December 29th, 2008 Dr. Decherd
Sometimes people think that tummy tucks are only for people who have a few extra pounds. This is not true. Many women who have had children have loose, stretched out skin that can be improved with a tummy tuck.
The following patient I just saw back and is 6 weeks out from a breast augmentation and a tummy tuck (which as a combination is sometimes called a mommy makeover). She is very slender to start, but has some loose skin that is improved with surgery. The scars are low enough in her to be hidden by normal underwear. The breasts will normally settle a little more over time.
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December 2nd, 2008 Dr. Decherd
I have learned how to insert a tummy tuck before and after photo into the blog! Here is a tummy tuck surgery I preformed in San Antonio who is now six weeks out. I think she is headed for a nice result! You can see more abdominoplasty before and after photos at my website www.drdecherd.com.
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December 1st, 2008 Dr. Decherd
Many times people want to have more than one procedure done at one time. While this is understandable and often achievable, we have to act cautiously.
One thing that we think about is total operative time. Obviously if you have more procedures done it will take longer than having less procedures done. So we have to draw the line somewhere at how much is too much.
Another consideration is recovery. We do not want to work on body systems that are needed for recovery of another area. For example, after a tummy tuck it is helpful to have full use of your arms and legs to take up the slack while your tummy is recovering, so I typically do not perform thigh lifts or brachioplasties with an abdominoplasty (tummy tuck).
So for people who want more than one procedure, we have to see them and work out a plan that seems reasonable for them. Common combinations include breast augmentation with abdominoplasty, breast augmentation with rhinoplasty, breast lift with abdominoplasty, and a whole variety of facial procedure combinations to include lower face, blepharoplasties and browlift.
And every person is different, and so that is why a they need to be seen to work out a plan that is right for them!
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October 3rd, 2008 Dr. Decherd
Many women think they mught need a lift but are not sure. Sometimes this is because the breast is deflated, due to age, weight loss, or post-pregnancy. In this case an implant alone may reexpand the breast without needing a lift.
A lift is needed when the nipple has fallen below the inframammary fold (IMF)–the crease where the breast and the chest meet. Since the bottom of an implant will sit at ot above the IMF, if the main part of the breast is below this, then without a lift the implant would ride up high while the breast hangs down low. A lift will add more cost and more scars than an implant alone, but if that is what a woman needs than that is what she needs.
When the nipple is at the same level as the IMF, it becomes challenging. Usually we are OK with an implant alone, but the chance remains that the breast will still sag a bit. This depends on how loose the breast is and the size of the implant. Sometimes we will need to do a small follow-up procedure to lift the nipple/areola.
When we clearly need a lift, the choice is whether to do a lift alone or a lift with implants. While a lift with implants is somewhat controversial, I will perform them at one sitting (as opposed to in two stages), but I do think that it raises the complexity considerably. Of course nobody is forced to select an implant, but many women opt for more volume to help improve their overall breast aesthetics.
And we can always make a woman smaller at the same time as a lift. In fact the difference between a lift and a reduction is essentially how much tissue is removed.
Whether a lift, an augmentation, or a reduction, we can usually help a woman achieve her goals!
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September 24th, 2008 Dr. Decherd
When a woman opts to undergo breast augmentation, she is committing (most likely) to maintenance surgery down the road, as breast implants are not lifetime devices.
Now I have seen breast implants that have been in place for 35 years. And I have seen deflations in a short period of time. So it is hard to know how long an individual breast implant is going to last. We look to the published data for guidance, but it is hard to get long-term data until a long period of time has passed, and if they improve or change the implant, then the old data may or may not apply. And remember that data such as failure rates apply to large populations of implants, but that in an individual woman, the actual time will vary.
So when should a woman revise her implants? Well, after surgery they will evolve for a period of months. So it will take a little time to get the “final” product (as final as possible given that your breasts will continue to evolve as you age). But if something seems off in the short term, I would wait at least 3-6 months before I consider revision surgery, depending on the nature of the problem.
As far as the long term, the basic answer is I would revise them when the patient wants them revised. Sometimes we get calls about a set of implants that is approaching 10 years old. There is an urban legend that implants need to be revised at 10 years–if they are doing well, I would leave them alone.
The only caveat is that if the implants are silicone and are ruptured, I would recommend removal with or without replacement. The new FDA guidelines ask for MRI’s 3 years after surgery and then every 2 years to look for silent rupture.
And with a revision, discuss with your doctor if you need a plance change, or a change in type of implant. Every patient is different and has different goals!
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August 20th, 2008 Dr. Decherd
A lot of women have questions about the difference between a full abdominoplasty (or tummy tuck) and a mini-abdominoplasty.
Although the terms sometimes mean slightly different things to different practitioners, in my practice a mini-adominoplasty involves a smaller incision and less dissection, and no scar around the bully button. Unfortunately, this also usually means less result. The reason is that I cannot get as much skin removed, and I certainly cannot achieve as much fascial plication. a full abdominoplasty involves more dissection, more plication, and a scar around the belly button, but also a typically more dramatic result.
So who gets a mini? Although most women I see are better candidates for a full tummy tuck, occasionally I see a lady who has just the right combination of tightness above the belly button and looseness bleow that I think they will get a reasonable result from a mini. And, as always, my job is to present them with options and let thaem decide.
And while some women are really concerned about the scar around the belly button in a full tummy tuck, most of these women are not revealing their tummies to the world anyway, so if they are able to get a good enough scar that they feel comfortable with a bare midriff-great. Otherwise they still usually derive benefit from clothes fitting better and having the abdomen be tighter.
The lower scar from either a full or a mini I try to keep very low, so as to hide under underwear or a bathing suit (perhaps not all styles!). Usually this is an acceptable tradeoff to people for a better shape.
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August 19th, 2008 Dr. Decherd
A lot of women I see want their abdomen rejuvenated.
A common question is if liposuction will work. For most women who have had kids, they probably need an abdominoplasty (tummy tuck) to get the result they are after. remember, liposuction only removes fat. A Tummy Tuck removes both fat AND SKIN, and also it tightens the abdominal wall. So if there is loose hanging skin, although you COULD suction it, I would hate for a woman to undergo the trouble of doing the procedure unless she is going to get what she wants out of it, and for many women this involves removing the extra skin. And the tightening of the body wall is the “secret weapon” that I find does a lot of good, but that women don’t understand on the front end. This tightening does not occur with lipo. (When I do this, I physically pull together the “six-pack” muscles that have splayed out either from pregnancy, or weight loss, or whatever reason.)
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August 15th, 2008 Dr. Decherd
Many great-sounding procedures in Plastic Surgery are a slight twist on established procedures that come with fantastic-sounding marketing names. Even catchy names that are not associated with a company gain traction. As an example, when I first got into plastic surgery, I thought “tummy tuck” sounded completely hokey and couldn’t believe, serious, educated, capable doctors used that term instead of “abdominoplasty”. (Now I am in that category–it seems totally normal!)
The term “mommy makeover” falls in the same category, in my opinion. I see a lot of women who never thought they would be seeking the services of a plastic surgeon, but have had pregnancy wreak havoc on their bodies.
What is a “mommy makeover”? Well, it could mean a lot of things. But typically it refers to rejuvenation of a woman’s breasts and abdomen after childbirth. For breasts, this could include breast implants, breast lift (mastopexy), breast reduction, or a breast lift in conjuction with implants (an “aug/-pexy”).
Usually the abdomen needs a tummy tuck, but occasionally we can do liposuction alone on the abdomen, or sometime a mini-abdominoplasty. (Most women who have had kids do better with a full abdominoplasty, in my experience).
And a lot of women are happy to consider a little liposuction on the outer or inner thighs.
So usually a mommy makeover is some combination of breast surgery and body contouring. These operations are not new, but the TERM “mommy makeover” seems to be pretty new. As always, my job is to give women education and provide options. The final choice is up to the patient!
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August 8th, 2008 Dr. Decherd
A lot of women have questions about the use of silicone breast implants.
All breast implants have a shell on the outside and a filler on the inside. Saline implants use salt-water as a filler, but the shell of saline implants is SILICONE.
Let me back up and tell you a little about silicone. Silicone can be classified as an oil, gel, or elastomer. Just like there are different metals or different plastics, there are different silicones. Silicone elastomer is solid and is what is used for the shell of breast implants. If you are wondering what this is like, imagine a thicker ziploc bag–this is similar to the shell of a breast implant (although I do not know what ziploc bags are made of!).
In the first generation of breast implants, the filler was silicone oil. This was a liquid, and while not as runny as water, could flow more easily than the silicone gel. Currently the fillers used in silicone breast implants is silicone GEL. This is thicker, and if you cut a breast implant in two in my office, it does not run out. Imagine Jello on a dish. It doesn’t run off. And although being in someone’s body is a different, dynamic situation than being on a dish, the newer gels are hopefully less runny than the older implants. Sometimes people call these GUMMY BEAR implants.
Why do we care? Well, in 1992 the FDA took silicone breast implants off the market because they were concerned that ruptured implants were making women sick. When they did the science to check on it, they found that there was no evidence that ruptured silicone breast implants caused any systemic disease (although the implant may not seem right). So in the fall of 2006, silicone implants were put back on the market in the US. They were never off the market in South America and Europe (as far as I know). Breast augmentation remains the #1 plastic surgery procedure for women.
Of course, saline implants remain a good option as well! At least women have the choice now.
For more information on Silicone Breast Implants visit breastimplantsafety.
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