Archive for October, 2016

Breast Reduction

Breast reduction surgery in Redding has been shown in many subjective studies to improve your quality of life by minimizing or eliminating symptoms that can be caused from heavy, ptotic (droopy) breasts. This includes pains in your shoulders, back, neck or breasts and headaches that ascend from your neck into your head. Other symptoms include shoulder grooving, rashes under the breasts, upper extremity tingling or paresthesias, and limitation of activities such as exercise.

The surgery involves repositioning your nipple to a higher position and resecting the heavy, hanging tissue. This will result in scars and you have to be willing to accept this in exchange for smaller breasts. A mammogram, if indicated in your age group, will be required before surgery. In general, most reduced breasts end up being a generous C cup or small D cup. If you wish to achieve another result, please let me know prior to your surgery and I will try my best to accommodate your wishes but no guarantees can be given as to what breast size you will ultimately have.

Three techniques are available for reduction surgery in Redding, CA. The following is a summary:

Anchor incision (Wise pattern) – this is the traditional way of doing a reduction but it involves the most potential for poor scarring. It is best for very large breast or very wide chests. It does produce the best initial result but does have a risk for ‘dog ears’ that consists of excess skin at the end of the incisions.

 Lollipop incision (Vertical technique) – this involves less scarring and is the newer way of doing this procedure. It takes 1-2 months for everything to heal and for the scars to smoothen. It also requires use of a snug bra during the recovery period as it helps mold the breast. Your breasts will look ‘funny’ until it starts molding into the normal shape and appearance. There is a considerable risk of needing a revision of the scar to smoothen contours out as perfectly as possible and you will be expected to cover any facility fees for this.

 Liposuction – liposuction is done on the breast and this diminishes volume and may help a little with improving shape but it won’t do much else. It does preserve nipple sensation and the ability to breast-feed is expected to be preserved. You have to accept a droopy breast as your end result.

The nipple is usually preserved on a pedicle and this can come from the top or the bottom. I employ the top approach as it diminishes the possibility of “bottoming out” where the bottom of the breast starts to stretch and the nipple starts pointing upwards. However, this technique will diminish your ability to breast feed whereas the inferior pedicle has a better chance of preserving that function.

The surgery is done in an operating room and usually as an outpatient. Your recovery is expected to last approximately 3-4 weeks with resumption of activities dependent on whether there are any problems encountered during your recovery. It is anticipated you will be able to resume normal, unrestricted activities in 4 weeks wearing a quality supportive bra and if there are no complications during your recovery.

Potential complications include nipple malposition, nipple numbness, nipple loss (this is not a typo), asymmetry, contour irregularities, wound complications, bleeding, pains, fluid collections requiring repeated aspirations, fat necrosis and incomplete resolution of your symptoms. Other complications are reviewed in the consent for reduction mammaplasty. In addition, if you are overweight and have rolls extending from your breast to your back, these will become very noticeable following a reduction procedure. Additional procedures at additional costs to you can be pursued to diminish or eliminate these rolls.

If you have extremely pendulous breasts or desire a maximum reduction, a free nipple graft technique may have to be implemented. This involves the removal of your nipple from your breast and then putting it back on as a graft after the reduction portion has been done. It will result in diminished projection of the nipple and also in numb nipples. Sensation has been shown to return in some cases. You will not be able to breast-feed but because most of the ductal tissue is removed, you do decrease your chances for breast cancer. If you choose to have a nipple graft used, you cannot wet your breasts for at least 10 days after surgery. I authored an article in that you can view if you wish.

Mammograms are required if you are older than 40 and have not had a mammogram done in the last 10 months. If you are older than 35 but not quite 40, it is your decision as to whether you would be more comfortable with having a mammogram before surgery on your breasts. I am personally aware of patients who have been found to have cancer on their specimens, estimated to occur in 1-2%. Appropriate referrals will be made if this is encountered in your case.

Most women who have this surgery are quite pleased with their results. I thank you for considering me as your surgeon hope your questions and concerns were addressed to your satisfaction during your consultation. I encourage you to call if you have questions that arise later or need additional information.

Tummy Tuck

Contouring procedures for your tummy can involve liposuction, mini-tucks, and full abdominoplasties. Ideally, you should be near your ideal weight and exercise regularly. Sometimes your clothing will just not fit right because of your shape. You should not have any metabolic or eating disorders, or any problems with healing. Your specific goals will often determine which procedure is best for you.

Medical reasons for a panniculectomy (removal of excess skin only) include inability to ambulate normally, chronic pains (that may have to be documented by another doctor), ulcerations under the overhanging pannus (tummy), and chronic rashes or yeast infections where there is skin to skin contact.

Liposuction is best for the individual with a strong abdominal wall, good skin tone, and simply an excess of fatty tissues. Full-term pregnancies will generally stretch your tummy muscles and skin, making liposuction less ideal. Liposuction depends on good skin tone to allow your skin to retract following removal of excess fat. Tumescent techniques, where high volumes of fluid with anesthetics are injected into the fat, are used minimizing blood loss and providing prolonged anesthesia following the procedure. Limited procedures may be done in the office under local anesthesia. However, extensive procedures or those with low pain tolerances should be done in an operating room where IV sedation or a general anesthetic is available. This does increase the cost of the procedure but is usually well worth it in terms of comfort.

Liposuction requires the use of a compression garment or girdle like garment following the procedure and this is worn 24/7 for a minimum of 3 weeks or longer, depending on your bruising. In general, you can return to work in 3-4 days but will again, continue wearing your garment. The more common risks of liposuction include contour irregularities, imperfect contours, asymmetries, numbness, and pigment changes of the skin, especially if you have excessive bruising. Any weight gains in your future will result in fat deposition in places where you have not received liposuction and can result in unusual shapes.

Mini-tucks are for those who have excessive tissues and protuberances below the belly button. This involves excising excess tissues, pulling the belly button down an inch or so, using sutures to tighten the muscles below the belly button and liposuction to thin the areas above the belly button. The scar is approximately 8-10 inches long and at the upper level of your pubic hairline. It is an outpatient procedure and requires use of a surgery center. General anesthesia is required but assures you of complete comfort. A compression garment is again necessary and should be worn 24/7, 4-6 weeks following surgery. Full activities may be resumed at 5-6 weeks following surgery. This can distort your belly button. You can maximize the tightening with an “extended” mini-tuck where the dissection goes above the belly button and muscles are tightened as high as I can reach and your belly button either dropped an inch or sacrificed and reconstructed at a later time. If you bully button already can be pulled to your pubic area, you need a full tummy tuck in Redding.

Full abdominoplasties in Redding, CA involves dissection to your ribs allowing the muscles to be tightened from your ribs down to your pubic region. Excess skin is then removed and you end up with a scar extending from hip to hip. Ideally, during your initial evaluation, the belly button can be pulled down to the pubic region indicating that the almost all of the lower abdominal skin (where most stretch marks exist) can be removed. If there is not excessive skin present but a full tummy tuck is needed to tighten the muscles, then you will eventually have a vertical scar above your pubic area. This scar will discourage you from wearing true bikini type swimsuit as the vertical scar will show. Location of the transverse scar depends on your preference for hi-cut type underwear/swimsuits or the traditional bikini which is cut lower on the thigh. A binder will be worn for 24/7 for 6 weeks with full activities resumed after 6 weeks. Recovery from this procedure takes longest compared to other methods and this is one of our most painful procedures.

A newer technique called lipoabdominoplasty combines aggressive liposuction with excision of excess skin. This is ideal for the patient who has a rather thick layer of fat on their tummy and who does not require or desire maximum tightening of the abdominal muscles. It is safer in that the risk for bleeding and seromas (fluid collections) are less and drains come out sooner, diminishing the risk for infection. This is the tummy tuck of the future and recommended if there is any significant fat layer under the skin.

Full abdominoplasties can be done either as an outpatient (with a pain infusion catheter or patient controlled analgesia IV infusion device) or in-patient where you spend the night at Patient’s Hospital in Redding. This procedure requires a general anesthetic and often requires some delayed (after several months), revisions to improve the result. It is common to have fullness in your upper abdomen after surgery that is amendable to liposuction. The tighter abdomen will require that you use more of your chest muscles (breathe like an athlete) in breathing and can aggravate heartburn if it is already a problem. Abdominoplasties (full and mini) eliminate using your tummy as an option for breast reconstruction should the need arise in the future but can give you a much improved figure. Finally, your tummy is numb below the belly button and sensation may not return to that area.

Additional costs may be incurred for revisions and are usually required to improve on the lateral scars or to flatten the upper abdominal wall even more. This may also apply to liposuction cases or mini-tuck procedures as undesirable contour irregularities may result and motivate one to pursue more procedures to improve on the results obtained from the initial procedure.