Thursday, November 27, 2014

Is it safe to breastfeed after having breast augmentation?

Breastfeeding has been shown to be of immense benefit for both baby and mother. Not only does breast milk provide the most ideal balance of vitamins, proteins and fats, but also provides antibodies that bolster the child’s immunity and ward of potential of infections. It lowers risk of long term ailments like allergies, has been linked to less likelihood of diabetes, obesity and certain cancers. Further, it has been correlated with higher IQ scores in later childhood.

As mentioned, it also benefits the mother in several ways. The hormone, oxytocin, is released which helps the uterus return to its normal size and shape for one. Breastfeeding also burns calories, which aids in the shedding of the accumulated pregnancy weight. It lowers the chance of breast and uterine cancers, and is linked to lower likelihood of osteoporosis. Perhaps the greatest benefit of direct feeding is the regular relaxation and bonding that occurs through the process. While the baby doesn’t remember the act later in life, it no doubt increases their sense of closeness and often provides the mom some of her most cherished memories of motherhood.

Naturally, the thought that breast augmentation may get in the way of this process is a concern of many younger women who have yet to have children of their own and would like to breastfeed if and when they do become mothers. Luckily, there is no reason to worry!

The only real issue here is a change of sensation around the nipples resulting from surgery, which may alter the experience to a certain extent. However, this shouldn’t affect a woman’s ability to breastfeed in any significant way.

A common concern is that the presence of implants will contaminate the breast milk causing it to be unsafe for the child. This is not the case. The size of both silicone and saline molecules disallows them from entering into the breast milk. Even if a few were somehow able to penetrate into the milk, it would have no negative effect on the child. Imagine how much silicone you inadvertently ingest from your lipstick on a daily basis!

Some women also worry about the act of breastfeeding having potential to damage the implants themselves. While breastfeeding poses no damaging risk to implants, the only precaution here is that women should do their best to wait until the healing process from the breast augmentation surgery has been able to complete itself prior to becoming pregnant. This is because the breasts naturally enlarge during pregnancy in order to develop milk, and this could slightly interfere with the recovery process.  

Ladies who are considering having children in the future need not worry about implants causing undue complications with breastfeeding or vice versa. If I learn that this is something a woman is considering, I fully take that into account when deciding where to place the implant and make incisions as to not affect the milk ducts or nerves. This, of course, depends on each woman’s specific anatomy and I may opt to do a more breastfeeding friendly operation even if a woman declares she wishes to never have children, because we all know that life has its surprises!

If you are interested in scheduling a consultation, feel free to fill out the request form here.

Thursday, October 2, 2014

What type of Liposuction is the best?

Tumescent Liposuction
This is a question I get frequently. Some of the newer approaches have made great claims as to their superiority over the more traditional method, but these have yet to be proven and published in scientific journals. I always think that if those new techniques are really what they promote, then every plastic surgeon in the world would do them, and that is not the case. They have been around for a long time and they haven't substituted traditional liposuction, and probably never will. At any rate, the variable of highest importance when selecting liposuction surgery is the experience level and efficacy of the provider.

Tumescent Liposuction is the original mode of treatment and continues to be regarded the gold standard by which other methods are compared. It functions by applying a local anesthetic to the area, injecting a fluid to shrink the blood vessels and expand the fat cells, and then inserting through small incisions a long rod-like device called a cannula through which the targeted fat cells are removed by vacuum suction. Some temporary bruising and swelling are typical with this procedure.

Micro-fat Grafting
This is the method that my team and I employ in my practice most frequently. Done correctly, it provides the incredible results that liposuction is known for with minimal risk. Unlike all other types of liposuction, the fat tissue removed is still in tact enough that it may be inserted into different areas of the body where more volume is desired, such as the buttocks or facial deposits. This is a common procedure known as micro-fat grafting.

Laser (Smart-Lipo, Slim-Lipo), Ultrasound (VASER), Water (BodyJet), and Power Assisted Liposuction are the newer, more heavily marketed types of liposuction. They all act to liquefy the fat tissue more thoroughly than the traditional approach prior to its removal, which disallows the removed fat to be used elsewhere in the body. While it seems true that this liquification may lead to slightly less blood being extracted with the fat, the claims about producing less swelling and tissue trauma have yet to be proven and published in medical journals.

Because of the extreme measures taken to liquefy the fat and the precision required, these alternative methods also come with elevated risk for skin, nerve, and tissue damage, mostly depending on the skill level of the operator of the equipment. There is a much greater learning curve involved, so it’s crucial that the providing surgeon has been utilizing these techniques for a long time. They can also require more time in the operating room. I would say that the most important contributing factor to these techniques, which separates them from the traditional method is less bleeding. Besides that, I don't see any other true benefit. 

While I stand by the traditional tumescent approach in my practice, I do occasionally employ Laser Liposuction when dealing with cases of extreme skin flaccidity. This is because it does seem to provide a slight edge in times of loose skin needing to be kept as tight as possible. But I use this on an as needed basis only, and all of my liposuction clients are routinely thrilled with their results.

Saturday, August 30, 2014

For those who prefer their scars not tell a story...

Any time you have surgery, there is an incision of some sort. Some surgeries use tiny entry points for laparoscopic or simple purse-string procedures, while others require a large open site to get the job done. At any rate, it’s useful to know a bit about how and why scarring occurs, and what can be done to minimize it.

In general, scarring is the skin’s way of repairing itself when it is wounded. Collagen is the protein that lays down lattice-like fibers in the skin, serving as a glue to bind the penetrated tissues back together. Over time, sometimes up to 18 months, this process completes itself through the eventual softening and fading of these mends.

There are several factors that contribute to how one person may scar differently than another. While there are measures that can be taken to decrease the severity of scarring, there are also influences over which we have no control. These include things like age, race, and genetic tendency to scarring.

This is one area where having a few more years under one’s belt may actually be of some benefit! Excessive scarring is often the result of excessive collagen formation, which occurs more before the age of 30 as younger skin has a tendency to over-repair itself. This can lead to what are known as keloids, or raised scars. Additionally, older skin typically has a few more blemishes and age-spots, which help obscure potential scars from being as noticeable.

Race also comes into play as those with darker complexions, such as African-Americans, or those with especially fair skin have a higher likelihood of developing keloids. Regardless of complexion, there are also certain genetic lines of any race that, for whatever reason, just have a greater tendency to scar more severely.

People who are overweight are also more likely to scar because the extra fat tissue under the skin can make it difficult for the surgeon to achieve a seamless reconnection of the incision. This is a big part of why procedures like liposuction or body contouring require patients to be as close to their target weight as possible prior to undergoing surgery.

While these characteristics may suggest an overall higher risk for more severe scarring, they don’t guarantee it, nor are people who don’t share these characteristics necessarily risk-free. There are several ways, however, that everybody can improve the chances that they will heal with less apparent scars to show for it.

First and foremost, it is vital that patients follow the guidance of their surgeon. Invariably, this will mean getting plenty of rest, avoiding certain movements or lifting actions, keeping the incision out of the sun, and staying well nourished and hydrated. Far too often, patients go outside or get back to work earlier than recommended simply because they feel they can, and that it might actually help accelerate the healing if they push through it. This couldn’t be more wrong.

Additionally, patients should avoid fatty and sugary foods that may cause inflammation while making sure to get plenty of protein to help the body repair itself. Drinking alcohol and caffeinated beverages leads to dehydration and should be avoided. Smoking, which inhibits proper blood circulation and pollutes the body, is one of the worst things you can do during the healing process and should be avoided completely.

These precautions aside, there is not a lot of material in the medical community that describes actual treatment for post-operative scarring. Pressure therapy, however, has been shown to be quite helpful in facilitating the healing of incisional scars. These methods utilize silicone sheets and ointments. I am constantly changing my prescriptions on these products, but in general I suggest the use of self-adhesive silicone gel sheets such as Cica-Care by Smith & Nephew. Additionally, gentle massage of the area by yourself or a licensed massage therapist can be useful in helping the new collagen fibers to lay more evenly and prevent scar tissue, especially for deeper incisions. If keloids do form, or if a patient is knowingly prone to keloid formations, I may suggest steroidal injections at the incision site to further minimize them.

Whether large, small, multiple or singular, the healing of incisions can be optimized by following the above suggestions. Through such doing, scars will be greatly minimized and the results of your cosmetic procedures enjoyed for many years to come. Thank you for reading this, and thanks for doing your part!

Tuesday, July 8, 2014

Liposuction is NOT a Weight-Loss Procedure

It’s funny how often I hear people suggest that this celebrity or that politician underwent liposuction to lose a dramatic amount of weight, and that they would like to do the same. Understandable as such allegations may be, it is simply not the case.

Liposuction is a type of surgery that is designated for people who are already at a normal weight for their height and build but have a few stubborn areas or pads of fat that simply won’t go away no matter how hard they work out or how disciplined their diets may be. Rather than removing large masses of adipose tissue, liposuction is more of a fine-tuning technique that can effectively define the contour of one’s physique offering dramatic results in his or her overall appearance.

In a fast-paced world such as ours where instant gratification has defined our expectations, it would certainly be ideal if someone who is substantially overweight could just take a week off of work and have the obesity removed. However, there is no such quick fix and to remove a high volume of fat would be incredibly invasive and potentially catastrophic to the neighboring tissues and blood vessels.

The guidelines set forth by most regulating bodies including the American Society for Plastic Surgeons (ASPS) limit the amount of fat removed in a single liposuction procedure to 5 liters. Once that limit is exceeded, risk increases exponentially and the surgery becomes extremely dangerous. At an average of 2.2 pounds per liter, this means that 11 pounds would be the most weight one could safely expect to lose from undergoing liposuction. Again though, the focus should not be placed on weight-loss but rather removing the subtle bulges that obscure an otherwise fit body.

For those who are overweight and looking to achieve rapid weight-loss, Bariatric Surgery may be a more appropriate route, though even that process takes several months to fully attain the desired result (at which point Post-Bariatric Plastic Surgery can help with removing the excess skin that results from massive loss of weight). This type of surgery is intended for people struggling unsuccessfully with obesity, which is measured as having a Body Mass Index (BMI) that is greater than 30, but more typically 35 or above.

Liposuction, on the other hand, is suitable for people already at a healthy weight with a BMI in the low to mid-twenties, 28 at the very highest in rare cases.

Calculate your BMI here.

Sidenote: there is also an increasingly popular technique known as Microfat Grafting which injects the fat removed by liposuction into other areas of the body to add volume in a way that is aesthetically pleasing, such as in the Brazilian Butt Lift where the backside is given a perkier and often more rounded appearance. Rather than using implants, this allows for augmentation using one’s own bodily tissue, which is generally more appealing to patients.

Wednesday, June 4, 2014

Reducing Risk of Pulmonary Embolism

Like any surgical procedure, plastic surgery involves a certain degree of risk. In order to minimize these risks, it is important to follow the directions of your surgeon before, during, and after your medical treatment. Of particular focus in this article is an avoidable complication known as pulmonary embolism. This condition is essentially the blockage in the arteries of the lungs, usually due to the formation and release of blood clots from the legs or other parts of the body.

In relation to pulmonary embolism, there are certain increased risk factors that I must take into consideration when patients are coming to me for surgery, and there is a table below that shows those. However, I'd first like to share some activities and precautions that will significantly lower the risk of pulmonary embolism for everybody. In addition to the requirement of not smoking and avoiding second-hand smoke, I recommend that all patients:

· Drink plenty of water (3 liters per day at least).
· Avoid lying down during the days before surgery.
· During the flight, avoid sitting down for long periods of time, try walking around or moving your toes, feet, and legs all the time.
· Preferably buy compression stockings for your flight and preoperative days and wear them at all times.

Following these guidelines keeps the blood circulating at optimum levels. Doing so insures that any clotting will be minimized, making the risk of embolism much less likely. Thank you for remembering these points. It is especially important for those of you who may answer yes to one or more of the following risk factors.

Table for determining risk factors for Deep Venous Thrombosis (DVT) and Pulmonary Embolism 
Risk factor
Major surgery in the past month

Varicose veins

History of Inflammatory bowel disease

Swollen legs

Obesity (BMI above 25)

Heart infarction

Congestive heart failure

History of sepsis in last month

Severe pulmonary condition in the last month

Abnormal pulmonary function (COPD)

History of deep venous thrombosis or pulmonary thromboembolism

Family history of thrombosis

Blood disorders

Hip, leg, or pelvic fracture in the last month

Multiple myeloma

Oral contraceptives or hormonal replacement therapy

Pregnancy or less than 1 month since delivery

History of miscarriages (more than 3)