Breast Q&A: Undecided – Lift vs Implants for Deflated Breasts
Question – Undecided, Lift or Implants. Surgery in 3 Weeks, Opinions Please
Hello. I have my breast surgery scheduled in June, however, am still undecided which route I should take. Would 500cc saline implants be sufficent to give me some volume, or will I end up with large, saggy breasts? If I decided to go just for a lift, my boobs will be tiny and scared. Hence, I’d rather go for implants even if I will have to get a lift 10 years down the road. I don’t want both surgeries, so it will be either tiny or big. What to do? I’m 40, 1 child. Thank you.
– via RealSelf.com
With deflated breasts, a lift + implant is needed for best result
Answer – For the best result possible, a vertical breast lift + submuscular, moderately sized implant is needed
In response to your question and based on your photos, this is not really a one or the other type of situation. You really need to have both a lift and an augmentation. If you do them separately you will probably not be satisfied with the eventual outcome. You have significant loss of volume, and if you were to only proceed with skin tightening all that would be accomplished is a higher position of the nipple areola complex. There would be no superior fill and an even smaller appearing breast mound.
Breast Q&A: Is a Perfect Breast Augmentation Result Possible in My Case?
Question – I think my “goal” photo = a perfect breast augmentation. Is it possible for my breasts to look similar after implants? Am I being realistic about what’s possible for me?
My plastic surgeon wants me to bring in pictures of what I want to look like after breast augmentation so he can be sure that he understands what “look” I like best. We’ve discussed this at my consultation; however I did not bring any pictures with me. My surgery is on the 5/26/2011. At my pre-op appointment, we will go into the specifics of the look/result I am hoping for. The first two pictures are “before photos” of my breasts and the third is what I believe is a perfect breast augmentation. The measurement from my collar bone to my nipple is 21 cm on both breasts. Am I being realistic? Thank you!
Patient provided two 'before' photos of her own breasts and one 'goal' photo
of what she feels are 'perfectly augmented breasts'.
Answer – For a similar result to the “perfect breast augmentation” look you like, a lift is needed.
I agree with my colleagues that it is difficult to compare apples to oranges since every breast has its own unique characteristics, but since the photo you chose as an example of your ideal postoperative outcome is mine, I will give you my thoughts on the situation. (n.b. here’s a link to the ‘perfect breast augmentation’ case you cited as an ideal result).
Patient Forums – A Discussion Of A Things Plastic Surgery
Open-house style info-sessions/discussions are an opportunity to explore the ins and outs of a specific cosmetic procedure, new/innovative surgery technique or medical product. The diverse interests of a small (or smallish) group has a tendency to generate lively discussion on a wide range of topics due to all of the different questions which get asked. And with the almost overabundance of procedure options and cosmetic solutions available today, it is more important than ever to help people interested in cosmetic surgery be as informed about their choices and options as possible.
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Laser Liposuction (SmartLipo) vs Tumescent Liposuction: Neither Truly Tightens Skin
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Since Dr. Illouz and Dr. Fournier first brought liposuction to the United States in 1982 – when I was beginning my residency in plastic surgery – there have been only 2 truly game-changing developments in how board certified surgeons approach/perform liposuction:
Suction Assisted “Tumescent” Liposuction (SAL) – First introduced in 1985, the suction-assisted tumescent liposuction technique involves injecting a special ‘tumescent’ solution directly into the subcutaneous fatty layer (which builds up between the skin and muscle layers) that not only makes the entire treatment zone numb, but also acts to constrict surrounding blood vessels so that very little blood loss and trauma to the surrounding tissue, vessels and nerves occurs during the procedure. In surgery, less trauma means less post-operative swelling. Less post-op swelling means less post-op discomfort and a quicker recovery. In most of my liposuction cases, patients are back on their feet the very next day and pain free soon-there-after. The use of local anesthesia in combination with very light general (re: light complete sedation) not only provides a very comfortable experience for my patients but also enables me to be fairly aggressive and very precise while addressing multiple locations which contain large amounts of fatty tissue.
Power-Assisted Liposuction (PAL) – Approved for general use by the FDA in 1998, power-assisted liposuction differs from un-powered suction-assisted liposuction (SAL) through the use of a special canula that vibrates rapidly (like an electronic tooth brush) while being moved through the fatty tissue by the surgeon. Without power, pushing and pulling the canula in the standard forwards and backwards motion through the fatty tissue requires quite a bit more effort and force. With power, the canula becomes like a hot knife through butter as it gently breaks up the fat before suctioning it out. The benefits to the PAL approach have been well documented and include less time under anesthesia, less bruising and swelling, a faster recovery and most importantly, smoother, more precise results.
And that’s it. Everything that’s followed is nothing more than marketing hype..
Neither Laser Liposuction (SmartLipo) nor Traditional (SAL) Truly “Tighten” Skin
Laser, sonic, super-sonic, and all the other “latest” liposuction products – SmartLipo™ included – are not game-changers…and if they were, there would be articles in scientific journals by board-certified plastic surgeons demonstrating as much. At best, newer liposuction machines have had an incremental effect on the quality and consistency of results. At worst, they’ve done more harm than good (especially when used outside of their very-specific use-cases). Case in point, I’ve personally taken care of patients whose burns from these “more advanced” technologies required surgery to repair.
As with most new products, after the initial hype and marketing settles down, the indications for use diminish. When laser liposuction (Coollipo™, Smartlipo™, Slimlipo™) first came on the scene, it was touted as a stand alone procedure. But after it became clear that the initial results were less than ideal, traditional liposuction got added to the procedure in order to achieve satisfactory results. Perhaps, in very limited use-cases (e.g. under the chin) there can be some added skin tightening, but as I have seen over the years, if properly performed on a properly chosen patient, there’s really no better option than traditional, suction-assisted tumescent liposuction.
What Actually Matters Most: The Skill of the Plastic Surgeon
Ultimately however, it remains the skill and talent of the sculptor rather than the make or model of their chisel that determines whether or not one ends up with a superlatively sculpted thigh, hip, neck, buttocks, arm, or abdomen.
When I first began performing liposuctions some 28 years ago (during my 8 years of formal residency/training) a professor told me that nothing can substitute the skill and technique of a master plastic surgeon who has, through years of training and experience, refined his technique to the point where such procedures becomes less about suctioning and more about sculpting. I remember thinking that this was easy enough for him to say given that he had already attained master-level status. But when I reached equivalent status, it became clear that he was right.
Much of one’s success depends upon how much pure natural talent, spatial intelligence, and aesthetic ‘taste’ one has. Over time, however, most first-rate plastic surgeons become much more intuitive and feel-driven in their approach to procedures like liposuction. And while the difference in CCs of fatty tissue suctioned out may not be much, the smoothness of shape and consistency of silhouette between the treatment area and surrounding tissue is more often than not, dramatic.
Communication Between Doctor and Patient in Albany, NY
Why Clear Communication is Key to a Successful Cosmetic Experience
I recently started answering questions on the plastic surgery Q&A website RealSelf.com – it’s a neat, quickly growing service that has the potential to be truly great (they just need to improve a few key features which I plan to write about in a later blog post). That said, from reading and answering the many questions that come into my email inbox each day I think what stands out most is the frequent lack of clear and completely open communication between patients and their doctors (exemplified most often in questions by patients who have recently completed their surgery).
The New Team in Town
In sports there is an old adage that in order to win make sure you pick the best player(s) available. This holds doubly true when setting up a new medical office. Although I have been practicing plastic surgery in Albany, NY for 25 years, I had no concept on what it takes to run an efficient and successful operation. Susan, our practice manager has been invaluable in this regard. She handles the many day to day functions, understands the complexity of insurance, sets the game plan and she keeps the team running smoothly. I may be the Owner but she is most certainly the Head Coach.
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