fat can no longer be stored there...it must go somewhere else.

The third is the breast.  This is a whole other animal sorry to say.  The breast is somewhat unpredictable.  For breast augmentations, they look great in younger women and generally hold up well with two caveats....pregnancy and weight changes.  Most women look fantastic with their breast implants... until pregnancy.  Then, in some, the wheels come off.  The breast inlarges during and after pregnancy, breast feeding occurs, and for some, the process repeats itself over and over.  After several pregnancies and several years the breasts start looking sad.

They droop over the implants or sometimes take the implants with them.  In these cases, the only solution (after a tubal or vasectomy) is a breast lift, removing the old implants, and deciding whether to replace the implants or not.  The only way to get fullness in the upper part of the breast in this situation is with an implant so it just depends on the final outcome you are looking for.  Of course implants can always be placed later.

Hope this helps answer your questions and don't forget all of the special pricing we have going on with hair removal, tummy tuck, and weight loss surgeries!!

Call for complimentary cosmetic consultation 918-786-7780 or 1-877-weight-0.  We can't wait to hear from you!

A good friend asked me to talk about fillers this week and I promised I would, so here goes.

First of all, what is a filler and why would someone want to use one??  Fillers are just what the name sounds like.  As we age, we lose volume in our face.  We lose it around the eyes, in the cheek area, and in the folds around the mouth and lips.  This is caused by hormonal changes and in many cases, genetics plays a significant role.

  As you can see in this graffic, as volume is lost, the skin begins to respond to gravity and "folds" in typical spots start to form.  Nasolabial folds are the most common, forming around the base of the nose to the corners of the mouth.  Secondly, "bags" begin to form under the eyes.  This is due to shrinkage of the fat pads in the cheek area that, in younger people, "windowshade" the fat pad under the eye.  This creates the dark circle under the eye which is really shadowing, as light is blocked by the overhanging fat pad.  The other commonly effected areas are the "marionette lines" at the lower corners of the mouth and vertical lip lines.  One other common complaint is thinning of the lips and loss of the youthful shape of the lip.

This picture depicts the "cone of youth" and how aging turns it into a box.  Again, most of this is due to loss of volume and loss of skin elasticity.

Now that we have covered what happens, what can be done about it?  There are a few ways we can correct or reverse the aging process.  The first thing I recommend is good skin care.  It wouldn't be right to fix up a vintage car and not re-paint the thing would it?  You want your skin to look as youthful as possible and I think Obagi is as good as it gets for that.

Second, we have to increase volume.  Even when we do face lifts to remove excess skin, most of us will add volume to fill up the upper part of the face...this is youthful.

The first and best way to increase volume is with facial implants.  They are solid silicone and never go away....one time and that's it.  The second best way is with fat grafting.  We use your fat, process it, and place it back in the face.  This is good because it can last a pretty long time...5-7 years.  The third way is with fillers.

Fillers have been around quite a long time.  First came collagen fillers that only lasted about 3-4 months and required skin testing.  We now have them that last a year or more and can be used in anyone.  The most commonly recognized one is Juvederm.  It is made of cross-linked Hyaluronic acid (HA).  HA is a substance that is present between our cells naturally.  Juvederm is clear and almost jelly like.

  It can be used literally anywhere in the face.  We use it to fill the cheek area, the nasolabial folds, marrionette lines, and lips.  It can also be used to correct nasal deformities or acne scars.  Think of it as putting dirt in a hole in your yard without disturbing the grass.  It is used to fill deformities or add volume to the cheek area, the nasolabial folds or marrionette lines.  It can be used to make lips larger or reshape them.    The second type of filler non-occuring in the body and made of a calcium compound mixed with a sugar based carrier.  This filler is good for volumizing but can only be used in deeper tissues. 

Radiesse is great for liquid face lifts where we place volume into the cheek area, lifting the face and restoring volume.  It can be used in nasolabial folds and carefully in marrionette lines.  It cannot be used in lips or in the dermis (skin).  Most other fillers on the market are made of HA, regardless of the name, except Artefill (made of collagen and spheres of solid material) and Sculptra (made of a powder material that causes collagen to form).  These two materials are made to inject deeply and last 5+ years.  All fillers have advantages and disadvantages.  You must consult with your injector to know which one is best to get the result you want.

My preferences are for Juvederm and Radiesse, for shorter term fillers.  I use silikon 1000 for my long term filler as it never goes away.  I use it to make great looking lips that stay.  I do small injections a month or so apart to get the right amount of correction.  Hope this helps everyone.  We love fillers and do them very well.  Call today and come see me at 918-786-7780.  All cosmetic consultations are complimentary.

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!!

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!!