Posts Tagged ‘Add new tag’

“Dr. Hause, what Plastic Surgery do I need?”

Monday, June 29th, 2009

I was at a Swimming Meet this weekend and one of my friends asked me if I perform Abdominoplasty at the same time as Breast Augmentation. My reply came in the form of explaining the concept of the “Hot Topic” of Mommy Make-overs and what they involve. She next told me that she knew a couple of friends (from the same grammar school) who had undergone these procedures. Strangely, both of them had gone in initially for Breast Enhancement and were strongly encouraged to add the Tummy Tuck. This was because that “would make the Breasts look even better.” I was visibly taken aback.

This brought up the discussion of “needing” versus “wanting” Aesthetic Surgery. Now let’s be honest. Although writing this may be blasphemy to the Priests of Nip Tuck, in reality no one “needs” Cosmetic Surgery. They “want” Cosmetic Surgery to improve their appearance. It is elective. I personally would find it appalling if I went to a Plastic Surgeon with one concern and they talked me into something additional.

This brings up the concept of vanity. We’re all familiar with the criticisms that Cosmetic Surgery is all about vanity. Well, frankly, it is. However, let’s put this into perspective. Since the dawn of time human beings have been altering their appearance to reflect the values of their culture. Consider the tattoos, piercings and scarification that are customary in some societies. Whether or not we want to accept it, the truth is that how we appear has an impact on how we feel about ourselves and how others perceive us. However, like most things, intelligent moderation is the key to success. A healthy amount of vanity may aid in maintaining our sense of self worth and positively impact our interpersonal relationships. In contrast, extreme vanity can emotionally cripple someone and turn them into a nightmarish Hollywood Cliché’.

It is true that when someone visits a Plastic Surgeon, they are looking for expert advice about their concerns. However, it is also true that this person is probably somewhat insecure and vulnerable. In my opinion, encouraging someone to have additional surgery when the advice was not specifically sought out is unethical. It is really easy to manipulate an insecure and vulnerable person into doing what you want them to do. As physicians, we have a much higher moral obligation to our patients. We are not selling cars and adding on an extended warrantee. Unfortunately, especially in our challenging times, patients need to beware of practitioners that insist on “the extreme makeover.”

As a Plastic Surgeon, it is a great privilege and humbling to have someone entrust their safety and well being to you while attempting to improve their life with surgery. However, the patient is the only one who has the right to decide what will work for them. I always tell my patients “There are a lot of things I know how to do that are great for my kid’s college funds. Not all of them are good for you.” When considering Aesthetic Surgery, be clear on what you are trying to accomplish and keep that in perspective. If you are curious, get options and get educated. Beware of grandiose artistic surgeons who “have a plan to make you better than you ever were before.” Getting more than one opinion is always prudent. As statistics of patient satisfaction will tell you, if done safely and well, Aesthetic Surgery can enhance your life. However, don’t let any interested party influence what you believe is right for you.

Mastopexy (Breast Lift)

Tuesday, June 23rd, 2009

Some patients desiring Breast Enhancement have breast tissue that is loose and saggy. The medical term for this condition is Breast Ptosis. This may be a consequence of advancing age, pregnancy, nursing and/ or weight fluctuations. Breasts progressively hang lower on the chest with loss of upper breast projection (perkiness), elongation and flattening. In some cases, the nipples point straight down. These changes are also common in patients with naturally large breasts.

The basic problem with ptotic (saggy) breasts is that there is too much skin for the amount of breast tissue present. Additionally, the nipple may reside too low on the chest wall. With mild stages of breast ptosis, a breast implant may be all that is needed. However, in many women, the breast has fallen too far down the chest to allow an implant to give an aesthetically pleasing result. In these women, some form of breast lift (Mastopexy) is indicated. In this situation, a simple breast augmentation would result in the implant residing in the normal location with the nipple appearing to have slipped off the front of the breast. Some doctors may suggest placing the implant above the muscle to minimize this appearance. It may work. However, all too often what results is a “rock-in-a-sock” appearance. In my opinion, this is totally unacceptable. It is also very difficult to fix and may require multiple operations to improve.

When natural breasts are large, similar changes to the skin and nipple position usually occur. The techniques of Breast Reduction and Mastopexy are similar with the exception that in Reduction, breast tissue is removed to fashion a more pleasing size and shape. Reduction may also relieve symptoms of neck and back pain.

Because of the anatomical changes described above, Mastopexy and Breast Reduction procedures are designed to remove the extra skin (+/- the extra breast tissue) and reposition the nipple. One of the consequences of doing this is a visible and permanent scar on the breast. This is a real compromise (a scar versus a saggy and/ or large breasts). Although many scars will heal with little visibility, if a scar is completely out of the question, you are not a candidate for mastopexy, period. The only exception is in patients that have a small amount of enlargement that can be improved with liposuction alone. As common sense would predict, this usually worsens any ptosis and produces a more saggy and bottomed-out breast.

The classic technique of Mastopexy and Breast Reduction requires a scar that resembles an “anchor.” This scar is located around the areola (pigmented part around the actual nipple), down the front of the breast and along the fold under the breast. Most Plastic Surgeons continue to use this technique because it can give a reliable and safe result. It is still the gold standard for comparison within the Plastic Surgery community and many excellent results have been achieved. With the Anchor Technique, skin is removed so as to create a new “skin brazier” which holds the breast tissue in place. Relying on the skin for the result can be a negative because, after all, what caused the problem in the first place was the stretchy skin. Because of this fact and the resulting large scar, newer methods of “Minimal Scar” Mastopexy evolved that may offer a better option. Not all women are candidates for these techniques, but many are.

In selected cases of women desiring enlargement and mastopexy, the scar can be limited to around the areola. This technique is called a Doughnut or Binelli Mastopexy after Louis Binelli, the French Plastic Surgeon who described it. In essence the procedure is done is by removing a doughnut-like circle of skin from around the areola and leaving the nipple attached. This allows for placement of the implant and can lift the nipple up to 1 inch.

In women who desire to lift their natural breasts into a more youthful position and contour, a third technique, called Lejour Mastopexy (Verticle Mastopexy) after the Belgian Plastic Surgeon Madeline Lejour, may be the best option. This technique differs from the others in that the result is not dependent upon the breast skin. In this technique, the breast tissue itself is molded with sutures into a new natural shape. The scar can usually be limited to around the areola and down the front of the breast (”lollipop”). Also, the result can be more natural and last longer. Because of these factors, the Lejour technique is my preferred method for correcting breast ptosis in those not desiring enlargement and in those women needing moderate amounts of reduction.

Mastopexy is performed as an outpatient and patients can usually return to work in 5 to 10 days.