Question #1:
>Hello.
>I was wondering what type of liposuction technique
>you used. Is it using local anesthesia or general?
>
>Thanks.
>Sonya
An Answer:
Except for very small jobs we prefer general anesthesia. The patients
generally (no pun intended) like it the same way. It is difficult to impossible
to adequately numb large areas with local medication. Local anesthesia
is used in the tumescent solution to decrease bruising and for post-operative
relief, but alone it is often inadequate. Liposuction can be difficult
as it is. It is harder to do (and less humane) when working on a moving
target. With general anesthesia, it is easier on the patient as well as
the surgeon.
Thanks for the question,
John Di Saia, M.D.
Question #2:
>I am interested in undergoing a mastopexy but have some concerns regarding
size after the procedure. I am currently a 34C, but after breastfeeding
and using a breast pump for 8 months, my previous sagging breasts, sagged
even more. Additionally, The firmness of my breast has since lessened making
them feel very soft and "elongated." I've been told that after a mastopexy,
you reduce in cup size. Although I've talked to a plastic surgeon about
these concerns, he said that I would remain the same size. Can you explain
to me how logistically if you raise the breast and tighten the skin underneath
so you are more firm, you are able to maintain the same size? Also, How
do they "lift" up the breast, if the only incision that is made is a vertical
one below the areola.
>
>I welcome your answers. Thank you.
An Answer: An increase in breast ptosis (or "droop") is common following pregnancy/breast-feeding. There are several methods of surgical mastopexy, some of which involve breast reduction. Mastopexy is technically repositioning of the nipple/areolar complex. I never guarantee that the breasts will stay the same size. I see them decreasing to some extend. This degree in your case may be small however. It seems conceivable that you could remain the same size depending upon your surgeon's planned approach.
It seems by your description of the "single vertical incision below
the areola" that the surgeon's plan here is a mastopexy after the French
surgeon LeJour. The breasts here look a bit funny but reportedly after
a year become more natural. The benefit is that the procedure is performed
through a single incision (as you described) resulting in less scarring.
I believe that this procedure also involves breast liposuction. By this
reasoning I would infer that you are a young woman and your surgeon is
trying to minimize scarring. I have not yet performed a LeJour mastopexy/breast
reduction as the preferred type in my geographical distribution is the
inferior pedicle type. Just be particular in your questions to your surgeon
so you clearly understand the expectations.
Thanks for the question,
John Di Saia, M.D.
Question #3:
>I am in my early 40's and in very good shape for my age.About 2 years
ago I had some lipo done on my upper thighs, I had a few pounds there that
I just could not lose. Before the surgery I had a small amount of cellulite
on the upper backs of my thighs. The surgeon told me not to expect these
areas to improve, this was fine.
>The problem is that now the inside of my thighs are "ripply" and I
can even see some bumpiness on the outsides of my thighs. My legs are thinner
and for the most part they look fine, but my questions is: Would it be
possible to have have these uneven spots sucked out? Or because of my age
should I just resign myself to the fact that my skin is less elastic than
it used to be?
An Answer:
Your problem here is not unusual. It is common in liposuction of the
medial thighs and happens to a lesser extent in other regions. We do rely
upon the skin to contract down around the remaining fat following the procedure.
Sometimes it is difficult to leave a smooth surface and redundant skin
can also contribute to the appearance your describe. The ability for it
to do so definitely varies with age becoming less reliable with age. Repeat
liposuction could help even things out, but will probably not leave a "perfect"
result. The adequacy of repeat liposuction to address the problem centers
upon the exact distribution of remaining fat and its consistency. Obviously,
scarring following the first procedure may leave the fat in the area less
amenable to liposuction which requires it be removed through a small tube.
You'll have to see a qualified plastic surgeon to get a better idea.
Thanks for the question,
John Di Saia, M.D.
Question #4:
>Hi! I'm a 25 year old female who's in fairly good physical shape. I'm
quite slim but regardless of my inner thighs still drive me crazy!
>
>I was wondering if you could provide me with both target excercises
and the cost for liposuction. My concern is that the operation would have
a negative effect on the quality of my skin: in terms of bumpiness or permanent
discoloration.
>
>Could you provide me with some details please of the proceedure and
the cost involved.
>
>Thanks!
An Answer:
The medial thighs are an area in which it can be difficult to get good results. The degree of course depends upon the exact distribution and character of the fatty deposits. I couldn't tell you much about exercises as patients usually have tried that prior to seeing a Plastic Surgeon. The cost is relative to who does the procedure and how much needs to be done. I will soon be updating my liposuction pages with more information on the proceduire itself.
Thanks for the Question,
John Di Saia, M.D.
Question #5:
>Hello Doctor,
>Your homepage is excellent! I truly appreciate all the informative
information, you have provided to those like myself. My question concerns
liposuction totally by local anesthesia. "The Tumescent Technique" invented
by Dr. Ives Gerald Illouz, a Doctor here in the Bay area by the name of
Dr. Jeffrey H. B____ currently performs the procedure. This sounds like
the answer for me. I'm looking into lower body "thighs and hips".
>My concern is, I have lupus, SLE I'm currently on 10mg prednisone and
after speaking with my Rheumatologist am wondering if perhaps this may
not work for me. I've been controlled for well over a year. My MD was concerned
with the extended length of my healing process and with the blood loss
and or drainage into the fat cells. Please offer advice, I was convinced
this was the solution to my body contouring issues.
>
>Thanks so much and good luck in all of your endeavors
An Answer: Your problem has two major foci:
(1) The anesthetic risk
You as a patient with Systemic Lupus may have increased anesthetic
risk. This would best be elucidated with an anesthesiologist
and/or your rheumatologist.
(2) Surgical Complications
As a patient with an auto-immune disease (and on systemic steroids),
you are at higher risk for surgical complications. These would include
delayed or incomplete wound healing and increased propensity for infection.
The exact incidence would be difficult to infer as the data is not abundant.
The distribution and character of your fat may also be somewhat different
than another patient. I am not sure the expectation of post-operative result
could be as clear.
On the other hand, you have Lupus, not a death sentence. Take into account the risks offered you be your doctors and make an informed decision. If your surgeon is willing to offer you surgery, take the risks to heart and consider them relative to your projected benefit.
One last comment for the record... Many surgeons (and even dermatologists)
seek credit for "inventing" tumescent liposuction. Don't let this claim
be the overriding factor in your decision as to who will be your surgeon.
Maybe your surgeon here did have something to do with the incept of this
procedure. It is the only form of liposuction I have performed and many
others offer it.
Thanks for the question,
John Di Saia, M.D.
Question #6:
>Hello! I am a 23 year old male, and I am in good health. I have had extra fat around my breast area since childhood, and thus it gives me the appearance of having small breasts. I am not overweight. I am 6 foot 2 inches tall, and weigh 175 lbs. I have tried working out, and doing many different bench press exercises. Doing these exercises has helped reduce their size, and give them a little more muscular shape, but it fails to completely remove them.
>What type of procedure would need to be done to give my chest area a flatter appearance? Is there a reason I have these "breasts"? I can never go swimming in public, or wear tight shirts, and this condition has a negative effect on my self- confidence because I feel like people are always staring at my chest, and laughing internally.
>Your WEB page is very informative. Keep up the good work!
An Answer:
Thanks for the kind words. There are several different causes of gynecomastia (male breast enlargement). Some are hormonally-related. It would make sense if you haven't seen an internist or endocrinologist (hormone specialist) for you to do so. Drugs can also cause it such as Tagamet. Marijuana can cause it. Withdrawal of these items and a work-up for hormonal influence should proceed surgical correction. In 13-15 year old males, it will resolve 85% of the time within two years. You are not in this age group, so this does not apply to you.
Surgery for the problem involves incisions in the places most plastic
surgeons use for female breast augmentation namely the lower border of
the areola. Possible problems with the surgery include inadequate removal
of material, excessive removal of material, scarring and sensory changes.
Removal of too much fatty tissue (believe it or not) is worse than inadequate
removal. It is relatively easy to go back to the operating room to remove
more.
Thanks for the question,
John Di Saia, M.D
>I visited a plastic surgeon who told me it is excessive skin from a pregnancy 10 years ago that is the cause of my lower abdominal bulge. The delivery was a C-section. I am a petite 30 year old who is an avid exerciser and vegetarian. My upper abs are quite muscular, but my lower abs seem out of place with the rest of my body.
>Please consider answering my following questions:
>How is excessive skin in the ab area removed?
>How much recovery time is typically required before one could return
to work?
>What kind of costs are involved?
>Is this inherited? Many women's abs return to normal after a pregnancy.
>
>Your time is sincerely appreciated!
An Answer:
By the way you phrase the question, I gather that your consultant recommended abdominoplasty which seems OK for what you described. I would go further than you and state that not only do you have extra skin now but also a lax lower (and perhaps upper) abdominal wall. The envelope surrounding the Rectus abdominus and oblique musculature often stretches during pregnancy. This may perhaps be worsening as Obstetricians are allowing women to gain more weight during pregnancy than that which was previously recommended. It is true that some women following pregnancy become quite similar to their pre-pregnancy shape. I would contend that not only genetics is in play here but also exercise patterns and absolute weight gained during pregnancy. For you this is all "water under the bridge."
An abdominoplasty would address this laxity as well as the skin and fat. Liposuction would only address the fat and may lead to even more noticeable excess skin. In abdominoplasty the abdominal wall is tightened with sutures and excess skin is removed surgically. A scar in the lower abdomen results which can be placed in the same position as the low transverse scar of a previous C-section. The length of the incision may need to be lengthened however to get all the necessary skin out. In cases in which the patient seeks a short scar, we simply take out less skin. It is a trade-off.
Recovery time is variable. I keep patients from working out for two
to three weeks. Heavy workouts are avoided for a month or more. Returning
to work really has more to do with the type of work. An exercise trainer
will take more time off than an office worker. Costs are variable as well
usually as a function of your doctor's overhead and professional fees.
The procedure is usually done as an outpatient which reduces the fees a
great deal.
Thanks for the question,
John Di Saia, M.D.
Question #8:
>Since I was 11 years old (and I just turned 40) I have wanted breasts.
It has been a thorn in my life. I have tried everything to override this
pervading desire. My question is what happens to this implants when a woman
is say 60 or older? Seeing that life is moving so quickly, would I have
to have them redone and then, what would an old lady of 65/70 look like
with firm uplifted breasts. Any comments about this subject would be very
helpful to my ability to make the final decision.
>Thank you.
An Answer:
You ask a very reasonable question with a less than definitive answer. The problem with Breast Augmentation (and to a lesser extent all cosmetic surgery) patients is that long term follow up is "hit and miss." These patients pay cold cash for their procedure and many like to keep the issue private. Multiple returns to the Plastic Surgeon are very infrequent unless problems arise.
To answer your question it is difficult to predict how a patient may look twenty or thirty years following a simple breast augmentation. Firm breasts (severe capsular contracture) are not always the result, but the exact frequency is difficult to measure for the aforementioned reasons.
You are more "forward thinking" than the average augmentation patient. I do remember in gross anatomy over ten years ago when I was a student looking at the preserved form of a roughly seventy year old female corpse. She had had breast implants and truly her bosom defied gravity. The breasts however were not overly firm even after preservation. I have also seen some patients at the Veteran's hospital with firm implants at the age of sixty five.
Thanks for the Question,
John Di Saia, M.D.
Question #9:
>Hi. I thoroughly read your home page. Thank you so much for posting
so much information. I am scheduled for breast augmentation on July 18.
I interviewed several doctors and went with the one who appeared most experienced
and calm. He was also the most expensive so money was not the deciding
issue.
>I am an extremely fit aerobic instructor/fitness trainer with slight
breast fold- around a size B. I am still confused because the three doctors
I spoke to said totally different things. The one I chose wants to go over
the muscle with the insertion in the breast fold. Another one I almost
went with raved about how bad over the muscle is and how horrible the incision
mark in the breast fold is. I almost went with him but the pictures looked
like a small or large ball sticking out.
>I know I chose a better doctor but I am nervous about the scar. I
am going to speak to him today. Any advice on your part would help. What
do you think about under the arm insertion when the implant is placed over
the muscle. Is the breast fold better than the nipple. I just want fuller
not really bigger. The doctor will be using approximately 300cc.
> Any information will be appreciated. If you wind up practicing in
New York City let me know. I have a wonderful clientele in both the entertainment
and publishing industries.
An Answer:
You put me in a difficult position as you already are in the care of another surgeon. I must say however that I am not impressed with the long term results of subglandular ("over the muscle") augmentation. The scar is not your only problem here. You also have to be concerned about wrinkling of the implant surface (with saline implants) which may be more conspicuous without the intervening Pectoralis muscle.
I would suggest before you actually have surgery that you talk to your doctor to completely work out your questions. Sometimes patients feel that they would be bothering him/her to do so. Try to defeat this feeling.
Once final thing....don't get caught up in the volume(300 cc).
Try to indicate to your doctor what you would like to look like with a
picture. I feel it is far more pertinent than either cups sizes or volume.
It is sometimes difficult to envision how a certain volume will look on
a patient. The "look" obviously is the most important issue here.
Thanks for the question,
John Di Saia, M.D.
Question #10:
>Hello, and _thank you very much_ for all the information! A few months
ago, I heard about a new procedure for liposuction on the news. They said
something about the fat being liquefied before removal, therefore allowing
more fat to be removed. I think they said there are concerns about too
much fat being taken out. What can you tell us about this procedure?
>Like someone else who wrote, I am 5'1" and 125 lbs., and am interested
in getting a pouch of fat removed from my tummy and in getting fat removed
from my thighs and buttocks. I exercise and eat right, but I cannot get
rid of this! Again, thank you very much for your help. I don't know where
you find the time to do this!!!
An Answer:
The new technique to which you refer may be Ultrasound-assisted liposuction. There are several variations of this technique some of which offer more than others. The risk of "over suctioning" is always present
with any form of liposuction and might be a little more common with these techniques. Take into account that more complete fat removal is not always good. As I have stated before, liposuction is a sculpturing procedure. This is not weight loss and most patients notice a few pounds or less lost post-operatively.
Thanks for the question,
John Di Saia, M.D.
