Breast Augmentation Revision: Capsular Contracture

Top:  Before Surgery with Capsules
Bottom:  After Surgery, Capsules Removed with Breast Lift

Capsular contracture is a complication which can result after breast augmentation. All breast implants will get a capsule around them. The capsule is a soft scar which the body produces to "wall off" the implant from the rest of the body. If the capsule stays soft it will never cause a problem. However, if the capsule become thick and hard it can become painful and distort and harden the breast.

Preventing capsular contractions is a mainstay of breast augmentation surgery. Great care is taken in surgery to avoid and stop all bleeding and to prevent infection.  It is also helpful to place the implant under the chest muscle which can decrease the incidence of capsular by fifty percent. After surgery, it is important for the patient to massage the implant as soon as cleared by her plastic surgeon and continue this massage indefinitely. I generally begin massage about a week after surgery and recommend massaging the implants three times per week.

I use a protocol where the patient is instructed to push the implant up, down, left, and right, and then press the implant firmly against the chest and then squeeze the base of the implant. We teach this massage technique on one of the first post-operative visits and monitor for capsular contracture on subsequent visits.

Because we are very meticulous to prevent capsular contracture and carefully monitor our patients, the incidence of capsular contracture in my practice is very small. However, I am frequently referred patients who have developed capsular contractures for a secondary revisional surgery. In these cases, I remove and replace the implant, remove the implant capsule, wash out the implant pocket with a steroid solution, and if necessary put the implant under the chest muscle to lower the incidence of recurrence. At the revisional surgery, many patients will want to change the size of their implants and often it is necessary to do a "lift" at the same time. We begin implant massage several days after surgery and continue frequently for the first several months. The above photograph is of a patient who was referred to my practice for this revisional surgery.

The best option is to avoid getting a capsular contracture by carefully choosing your plastic surgeon and following the instruction for implant massage after surgery. If, however, you have developed a capsular contracture then a revisional procedure can restore your breast to normal.

Plastic Surgery Financing: Some Great and Convenient Options

Given today's difficult economic environment, plastic surgery financing has evolved into a very customer friendly and economic way to schedule surgery. In the past, financing was difficult to obtain and often had unreasonable interest rates. This was often limiting for patients who had good but not perfect credit.

Statistically, plastic surgery patients are not wealthy and have annual incomes around the national average. A study by the American Society of Plastic Surgeons revealed that the average plastic surgery patient is "the young mom next door, the waiter who served you coffee this morning, even your coworker.” (www.plasticsurgery.org/Media/Press_Releases/Study_Reveals_Who_Is_Really_Considering_Plastic_Surgery.html)

Two excellent companies allow potential patients to apply online in a private and confidential way. Response to the online application is usually within 24 hours and the company will work with our office giving our patients a simple and easy way to finance. There are many different financing plans to choose from with variable interest rates.

Surgeryloans.com (www.surgeryloans.com/splash/) and MyMedicalLoan.com (www.mymedicalloan.com/index.html) can be accessed online using these links. Our office works closely with these companies to make schedule your plastic surgery an easy and headache free process.

Breast Augmentation Fat Transfer: Could Today's Love Handles Be Tomorrow's Boob Job?

Breast Augmentation Fat Transfer: Could Today's Love Handles Be Tomorrow's Boob Job?

Fat Grafting for breast enhancement is still a controversial procedure. Some doctors are using the Brava system which uses negative pressure to enlarge the breast with fat injections.

Fat grafting, while natural, can obscure mammograms as the fat is injected directly into the breast and can mimic suspicious areas on mammograms. The fat will only give a modest increase in size and won't give a "lift" like an implant can do.

Given these limitations, it is save to say that currently breast augmentation with implants is still the time tested procedure of choice.

Neck Liposuction: The Less Invasive Alternative to a Youthul Neck

One of the most common complaints patients express about their appearance is the neck. The neck is one of the most visible areas in the body and its loss of shape and contour is a telltale sign of age.

With weight gain, there can be fat deposits below the chin which obscure the youthful angle of the neck (cervicomental angle). The underlying muscle (platysma) also weakens and splits into bands (platysmal bands) which contributes to the loss of neck shape and contour.

Necklift procedures typically involve an incision below the chin and behind the ear. The skin is "undermined" to allow it to move freely. The muscle is sewn tightly in the middle from the collarbone to the chin (platysma plication) and the excess skin is removed from behind the ear. Excess fat can be removed through the chin (submental) incision. This procedure is best done in conjunction with a facelift so that the youthful neck will match the face.

A less invasive way to restore a more youthful appearance to the neck is with liposuction (see above photo). The incision is less than a centimeter and is concealed below the chin. There are several methods to remove the fat including laser liposuction (Smart or SLIM liposuction), ultrasound liposuction (VASER), and traditional tumescent liposuction. After the liposuction is complete the patient wears a compression band for a few days. The recovery is very quick with minimal pain and swelling. The results are immediate and improve for up to 6 months. The skin will recontour to the underlying neck muscles to improve the shape of the neck and restore the youthful appearance of the neck.

Butt Augmentation: Fat Grafting for Size and Shape

Butt augmentation has gained widespread popularity as plastic surgery techniques have evolved to match the increasing demand. Importantly, butt augmentation should be viewed as both a volume and shape procedure. The idea that bigger is better is simply not true. The art in this procedure is to give both the proper size and shape in proportion to the height and weight of the patient.

The two methods of butt augmentation are implant placement and fat grafting. The advantage of implants is that they can be used in patients who might not have enough fat to harvest for injection. They are also permanent. However, implants also have many common side effects including chronic pain, infection, seroma formation (fluid collections around the implants), and hardening with unnatural feel. Because of these possible complications, many surgeons prefer fat injections.

Fat grafting has the advantage of being completely natural. Liposuction is used to "harvest" the fat by removing fat from unwanted areas such as the abdomen, love handles, thighs, and around the buttocks. The liposuction part of the procedure can be used to shape the butt and to improve other areas of the body. The fat is collected in a sterile container then washed and centrifuged to remove unwanted impurities. The "pure" fat containing the best fat cells is then carefully injected into the butt to give it a perfect shape. The technique for harvest and preparation of the fat is extremely important and can determine the success of the procedure.

There are several limitations of fat grafting. Only some of the total volume of injected fat will survive permanently. For this reason, many patients will need additional fat grafting to maintain the result. As a very general rule, about half of the injected fat will be permanent. Fat grafting is also limited in thin patients who do not have adequate fat for harvest.

Currently, most surgeons prefer fat grafting due to the natural look and feel and to avoid the complications of butt implants. For those women who desire a more shapely and full figure, butt augmentation with fat grafts is the natural choice.

The Best Plastic Surgeons in America

Cosmetic Surgery Today names Dr. John Burns to their best plastic surgeons in America list. (www.cosmeticsurgerytoday.com/cosmetic_surgeon/best-plastic-surgeon/)

Best Plastic Surgeons Nomination Process

The utilization of extensive research and relevant medical doctor credential information databases are what go into locating the best plastic surgeons in America.
best-plastic-surgeon

Plastic surgeons must possess a certain amount of experience and expertise in the field of plastic surgery. Best plastic surgeons are chosen based on these steps:

* Must be board certified and are randomly selected using databases and a proprietary system
* The proprietary system and software emails or faxes generally ask the question, “If one of your loved ones needed medical attention in your field, which of your peers would you choose?”
* In those same emails, physicians can log in and choose a username in which they nominate their peers and submit
* The researchers collect all the information and prepare for the next phase

The next phase involves those peers who were selected being reviewed for the proper nationwide licensure status, malpractice judgments, and disciplinary actions.

They are then cross-referenced utilizing thirteen leased/owned doctor credential information databases confirming physicians complete nationwide licensure statuses and relevant credential information.

The last step includes the researchers collecting and reviewing the pool of nominated plastic surgeons and verifying credentials.
The best plastic surgeons in America

Dallas - Dr. John Burns
Los Angeles - Dr. Renato Calabria
Chicago - Dr. Susan Jane Taub
New York City - Dr. Scot Glasberg

Dr. John Burns is a surgeon who specializes in facial surgery, breast cosmetic surgery, and body plastic surgery procedures. His website address is: http://www.drjohnburns.com.

Mini Tummy Tuck

The term "mini" is quite popular among plastic surgeons hoping to promise amazing results with little to no downtime. This term has been recently popularized in reference to tummy tucks; also called abdominoplasty. In my opinion, there is no TRUE definition but several factors are important in defining what goes into a tummy tuck operation.

To understand some differences which can apply to a mini tummy tuck, it is important to understand the standard tummy tuck operation. The procedure is designed to remove excess skin and fat below the belly button (umbilicus) and above the pubic area. A typical tummy tuck scar will extend from hip bone to hip bone and should be positioned as close to the pubic areas as possible in order to conceal the scar. A wide ellipse (football shape) of skin and fat is removed. The remaining tissue is undermined or dissected just above the underlying abdominal muscles to the rib cage area. This tissue is pulled down to meet the tissue above the pubic area. Before sewing the incision closed, the abdominal muscles are sewn together (rectus plication) to narrow the waist. The belly button is left attached to the abdominal wall but it is brought out through a new incision so that remains in the same place.

A mini tummy tuck seeks to eliminate one or more of the steps in the tummy tuck procedure to avoid scarring, recovery time, or cost. The size of the tummy tuck incision can very widely from a circumferential scar around the body, an extended scar which goes onto the flanks, a standard scar from hip bone to hip bone, or the mini scar which is confined to a small area between the hip bones. A "mini" scar would stop short of the hip bones and be easily concealed in a two piece bathing suit.

A mini tummy tuck may also refer to a procedure which leaves out the tightening of the abdominal muscles (rectus plication). Often women have not experienced stretching of the rectus abdominal muscles (rectus diastasis) and do not need to have the muscle tightened. Rectus plication, while beneficial for many patients, is also associated with post procedure pain and leaving out this part of the procedure can drastically shorten the recovery period.

Often in a mini tummy tuck, the belly button will not have to be relocated through the abdominal tissue flap. Leaving the belly button attached to the flap allows tissue to be removed with minimal undermining or dissection. This can also lessen discomfort and shorten recovery.

Patients who are typical candidates for the "mini" tummy tuck procedure will be of normal weight, have an adequately long trunk, and minimal abdominal muscle stretching (rectus diastasis). For those patients who fall into this category (see above photograph as a typical example) the "mini" tummy tuck can be a great option.

The following websites can provide additional information:
www.webmd.com/skin-beauty/guide/cosmetic-procedures-tummy-tuck