Total Body Surgical Blog

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!!

What's the point???  Well, there are several.  This week I would like to summarize the past several weeks.  As obesity becomes a growing world wide problem, obesity surgery is becoming a common thing.  The common procedures are the Lap Band, the gastric sleeve, and the Roux en Y bypass.  They all have their place in the treatment of obesity.  As the procedures and massive weight loss occur, the desire and need for body contouring increase.  If you did not see the previous installments, go check them out to see what procedures are most common and in greater detail.  This installment will cover some of the high points of more detailed discussions of weeks past.

1.  Your weight should be stable for a minimum of 12 months.  Lose the weight, get where you want to be and stay there for at least 12 months before having surgery.  Doing it this way gives better results and leads to fewer repeats.

2.  You must be healthy.  Cosmetic surgery is not "minor" surgery.  People can have complications and even death from this type of surgery.  Make sure you have a healthy heart, lungs, kidneys, and that diabetes and hypertension are controlled prior to your surgery.

3.  You cannot have it all done at once.  These surgeries can be very taxing on the surgeon and you.  Sit down and figure out, in order, what bothers you the most.  Then discuss with your surgeon a strategy to attack the areas in a planned way that makes sense and is safe.  Sometimes procedures can be combined but don't get in too big of a hurry, be safe.

4.  Know what is available.  The most common procedures I see, in order, are:

-Tummy tuck

-Breast lift

-Arm reduction

-Butt lift

-Face lift

-Thigh lift

-Back lift

5.  Seek out a safe and well trained professional....nuff said.

Hope this helps.  New topic next week.  If there is anything you would like to hear about, drop me a line, jeffswetnam@yahoo.com and I will try to address it.

Thanks for tuning in and don't miss our specials.  New ones coming for the fall to so keep looking here.

For the last installment on massive weight loss, we will look at the face. Massive weight gain can cause unrecognizable changes in the face.  The neck, cheeks, and chin become stretched with fatty deposits and cause skin changes that may be permanent even after weight loss.

For the lucky few, facial skin will shrink back to its near normal state.  In these cases, nothing is needed.  For the most part, however, what we see is skin that sags in the neck area and jowl formation in the lower face.  Wrinkles may also appear in the cheek area and in the mid face we see volume loss that creates that "tired" look.  In people that lose massive amounts of weight, these changes can occur regardless of age.  When weight loss patients present, they usually have numerous areas of concern and I try to help them prioritize because we cannot do all procedures at once.  Some want their face fixed first, some don't, again, it is a matter of priority.

The only way to gain long term results in recovering a youthful face are lifting procedures.  We devide the face into three main areas. 1. The lower face and neck. 2. The mid face. 3. The brow.  A fourth area would be the eyelid that I will talk about in a later blog.  

The lower face and neck lift.  This procedure addresses the excess neck skin, jowling, and wrinkling in the cheek area.  Sagging skin in these areas can be very pronounced after massive weight loss.  Incisions for this procedure are placed around the ear   and a small incision under the chin.  The arrows show the direction of pull on the skin and the underlying muscle.  If the neck is not lax, a mini face lift (s-lift, lifestyle lift, day lift, etc.) can be done which shortens the incision to the front of the ear and only partially up the back of the ear.

The brow, when sagging, can cause visual problems and most notably can cause wrinkling in the forehead because of continuous muscle contraction as your brain lifts the brow.  For the most part, I use the endoscopic approach to lifting the brow.  This is done through small incisions in the hair that are essentially invisible.  The brow is lifted and anchored.  After doing this procedure, the forehead becomes smooth and the hooding over the eye is gone.

The face lift and brow lift can be done simultaneously if desired.

For the mid face, the problem is usually loss of volume and a hollow appearance develops.  I feel the best way to remedy this problem is by replacing this volume.  This can be done in several ways.  The shortest lasting way to do this is with a filler product.  The volume is placed over the cheek area.  The second best product is fat.  The fat is harvested from the hip or abdominal area and transplanted back into the face rejuvenating the mid face.  The longest lasting way is with implants.  These are solid silicone, pre-formed devices that replace the lost volume in the area.

These three procedures are the ones most commonly used to treat and rejuvenate the face after weight loss.  Not everyone fits the usual mode however, and consultation to figure out the best treatment for you is essential.  Come see us at INTEGRIS Total Body Surgical for a complimentary cosmetic consultation.

Don't forget our breast and lap band specials that are still going on. Act now to take advantage of great savings!! 

I will continue to discuss procedures that are common after weight loss surgery.  The most common is the tummy tuck which was discussed in previous blogs and breasts are probably the second most common area addressed in women. 

The reason breast take such a beating after significant weight loss is that breasts are about 80% fat to begin with.  It follows that when women lose a large amount of weight, what is lost is fat and muscle.  The skin of the breast is "deflated" and what actual breast tissue remains hangs in the deflated skin....Rocks in Socks.

The objective when reconstructing the breast is to reposition the nipple and areola and if desired, refill the breast envelope.  There are options when rebuilding the breast.  One option is to lift the nipple and remove excess skin only.  This choice is certainly acceptable but does not give the fullness in the upper breast many want.  To get this, an implant must be used.  The incisions for reconstruction of this type vary based on the distance the nipple must be moved above the lower fold of the breast.  Usually the incision is an anchor type incision, around the nipple, a vertical and a horizontal incision below.  The nipple is not removed, just moved on a pedicle into its new position.  Breast skin and tissue is removed to reshape the breast.  An implant adds fullness to the upper aspect of the breast.  The implant can be placed at the same time.

Come see us at Total Body Surgical and take advantage of the specials above!!

Choosing Breast implants 2.0....

Very funny huh!! Problem is, most women stress about how to pick implants. There are many questions that must be answered before making a life altering decision. Questions that you should ask are:

1. Saline or silicone, what are the risks and benefits?

2. Approach, how should I have the implants placed?

3. Size and how they will look IN me?

4. Price, how much can I afford?

5. Recovery, how long will it take?

6. Implant warranties....what are they?

7. Should I place the implants above or below the muscle?

8. Do I need a Breast lift? 

At Total Body Surgical we have a check list that we cover with every patient to cover all of these questions and more. I will answer the questions in a short fashion here but you should ask your Doctor as his or her opinions may differ.

1. Saline or Silicone....I like them both. Some women prefer the feel of silicone as they think they look and feel "more Natural". Some women have a fear of silicone. I let them feel both, explain the cost difference and let them decide. I cover what I have discussed in previous blogs about the implants.

2. Approach.....we do them all. Silicone can be placed around the nipple, under the breast, through the arm pit. Saline can be placed through all of these approaches and through the belly button as well. I prefer the arm pit as I can use creases in the skin that heal well and are concealed leaving no scar on the breast. I let you decide however.

3. Size. As explained before, we let you help choose. I will give you a range based on the size of your chest and let you try them on. My bias is this...if a Doctor tells you he will decide based on experience what looks best for you....don't walk....run from his office. This is an important decision that you should be involved in. You try on clothes don't you????

4. Price. Saline implants are usually about $1000 cheaper than saline. This is because they are more expensive to make, and carry more liability for the manufacturer. In my office, it is up to you to choose. I explain the benefits of each and you try them on. Unless you want a high profile implant, you decide based on look and feel. High profile implants are a bit different as I feel that the silicone have a far superior look.

5. Recovery. Recovery is usually a few days. I like for you to be careful lifting or raising your arms for around 2 weeks but pain is minimal after the first 3 days if you have any at all. The implants will find their home after about 1-3 months if under the muscle and shorter if above.

6.  Implant warranties, what about them?  Both of the major manufacturers will cover the cost of the implant if there is a mechanical failure due to a manufacturers defect.  This does not pay for the surgery to replace them.  They both do have a very inexpensive insurance policy that will cover this cost for 10 years.  The implants are also covered for 10 years.

7. Above or below the muscle. I usually put them below the muscle. I put them below with saline, always to avoid seeing the implant or ripples in the implant. I put silicone above the muscle in women with a slight bit of droop of the nipple.

8. Do I need a lift?? The answer to that question is complicated. Usually if you look at the fold under the breast where it attaches to the chest wall and the nipple is above this fold, you probably won't need a lift, if below, you may. However, there are other factors involved that you will need to consult your physician about.

These are the most commonly asked questions.  Hope this helps.  Breast augmentation is a very personal event.  You should have a big say in how it is done.  One of the biggest problems I see is when a girl comes in with a centerfold picture and her body is very different.  This is an expectation that cannot be fulfilled.  BE REALISTIC!! 

Come see me at INTEGRIS Total Body Surgical.  Our spring introductory offer is:

Call 918-786-7780 now for and appointment.