Tag Archives: breast implant

Buttocks plastic surgery update

Buttocks plastic surgery update

 

buttock shapes

I recently saw a classification for buttock shapes. It turns out there are pear, apple, mandarin and tomato buttock shapes.  Funny but no one told me that during my training. It also appears that the citrus fruit among these, mandarin, is the shape most aspire to: two round balls for buttocks. Buttocks plastic surgery keeps on evolving and its time for a buttocks plastic surgery update!

From a cosmetic plastic surgeon’s perspective, there are three types of buttocks plastic surgery that can be performed: patients want their buttocks larger, smaller or just lifted.

A.

Making buttocks bigger

The options for making buttocks larger are:

1. Silicone implants

In this outpatient cosmetic procedure, a 2-3 inch incision is made between the buttock cheeks and a solid silicone implant is placed under the buttock (gluteus) muscles.

  • Silicone implants used are different from ones used in breast augmentation and are firmer to touch
  • Implant have to be placed higher in buttocks, as you cannot sit on implants for fear of rupture; we all sit on the bone under our buttocks
  • Healing takes about 10 days and full recovery 1-2 months

2. Fat injections – Brazilian buttock lift

  •  Even though the Brazilian buttock lift has “lift” in its name, it’s a plastic surgery procedure that both enlarges and lifts buttocks
  • Liposuction of abdomen and hips is performed, and harvested fat is injected into buttocks
  • I typically inject about 800 cc into each buttock at one surgery for maximum effect
  • This is an outpatient cosmetic surgery requiring 3-4 days for recovery and 1 month for full healing
  • About 30% of  fat injections will naturally disappear, but some will remain permanently; everyone is different

B.

Making the buttocks smaller

There is really only one cosmetic procedure to make buttocks smaller, and that is liposuction. In this procedure, three to four small incisions are made around either cheek and fat is removed, leaving behind a smaller buttock. The cosmetic danger is in removing too much fat and turning a plump cheek into a flat and droopy one—not a good idea.

C.

Lifting the buttocks

There are two options for this cosmetic procedure, buttock lift surgery and, again, Brazilian buttock lift.

Buttock lift surgery

In this surgery, a scar is placed in a crease under the cheeks and the skin is turned in to give a modest lift.

The problem is that the plastic surgeon is trying to push and hold your skin and fat tissues in a high position against gravity’s force; given the weight of skin and fat, gravity wins. The scars are not great from this surgery, and I try hard not to perform it!

Brazilian buttock lift 
As above, fat injection will not only make a buttock larger but will also lift it, in the same way an empty bag is “lifted“ when full. With liposuction I can actually change the shape of the buttocks to to make them larger and lifted or smaller and lifted!

The concept to keep in mind with all these surgeries is that by changing the shape of the skin and fat around an area I can change the apparent shape of the area itself!

The update

I first wrote this blog in 2010. $ years later not much has changed other than…

I now perform a lot more Brazilian buttock lifts than before; it is a routine procedure now.

I do very few silicone implants these days

I have not done a simple lift with cutting of the skin in 4 years! – It is just not a good surgery.

We still do not know how come much fat cells survive in some areas and not in others as well!

Fat injections for breast enlargement

Fat Injections to Breasts

 

I have previously written about fat injections for breast enlargement but new information keeps on coming up and cosmetic plastic surgery patients continue to show interest in this plastic surgery procedure. here are photos from an article in the Aesthetic Surgery Journal of March 2014 by Drs. Spear and

 

Breast augmentation with fat injections  Breast augmentation with fat injections

Breast Enlargement with implants

The traditional methods of breast enlargement by either placement of saline or silicone breast implants under the chest muscles have been performed by board certified plastic surgeons since the late 1960 s.  Breast augmentation surgery has withstood the test of time. The surgery will produce consistent results and has a 98% satisfaction rate amongst patients.

Multiple variations of breast sizes and shapes are possible now that moderate profile implants, moderate -plus sized implants, and high profile implants are available from multiple breast implant manufacturers. These implants satisfy the needs of patients who typically are looking for at least a 2 cup size increase in their breasts.

Breast implants are foreign objects for the body and will form capsules of scar tissue around them which can become problematic at time. The implants can also break or rupture and in general need upkeep.

100% of patients will get a substantial improvement in breast size that is long lasting. Breast surgery with implants takes one hour.

Breast Enlargement wit Fat injections

In order not to have the problems that implants can sometimes cause, fat injection to the breasts has been advanced as an alternative surgery by some plastic surgeons.

Fat is removed by liposuction from one area of the body and injected into the breasts to enlarge them. Breasts are made up of a combination of breast glandular tissues and fat. Breast enlargement with fat injections adds to the fatty tissue already there.

Advantages of breast augmentation with fat injections

  1. Natural tissue and feel of breasts

Disadvantages of breast augmentation with fat injections

  1. Un-predictable loss of  breast volume- some of the fat always dies after a fat transfer. How much will die is unpredictable despite multiple techniques for handling and injection of the fat. Typically the latest study shows that only 30% – 40% of the fat injected remains within 6 months.
  2. Risk of development of breast cancer – The fat that is injected will have stem cells which when in the vicinity of breast tissue could cause breast cancer. This has been shown to occur in animal models. Even the latest plastic surgery article about breast enlargement with fat injections mentions that patients should be counselled about the risk of developing breast cancer!
  3. Small volume of breast enlargement possible.  In general breast augmentation achieved with fat injections only gives one cup enlargement of the breast. Typically about 250 cc fat is injected.  Within a few months after surgery only 30- 40 % of the fat remained. How much of that actually stays long term is unknown.
  4. Longer operative time. Typically surgery took 3 hours for fat injections.
  5. 10% of patients have substantial improvement in breast size, and 50% have a moderate improvement in breast size.

So,

Breast enlargement with fat gives minimal improvement in breast size ,has un-predictable results, of unknown duration, requiring three times longer surgery, and increases the risk of breast cancer.

No thanks- I’ll stick to implants for now.

 

 

 

Plastic surgery causes jealousy

Why plastic surgery causes jealousy in husbands

 

I have written in the past on the psychological effects of plastic surgery and specifically cosmetic plastic surgery.

Over the last few weeks though I have seen two husbands who reminded me  that cosmetic surgery effects the partner of the patient as much as the cosmetic patients themselves.

jealousy

Reasons for jealousy in partners of plastic surgery patients

There are a number of reasons that a plastic surgery patient’s partner may become jealous .

1. Fear of being dumped

The most common reason for being jealous of plastic surgery patients is the fear of the patient’s partner of being dumped. I have had several patient’s husbands ask me just that. ” Doc, how many women get a breast augmentation and then move out and leave their husbands?”

There are obviously some serious problems of self-confidence in these chaps if they feel that the only reason a woman is staying with them is because she has small breasts. Still you would be surprised at the number of men who think like that- and rightfully so!

After a breast augmentation or any cosmetic surgery for that matter, a patient’s self confidence is markedly improved. Patients will stand taller, smile more, be more outgoing etc. That new state of psyche obviously makes people react to the patient differently and, if there were any problems in a relationship to begin with, it just might be enough to push the patient to realize the dud they are with and move on to better things.

2. Fear of partner looking too good

Another set of fears for plastic surgery partners is related to the fear of being dumped but takes the form of possessiveness. Some people are jealous if their partners are attracting too much attention. They fear that if their wife has bigger breasts they will attract too much ogling and that makes them uncomfortable. These are people who are again not confident enough in themselves to allow their partners to wear anything but a sac and cover their heads with a bag.

The subject comes most commonly when discussing sizes for breast implants. All husbands of this type will tell the patients to choose smaller breast implants while the other types of husbands will go for “the bigger the better” size of implants. It is the patient who must make the decision about the size of implants and others point of view is guidance and nothing else!

In summary there are multiple reasons for cosmetic plastic surgery patients’ partners to become jealous of the newly found  self- confidence that their partners achieve after plastic surgery.

The normal, balanced, happy, confident partner is one who supports the decisions of their spouse in cosmetic surgery, is there to be of help during the recovery period and is there to benefit from the improved outlook on life that their spouse has.

By the same token, plastic surgery patients should realize that just changing their bodies through surgery will not solve all of life’s problems and may make relationship issues come to a boil.

Breast enlargement surgery revisions

Breast augmentation revisions

 

Breast enlargement surgery revisions are a tricky topic since its is a mixture of  a number of factors which are all prickly to consider for plastic surgeons and patients. This patient came to me complaining of differences in breast size after surgery elsewhere. The previous  plastic surgeon had placed two implants of markedly different sizes in her. I assume he had his reasons. She was unhappy with the difference in size and in the revision surgery I performed, I placed two implants of the same size for a great result.  However, breast revision surgery can be a tricky surgery due to previous scarring and changes in blood supply and the results can sometimes be worse! A careful analysis of the risk benefits of the cosmetic breast surgery must be performed. Even here the difference may not be noticeable to the untrained eye!

 

Before breast revision surgery

after breast surgery

 

 

 

 

 

Causes for breast augmentation revisions include

  • Technical error by plastic surgeon
  • Poor tissues  and tissue healing of patient
  • Lack of patient following directions post op
  • Complications of surgery
  • Perception of a bad result by patient
  • Perception of a bad result by plastic surgeon
  • perception of results by everybody else
  • Bad luck

Technical errors

Problems arising from technical errors by the surgeon at surgery include

  • rupture of breast implants
  • mal-position of breast implants
  • Inadequate hemostasis leading to bleeding

Poor Tissues

These problems arise from poor genetics on part of  patients.

  • Loose skin /poor elasticity
  • Thin skin / lack of strength
  • Reactive skin / skin which does not heal properly

Poor follow up

Specifically poor follow up of the plastic surgeon’s directions. After breast augmentation massage is essential. Lack of massage can lead to capsular contracture and breast hardening needing a revision surgery.

Complications of Breast surgery

  • Bleeding
  • Infection
  • Nerve damage
  • Implant deflation
  • Scarring
  • These are all known reasons for complications of surgery amongst many others

Perceptions of surgery result

Perceptions of defects ion the surgery results and the reason to change the surgical result with another procedure differ amongst

  • Plastic surgeons- for whom minor defects in the surgical result are acceptable based on the patient’s anatomy and the naturalness of the result
  • Patients – who may have expectations that are not real. Often patients forget that their two breasts are not exactly the same and never will be
  • Friends and family of patients may say something regarding the surgery result which even the patient and plastic surgeon were unaware of .

Bad luck

Sometimes the reason is just bad luck and no known cause can be found and there is no one or anything to blame!

In summary- beware of revisions and listen to your plastic surgeon. Sometimes the risk is just not worth it.

 

 

Mommy makeover-Breast-Abdomen plastic surgery

Mommy makeover

Mommy surgery before

                                                                                    Mommy surgery after

Cosmetic Plastic surgery of breast and abdomen after childbirth or massive weight loss is often called a Mommy makeover. Recently a patient asked me if in fact it was not a ‘Mummy makeover” since patients are often bandaged up like mummies after this cosmetic surgery duo!

 

Changes  to body after pregnancy or weight loss

Several distinct but common changes occur to the body after pregnancy or weight gain and loss.

  • Fat Deposits – occur in the flanks, love handles, back and abdomen
  • Loose skin – as a result of stretching of the skin leads to loss of elasticity of skin and its hanging down
  • Breasts become smaller and may also become droopy due to loss of volume and elasticity- in women and men!
  • Arm skin becomes droopy but fat accumulation in the arms may increase
  • Facial  and neck skin may droop giving an older look

 

Surgery of the abdomen and breasts

Mommy makeovers typically include

Other procedures may include

Mommy makeovers will take between 3.5 to 4.5 hours depending on the type of surgery that needs to be performed. Though some surgeons like to continue to operate on other body areas at the same time, I find that 8 hour cosmetic surgeries are just too much for me. They are also way too much for the patient! I prefer to divide up the surgeries into more reasonable segments, sometimes just by a few days, to allow easier healing for patients.

Recovery from Mommy makeover

After a mommy makeover the recovery will depend on the number and type of procedures performed as well as all the usual reasons for differences in individual healing. Although patients are up and walking the same day as surgery, typically it will take about 10-14 days before patients are back at work. I have had patients return as soon as 3 days after surgery and as long as 14 days.

Here is a link to a patient returning to the office after only 12  hours following mommy surgery;  http://www.youtube.com/watch?v=HCqqri8Yt5M&list=UUGHAP0wTkrkJuRo1yN1CFjg

Full healing though will take about 4 months though their healing is gradual and progressive.

Mommy makeover surgery gives women a new look . A new look for their bodies and a new look on life.

Breast Augmentation Implants

Confusion about breast augmentation implants enlarged

 

The other day a patient came for consultation for breast augmentation. I have written extensively about these procedures in the past. Here are a few of those posts;

https://www.tavmd.com/2011/12/08/how-to-choose-breast-implant-size/

https://www.tavmd.com/2010/11/04/saline-breast-implants-or-silicone-breast-implants/

https://www.tavmd.com/2010/12/12/breast-enlargement-surgery-with-implants/

A great deal of confusion has arisen over the past 20 years with respect to breast implant sizes and types.

1. Saline vs Silicone

Initially there were just two types of implants;   Saline and Silicone. The shapes were the same; what we now call moderate profile implants.  Patients choose between volume they wanted and the type of material.

Then came new types of textures.

2. Smooth vs textured

Patients ( or rather their plastic surgeons) could now choose between smooth silicone implants and textured implants. The idea behind textured implants was to decrease the rate of capsular contracture or scar formation around the implants. There was no difference in shape of implants with textures…initially.

smooth-round-implants-

            siltex gel family plus ultra

3. Round vs Teardrop

Textured implants were noted not to move! So the breast implant manufacturers came forth with tear drop or “anatomic implants” which supposedly gave a more natural form to the implants. However it was noted that all implants in the body will have some tear drop shape due to gravity anyway. Also these anatomic implants sometimes flipped giving a very “un-anatomic” shape to breasts.

tear drop breast implants

 

 

 

 

 

 

4. Low, Moderate, Moderate plus, high profile implants

More recently there has been an explosion in breast implant shape options. The are now different profiles, or base diameters, for every volume of a breast implant. The same volume can now look very different indeed.

Breast implant profile

 

 

 

 

 

Here is an example of just a how different an implant of the same volume can look.

 

Given the huge choices that now exist in breast implant shapes, types, textures and volumes, things are now complicated. It is no longer enough to say i want a “350 cc implant”  . Let your board certified plastic surgeon choose the right implant for your body. That should be based on your

height,

weight,

size of hips

chest wall

amount of breast tissue

quality of the skin of your chest

experience of the surgeon

your preference for materials based on risks and upkeep, size of scars, just to mention a few of the variables.

Breast augmentation surgery with implants; Its complicated.

 

 

 

Seven Deadly Sins in the US and Plastic Surgery

What the seven sins tell us about plastic surgery

One of my particular interests is the point where theology, psychology and health meet cosmetic plastic surgery. I have written about the seven deadly sins in the past;

https://www.tavmd.com/2011/09/22/the-sin-of-plastic-surgery/

http:/www.tavmd.com/2013/09/01/gluttony-why-america-is-fat/

 

Here is a map someone forwarded to me from Deadly Panda, which seems to produce some rather interesting maps.

The map shows the distribution of the seven deadly sins across the United States. Areas in red are “devilish,” those in green “saintly.”

7-deadly-sins

Greed

Greatest in the big cities. From Boston and New York to D.C., Los Angeles and Chicago to Seattle. Not too surprising. They did not examine the greed that some plastic surgery patients exhibit with too many plastic surgery procedures, too much Botox and too many fillers. Some women from these cities can be considered greedy when it comes to plastic surgery.

Envy

Overall, the rate of theft appears to be greatest in the South. Envy of others’ beauty, breast size or abdominal six pack was not measured.

Wrath

Murder rates are greatest in the South, New Mexico, Louisiana and Northern California . . . those boys at the bayou must not be so easygoing after all.

Sloth

Expenditure on “unnecessary” things is greatest in the Dakotas and Montana. This shows that expenditure on plastic surgery was not considered a sin by the producers of this map, as cosmetic surgery rates in these states are rather low.

Gluttony

The map displays the number of fast food restaurants per capita—not really my definition of gluttony. The number of expensive restaurants per capita would be a better indication. These areas in no way correspond to areas with the highest liposuction rates in the US, proving that gluttony does not necessarily make you fat.

Lust

The southern and eastern seaboards seem to have a preoccupation with sex. At least, that’s what the distribution of sexually transmitted disease cases seems to imply. Of course, it may be that the rest of the country is equally obsessed but simply has better doctors!

The larger average breast implant size in the South may have something to do with this phenomenon.

Pride

As the aggregate of the other sins, pride seems to be greatest across the south of the country. Consider, though, that it may be pride in their beautiful bodies!

Now that was interesting, wasn’t it?

 

Morad Tavallali, M.D., FACS