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Monthly Archives: September 2015

Mommy Makeover / Tummy Tuck & Breast Lift

I was presented with a 40-year-old female who was looking to have a mommy makeover. During the consultation she was looking to have her abdomen enhanced as well as a breast augmentation. She explained that after 2 hernia surgeries and post pregnancy her goal was to get her shape back to pre pregnancy.

After setting her expectations, we decided to perform an abdominoplasty or tummy tuck, along with a breast lift and 240cc saline breast implant filled to 270cc to her right breast and 350cc to the left breast.

As you can see, after only six weeks post op, the patient is looking fantastic, and I’m very pleased with her recovery.

 

REQUIRED STEPS OF AN ABDOMINOPLASTY

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We perform abdominoplasty and tummy tuck procedures weekly in our Beverly Hills Surgery Center as our patients undergoing complete mommy makeover reconstruction, including augmentation, breast enhancement, mastopexy, body lipo contouring and abdominoplasty. The perfect tummy tuck requires multiple steps during the surgical procedure. The first step includes the incision site being made near the inferior position above the suprapubic hairline. This should be placed low enough that the patient will be able to wear postoperatively the clothing and fashion that the scar will be well hidden. The dissection should be carried out carefully meticulously above the fascia of the external oblique muscle midline rectus sheath up to the subcostal ribs maintaining a cuff of fat with the umbilicus to maintains its blood supply, preventing avascular necrosis; however, death of the umbilicus or belly button. The photographs displayed here show a clean dissection anatomically of the entire abdominal wall. Notice the midline rectus fascia and notice the sutures of the O-Ethibond in the midline rectus sheath. This patient is 42 years old and status post deliveries. Notice the external oblique muscle laterally. It’s tight and does not require further tightening sutures. Midline plication has been performed both supraumbilical and infraumbilically from two fingerbreadths below the subxiphoid point to the umbilicus and once again below to the suprapubic region. Plication of the muscle sheath is absolutely essential for a firm and tight appearance to the lower abdominal wall.

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The next photograph shows specifically patient in a V-Y configuration, also referred to as the semi-Fowler position with redundant dermoglandular tissue retracted inferiorly, carefully marked and incised as well as allow for the removal of the redundant skin and fatty tissue. After closure of the wound, tumescent liposculpturing the bilateral iliac crest hip region with tumescent liposculpture technique is performed and the reposition of belly button and umbilicus. This ends the final step, which should be done in an oval-like fashion, which will allow for a more natural appearance to the umbilicus rather than round. We used two 10 mm JP drains in order to remove serous fluid as well as small amount of blood as well as tumescent liposuction fluid from the abdominal wall which is furthermore also allows scarring back down in the abdominal tissue to the muscle fascia. Patients are placed with abdominal binders for up to six weeks. Antibiotics were seven days, pain control with Norco. It is important to understand the specific anatomy and the specific pathological diagnosis and physiological sex of pregnancy and significant weight fluctuation on the abdominal wall. The tightening of the abdominal muscle is essential for retraining optimal results and intraoperative photos are taken prior to abdominal wall closure. It should be discussed with your plastic surgeon prior to the operation.

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Dow Corning Ruptured Silicone Breast Implant

Before and After Dow Corning Ruptured Silicone Breast Implant RevisionI was presented a 55 year old patient with with a ruptured Dow Corning silicone breast implant. During the consultation we discussed her goals and outlined the approach to achieve her breast revision and enhancement.

For the left breast we selected 425cc silicone high profile gel implant.  The right breast we selected 400cc silicone high profile gel implant. As you can see from the 6 week post op photo the augmentation achieved a nice symmetrical balance.

 

 

Post Pregnancy Baker 4 Capsular Contracture

I was presented a patient who, after pregnancy, developed a Baker 4 capsular contracture to her breast. When any type of breast implant is inserted, the body naturally forms a protective lining around it. This is referred to as the capsule or tissue capsule. This happens in everyone whether the breast implant is smooth or textured, silicone or saline.

After pregnancy, this 27-year-old patient developed capsular contracture  where the  capsule began to shrink and formed a abnormal shape. As you can see, the preop photo to the left shows her breasts being squeezed out of their normal position by the progressive tightening of the capsule.

To correct this, I performed a open capsulotomy, releasing the capsules from the implants and replacing them with 280 moderate plus silicone implants. After 6 weeks, the postop photo shows a natural and symmetrical look.

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