Breast Augmentation (Augmentation Mammaplasty)

Breast augmentation is a surgical procedure that enhances the size and shape of the breasts. Indications for cosmetic surgery are small or asymmetrical breasts. The procedure is accomplished by the insertion of saline- or silicone gel-filled implants behind the breasts. Placement may be either directly under the breast tissue or beneath the chest wall muscle. Some surgeons believe that placement beneath the chest wall reduces the risk of capsular contracture. Surgery is usually performed in an outpatient setting with the patient under general anesthesia or local anesthesia with sedation. The procedure typically lasts from one to two hours. Breast augmentation may be combined with breast lift (see below) and, if so, the total surgery will take longer.

After surgery, the patient will probably experience some soreness, swelling and bruising. The nipple and/or other areas of the breast may have temporarily altered sensation, and the operated breast may be sensitive to touch.

Risks include capsular contracture, which may require surgery to release the scar, and/or removal of the implant. Implant rupture will result in implant removal and/or replacement. Other risks are bleeding, infection, malpositioning, skin rippling secondary to the use of the saline-filled implant and permanently altered sensation in the nipple and/or other areas of the breast.

Patients can go back to work and resume some activities within a few days to one week, but breasts will be sensitive to touch for two to three weeks. Scars will fade over time, but never disappear entirely.

The duration of improvement is variable, and implants may have to be removed or replaced in a number of years. Women considering breast augmentation should be aware that special techniques are necessary to get a reliable mammogram of a breast with an implant, and experienced technicians are not available at all mammography facilities. Ultrasound examinations may help to detect breast lumps or evaluate the status of an implant.

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Breast-Lift (Mastopexy)

Pregnancy, nursing and the aging process take their toll on a woman's breasts, and they eventually begin to sag and lose their shape and firmness. Breast lift is a surgical procedure that raises and reshapes sagging breasts, and (if desirable) reduces the size of the areola. Breast lift combined with implant surgery can enlarge as well as firm sagging breasts.

The technique involves removing excess skin and repositioning the breast tissue and nipples. Women with small, sagging breasts are the best candidates for breast lift. Breasts of any size can be lifted, but results in larger, heavier breasts are less enduring. The procedure takes from one to three hours, and it is usually performed in an outpatient setting, but a one to two day inpatient stay is not uncommon. The patient may receive a general anesthetic or local anesthetic with sedation.

Pain, bruising, swelling, soreness, numbness and dry breast skin are common temporary side-effects after surgery, but discomfort is unlikely to be severe. Loss of feeling in the nipples and breast skin will usually return.

Risks include bleeding, infection, thick wide scars, asymmetry and unevenly positioned nipples. Permanent loss of feeling in the nipples and/or breasts is rare.

Patients can go back to work in a week to 10 days and resume more strenuous activity in about a month. Scars are permanent, but usually fade and become less noticeable after several months to one year.

The duration of results is variable. Factors such as pregnancy, age, weight fluctuations and breast size affect the longevity of the improvement. Women who have implants along with breast lift may have more enduring results.

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Male Breast Reduction (Gynecomastia)

Men with gynecomastia (overdeveloped breasts) may benefit from male breast reduction surgery. The procedure removes excess fat and/or glandular tissue and sometimes excess skin from the breasts so that the chest has a more masculine contour. The best candidates for surgery are men with firm elastic skin. Heavy users of alcohol, marijuana or anabolic steroids are generally not considered good candidates for surgery. These drugs may cause gynecomastia, so discontinuing their use may resolve the problem without the need for surgery. Likewise, overweight men may find that normalizing weight will reduce breast fullness.

Breast reduction is usually accomplished through open excision of excess glandular tissue, sometimes with the addition of liposuction to remove excess fat. When fatty tissue is the primary problem, the surgeon may use liposuction alone. The procedure takes one hour or more and is generally done on an outpatient basis. Anesthesia may be general or local with sedation.

Bruising, swelling, numbness, soreness and a burning sensation are common transient side effects after surgery. Discomfort usually subsides within a few days, but swelling and bruising may persist for three to six months.

Risks include bleeding, infection, excessive fluid loss leading to shock, fluid accumulation, injury to the skin, baggy or rippled skin, pigmentation changes and altered sensation. Some patients may need repeat procedures to remove additional tissue.

The patient can return to work within three to seven days and resume more strenuous activities in two to three weeks. He should avoid exposing the operated area to the sun for at least six months to eliminate the risk of permanently altered skin pigmentation. Improvement is permanent, barring massive weight gain or use of certain drugs.

Improvement is permanent, barring massive weight gain or use of certain drugs.

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Tummy Tuck (Abdominoplasty)

Tummy tuck is a major surgical procedure to flatten the abdomen by removing excess skin and fat from the lower abdominal region and tightening the muscles of the abdominal wall. Appropriate candidates for tummy tuck are men and women with large fat deposits or loose abdominal skin that does not respond to diet or exercise, and women with slack muscles and skin due to multiple pregnancies. Older patients whose skin has lost its elasticity may also find improvement. Obese patients who plan to lose weight should postpone surgery.

For complete tummy tuck, the surgeon generally makes a long incision from hip to hip, just above the pubic region. A second incision releases the navel from surrounding tissue. The surgeon separates the skin from the abdominal wall up to the ribs, lifts the skin flap, and tightens the abdominal muscles by pulling them closer together and stitching them into position. Excess skin is removed from the flap and a new hole cut for the navel, which is then stitched into place before the incisions are closed. For a partial or "mini" tummy tuck, the incision is shorter and the navel may remain in place.

Tummy tuck may be performed in a hospital or outpatient facility, depending on the extent of the procedure and the individual patient. The duration of the procedure varies but typically takes from two to three hours. For extensive procedures, general anesthesia may be preferred, but some patients may receive a local anesthetic with sedation.

For the first few days after surgery, the patient will probably experience pain, abdominal swelling, soreness, bruising and numbness of the abdominal skin. Reduced energy levels for weeks or months are not uncommon.

Risks include infection, blood clots in the legs or pelvis, bleeding beneath the skin flap, loss of the umbilicus, poor healing that results in conspicuous scarring or skin loss and numbness or other permanent change in skin sensation. Swelling of the abdomen may take several weeks to months to completely resolve. Some problems may require revision surgery.

Patients will need to stay home from work for two to four weeks and should wait four to six weeks or more to resume strenuous activities. Scars will fade and flatten in three months to two years.

Results of abdominoplasty are permanent, barring major weight gain.

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Panniculectomy (in obese patients)

Panniculectomy is a major surgical procedure for removal of the large abdominal apron of fat in obese patients. Panniculectomy may be performed in conjunction with other scheduled surgery, such as hysterectomy.

Panniculectomy in obese patients is usually performed in a hospital due to the medical status of these patients and the extensive nature of the surgery. Patients may be hospitalized for one or two weeks or more, and complete wound healing may take several months. With preauthorization, this surgery is often covered by insurance.

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Endoscopic Plastic Surgery

The endoscope is a tubular probe containing a tiny camera that transmits magnified images of the body's internal structures to a video monitor. The device can be inserted into the body through a very small incision so that the surgeon can view the operating field on screen instead of opening up a long incision and viewing the site directly. Endoscopic surgery is not new, but plastic surgeons have only recently adopted the technique for cosmetic and reconstructive procedures.

Many plastic surgeons today offer the option of endoscopic surgery for forehead lift, facelift, breast augmentation and tummy tuck. Patients without excess skin are good candidates for endoscopic surgery.

As with any other surgery, there is always s risk of infection. Other risks include bleeding, fluid accumulation beneath the skin, blood vessel damage, nerve damage or loss of feeling, internal perforation injury (from the endoscope) and skin injury. In some cases, the improvement may be less satisfactory than with conventional surgery. Patients who opt for endoscopic surgery should be aware that, should complications occur during the operation, the surgeon might have to switch to an open procedure.

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Liposuction Suction-Assisted Lipectomy

Suction-assisted lipectomy (SAL), traditionally known as liposuction, is a method of removing unwanted fatty deposits from specific areas of the face and body. The surgeon makes a small incision and inserts a cannula attached to a vacuum device that suctions out the fat. Suction-assisted lipectomy is not an alternative to weight loss. It is intended for use on localized areas of fat that do not respond to diet or exercise. Areas suitable for liposuction include the chin, neck, cheeks, upper arms, area above the breasts, the abdomen, flanks, the buttocks, hips, thighs, knees, calves and ankles. Liposuction can improve body contour and provide a sleeker appearance. Surgeons may also use liposuction to remove lipomas (benign fatty tumors) in some cases.

The procedure takes from one to four hours, depending upon the amount of fat to be removed. Procedures that are not too extensive can be performed on an outpatient basis on patients under local anesthesia, although some surgeons may use an epidural block instead. Extensive procedures are usually performed on patients under general anesthesia.

Fluids as well as fat are lost during the procedure, so the patient will receive intravenous fluid replacement.

After liposuction, the patient can expect some temporary bruising, swelling, soreness and/or a burning sensation. The treated area may feel numb for a few months.

Risks include bleeding, infection, excessive fluid loss leading to shock, fluid accumulation, injury to the skin, baggy or rippled skin, asymmetry, pigmentation changes, blood clots, fat embolism and organ perforation. Major complications are rare. Although it is extremely uncommon, death is also a risk.

After suction-assisted lipectomy, patients can generally go back to work within one to two weeks and can resume strenuous activity in two to four weeks. Swelling and bruising may persist for up to six months.

The best and most longlasting results from liposuction are in those patients committed to a healthy lifestyle, which includes proper nutrition and physical activity.

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Ultrasound-Assisted Liposuction

Ultrasound-assisted liposuction (UAL) is a relatively new liposuction technique in the United States. It is similar to traditional liposuction procedures. However, UAL uses ultrasonography to target and remove fatty tissues more selectively and with minimal impact on surrounding tissues and blood vessels. Ultrasonic energy is used to fractionate or burst the fat cells. The fat is then removed with relatively low-volume suction, resulting in less trauma to tissues. Incisions, however, are larger.

Certain anatomic sites may respond preferentially to UAL treatment, including the hip, posterior back and central body regions.

At present, however, fat removal from other body areas such as the face, neck, knees and inner thighs is still best accomplished with traditional suction-assisted lipectomy. In fact, traditional liposuction may be required in addition to UAL in many cases.

Patients undergoing UAL may receive either local, epidural or general anesthesia, depending upon the extent of the procedure.

Risks associated with UAL are similar to those of traditional liposuction techniques. Patients will experience some discomfort, such as temporary swelling and bruising. The treated area may feel numb for a variable length of time. Many surgeons require patients to wear a compression garment or girdle which compresses tissues to lessen swelling and bleeding from two to six weeks after surgery. UAL also poses the risk of skin injury and burns from the suction cannula which becomes heated during use, although it is extremely rare.

Because UAL is a relatively new technique in the United States, it is important to select a surgeon with appropriate training and experience.

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