Total Body Surgical Blog

LAST CALL for spring breast augmentation special pricing!!  It ends on the 30th at midnight.  You don't have to have your surgery before then, just get your quote that will be good for 60 days.  Hit this button to get all of the details.

This week, I wanted to address some of the more frequently asked questions about liposuction.  Most people have a number of questions and if you have one I don't cover, email me your question to jeffswetnam@yahoo.com and I will do my best to find an answer for you.

Liposuction, as covered last week, has really grown up over the past several years.  Used to be, lipo was done under general anesthesia, in a hospital, with significant blood loss, often requiring transfusion.  This all changed when the tumescent techniques were developed using lidocaine and epinephrine.  What this does is provide an anesthetic "block" to the area with the lidocaine (the same stuff used by the dentist to allow them to drill teeth) and limit blood loss with epinephrine as it causes constriction of blood vessels and slows the absorption of the lidocaine.  Once these techniques were perfected, liposuction pretty much moved to an office procedure.  With the addition of lasers, ultrasound, and other ancillary energy, we are now able to affect how the skin reacts to removing the underlying fatty tissue, i.e., we can make it contract and lose some of its sagginess.

Many questions remain.  One of the most often asked questions is "what happens if I gain weight after liposuction?"  To understand the answer to that question, you need to understand the reasoning behind the answer.  Theoretically, we are all born with a finite number of fat cells.  These cells increase or decrease in size as our weight goes up or down.  With liposuction, we remove a population of these cells in the area treated.  Therefore, if you gain weight, you cannot gain as much in the area treated, so, you will gain it in other places.  5-10 pounds probably will go unnoticed but 20 or 30, and you will have significant changes in other areas.  You may also notice lumpiness in the treated areas as the fat cells that are left (we cannot remove them all) will grow in size.

The second question often asked is will my skin shrink?  This is also a great question.  I look at the quality of the skin and evaluate it prior to recommending liposuction.  If the skin in the lower abdomen say, has numerous stretch marks, wrinkles and scars, then liposuction may not be the best choice as we are expecting poor quality skin to contract and smooth out. For the abdomen, in the person mentioned above, I would probably recommend a tummy tuck instead. Skin that has no stretch marks, no scars, and is good quality anyway will usually respond well.  We use the laser to promote the skin contracture and also to make the procedure less traumatic. 

The third question is usually, how much can I do at one time??  The answer to this question requires a multiple part answer.  First, how big are the areas?  We can do multiple small areas at one time.  Larger areas may have to be devided up.  Why??  Well, it depends on how much lidocaine we have to use, and, how much fat we are going to remove.  Of course, there are limits on the amount of lidocaine we can use based on a persons weight.  We also usually don't remove more than 4 liters of fat (two, 2 liter coke bottles full) at each setting as rates of complication increase exponentially when 4 liters is exceeded. I try to estimate how much fatty tissue will be removed from each area and make a plan accordingly. 

Well, that's enough for this week!  Again, if you have a question you would like addressed about liposuction, or anything else, email me and we'll do our best to address it.

Remember, Cosmetic consults are complimentary so call 918-786-7780 or 1-866-weight0 TODAY!!   

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!!

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!!

"Should I be scared of silicone implants?"  I hear that question quite a bit.  Nearly every consult I see for breast implants raises this question.  Here is the skinny, and a video that will show what the new implants are all about....opened up for all the world to see.  First of all....the video...

http://youtu.be/kceaEMmi7pA

Now that you've seen it, you know that the gel in these implants is very cohesive.  It wants to stay together.  The old silicone implants were filled with a more liquid silicone substance that would leach through the cover slowly.  This allowed it to enter the lymphatic system and after much legal hooplah, numerous conditions were blamed on this phenomenon.  The old implants were taken off of the market in about 1991 and the new ones were engineered and released for general use in 2006.

What is the advantage??  Some say they feel more natural. 
Some say they look more natural.  I have even heard they are "warmer" than saline. 

The fact is that they do ripple "wrinkle" less but can still do it.  They are a lower pressure implant and cannot be over filled, therefore, saline implants, when overfilled, can be made to look like implants.

Are they safe??  To date, there is no evidence to the contrary.  I think they are safe and look great.  Saline implants are also very safe and look great.  The choice is a personal one. When you come to Total Body Surgical, we will help you choose saline or silicone and choose size too.  I won't try to talk you into one or the other, just give you the facts and a range of size that is best for you.  Come see us today!!  Cosmetic consults are complimentary...918-786-7780