I evaluated a female who was looking to have a body contouring makeover. During the consultation, she stated she wanted to have her abdomen, hips inner and outer thighs shaped. During the examination we identified that her abdomen between the breast bone and the belly button was weakened. After confirming this with a general surgeon we set the expectations, and schedule to repair the hernia while we performed her body contouring.
During the surgery we concurrently perform the abdominal wall reconstruction with a board certified general surgeon, tummy tuck and liposuction procedures
The post-op photo is 3 months out. As you can see, her shape looks great, and most importantly she in very happy with her new and improved look.
To schedule your consultation with Dr. Linder or learn more about body contouring, call our office at 310-275-4513 or fill out our online contact form today.
Back in July, 2015 I was presented a patient looking to enhance her shape by lifting her breast and contouring the abdomen. During the consultation and examination we detected two weak spots in the abdominal wall, which she stated, she was having pain during certain activities or in certain positions. We discussed her expectation and agreed that we would proceed with a Breast Augmentation with lift, tummy tuck and repairing the two hernias.
For the procedure we had a general surgeon repair the hernias, and then I performed the abdominoplasty (tummy tuck) along with a breast lift and 350cc saline breast implant filled to 370cc to her right breast and 350cc filled to 380cc to the left breast.
As you can see, after only six months post op, the patient is looking fantastic, and I’m very pleased with her recovery.
For more information regarding body contouring procedures, or to schedule a consultation, please call (310) 275-4513 or contact us via email.
MULTIPLE BODY RECONSTRUCTIONS
The patient presents with severe Baker IV capsular contracture, painful breast deformity with bilateral breast implants presented over 15 years ago by a different surgeon. She also has multiple abdominal wall hernias both epigastric and umbilical and incisional status post midline laparotomy for 11 ulcerations in her gastric region. The patient underwent bilateral open periprosthetic capsulectomy, removal and replacement with 500 to 550 cc smooth saline implants, abdominoplasty with epigastric umbilical hernia repair and tightening of the lower abdominal rectus fascia. The patient’s postoperative results show excellent tightening of the lower abdominal muscle with revision of the lower abdominal scar. The hernia is both incisional epigastric and umbilical had been repaired. She has increased projection with her breasts with softening and decrease in scar tissue contracture. Notice the softness of the hips, the resolution of skin laxity both upper and lower abdomen and the pink scar that will take well over one year to heal. Patients often undergo multiple cosmetic and functional surgeries concurrently. This is an example in which both the breasts and the abdomen were functionally reconstructed for severe encapsulation and Baker IV capsules as well as multiple hernias. She has a beautiful postoperative result with soft breasts and hernias repaired with a nice smoothing of the stomach from the abdominoplasty.
The patient below presents for Mommy Makeover Procedures. The patient has multiple complaints of the body, including breast dysphoria and grade 2 ptosis with sagginess of the breast as well as abdominal wall laxity and vertical midline scar status post gastric bypass surgery procedure as well as a significantly large pannus requiring a panniculectomy, liposculpture of the hips, repositioning of the umbilicus and repair of an upper epigastric hernia with a general surgeon.
Her front views preoperatively show grade 2 ptosis; however, patient declines a breast lift at this time and therefore conservative high profile saline implants will be placed subpectorally in order to reposition her nipples without performing a skin lift. She also has a large abdominal pannus of lower abdomen with midline upper epigastric hernia found on abdominal CT scan. The patient was referred to Dr. Robert Uyeda, our general surgeon, for concurrent reconstruction of abdominal wall with abdominoplasty and augmentation mammoplasty procedure.
The patient’s after photos show a very nice contouring of the lower abdominal area. The midline vertical scar is now found below the umbilicus and the umbilicus has healed nicely. The abdominal hernia was repaired with epigastric mesh, Marlex mesh graft reconstruction as well as liposculpturing of the iliac crest rolls and implant placement in the dual plane technique. The patient is very happy with the results, showing a full C size breast with dual plane saline augmentation mammoplasty procedure using high profile saline implants, full tummy tuck with complete skin removal, tightening of the rectus sheath, hernia repair and sculpting of the iliac crest roll and muffin top procedure.
Mommy Makeovers in Beverly Hills are performed in my operating room weekly. These patients should be preoperatively evaluated by their internists, cleared for surgery for general anesthesia and if hernias are found, abdominal wall reconstruction should be performed concurrently with a general surgeon.
Although the majority of Board Certified Plastic Surgeons have training in general surgery, there are surgical procedures that we perform that I believe would be better for the patient to have a combined plastic and general surgeon in the operating room. Today, we are performing an abdominal wall reconstruction. The patient has an epigastric hernia and a periumbilical hernia. These patients with significantly large hernias, I believe personally, should have repaired concurrently with a Board Certified General Surgeon. Mesh graft reconstruction is often required and this is a surgery that is performed by general surgeons on a weekly basis. In order to reduce the risk of recurrence, abdominal hernia reconstruction should be performed often with Marlex mesh of Polypropylene mesh graft reconstruction. I have worked with the same general surgeon now for over 15 years. He is experienced with over 35 years of general surgery with understanding of the abdominal wall and reconstruction. Large fascial defects again may require reinforcement of the abdominal wall. Simply suturing the rectus diastasis together often leads to recurrence. With large breast reduction surgeries, we also often have our general surgeon in the operating room to help with reducing OR time, anesthesia time and bleeding. Finally, with breast reconstruction, if we are concerned about possible recurrence or metastasis, it is nice to have a second set of eyes, especially as a general surgeon, with the knowledge of the breast in order to survey for possible recurrence of breast tumors. As Board Certified Plastic Surgeons, our number one goal is to yield the most predictable and safe results to our patients. Having a Board Certified General Surgeon for the above situations I believe greatly enhances the overall experience to the patient.
MASSIVE ABDOMINAL PANNUS WITH VENTRAL EPIGASTRIC AND UMBILICAL HERNIA REPAIR
The patient is a 45-year-old African-American female presenting from out of state with significant abdominal wall protrusion. On examination, it was very evident that she had a significant hernia, both in the upper epigastric area as well as the umbilicus. As a result, the patient was scheduled for abdominal CT scan and referred to our general surgeon for consultation for concurrent repair of abdominal hernia repairs with mesh wrap reconstruction and a panniculectomy. The patient underwent the surgery recently with the abdominal wall reconstructed, requiring mesh graft. A mesh graft is important and was placed in order to reduce recurrence of this very large rectus diastasis and significant epigastric hernia. Hernias that are large, especially with abdominal wall diastasis that is severe, usually require reconstruction using a prosthetic mesh graft. A Board Certified General Surgeon is a must when considering abdominal wall reconstruction concurrently with cosmetic or plastic surgery of an abdominal pannus removal.
The hernia is shown which is quite large from the abdominal wall. Preperitoneal fat has been exenterated and the hernia fascial defects have been dissected out. The general surgeon then reconstructs the abdominal wall and the massive abdominal pannus skin is then removed. These surgeries most likely should be performed in a hospital setting in order to allow for intravenous fluid hydration pain management postoperatively. Whenever considering large abdominal protruding abdomens, it is extremely important to preoperatively obtain diagnostic CT scans in order to determine the integrity of the abdominal wall for fascial defect hernias.
STATUS POST MASSIVE WEIGHT LOSS
The patient to the left presents with massive weight loss, weighing over 340 pounds, having had a laparoscopic banding procedure (gastric bypass surgery), lost over 140 pounds, now weighs 200 pounds even. He has massive amounts of skin from the chest area extending to the lateral breast and extending down to the pannus. He will undergo a partial subcutaneous mastectomy with tumescent lipectomy, lipo-sculpting of the lateral chest area as well as a full panniculectomy or large abdominoplasty with umbilical hernia repair with our general surgeon as well as lipo-sculpting of the hip region.
The second photograph shows the patient undergoing a partial mastectomy. Tissue is being removed in the retroareolar plane, extending to the fascia over the pectoralis major muscle. Once this tissue is removed, complete lipo-sculpting of the rest of the chest from the infraclavicular, parasternal, inframammary into the lateral anterior axillary line was performed. Subsequently, at this time a mastopexy or lift will not be performed. We will determine how much skin tightening occurs and then on a separate stage several months from now a breast lift may be required in order to tighten up representative skin. Looking at the pannus, there is a massive overhang. He does have an umbilical hernia on examination and the general surgeon will be repairing this. In the operating room he was found to have rectus diastasis. The muscles were plicated. The hernia was repaired.
The postoperative photo here on the operating table shows the chest is softened immensely. There is great smoothing out of the chest wall as well as reduction of the lipodystrophy of the lateral breast chest area. Notice the incision is hip-to-hip and there are three drainage tubes in. The abdominal wall is now flat. The patient has done extraordinarily well.
The photograph shows the actual 25 pounds of tissue that was removed from the abdominal wall as well as the liposuctioned fat from the lateral chest and hips.
Patients present after massive weight loss laparoscopic banding procedures for tummy tucks, paniculectomies and gynecomastic surgeries or possible breast lifts. This is an excellent example.
Recently, the patient presented with a very large periumbilical lower abdominal epigastric hernia combined with significant amounts of abdominal skin laxity. This patient will require both a concurrent epigastric umbilical hernia repair with our general surgeon at the same time as the elective panniculectomy/abdominoplasty. Patients who present with hernias should be seen by general surgeons as well as, if required, have diagnostic testing, including ultrasound and abdominal CT scans if necessary.
The patient above underwent a full abdominoplasty with a hernia repair by our general surgeon, repairing both the epigastric hernia, the umbilical hernia and tightening of the rectus sheath at the same time. Large hernia repairs, especially after gastric bypass surgeries should include the use of a Board Certified General Surgeon, especially with the use of mesh grafting of the abdominal wall.