Underwire Bras after Breast Surgery

 Breast surgery in my practice varies greatly from augmentations, to reductions, to lifts and reconstructions, as well as a combination of all of these.  All of my surgery patients are seen at least twice in consultation before surgery, to insure that they fully understand everything that will be taking place preoperatively, operatively and postoperatively, and to insure compliance with instructions.    My philosophy  is that a patient who has a global understanding of what is taking place, is one who will be more compliant and is more apt to heal without complications.   

I recommend not wearing an  underwire bra after surgery.  I am not a big fan of underwire bras following breast surgery for the first 6 months.  Whatever the breast surgery, the inframammary fold is affected, and  there are incisions that may be  at the bottom of the breast, which can be irritated by the wire and delay healing. 

Even though  I have instructed patients not to wear an underwire bra immediately after surgery, some patients have ignored this and then complain of the wire hurting their breasts, unlike before the surgery.   I suspect that this is because there is inflammation in this area which then  causes discomfort due to the wire.

Thus,  I advise all of my breast  patients to wear either jogging/athletic bras or support bras which  do not have wires.  Stay comfortable, follow instructions and     do no harm  to your recovering breasts.  

The Best Breast Size

How big is big??  One of the most difficult questions for my patients undergoing breast augmentation is deciding their new breast size. 

There’s a great deal  to consider.  What look does the patient want?  What is safe for them?  What will offer the most natural results?  How much cleavage?

The best breast size is the size that best fits your body.   I  also take into account   body image, as each woman has their own  unique  image.  

Regardless of your cup size or the shape of your breasts, I need to determine the best size and shape for you, and what you are comfortable with.   During breast augmentation consultations, I discuss this at length with my patients and ask them to try  different sizes in a jogging bra,

At least two weeks prior to the surgery, I lay out several sizes of implants and have the patient put on a jogging bra and together we select the best implant size.    The patient is not told the volume of the implant at that time, and  only comments on whether or not she likes or dislikes the look with the implant under the jogging bra.  

It’s vitally important that patients are comfortable and happy  with this long term decision. 

Does Immediate Laser Treatment Minimize Scarring?

A recent Reuters Health reports states that “treating the edges of a surgical wound with a fractional carbon laser immediately before closing the wound — rather than the more traditional method of waiting months to resurface surgical scars — will minimize scarring later.”

People need to be wary of studies quoted to support absolute statements. There are few real absolutes in science and far more in advertising. The study quoted  reflects the interpretation of ten patient photographs after skin procedures performed by dermatologists in which half a wound was treated with  laser.

The conclusion that immediate fractional carbon laser treatment will make scars less appreciable later is premature, to say the least. The second supposition,  that using a laser months after an operation for scar treatment is standard,  is spurious as well. 

What does the study prove?

Further study is indicated to determine whether or not patients who have procedures by dermatologists might benefit by laser treatment. With a small sampling of just ten patients, no other conclusions are reasonable. Making a broad-based absolute conclusion based on this very small study is not good science. 

Problems?

(1) Scar formation varies greatly, depending on the area of the body, type of skin, age of the patient, and surgery performed.  

(2) As a general rule, health insurance companies will not pay for laser procedures to treat scarring, and costs vary, greatly depending on the type of laser used and  the size of the area to be lasered. 

FDA officially approves Restylane.

The U.S. Food and Drug Administration (FDA) has approved another use for Restylane Injectable Gel: this week the agency gave its official blessing to use the filler for lip augmentation.     

Restylane was previously approved to treat facial wrinkles. While we have long used it for lip augmentation, this was known as an unofficial or "off-label" use. Restylane is the first filler to get the FDA's approval for this particular use.

In the multi-center study that Medicis, the makers of Restylane, presented to the FDA, Restylane was found to be highly effective for lip augmentation, for up to 6 months. It did not have any serious side effects. About 80% of patients liked the results so much that they signed up for a second treatment after 6 months.

This is certainly our experience at my practice: both restylane and juvederm work very nicely to shape and fill the lips in a pleasing and natural-looking way. Patients love it!

The Waiting Game After Breast Augmentation.

It is very important that you build a solid rapport with your surgeon, and it’s paramount to develop an open line of communication him/her and with the entire staff. After the initial consultation, and once a patient has scheduled surgery, we see the patient twice prior to the procedure, and ask each patient to write down questions and bring the list into the office, or call if there are any immediate concerns. The most frequently asked questions are, “How long after surgery can I return to work?” “How long before I can begin to work out and engage in other sport activities?”

Return to work after Breast Augmentation

Most of my patients can comfortably return to sedentary desk jobs within a week of their breast augmentation surgery. Patients having breast implants placed above the muscle tend to be a little less sore than patients who have the implants placed beneath the muscle. Generally, by the beginning of the third week following breast augmentation, I will encourage the patient to start light exercise. Full activity is generally the rule by week four.

Sports activity following Breast Augmentation

I encourage playing "couch potato" for two weeks! Clean out the DVR, tackle the Netflix queue. You should be able to escalate to gentle activity by the beginning of the third week and full activity by the fourth week. There are exceptions to every rule, of course. So please speak with your surgeon; they will know what’s best for their patient!

Be safe, and if ever in doubt contact your surgeon’s office with any post op concerns and questions. I see each patient postoperatively numerous times during the healing period, and either myself or a member of my staff is on the phone daily for at least the first 7 postop days.

I cannot stress strongly enough the importance of asking questions, as a fully informed and compliant patient will generally recuperate much better.

What you need to know about DIY Botox

DIY Botox first gained popularity in late 2008. Today,  if one were to initiate  a Google search, there are over 2 million results.  Among them you would even find a  step-by-step tutorial on YouTube.  Do-it-yourself Botox and other dermal filler kits are becoming prevalent internationally, but is it safe?

The dangers are countless, and  I’ll enumerate a few of them: 

DIY Botox is not legal.   The Botox and other dermal fillers I use in my practice are  approved for use by the FDA by physicians and nurse practitioners under the direction of a physician only, in a clinical setting.

Injectables which are readily available to the public, on-line or otherwise, have not been approved by the FDA, and are not  monitored.    These fillers and other injectables  are not subject to safety measures, and myriad complications may ensue.    These non-FDA approved products may be even more  potent than licensed Botox. The consequences could be fatal, or  result  in  short-term or permanent  paralysis.

DIY Botox is not sterile. 

Prescription Botox is packaged in a sterile environment, using sterile equipment.   Botox  purchased through a non-FDA approved source is often not prepared under sterile conditions, may contain other  toxins, and the risk factors are vastly greater for complications. 

As with any sterile procedure, whether it’s in the operating room or the examining room, proven methods of sterile technique are adhered to, and this also applies to the use of Botox and filler injections. 

Counterfeit Botox and Juvederm has not been approved by the FDA and is not legal in the United States.  Patients subjecting themselves to injections of these substances by non-professionals using illegal substances will not be saving money in the long-term, as the risk of infection, disfigurement, abscess and even death is high.  

It's a Bird...It's a Plane...It's Superman?

When Clark Kent wanted to transform into his heroic alter-ego, Superman, all it took was a quick whizz round inside a phone box.  In real life, things are rarely so easy as I read on an ABC news article! A 35-year-old man has had extensive cosmetic surgery to make him look more like the comic book character.

Herbert Chavez, from the Philippines, has dramatically altered his appearance to look more like the famed Man of Steel. In his quest to emulate his favorite superhero, he has undergone a variety of procedures ranging from chin augmentation to thigh implants.

Mr Chavez, whose profession is given as 'pageant trainer', has been going under the knife since 1995 to achieve the transformation.  So far Mr Chavez has admitted to having a chin augmentation to give him Superman's iconic cleft; Rhinoplasty to transform his Asian nose into one more closely resembling Superman actor Christopher Reeves; silicone injections to his lips to make them fuller and thicker; and thigh implants to make his legs appear more muscular.  

Based on the before and after photos, I would also suspect eye surgery, cheek augmentation and a jaw augmentation.  His look appears to be an amalgamation of all the actors who have played Superman, as well as comic book depictions of the fantasy character.  Surely an interesting yet extreme look at what plastic surgery can do.  Although I wouldn’t necessarily advocate plastic surgery to become your favorite super hero.  

Can lipo make you healthier?

On today’s blog I wanted discuss a new study recently presented at this years the annual conference of the American Society of Plastic Surgeons has found that liposuction can not only make you thinner, but could possibly simultaneously decrease the triglyceride content in your blood.

 

According to ABC News:

Researchers studied levels of cholesterol and “bad” fats called triglycerides in the blood of more than 300 patients who were undergoing liposuction. Patients who had elevated triglyceride levels before the procedure showed an average 43 percent reduction in their triglyceride levels after they had liposuction.

The patients showed no changes in their cholesterol levels, but researchers did find a post-liposuction reduction in counts of white blood cells, which are associated with heart attacks, obesity, strokes and high blood pressure.

This is the first study that has shown any beneficial health effects of liposuction removing subcutaneous.  However, I would still say it’s a stretch to say that lipo alone will make you healthier.   There are fats that cannot be removed via liposuction such a visceral or intra-abdominal fat.  Unfortunately, these carry with them a higher risk of heart disease, unlike subcutaneous fat. 

There is a place for liposuction.  But it won’t  be a substitute for a good diet and regular exercise.  It’s purpose is to treat stubborn areas of fat in people who have a healthy body weight.

Beauty sleep is not a myth

Want a free a simple idea to improve your appearance?  My answer:  Get at least 8 hours of sleep a night.   The idea of people needing "beauty sleep" has acquired some scientific backing, according to a Swedish study.

The study, led by John Axelsson of Sweden's Karolinska Institute, was published Dec. 14 in BMJ, a British medical journal. It set out to explore the effect that sleep has on how one is perceived, specifically on others' judgments of an individual's attractiveness and health.

People deprived of sleep for long periods appear less attractive and more unhealthy than those who are well rested, say researchers.  Volunteers were photographed after eight hours sleep and again after being kept awake for 31 hours.Observers scored the sleep-deprived participants as less healthy and less attractive, the BMJ reports.

The concept of beauty sleep is well known. But, according to researchers at the Karolinska Institute in Stockholm, it has lacked scientific support. The team asked untrained observers to rate the faces of 23 young men and women who had been photographed after a normal night's sleep and then after a night of sleep deprivation.  The photographs were standardized so that people were the same distance from the camera, wore no make-up and used the same expression.

The authors wrote in their paper published in the British Medical Journal: "Sleep deprived people are perceived as less attractive, less healthy and more tired compared with when they are well rested." They say the results may be useful in a medical setting, helping doctors to pick up signs of ill-health in their patients.

Commenting on the study, Derk-Jan Dijk, Professor of Sleep and Physiology at the Surrey Sleep Research Centre, said the effects of sleep loss on beauty may be even more dramatic than the photographs show. He said: "The photographs were taken during the daytime when the biological clock promotes wakefulness.  Can you imagine how sleep loss makes you look at night or early in the morning when the circadian clock (body clock) promotes sleep?"

Findings showed that sleep-deprived people appear less healthy, less attractive and more tired compared with when they are well rested," wrote the researchers. This suggests that humans are sensitive to sleep-related facial cues.

 
While the long-term effects of poor sleep on overall health have been widely researched, this is the first study to provide evidence that in the short term, sleep deprivation does in fact show up as a discernible change in facial appearance.

So, get some sleep and go from rough to ravishing!

Should you Combine Plastic Surgery Procedures?

One of the questions I’m most often asked by patients: “Is it possible to have more than one surgery at the same time?” This has been a particularly growing trend in the past few years.   Over the last several years more and more patients come to the office wanting to address more than one problem area at the same time.

For many years plastic surgeons have been combining facial rejuvenation surgical procedures because as we all know, humans don’t age one facial part at a time.  We commonly perform eyelid surgery and facelifts surgery simultaneously   They are even combined with other rejuvenation surgical procedures because they can be done so safely.    Patients are recovering at one time, and they end up with a more harmonious result.

As long as sound judgment and safety are the primary focus of all consideration, then even larger operations on the body can be accomplished in one operative visit. Preoperative screening should always be completed prior to an operation of larger magnitude or other longer and delicate procedures.  The pre-op assessment will be a good indicator of what the patient will be able to safely handle.  It is also important to make sure that you are choosing a plastic surgeon with proper credentials and plenty of experience as well as one that performs their surgeries in a certified operating facility. 

As a double board certified surgeon, I say safety first! 

Breast Reduction

Breast reduction is often misunderstood online. The operation is defined as the reduction and lifting of breasts. This is not the same as removing or reducing the size of breast implants in a woman’s breasts. That is called an implant exchange.

Implants are not usually involved especially when an insurance company is scheduled to pay for it with the possible exception of surgery to reconstruct a woman’s breasts after breast cancer surgery.

It is difficult enough to get most insurers to pay for “clear cut” medically-necessary plastic surgery. Breast reduction surgery is the reduction of naturally enlarged breasts and that is all.

Breast reduction used to be one of the more common insurance-covered procedures. With the economy as of late, insurers are not always so quick to approve them, but for the right patient they are still do-able.

Usually we see our patients for a consultation and then apply to their insurers for pre-approval if the case seems reasonable by insurance company standards. We don’t make the rules on approval, but we do know the game. Appeals are not uncommon.

These days, insurers are looking for a certain amount of breast gland to be removed in a certain sized woman in order to allow coverage. In addition they like to see documentation of things like bra strap furrows, the “dents” some larger breasted women get in their shoulders from breasts weighing against them throughout the day. Insurers don’t tend to like claims where liposuction has been involved. This can trigger denials on cosmetic grounds at the time of billing.

Insurance pre-approval usually covers surgery for a 90 day period. The exact nature of that coverage varies by the plan.  Be sure to talk to your surgeon about what your options are and what the best plan of action is for you.