Do I need to lose weight before having breast reduction?

Many of the patients I see coming in for information on breast reduction surgery are overweight. In today’s blog post I am going to discuss how being overweight can affect breast size, and whether or not you should lose weight prior to considering surgery. Let’s break it down into several commonly-asked questions:

  • Will my breasts be smaller if I lose weight?  Maybe, maybe not. Breasts are composed of both fat and glandular tissue. Younger women tend to have more glandular tissue, whereas older women tend to have more fat. If you lose weight, the amount of glandular tissue does not change, so if your breasts are largely glandular tissue, you won’t see a dramatic size decrease. In addition, everybody loses and gains weight differently. I tend to gain weight in my hips and thighs, whereas another person might gain weight in her stomach. So losing weight in and of itself is no guarantee that your breast size will decrease.
  • What if I lose weight after I have breast reduction surgery? The answer to this question is similar to the question above. You may or may not see a decrease in breast size if you lose weight. The more weight you lose, the more likely you are to see a change in your breast size. An if your breasts do decrease in size, they can become droopy (ptotic). I generally recommend to my patients that if they are planning on losing more than 25-30lbs, they should try to do this prior to having breast reduction surgery.
  • What if I’m happy at my current weight, even if I am overweight? We all have dreams, er… goals, of losing that last 10, 15, or 20lbs right? If you are considering breast reduction surgery, ask yourself honestly if you have a plan of losing weight, or if it’s just a dream. It’s okay to be happy at your current weight. But my goal as a surgeon is to perform a safe operation and minimize the risk of complications, and a patient’s weight does affect the risk of complications. A study published in Plastic and Reconstructive Surgery looked at the number of complications after breast reduction in 675 patients. They noted a significant association between body mass index (BMI) and complication rate. This complication rate increased significantly when BMI was 35.6 or larger.

In my own practice, I balance the risks of surgical complications with the benefits a patient is likely to obtain from having a breast reduction. I often ask patients with a BMI>35 to lose weight prior to surgery, especially if they have other risk factors such as diabetes or a history of smoking. There are no hard and fast rules regarding weight, but understanding a patient’s weight loss goals is an important part of the surgical decision-making process.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Will I lose weight if I have liposuction?

The short answer to this question is: most likely not. As I’ve said in previous posts, liposuction is not a method of weight loss. I do around 5-6 liposuction cases per week. The average amount of fat I remove is one to two liters, which weighs around two to four pounds. This doesn’t sound like much, but when fat is removed from a single area such as the stomach, two pounds of fat is enough to make a huge difference in the way you look and the way your clothes fit. But in terms of numbers on the scale, your weight varies by a couple of pounds depending on how much water you are retaining. So you won’t see a difference in your actual weight after liposuction.

courtesy of shutterstock.com

courtesy of shutterstock.com

There are some cases where patients do see a change in their weight. These are usually instances where someone has gotten several areas treated, e.g. stomach, waist, hips, inner thighs, arms, and back. This much liposuction is actually separated into two operations because there is a limit to how much fat we can remove safely in one day. And even in these large, two-stage, operations, I’ve never seen a patient lose more than 10lbs.

Do you have any questions about liposuction? I would be happy to answer them in the comments section.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

What is the difference between a neck lift and a face lift?

Face lift and neck lift are two procedures that are nearly always done in a single operation. Today I’m going to talk about the difference in the two operations, and when you might only need one vs. both.

  • Face lift: addresses only the mid-face, which is the area from your jawbone to your cheek bone (outlined in blue on the photo below). I’ve spent time in another post discussing exactly what happens during a face lift, but to summarize, the skin anterior to the ear is elevated using an incision that starts just in front of the ear and continues around to the back of the earlobe. The underlying layer of muscle and connective tissue is then tightened using suture. This is the actual “lift” that occurs. Then the skin is re-draped and any excess removed before closing the incision. face lift and neck lift locations
  • Neck lift: addresses only the anterior neck, from the just behind the ears to the midline (outlined in purple in the diagram to the left. A neck lift is done through nearly the same same incision as a face lift. The only difference is that the incision continues further behind the ear to remove the excess skin over the neck. There is also an additional incision under the chin. This incision is used to tighten the muscles along the front of the neck, and to remove any excess fat. The excess skin is then removed and the incision is closed.

From the description, I think you can see why face lifts and neck lifts are usually done together. If you have laxity (loose skin) along the jawline, then you very likely have laxity under the chin as well. I do see the rare patient, often younger, who only has laxity along the jawline. And in this patient, it may be appropriate to only do a face lift. The other time I will do only one of the two procedures is in a patient who has had prior surgery. In this case, it is common for only the neck or only the face to need a touch up.

 

Do you have a question about face lifts or neck lifts? I would love to answer your questions in the comments section.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

What gives away your age?

We all know that wrinkles and sagging skin on the face are dead giveaways of our true age. But there are two other body parts that indicate your age that you may not even aware of.

1) Your neck and décolletage. Most women focus on the face when applying skin care products, sunscreen, and makeup. But the neck and décolletage receive as much sun, if not more. Fine lines and brown spots in this area are a dead giveaway of age. There are several treatment options for this area:

  • Skin care products: The same skin lightening creams (e.g. Lytera) that work on the face work on the chest and neck as well.
  • Resurfacing: Although a traditional laser peel is too harsh for the delicate skin in this area, more mild chemical peels and Profractional laser treatments can both be done on the neck and chest. These options will improve both texture and pigmentation.
  • Fotofacial or BBL: The primary goal of a fotofacial treatment is to even out the pigmentation, and it is very effective over the décolletage.

    BBL treatment of the chest

    BBL treatment of the chest

  • Skin tightening treatments: Marketed under many different brands (Venus, Skintyte, Ulthera, Thermage), these treatments heat the skin, which stimulates collagen remodeling and tightens skin gradually over a 4-6 month period. This is a great option when skin on the neck develops a crepey texture.

2) Your hands. Hands are subject to the same pigmentation issues as the rest of the body. And although skin on the hands does not develop wrinkles in the same way, the soft tissue does thin out (atrophy) over time, making the hands appear bony or gaunt.

  • Skin lightening creams and fotofacials are both great options for achieving more even pigmentation out on the hands.
  • There are two options to treat volume loss in the hands. Radiesse® has been used to add volume to the face for many years, and was recently approved by the FDA to add volume in the hands. Radiesse® is composed of hydroxylapatite, a mineral found in bone. It is injected under the skin to add volume, and lasts about 9-12 months. The other option for adding volume to the hands is fat grafting. This procedure takes fat from the abdomen or thighs, and injects it under the skin. Unlike Radiesse®, fat-grafting is permanent.

What body area shows your age the most? I’d love to hear from you!

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

What is a free-nipple breast reduction?

I’ve talked a little bit about breast reductions in previous posts, including how a breast reduction is done, as well as the possible complications of breast reduction and what the scars look like. But breast reduction is a broad topic, and there is a wealth of information I haven’t covered yet. In today’s blog I’m going to talk a little bit more about free-nipple breast reduction. First let’s review the two types of breast reduction:

Courtesy of office.com

Courtesy of office.com

  1. Pedicle reduction. This is the most common type performed. In a pedicle reduction, the nipple is left attached to the breast, and its blood flow is supplied by the underlying tissue (the pedicle).
  2. Free nipple reduction. In a free nipple reduction, the nipple is actually removed from the breast and reattached as a skin graft.

Removing the nipple seems like a pretty drastic step, right? And it does completely remove the ability to breast feed, as all of the milk ducts are divided. So why do it? It’s a matter of blood flow. A nipple placed as a skin graft has a lower metabolic requirement (i.e. needs less oxygen and fewer nutrients) than a nipple which remains attached. So free-nipple reductions are done in cases where blood flow to the nipple might be decreased such as:

  • Patients with diabetes.
  • Patients with a heavy smoking history.
  • Very large breasts – in this instance the blood has to travel a long distance to reach the nipple.

But what do your breasts actually look like after a free nipple reduction? For the first week there will be a dressing over the nipple which is held on with stitches. This dressing is called a bolster, and it holds the nipple flat to the underlying tissue both to allow nutrients to diffuse into the nipple and for new blood vessels to grow into the graft.

After the dressing comes off, the nipple may undergo some superficial sloughing, which is when the outer layers of skin peel and flake off. This happens because nipples are fairly thick, and the very outer layers of skin do not get good blood flow initially. This superficial sloughing may result in some irregular pigmentation, especially in darker skinned individuals.

As the nipple graft heals over the ensuing weeks and months, the pigmentation returns. New cutaneous (skin) nerves may also grow into the graft, returning a little bit of sensation to the area. After a year of healing, the nipple graft looks very much like the nipple after a pedicle reduction, although some irregular pigmentation may persist.

 

Do you have any questions about free nipple grafts? Leave them in the comments and I’ll get back to you.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.