FAQs on Real Self
Frequently Asked Questions from Dr. Brenner's Blog:
Q: Hernia repair right after c-section?
I am pregnant with my 3rd child, which will be a repeat c-section. I already had 2 c-sections with my other two children before. I have developed Crohn's and had surgery to remove 2 feet of small intestine back in 2002. Then within a year, I developed an umbilical hernia which has just gotten worse and worse (no insurance).
Now, my ob-gyn has referred me to general surgery to see if they will repair the hernia when I have my c-section. I am very fearful that the bigger I get with this pregnancy, the worse it's going to be. I am all for it, but what do you think? Is it a good idea? Do you have any suggestions? Thank you so much.
A: Elective surgery and hernia repair
I see many women who develop umbilical hernias around the time of their pregnancy. Umbilical hernias can get larger during pregnancy as the abodmen enlarges, but they rarely pose a problem. The abdominal tissues get very swollen and are not entirely normal immediately after delivery. For that reason alone, I feel that repair of the hernia should be done about 4-6 months after the C-section (not at the same time), once you are down to your normal weight. If you have your hernia repaired at the time of C-section, you run a higher risk of the hernia recurring.
Q: Will I have visible scars from a tummy tuck?
I imagine that you have them hidden below your underpants but is this true? can i wear a bikini after tummy tuck?
A: Tummy tuck scars
Los Angeles moms tend to be extremely conscious of these incisions. When I perform my Mommy Makeovers, I intentionally keep the scar as low as possible so that my patients can wear their lingerie, bikinis and "hip-hugger" blue jeans. The real "tip-off" that someone had a tummy tuck is usually the belly button. I believe that many plastic surgeons don't know what looks good when it comes time to inset the belly button during a tummy tuck. For this reason, I developed a new technique for sewing in the belly button which reduces the amount of visible scar tissue.
Q: Duration of hospital stay post-Tummy Tuck?
I'm thinking of having a Tummy Tuck, and I was wondering, how long would I have to stay in the hospital after the procedure?
A: Safety is most important with Tummy Tuck!
Hospitals are for sick people, not patients recovering from cosmetic surgery. Safety is very important, so I send all of my tummy tuck patients to an outpatient, nurse-supervised recovery retreat for a minimum of one night.
Q: What is an open roof deformity?
Hello all, what is a roof deformity? I think I may have this problem pretty severely. I've read that seemingly quite a few problems can cause this, such as improper bone re-setting, shaving too much cartialge, etc.
What does this deformity usually look like? How would it be corrected depending on the problem? And also, generally what is going on with the cartilage/bone when a open roof occurs? Does it get worse with time? Thank yall very much!!!
A: The Open Roof Deformity can be fixed
An "Open Roof Deformity" can occur after a rhinoplasty if the surgeon reduces the bone and cartilage along the bridge and inadequately repairs the defect. It can usually be repaired in one of several ways:
1) Re-breaking the bones.
2) Placement of new cartilage grafts (called Spreader Grafts).
3) Camouflage with other types of nasal grafts (Fascia and Diced Cartilage).
These are common strategies that I use in revision (aka secondary) rhinoplasty operations.
Q: What to do for insurance coverage for tummy tuck and breast reduction?
I have spreaded since I had my daughter 3 years ago. I am a size D and my breasts get in the way. I also need a tummy tuck because my fat on my stomach gets stuck in the zipper of my pants. I have Amerigroup Medicaid insurance and I live in Maryland. I called to ask if they cover tummy tuck and breast reduction, and they said that it isn't. I have no hope but to cut it myself because I am so depressed. Ever since I had her my self-esteem went down..I need help, these surgeries will make me feel so much better. Any idea on how I can get these procedures covered?
A: Insurance will pay for some operations
Kim,
Many insurance plans will pay for certain operations for body contouring when medically necessary, such as:
1) BREAST REDUCTION
2) PANNICULECTOMY (removal of excess abdominal skin)
3) HERNIA REPAIR
Most PPO, and POS plans and even Medicare will cover some of these operations. However, every insurance company has different requirements before they will cover them. You should check with your insurance company and even consider upgrading to a different insurance company or insurance plan.
Q: Breast implant removal: does it require breast lift surgery?
i want to remove my breast implants. too big. if i do this will i most likely need a breast lift? is my skin stretched permanently as a result of implants?
A: Every breast implant removal patient is different
Whether you need a lift after removal of breast implants depends on several things:
1) Amount of BREAST TISSUE you had before your augmentation.
2) Degree of SAGGING of your breasts.
3) Number of STRETCH MARKS within your breast skin.
4) Position of your NIPPLE & AREOLA in relation to the lower breast fold.
Q: Silicone Breast Implant removal and replacement cost?
How much does a silicone Breast implant removal and replacement usually cost? I had the original implants put in 23 years ago. I would like them removed and replaced with the memory Silicone implants.
A: Removal and replacement of Silicone Breast Implants
Removal of silicone breast implants can be covered by your medical insurance in certain situations. I work with many insurance companies in cases such as removal of ruptured silicone implants, or removal of painful or distorted implants as a result of severe capsular contracture. If your silicone implants are 23 years old, the likilihood that they may be ruptured or leaking is very high. In these situations, insurance companies will pay for for the removal and you would only be responsible for the cost of replacement with new implants should you desire.
Q: Sagging breasts: How to perk things up
after babies and i guess aging :( my breasts sag more than i'd like. is breast lift or plastic surgery my only option for getting them perked up again?
A: Breast Lift with or without an implant
Breast shapes and sizes vary between patients. "Sagging" for one patient may actually only be loss of breast volume. True sagging, where the skin is stretched out and the nipple sits too low, usually requires some sort of breast lift. Loss of volume is usually best treated with an implant. Commonly, both operations need to be performed at the same time.
Q: When is a body lift covered by insurance?
I understand that most of the time, body lift surgery isn't covered by medical insurance, but in certain cases it is. What are the normal criteria for having a body lift paid for by insurance?
A: Some portions of the bodylift procedure may be covered
Insurance companies will likely not pay for your entire bodylift outright. Although it is usually a cosmetic operation, some portions of the procedure that need to be done as a component of, or concurrently with, the bodylift may be covered benefits under your insurance plan. Examples of medically indicated procedures are:
1) Panniculectomy.
2) Abdominal Hernia Repair.
3) Repair of disfiguring scarring from trauma or previous surgery.
Q: 360cc Breast Implants to get C cups?
I'm scheduled for Breast Augmentation surgery in a week. I'm 5'1" and 100 lbs, currently a large A cup / small B as my surgeon calls it, and I want to be a full C cup.
He's thinking about a size 300cc saline moderate profile implant filled to about 360cc. First off, is that too much of overfilling? And second, is that too big of an implant for me to achieve my desired results?
A: Don't get stuck on an absolute bra cup size
I never guarantee a cup or bra size to my patients because bra cup sizes vary between bra manufacturers. Further, the cup size is not important; what matters is that your new size actually fits your frame. Saline implants do have a fill range, as dictated by the implant companies, which is usually between 50 and 75 cc over the volume listed on the implant. As long as the final volume is within this pre-determined range, the implant is not overfilled. 360 cc may be within range for a 300 cc implant, but this really depends on the actual implant. However, a 360 cc implants sounds like it may be a bit too big for your frame.
Q: Should I massage my breasts after breast implant surgery?
A: Breast massage after augmentation is helpful
I have found that self-breast massage is beneficial after breast augmentation because:
1) Massaging your implants will help to counteract scar formation, keeping breast capsules softer.
2) Massaging your implants will help to facilitate descent of the implant after surgery; particularly when placed below the pectoralis muscle.
3) Massaging your implants will force you as a patient to become familiar with the size, shape and consistency of your breasts after augmentation. This is extremely important so that you, as a patient, will be immediately aware of any change that may occur with your breasts (i.e. such as capsular contracture).
Q: How is Breast Implant replacement surgery done?
I have textured silicone implants in a subglandular placement and want to replace them with smooth silicone implants under the muscle.
Will the new implants be placed in at the time of removal of the textured ones? Or will it have to be done in two separate procedures so I can heal from the first surgery first. I hate to have to walk around with deflated boobs for months.
A: Removal, Replacement & Repositioning: One Operation
Removal of your textured implants and replacement with smooth silicone implants in a new pocket should usually be done in one operation. However, if you have very little native breast tissue and require an extensive total removal of the breast capsule (capsulectomy), then it may be necessary to wait in between the removal and the replacement.
Q: What is the average "life" of a breast implant?
What is the procedure for replacing implants? I have had my saline implants for over 15 yrs. How long is the expected time period before you need to replace them? Is the procedure more painful or difficult than the original implant? I have a lot of rippling, even though I went under the muscle. My bags are textured, I believe. I also think that they may have loss some of their initial volume. Can you describe the average "life" of an implant, the replacement procedure and any new advancements in the last year or two? Thank you
A: New advances in breast implants
I agree I with some of the advice from the other surgeons; the average life span of a saline implant is about 10-15 years. However, if your implant has lost volume, it is leaking and should be replaced no matter its age.
The most recent advance in breast implant technology is a new device called "Ideal Implant" which is currently going through and FDA trial. It is a saline implant which was designed with an internal baffling system with the intent of decreasing implant rippling as well as internal movement of the saline. The manufacturer describes it as a HYBRID implant, because it is filled with saline only, but has a look and feel that is closer to a silicone implant than any saline implant that I have ever seen. So far, all of my patients that have them in are very pleased.
Q: How can I get rid of loose sagging skin after pregnancy?
will a mommy makeover take care of all the loose skin from pregnancy?
A: Mommy Makeover is the answer to sagging or loose skin after pregnancy
An abdominoplasty, or tummy tuck, will remove the extra skin, fat and stretch marks from your abdomen while tightening the abdominal muscles at the same time. For breasts that have lost volume and sag after breast feeding, a breast augmentation along with a breast lift will restore the breast to its correct position and pre-pregnancy volume. Some women retain adequate breast size after breast feeding and only experience sagging of the tissues along with stretching of the breast skin. These patients are excellent candidates for breast lift (mastopexy) alone.
Q: Is Brow Lift the only option for deflated eyelids?
One year ago, I had fat removed from the upper eyelid. Now, the skin has deflatted and my eyes look like they have excess skin. My doctor said a Brow lift would correct this but I want to know if I can do anything else.
A: Brow lift may help your upper eyelids
If your eyebrow position is too low and is causing the skin of your upper lids to bunch up, then a brow lift is a good solution. If your brow position is normal, then a better option would be to have some skin removed from your upper lids.
Q: Preventing eye ptosis from Botox?
I keep hearing more and more cases of eyelid ptosis or "droopy" or closed eye from Botox. Is there a way to decrease the chances of this happening? Does it happen as often with Dysport as well?
A: Selecting your Botox injector carefully can help prevent problems
It is important to distinguish between Eyelid ptosis and Eyebrow ptosis.
Eyelid ptosis occurs when the eyelid excursion (ability to open and close) is diminished and the upper eyelid begins to cover the pupil, interfering with the upper visual field.
Eyebrow ptosis is when the eyebrow position is too low, and falls below the bony rim of the eye socket. This can make a patient appear as though the eyelid cannot open, when in fact there is nothing wrong with the eyelid muscles.
Both conditions can occur in patients who have had botox injections. The best way to prevent either of these from happening is:
1) Have a doctor inject you who is very familiar with the pertinent anatomy of the face.
2) Do not rub any area for 24-48 hours after injection. Doing so can cause the botox to migrate.
3) Avoid excessive exercise for 24 hours after injection.
Dysport works in the same manner as botox and can therefore exacerbate both of these conditions as well.
Q: Does breast lifting alone leave suture marks and scars?
A: Breast Lift scars, yes. Suture marks, no!
The purpose for a breast lift is to elevate the nipple back up to the proper position. Doing so requires that a certain amount of skin be removed, in conjunction with reshaping of the breast tissue. The only way to remove excess skin, is to make an incision and actually cut it out. Anytime that an incision is made in the skin, a scar will result. The amount of scarring that result is in directly related to the amount of excess skin that exists. Suture marks only occur when skin sutures are left in too long. Suture marks can be prevented by using absorbable sutures in the deeper tissues, and by removing and skin sutures within the first week after surgery.
Q: Possible to get larger breast implants without fake look?
I was a 34A (if not less) before my Breast Augmentation 2 years ago. I got 320CC cohesive gel implants that brought me to a 34C (not full). I now wish I could have gone larger! I want to be a 34D (full). I am now considering the same implant with 550 CCs. Is that too big for me? I do not want the fake look, just a larger size of what I am now. I look very, very natural now and would not like to destroy that. Is it possible to go larger without obtaining a fake look? I am 5'4 and 135 lbs.
A: Decide what you want before changing your breast implants
It sounds like you are not quite sure about what you want exactly. A size 34C breast sounds like it is in good proportion for your height and weight. If you would like your breasts larger, then by all means have it done. But realize that an additional 230 cc on each side will be a very big change for you.
Q: Mini tummy tuck less painful than a full tummy tuck?
Is a mini tummy tuck less painful than a full, regular tummy tuck?
A: It all depends on whether the muscle needs tightening.
Most of the discomfort from a tummy tuck relates to the tightening (aka plication) of the abdominal muscles. Usually with a mini-tummy tuck, the muscle is only tightened below the belly button versus a full tummy tuck, which tightens the muscle from the rib cage to the pubic bone. However, both can be painful.
Q: Breast reduction recommended if overweight?
there is some hestitation on my part to get breast reduction. would a good candidate for breast reduction surgery be overweight?
A: Losing weight will make your breast reduction operation easier
Losing weight prior to surgery will make the entire process easier for you. In particular, the anesthetic-related co-morbidities (i.e. complications) are usually less frequent in patients you are closer to their ideal weight. When you lose weight, you will also lose volume in your breasts. However, simply losing weight does not guarantee that your breasts will get smaller, so you will still likely need a breast reduction.
Q: Breast reconstruction for infected breasts?
I have had breast infections due to Gamella bacteria first, then had a bilateral periductal fistula on both breast 3 times, then contracted HA MRSA. I underwent surgery for that. I still have infection but my breasts look terrible now. They are scarred from the many procedures, and the right nipple is actually at an angle now instead of horizontal.
I was wondering if there's any type of corrective surgery that would be helpful for my situation. We are still treating an infection, although unknown. The last culture was " normal skin flora". Thank you for your time.
A: Breast reconstruction with your own soft tissue
Sometimes when breast tissue becomes severely scarred, the best option is to remove the extensively damaged tissue. This does not mean you will require removal of the entire breast, but possibly a portion of it. Replacement with your own tissue by means of a flap (using the Latissimus Dorsi or Rectus Abdominus muscles) will bring new soft and pliable tissue with a healthy blood supply.
Q: Is it possible to have normal looking breasts after explant surgery?
I have had saline breast implants for 8 years and am scared of the aesthetic outcome should I have them removed. I am 29 years old, I have very little breast tissue and stretch marks on my breasts from having a baby. I have constant aches and pains in my left breast. I have considered get revision surgery, but what I really want is them to be taken out. I have been researching this for a year now and would really like some advice (especially when it comes to finding the right surgeon to remove them).
A: Breast shape after explantation
If you are planning on having your implants removed permanently, you may need to have the following done:
1) Implant removal;
2) Capsule removal;
3) Breast lift.
Without examining you, it is difficult to say which of these you will require. Some patients will require all three. Some patients can avoid a mastopexy (breast lift) by allowing their surgeon to remove the implants and capsules and wait. In certain situations, the skin envelope may tighten up over time. However, be prepared to possible need a second operation to lift the breast back to an aesthetically pleasing position.
Q: Breast implant removal - Will my breasts sag if I decide to explant?
What if you decided to explant? Will your breasts sag?
A: Factors to consider before explanting
The most important factors that will determine if you will require a lift after explant are:
1) SIZE of your current implants.
2) Amount of BREAST TISSUE that you had before.
3) TIME interval since your augmentation.
4) Degree of BREAST SAGGING that has occurred since your augmentation.
5) POSITION OF YOUR NIPPLE in relation to the lower breast fold.
Q: Breast augmentation redo?
I
had a breast augmentation 4 years ago after the birth of my second
child. Thanks to weight gain, breast feeding and weight loss. I went
from a B cup to a D cup. However, because of the weight of the implants
and aging, the breasts are no longer high and create a clevage; they
hang to my waist and look sad:)
I am thinking about getting to a size C cup and making them perkier.
They feel to heavy, and the bra straps dig into my shoulders despite
fitting every three months. Any words of advice?
A: Downsize your implants and lift the breast tissue
I have not even seen your photos, and I can tell that you will need:
1) removal of your current implants;
2) replacement with smaller implants; and
3) Breast lifting, most likely a full lift, but depends on your degree of sagging.
Q: Unusual approach to gynecomastia?
I am a 32 year old male who had Liposuction of breasts about a year ago. Also, my surgeon chose to address the gynecomastia through incisions below and medial to my nipples. Is this an unusual approach?
A: Liposuction incision placement less important than the result.
The choice of site for incisions for liposuction of gynecomastia really depends on the extent of breast tissue that exists. Truth is, that the contour that you have afte surgery is probably more important than the exact location of the incisions. Occasionally I will make additional access incisions during liposuction of gynecomastia if I think it will allow me to obtain a better final contour.
Q: Flying after Breast implants revision
How long until I can take a 2 1/2 hour flight after breast augmentation revision? I am traveling to Florida to have my breasts re-done and wondering when it is safe for me to take the 2 1/2 hour flight back home.
A: Traveling after breast implant revision surgery
I care for many patients from out of state, so this is a very common question in my practice. I do like to have frequent contact with my patients during the first week after surgery, so that I can manage their sutures and dressings and deal with any problems that might occur. Although it rarely occurs, the most common early complication after breast surgery is bleeding. When it happens, it usually occurs within the first 24-48 hours after surgery (although it can occur later). Traveling itself, for short durations, is relatively safe after surgery. Make sure that you stay in close contact with your surgeon after surgery and that you have the ability to travel back to your surgeon should a problem develop.
Q: Breast reduction after pregancy
hi i'm a 21-year-old-mother who gave birth over 14-months ago,my problem is that i always had an a-cup breast and during my pregnancy my breast changed to a c-cup and stayed that way. i never felt back pain until my pregnancy and now a year later its still there. hypothetically i drew the conclusion it's my breast after reviewing diffrent stories. because my back,neck and sholders are hurting and my breast is so heavy. do you think my insurance company would cover it even though i'm not a d-cup? (i included a pic) thanks in advance dana321
A: Insurance will pay for true breast reductions
Your symptoms of back, neck and shoulder pain are quite typical. Most insurance companies will pay for breast reduction that needs to be done for medical reasons. However, each company's criteria are a bit different, so be sure to check with your insurance provider beforehand.
Q: Navel area tightening procedure?
I am very athletic and I maintain a healthy, low-calorie diet. My body fat is low, but lately I've noticed that the skin surrounding my navel is a bit loose. I have a flat and tight stomach and I can even see abs, and I haven't had children, so I don't think a Tummy Tuck is suitable for me. Also, I really don't want a scar. Is there a minor procedure for tightening the skin around the navel?
A: It all depends on the degree of skin laxity
For minor skin laxity, you could try the Accent device, which is a RFA (Radio Frquency Ablation) laser. More severe laxity will likely require some open surgical contouring procedure.
Q: Body lift - How long do results last?
How long does the "lift" from body lift surgery last? I am 35, and I want to get a body lift, but I may wait if the results won't last well into my 40s or 50s.
A: Body Lift results can depend on your weight maintenance
Removing the skin and fat that remains after massive weight loss with a body lift is permanent. That is why you should have surgery once you reach your ideal, stable weight. Should you continue to lose weight after surgery, you may develop some new laxity and require a "touch-up" procedure years later.
Q: Reduce saline breast implant volume without surgery?
Is it possible to reduce approximately 70 cc from saline breast implants without having surgery (for example, with a very small needle)? Would it continue to leak afterward? Thank you.
A: Reducing saline implant volume without surgery?
It is only possible to adjust saline implant volumes without surgery if you happen to have the type of implant that has a special port. These implants are very rare, and in fact I do not use them. However, saline volume can be adjusted with a very minor procedure which; sometimes even using local anesthesia.
Q: Waiting period for Breast Reduction or Lift after weight loss?
I have recently lost 46 lbs and have about 15 more to go. My breast size has not decreased significantly, only from a DDD cup to a DD cup. How long after my weight loss is complete should I wait to have a breast reduction or breast lift? Thank you.
A: Breast size can vary with weight loss
A woman's breast size will change during weight gain and weight loss. However, the amount of change is unpredictable. Ideally, breast lift and reduction should be performed once you have reached a steady weight for at least three months; even if it is not your ideal weight.
Q: Waiting period for Breast Reduction or Lift after weight loss?
I have recently lost 46 lbs and have about 15 more to go. My breast size has not decreased significantly, only from a DDD cup to a DD cup. How long after my weight loss is complete should I wait to have a breast reduction or breast lift? Thank you.
A: Breast size can vary with weight loss
A woman's breast size will change during weight gain and weight loss. However, the amount of change is unpredictable. Ideally, breast lift and reduction should be performed once you have reached a steady weight for at least three months; even if it is not your ideal weight.
Q: Are silicone breast implants safe?
need to know before i'd consider silicone implants
A: Silicone is safe, but consider a hybrid implant
Saline and Silicone are both safe implants. However, the FDA is currently investigating the newest "hybrid" implant on the market. This IDEAL IMPLANT, is a baffled saline implant which was designed to look and feel more like a silicone implant, but without the silicone. You should check to see if there is a plastic surgeon investigator near you.
Q: How do I choose the best breast implant for me?
i dont know whether to go big or medium, saline breast implants or silicone breast implants, under or over muscle. help!
A: Saline, silicone, or hybrid breast implants
Choosing the correct implant size is truly a matter of a patient's personal choice. Although I tend to be conservative with breast augmentation size, ultimately what matters most is whether the patient is happy with the final size. As far as implant type is concerned, there are both advantages and disadvantages to either type of implant. An excellent compromise is the Ideal Implant, which is a baffled saline "Hybrid" implant. It has the look and feel of silicone, without the risk of silent rupture.
Q: Uneven nipples after breast augmentation and lift
I recently had breast lift and implants (200 cc, 1 cup size bigger, age 26 no kids) 2 weeks ago, and my nipples look like something out of a child's coloring book. They're completely uneven, choppy, and not at all near perfectly circular. Will these eventually fix themselves? I also thought the breasts would be higher. Does this look like a well executed lift?
A: Every woman's breasts are asymmetrical to some degree
Small asymmetries are common. Every patient has two different breasts before surgery. As a result, they usually tend to heal a bit differently. Breast implants also will settle or drop over the first month or two once implanted. Occasionally, they descend at different rates. Be patient, most likely this discrepancy will even itself out.Q: Lose weight before breast implant revision?
I have gained 80 lbs since having my 800 cc breast implants. Back then I was a double D. I just want them removed until I lose weight and then will get a more reasonable size. Would you recommend I lose weight first? They are really causing me issues due to their size.
A: Simply downsizing breast implants may be the way to go
800 cc implants are indeed large for the average breast augmentation patient. However, if you have had them in for a while, your breast skin most likely has stretched to accomodate the implants. If you remove them, you may be left with very saggy breasts. Consider downsizing them first.
Q: Inverted nipple a sign of breast cancer?
my left breast nipple is dented. i've been ok with it, yet i saw a story in the news that it could be a sign of breast cancer. so now i am really scared! what's the cause of inverted nipples and is it something i need to get checked out right away?
A: Inverted nipples are worth investigating
New changes in your breast that cause your nipple to become inverted are worth investigating with your doctor. Especially if it is associated with nipple discharge or with a new bump in your breast. Talk with your doctor, get an exam by your doctor and consider a mammogram if you have not done so already. However, an inverted nipple can be a normal variant, particularly if you have had it for a long time.
Q: Risk of getting keloid scars from breast lift?
I am interested in breast lift surgery. I'm wondering, will I have a high chance of having keloid scars on my breasts, seeing that both my C-sections had thick, bumpy scars?
A: Scars can vary, even on the same person
Although there is always a risk of developing thick scars after any operation, the chance with a breast lift is very low. How a scar heals often depends on the location on the body as well as the technique to close the skin. It is possible to develop a thick scar on your abdomen and heal an incision on your breast normally. There is no way to know for sure if you will develop hypertrophic (thick) scars or keloids. However, African-American, Hispanic and Asian skin types tend to have a higher risk.
Q: Tummy tuck surgery - where will I have scars? How big are they?
A: Tummy tuck incisions kept low
Incisions for tummy tucks are essential; it is the only way to remove the excess skin that inevitably exists. I keep the transverse (horizontal) incision very low, just above the pubic hair line, so that my patients can easily hide them with a standard bikini. I also take great care re-creating the belly-button incision, so that only half of it is visible.
Q: Will insurance allow breast reduction from F to D cup?
I have always been large breasted and have always wanted a reduction. In the past 2 years, I have given birth to two children and breastfed. My youngest is now a year old and my breast have not returned to "normal" size. I am still wearing my maternity, size F bras. My back and neck hurt all day long. As I said earlier, I have always been large breasted. Will insurance allow me to be a size D, or must you go really small? Am I a good candidate for insurance to cover my breast reduction? I am 33 years old, 5'7", and 165 lbs.
Asked by GarrisonJ on RealSelf.com
A: Medical insurance coverage varies between plans
Although you appear to be an excellent candidate for breast reduction, whether your insurance will pay for it depends entirely on your plan. Insurance coverage varies between companies, and even between different plans in the same company. Generally, however, most plans will cover breast reduction if the following criteria exist:
1) Back pain (from breasts being too big)
2) Bra strap grooving on the shoulders.
3) Rash in the lower breast fold that does not respond to medical treatment.
4) Your surgeon believes that a minimum amount of tissue can be removed (usually 500 gms per side, sometime less)
Q: Can tummy tuck scar be lowered to the pubic area?
I had a full tummy tuck five years ago. I would like my scar to be lowered well into my pubic area (at least two inches lower) I have extra skin now from two pregnancies after the surgery. Would this be possible? Will the belly button be re-done? Would it be considered a scar revision or a tummy tuck redo? Thank you!
A: Re-doing your tummy tuck
From your photo, it does appear that you have some addtional laxity to your abdominal wall skin. This can be improved, but will require re-opening all of your incisions. Since you have had two pregnancies since your original tummy tuck, most likely the muscles will also require re-tightening. Your incision can be lowered into the pubic area, but you will almost certainly also need to have an additional incision in the midline to relocate the belly button to the correct position.
Q: How much weight to lose before Tummy Tuck?
Hi. I am interested in having a Tummy Tuck done and I want to know how much height to lose before having the surgery. I am 5'7" and currently weigh 210 lbs.
A: Sometimes staging your operation works best
I have found that many overweight patients have difficulty exercising because their extra abdominal fat and skin either gets in the way or makes them self conscious. In select patients, removing the skin with a tummy tuck increases their confidence and frequently stimulates them to start heading for the gym to lose the remaining weight. However, if you go on to lose a significant amout of additional weight, you may likely need a second operation to adjust your contour.
Q: When does swelling after breast augmentation begin to subside?
I had 325cc silicone breast implants 5 days ago. I am 5'1 and 102 pounds. I was hoping to be a C cup, but I am fitting into a D bra. Is this because of the swelling? If so, when will the swelling begin to go down? When will I know exactly what bra size I will wear?
Asked by kcali on RealSelf.com
A: Bra cup sizes vary
It is important to remember that bra cup sizes vary between different bra manufacturers. What fits 34C in Cosabella, may be too tight or a bit loose in a comparable Victoria Secret bra. The swelling will go down, but it usually takes at least one month...and frequently longer. I recommend that my patients wear a snug fitting sports bra for the first four weeks after surgery to provide both compression and support. In the mean time, have a few different size bras available.
Q: Vertical skin bunching after Tummy tuck
I'm 3 days post Tummy tuck. Will this vertical bunching up of my skin after Tummy tuck go away? Doctor said it happened because he had to pull muscles together so tight due to severe separation of muscles.
A: Vertical bunching after Tummy Tuck will likely need revision
If this bunching does not completely flatten out over the next few months (I suspect that it will not), you will probably require revision of your tummy tuck. Your surgeon is correct about the bunching resulting from the underlying muscle tightening. Although that was likely corrected very well, the overlying skin and fat is not laying correctly and will likely need to be re-draped, or possible converted to a "Fleur-de-lis" pattern for your incision, which would result in an long vertical incision.
Q: Surgery to correct puffy areolas?
I'm a 20 year old female, no kids. And I was considering puffy areola reduction. My areola is a little bit wider then a quarter in diameter. Everything else with the breast is fine, size and shape. But I have a puffy areola and so in the relaxed state there is no nipple just areola.
I know it's a simple incision and quick healing process, but will having a puffy areola be a problem for breast feeding if I get pregnant in the future? And I haven't been able to find any before and after pictures of puffy areola treatment, where can I find some? And is this surgery by itself costly?
A: Correcting large areola
There is a great variation between every patient in terms of breast, areola and nipple sizes. Despite this variation, some patients simply have an areola that is too large for their breast and simply is unpleasing aesthetically. There are operations designed to reduce or change the size of the areola; they are similar to the techniques that we use to do a Periareolar Mastopexy (Breast lift using an incision only around the areola).
Q: Lumpy area and dark stitch marks after Lipo
I have lumpy area and dark stitch marks after Liposuction. What can I do about this? Preferrably NOT a second Lipo.
A: Tips to improve the look of you liposuction scars
All scars take at least a full year to fully heal, fade and mature. Sun exposure during this first year can lead to permanent color change...in particular darkening of the scars known as hyperpigmentation. To help lighten the scars, you may try:
1) Bleaching with HYDROQUINONE CREAM
2) Laser treatments with IPL (Intensed Pulsed Light) or FOTOFACIAL laser.
For thick scars: Careful injection with a steroid liquid (i.e Kenalog) is effective.
For irregularities in your fat after liposuction: Accent RFA non-surgical treatments.
Q: Possible have nipple implants for more realistic appearance?
I had my nipples replaced with skin from my inner leg. They have very little fat and look like mounds. They are shaped like nipples but they don't look real. I think I found the answer in round, pearl-like beads that people put in the forehead or strange areas. I have breast implants under the muscle. I can’t find anyone who will do this. Tattoo parlors the only people who understand. Is this procedure even possible? I don’t want to die with mounds. Is there anyone who can help me?
A: More realistic Breast Reconstruction
The most difficult part of recreating a natural appearing breast after reconstruction for cancer is frequently the creation of a realistic nipple.There are devices that can be placed behind reconstructed nipples to help give them more structure. However, I have found that reconstruction with a patient's own tissue has less risk, lower incidence of incorrect positioning and a reduced incidence of infection.
Q: Body lift or thigh lift for stretch marks on calves, hips, and thighs?
I gained 33 lbs with one pregnancy and 28 lbs with the other. I'm 30 years old, and feel as though my lower body looks 60! I know there is nothing permanent for stretch marks and cellulite removal. I had 6 Fraxel treatments on my legs and there was some improvement. I want to wear shorts again. I would like to get rid of the stretch marks on my hips and calves. Is this possible with a lower body lift or thigh lift? I understand I will have another scar, but its better than many. I have olive skin and always scar lighter than my skin tone.
A: Getting rid of stretch marks
Stretch marks are particularly troublesome to many of my patients who are new moms. Depending on the severity of the stretch marks and their locations, sometimes a surgical procedure to remove the damaged skin (i.e abdominoplasty or lower body lift) is a more effective choice. For my patients who have scars that are not amenable to surgical removal, I have had very good success with a combination laser treatment with the Pixel Fractionated Erbium Laser and Skin Tightening Laser. Cellulite can also be addressed with non-surgical Accent RFA laser treatments.
Q: Duration of hospital stay post-Tummy Tuck?
I'm thinking of having a Tummy Tuck, and I was wondering, how long would I have to stay in the hospital after the procedure?
A: Safety is most important with Tummy Tuck!
Hospitals are for sick people, not patients recovering from cosmetic surgery. Safety is very important, so I send all of my tummy tuck patients to an outpatient, nurse-supervised recovery retreat for a minimum of one night.
