Will liposuction give me a flat stomach?

When diet and exercise don’t work, surgery may be an option to obtain a flat stomach. In previous posts I’ve talked about abdominoplasty and combining abdominoplasty with liposuction. But how do you know which is right for you? It depends on what is causing the problem. And there are several possible culprits:

  • Stretched abdominal muscles. The rectus abdominus muscles are your six pack muscles which down the front of the stomach. The two strips of muscle spread apart during pregnancy or with significant weight gain, and they don’t always rebound back into place when the pregnancy ends or the weight is lost. This widening is called a rectus diastasis (diastasis means separation), as you can see illustrated in the diagram below. The only fix for a rectus diastasis is surgery; the separated muscles are brought back
    photo credit: www.momsintofitness.com

    photo credit: www.momsintofitness.com

    together in the midline using suture. This is typically done as part of an abdominoplasty surgery.

  • Excess skin. Excess skin also commonly results from weight loss or pregnancy, and like a rectus diastasis, the only fix is surgery. This is the other main component of an abdominoplasty
  • Excess fat. This is where liposuction comes in. Liposuction removes fat over a focused area, which can be perfect for the abdomen. But most people don’t realize that there are two types of abdominal fat. Subcutaneous fat is the fat right under the skin, and this fat can be removed using liposuction. While you’re reading this, go ahead and pinch the skin of your stomach between your finger and thumb. The thickness of this pinched skin is determined by how much subcutanous fat you have. If it’s a big, wide fold of skin, then there is lots of fat under the skin. Compare a pinch of skin over your abdomen or hips with a pinch of skin over your forearms or neck and you’ll see what I mean. The second type of fat is called visceral fat. This is the fat which surrounds your internal organs. It is inside the abdominal cavity, below your abdominal muscles, and liposuction cannot remove this fat. Visceral fat is more common in men, and subcutanous fat is more common in women.

Surgery can in many cases give you a flatter stomach. But what type of surgery you need depends on what is causing the problem. Seeing a plastic surgeon for an consultation is the best way to find out. You can find a board-certified plastic surgeon in your area by checking the American Society of Plastic Surgery website.

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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.

Do breast lift and breast augmentation require two surgeries?

Placing breast implants (augmentation) and lifting the breast (mastopexy) are each fairly straightforward operations, with a low risk of complications. But when the two procedures are combined, the risk of complications increases significantly. This is because the two operations have goals in opposition to one another.
Mastopexy:
  1. Removes skin

    image from shutterstock.com

    image from shutterstock.com

  2. Changes the position of the nipple
  3. Reshapes the breast

Augmentation:

  1. Adds weight to the breast
  2. Stretches the skin envelope

Combining these two procedures can potentially lead to serious complications. For example, if the nipple does not have adequate blood supply after surgery it can die. The risk of this happening with either a mastopexy or an augmentation is very small, but when both are done at the same time, the blood supply to the nipple can be compromised.

Even when a mastopexy and augmentation are combined safely, the results are not always predictable. The result could be an implant that is too high or too low, or an implant that is not the right size. If this happens, a second operation is needed to correct the problem.  To provide safe, reliable results, I prefer separating the two procedures in most cases. If only a very small mastopexy is done, then I will place an implant at the same time. But if a more significant lift is needed, I do the mastopexy first and let things heal for 6 months before placing breast implants. This provides a safer, more predictable result than combining the two procedures, and some patients even find they don’t need an implant after the mastopexy, because moving the breast tissue back up where it belongs gives a fuller appearance as well.

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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.

Are you wearing the right size bra?

I realize I’m going a little outside my “zone of expertise” by delving into the world of women’s fashion, but there is actually a really good reason for that. A large part of my practice is breast surgery: breast reductions, breast augmentations, and breast reconstructions. Patients often focus on postoperative bra size, which is very, very difficult to predict. In fact, most women are not wearing the correct size bra preoperatively. So basing your ideal bra size on the incorrect size that you’re currently wearing is simply not helpful in terms of predicting what you’ll actually look like after surgery. Today I’m going to explain how to properly measure yourself for a bra, and how surgery changes bra size.

bra measurement band real simpleWhat size bra do you wear now? If you’ve read up on measuring for bras, you know that your band size is the measurement around your chest, just under your bust, plus 4 or 5 inches (4 if it’s an even measurement, 5 if it’s an odd measurement).  As an alternative, you can measure the chest circumference just over the breast, right under your armpits. So that gives you some wiggle room right there in terms of measuring incorrectly.

Photo credit: RealSimple.com

Photo credit: RealSimple.com

Next you need to measure your bust size, which is across the fullest part of your breast. But most women’s breasts are not perfectly perky, so you actually need to do this measurement wearing a non-padded bra.

Finally, you use these two measurements to calculate your cup size. This is the difference between the bust measurement and the band measurement. An A cup is a 1″ difference, a B cup is a 2″ difference, and so on. Real Simple magazine has a great article on how to measure bra size, which I recommend reading before you measure.

Once you have the correct measurement, you need to make sure the bra actually fits. Breasts are moving targets, so to speak, so this isn’t as simple as trying on a pair of pants. I found a fabulous blog post on putting your bra on properly, which explains how to tell if your bra fits correctly.

Now that you understand how to measure yourself for a bra, and how to tell if your bra fits, you are starting to understand why estimating postoperative bra size is so impossible:

  • The band size usually stays the same, but may change if any liposuction is done under the arms or over the upper back.
  • The cup size change depends on the change in bust size compared to the change in band size. This isn’t a straightforward calculation based on volume. A woman with a broader chest (i.e. larger band size) will need a larger volume change to change a cup size compared to a woman with a smaller chest (i.e. smaller band size).

Bra fitting is a tricky business. But as with most clothing, it’s really more important how you look and how you feel than what size you wear.

 

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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 cellulite?

Tabloid magazines love to show “shocking” photos of supermodels and celebrities with cellulite showing, as if cellulite is some ashaming indictation they’re overweight.  Well guess what? Cellulite is actually completely normal, and is not a sign of being overweight. Babies have cellulite! (although I fully admit those dimples are much more adorable on my 1 year old son’s thighs than on mine). So what causes cellulite?

Strands of connective tissue called septae tether the skin to the deeper layers of tissue. Fat pushes up between these septae, similar to stuffing pushing up against the buttons on an upholstered chair. Compare the two images below to see what I mean.

www.potterybarn.com

www.potterybarn.com

cellulite

Now that you understand what causes cellulite, we’ll explain which treatments work. Cellulite may be more severe if you are overweight, so losing weight may help improve the appearance of cellulite. But no skin creams or non-invasive treatments have been shown to permanently improve the appearance of cellulite. Liposuction doesn’t necessarily improve cellulite, and can actually make it worse. The most effective treatment currently available passes a laser probe through a tiny incision in the skin, then uses the laser to break up the septae. This removes the little indentations where the septae tether the skin, similar to popping the buttons off that tufted chair in the photo. These treatments show some promise, but are not yet widely available.

Do you have any questions about cellulite? We’d love to hear them!

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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.

I’m thinking about breast reduction. Where do I start?

I’ve covered some of the aspects of breast reduction surgery in previous posts, including complications, scarring, breastfeeding after breast reduction, and how the operation is actually performed. Today I’m going to cover the process of obtaining insurance pre-approval.

One of the most common questions I hear about breast reduction surgery is: “Where do I start?”  If you’re at this point, the first step is a visit to your primary care physician (PCP) or Ob-gyn. He or she will evaluate your symptoms to see if they might be caused by large breasts, as well as ensure you are healthy enough to have surgery. The next step is seeing a Board-Certified plastic surgeon for an evaluation. This evalation will consist of several parts:

  • History of symptoms and the treatments you have tried. Insurance companies will only cover breast reduction if it is medically necessary. They require that you have symptoms caused by large breasts (e.g. neck pain, back pain, rashes under the breasts) that have not improved with non-surgical treatement. These non-surgical treatments might include physical therapy, ice or hot packs, wearing a sports bra, or even losing weight. This is why that first visit to your PCP or Ob is so important; it starts the process of documentation necessary to obtain insurance approval.
  • Basic health history. Some conditions, including diabetes and smoking, increase the risks of complications during breast reduction surgery. Your plastic surgeon will take a full health history to look for any medical issues.
  • Physical exam. The second part of obtaining insurance approval is being able to remove enough tissue. Your plastic surgeon will estimate how much tissue he or she can remove during surgery, and submit this number along with the request for preapproval. Photos will also be taken to send to the insurance company.

After your evaluation, your surgeon will gather together any supporting evidence. This will include notes from your PCP or Ob, as well as evaluations by any chiropracters or physical therapists you may have seen. This information will then be submitted to your insurance company. There are a couple special circumstances that may come in to play at this point in the process.

  1. We find out your insurance company does not cover breast reductions- i.e. they are an excluded procedure. Some insurance companies do not cover breast reduction for any reason, even if it is medically necessary. For this reason, I recommend making a phone call to your insurance company before you see a plastic surgeon to confirm breast reduction is covered under your policy.
  2. You have Medicare. Medicare does not allow physicians to obtain preapproval for surgery. Instead, the surgeon does the operation if he or she thinks it is medically necessary, and then Medicare decides whether or not to pay. Thus if you have Medicare, your surgeon may have you sign a document stating that you are responsible for any charges or fees if Medicare does not cover your care. Make sure you know how much these charges or fees might be before you sign anything.

If neither of the above apply, then your insurance will either approve surgery or not. It usually takes 2-4 weeks to hear back from insurance after the request for approval has been submitted.

 

 

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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.