Can I Breastfeed after Breast Reduction?

Breast reductions are commonly performed on women of child bearing age. For this reason, it is critical that women considering surgery understand the impact that breast reduction may have on their ability to breast feed. We’re going to cover this topic today. If you don’t know much about breast reduction surgery, you may want to read up on how the surgery is performed.

Photo credit: shutterstock.com

Photo credit: shutterstock.com

There are two main types of breast reduction surgery, and they affect breast-feeding differently:

  • In a free-nipple breast reduction, the nipple is removed completely from the breast and placed back on as a skin graft. This severs the milk ducts, thus making breast feeding after surgery impossible. This type of reduction is not particularly common, and is generally reserved for patients with exceptionally large breasts, or medical conditions which put them at risk of healing problems, such as diabetes or smoking.
  • In a pedicle breast reduction, the nipple is left attached to the underlying breast tissue. This means the milk ducts are left intact, and breast feeding should be possible. But some breast tissue has been removed, meaning the breast might not make as much milk as it would have without the reduction surgery. Overall, however, the success rate for breastfeeding after breast reduction appears to be fairly similar to the success rate for women who have not had breast reduction surgery.

So what does this mean for you? If you are planning on having children, and breastfeeding is extremely important to you, then the safest course of action is to wait to have breast reduction surgery until you are finished having children. If you are unsure about breastfeeding, then at least be certain you understand how breast reduction surgery can affect your ability to breastfeed.

 

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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.

Who Should I go to for Fillers?

Injectable cosmetic medications such as Botox and fillers are a hot commodity for physicians. With the decreasing reimbursements provided by insurance companies, a wide variety of practitioners have entered the injectables market as a way to bring in extra revenue. Laws vary by state, but you may find your dentist, oral surgeon, family practice doctor, Ob-gyn, or medical spa offering Botox and fillers. Many states also allow nurses to do injections if overseen by a physician.

courtesy of Office.com

   Photo Credit: Office.com

With the wide variety of locations available for treatment, which is really the best option? For the purposes of this discussion, I’m going to divide medical practitioners into two broad groups: those that learn injectables as a natural part of their training, and those that add injectables to their practice later as an additional revenue stream.

Into the first group would fall Plastic Surgeons and Dermatologists; these specialties learn how to inject Botox and fillers as a routine part of their training.  Otolaryngologists (ENT) learn injectables to a varying degree as well, and some otolaryngologists actually do extra training in a cosmetic fellowship. Finally, oculoplastic surgeons, who are ophthalmologists that did additional training in cosmetic surgery, are trained in injectables as well.

The second group, practitioners who add injectables to their practice as an additional revenue stream, would include everybody else. From a purely technical perspective, injecting Botox or fillers is not difficult. And doctors and dentists all learn how to perform injections of other medications while training. So what makes cosmetic injectables different? For one thing, performing cosmetic injections requires having a sound understanding of facial anatomy. Understanding how the facial muscles interact and how the soft tissues and bony framework change with age, allows for more effective treatment. So although a dentist or Ob-gyn may be able to safely inject Botox, I would argue that a Plastic Surgeon or Dermatologist would be able to use Botox more effectively.

So what about nurse injectors at either a physician’s office or medical spa? I think it really depends on who is over seeing the nurse injector. Most nurse injectors I have worked with are very well-trained, but ultimately they learn from and use as a resource the physician that oversees them. So if you go to a nurse injector overseen by a Plastic Surgeon or Dermatologist, the nurse injector has that person’s experience to draw upon if there are any questions or concerns. A nurse injector overseen by a Primary Care physician, on the other hand, may not be as good a choice to go to.

Where was the strangest or most surprising place you saw offering Botox or fillers? We’d love to hear about it! (The most surprising place for me was on a cruise- for some reason I just didn’t expect that.)

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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.

Breast Augmentation – where is the incision located?

I’ve touched on the topic of breast augmentation in prior posts, including the recovery, how long breast implants last, and the different types of breast implants. But it occurred to me today that I’d never explained some of the basics of breast augmentation. Today I’m going to discuss the types of incisions used in breast augmentation, and where the implants are placed. In a future post I’ll explore the possible complications of breast augmentation.

Breast implants can be placed through a few different types of incision:breast-augmentation-incisions asps

  1. Inframmary: this hides the scar in the crease under the breast, and is my preferred incision for a couple reasons. First, it allows excellent access to dissect out the pocket where the breast implant will be place. Second, breast implants do not last forever. And when they are removed, this is frequently done through an inframmary incision. If you’re likely to have a scar in this area at some point in the future, why not limit the overall number of scars and do the initial operation through this inicision as well?
  2. Periareolar: this hides the incision in the transition between the areola and the lighter surrounding skin. The incision is smaller than an inframammary, so it can be difficult to get a larger silicone implant in through this style of incision. Cutting through the breast tissue itself may also expose the implant to bacteria from the milk ducts, which theoretically could raise the risk of infection, although this has not been proven. I tend to reserve a periareolar incision for when I plan to do a mastopexy along with the augmentation.
  3. Axillary: this incision is hidden in the axilla, or armpit. A camera is used to visualize the implant pocket during surgery. It can be difficult to place implants in precisely the correct position when the incision is so far away. And I personally don’t like this incision because it is visible when wearing a sleeveless blouse or tank top.
  4. Umbilical: known as a TUBA, or transumbilical breast augmentation, this hides the scar in the upper curve of the belly button, or umbilicus. This isn’t a very popular type of incision, for the simple reason that the breasts are a long way from the belly button. It is difficult to place implants precisely where you want them over such a long distance. In addition, this incision limits your implant type to saline. Saline implants are placed in the breast empty, and then filled, whereas silicone implants are filled by the manufacturer. And it’s simply impossible to squeeze a full silicone implant through such a small incision.

And that’s it- those are the four types of incisions currently used to place breast implants. Have you had a breast augmentation? If so, where is your incision?

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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 causes stretch marks?

Stretch marks, or striae, are very common in both men and women. They are literally caused by stretching of the skin.  Although characteristically associated with pregnancy, stretch marks can develop with any type of rapid growth or weight gain.

Abdominal striae. Wikipedia.com

Abdominal striae. Wikipedia.com

Thus stretch marks often appear during puberty or in weight-lifters, as both conditions result in rapid growth over a limited body area.  Stretch marks are more severe when they develop in association with excess cortisone, which is a hormone produced by the adrenal glands. This is because cortisone weakens elastic fibers in the skin. This can occur as a result of using medication containing cortisone (e.g. long-term use of cortisone cream), or with diseases that cause production of excess cortisol, such as Cushing’s syndrome. Severe stretch marks are also associated with connective tissue disorders- disorders where the proteins that form the skin, soft tissues, or bone are made incorrectly. Examples of connective tissue disorders include Marfan syndrome and Ehlers-Danlos syndrome.

So what do stretch marks look like on a microscopic level? The skin is composed of two layers: a thin outer layer called the epidermis, and a thicker inner layer called the dermis. Stretch marks appear when the dermis tears. This tear heals, but leaves a scar behind- this is the stretch mark or stria. I commonly operate on areas of the body that have stretch marks, for example when performing an abdominoplasty. And when you look at the cross section of skin that has stretch marks, you can actually see where the dermis has torn.

Initially stretch marks appear red, pink or purple, similar to any scar. Over a period of months to years they fade to the same color as the surrounding skin. Laser treatments can help speed the fading process. There is no way to actually get rid of stretch marks, as this would require repairing the tears in the dermis (i.e. surgically excising the stretch mark, which would leave a scar). Some laser treatments such as SkinTyte  and Profractional have shown promise in improving the appearance of stretch marks. But they tend to be very time intensive to do over large surface areas. And since the cost of laser treatments is related to the time involved, this can make these treatments cost-prohibitive.

 

Do you have any questions about stretch marks?

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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.

Why are there so many different types of face lifts?

If you’ve done any research into having a face lift, you are probably overwhelmed by all the different types of lift. Some of these include MACS lift, mini-lift, short-scar lift, thread lift, and LifeStyle Lift. So what is the difference between these different face lifts? And how is a face lift done?

First I’m going to explain the basic face lift. After you understand this, I will explain some of the variations.  The goal of a facelift is to tighten the midface- the area from the cheekbones down to the jawline. The neck is not addressed unless a separate neck lift is done, but these two procedures are frequently combined.

  1. An incision is made just in front of the ear (known as a pretragal incision). This incision may extend up into the hairline, and may also extend around behind the ear.
  2. The skin is elevated, raising up a skin flap to reveal the layer of connective tissue and muscle underneath. This tissue is known as the superficial musculoaponeurotic system, or SMAS. How far anteriorly (toward the front) the skin is raised can vary. In an awake setting such as LifeStyle lift, the skin elevation may be very minimal. For a full face lift, the skin may be elevated over the entire cheek, nearly to the smile lines (nasolabial folds).
  3. The SMAS layer is tightened. This step is what does the actual lifiting portion of a face lift.  There is significant variation in this portion of the procedure as well. On the less invasive end of the spectrum, sutures may be used to tighten this layer without lifting it up or removing any tissue. On the more invasive end of the spectrum, the SMAS may be raised up and some of it removed.
  4. The skin is redraped over the underlying tissue, and the excess skin is removed before closing the incisions.

These are the essential steps of any facelift: elevate skin, tighten SMAS, redrape skin and remove the extra prior to closing incisions. If a neck lift is done at the same time, as is common, the steps are very similar: the skin over the neck is elevated, the muscular layer is tightened, and the skin is re-draped before removing the excess. So where do all the different names come from?  There are several possible variations:

  • How long the incision is. The short-scar facelift limits the incision to in front of the ear.
  • How much the skin is elevated. The MACS lift stands for minimal access cranial suspension lift. In this type of lift the incision is up higher in the hairline, and minimal skin undermining is performed.
  • If the SMAS layer is elevated, or just tightened. In a mini-lift, for example, the skin is elevated just enough to tighten the SMAS, but no SMAS tissue is removed.

So all those different types of face lift that you’ve heard about are just variations on a theme, and there are very, very few studies comparing them head-to-head. But it’s really not critical for you to understand all the minute variations in face lifts. Just be aware that the different names out there are essentially marketing gimmicks trying to carve out a niche. All that really matters is that your surgeon obtains good results with his or her chosen technique.  The one type of lift I would like to mention specifically, however, is a “thread lift”. This is not a true face lift at all. Instead of elevating the skin and tightening the muscle layer below it, the “thread lift” attempts to perform a lift by running a suture through a very small incision. Because the skin and underlying SMAS are not separated from one another, thread lifts tend to not be very effective or last very long.

I hope this post cleared up some confusion about the different types of face lift out there. I would love to hear any questions you might have.

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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.