Plastic Surgery Forum

Plastic Surgery Procedures After Weight Loss
Dramatic weight loss, whether achieved by proper nutrition and exercise, as the result of bariatric surgery, or from other forms of medical treatment, has many benefits. However, once you reach your weight loss goals, you may find that you still don't have the fit and healthy body image you desire. Skin may be loose, sagging and, in many cases, your body contours may appear irregular and unharmonious.

Serious Procedures, Tough Recovery
The removal of excess skin resulting from loss of substantial weight is very important to the health and well-being of many people who find themselves with misshapen bodies and infected skin. Many of these people consider plastic surgery to be inevitable at some point in the future. Nothing about plastic surgery, however, is trivial. The procedures used to correct baggy skin are highly specialized, and even an uncomplicated recovery can take weeks or months.

Weight loss patients continue to drive the desire in body contouring; however, more patients are choosing these procedures as awareness grows and as plastic surgeons apply improved surgical techniques. More than 106,000 body-contouring procedures were performed in 2004, up 77 percent over the last five years, according to the American Society of Plastic Surgeons. Massive weight loss patients, who accounted for nearly 56,000 procedures, continue to drive the growth in body contouring; however, more patients are choosing these procedures as awareness grows and as plastic surgeons apply improved surgical techniques.

While this is a growing specialty in plastic surgery and more and more surgeons are billing themselves as experienced and trained in body contouring, it can still be a challenge to find a truly well qualified surgeon. So, it pays to do your homework and know what is reasonable to expect from a surgeon, as well as the risks and costs you can expect to find for a given procedure.

This section is designed to help you determine some of those basic facts so that you can already be prepared when you start speaking with potential surgeons. We outline here, using information provided by the ASPS, several of the most common procedures done to correct problems resulting from weight loss. We recommend that you begin by reading the section on Body Contouring, as it will provide you with an overview. Then, you can click on one of the links below to find information about a specific procedure, or you can read about all of them by simply reading this page from top to bottom. We invite you to bookmark this page and to refer back to it throughout your plastic surgery process.

• Body Contouring
• Body Lift
• Abdominoplasty (Tummy Tuck)
• Thigh Lift
• Brachioplasty (Upper Arm Lift)
• Buttock Lift
• Breast Lift
• Breast Augmentation
• Breast Reduction

 Body Contouring

The condition of being significantly overweight can cause stress on your health in many ways. If your physical activity had been limited by your weight, you many have weak muscle and skin tone, and your skin may be severely stretched.

What is body contouring after major weight loss?
Following weight reduction surgery, or any substantial amount of weight loss, the skin and tissues often lack elasticity and cannot conform to the reduced body size. As a result, skin that has severely stretched now is unsupported and begins to sag in pockets.

Pockets of sagging skin are often found around the:

• Face, neck and jowls, resulting in a droopy, sad appearance
• Upper arms, resulting in a bat-wing like appearance
• Breasts, causing them to flatten and hang with nipples pointed downward
• Abdominal area, extending around the sides and into the lower back area, resulting in an apron-like overhang
• Buttocks, groin and thighs, causing hanging pockets of skin

Weak and sagging skin that becomes macerated (wet and infected) is not only unattractive; it is also a serious threat to your health that must be treated. Surgical body contouring following major weight loss improves the shape and tone of the underlying tissue that supports fat and skin, and removes excess sagging fat and skin. The result is a more normal appearance to the body, with smoother contours. This is, in essence, the final phase of your total weight loss experience.

However, before you decide to undergo body contouring following major weight loss, it is important to understand that your weight loss must have stabilized. If you continue to lose weight, sagging pockets will redevelop. If you rapidly regain the weight you have lost, you will dramatically stress the already weakened and thinned skin, causing further stress to the skin, visible stretch marks and wide scars.

In general, good candidates for body contouring are:

• Adults of any age whose weight loss has stabilized
• Healthy individuals who do not have medical conditions that impair healing or increase risk of surgery
• Non-smokers
• Individuals with a positive outlook and realistic goals for what body contouring can accomplish
• Individuals committed to leading a health lifestyle including proper nutrition and fitness

Where do you begin?
A consultation with your plastic surgeon is the first step to learn how body contouring following major weight loss can help you achieve better health and an improved appearance. A consultation is designed to educate you about body contouring in a non-pressure environment, and will include:

• A discussion of your goals and an evaluation of your individual case
• The options available in body contouring surgery
• The likely outcomes of body contouring procedures and any associated risks or potential complications
• The course of treatment recommended by your plastic surgeon

Evaluation
Overall health and personal outlook can greatly impact the outcome of your surgery. These will be carefully evaluated in your consultation with your plastic surgeon. The success of the procedure, safety and overall satisfaction require that you:

• Honestly share your expectations
• Fully disclose health history, current medications, the use of vitamins, herbal supplements, alcohol, tobacco and drugs
• Commit to precisely following all of your plastic surgeon's instructions

Safety
By making the decision to consult with your plastic surgeon and following all the instructions given, you are taking an important step in helping to assure your safety.

Your Body Contouring
Your body contouring following major weight loss will be individualized to your specific conditions and the regions to be treated. The procedures necessary to achieve your goals will be defined along with a plan for the timing of these procedures.

Specific plastic surgery procedures that may be recommended for your body contouring include:

• Facelift: to reduce sagging of the mid-face, jowls and neck
• Breast life: to correct the apron of excess skin hanging over the abdomen
• Lower body lift: to correct sagging of the abdomen, buttocks, groin and outer thighs
• Medial thigh lift: to correct sagging of the inner, outer and mid thigh
• Brachioplasty: to correct sagging of the upper arms

Information on all these procedures follows. Ask your plastic surgeon for more information on any procedure recommended for you.

You must accept that all body contouring requires incisions to remove excess skin. In many cases, these incisions may be extensive. Incision length and pattern depend on the amount and location of excess skin to be removed, as well as personal preference and surgical judgment. Advanced techniques usually allow incisions to be placed in strategic locations where they can be hidden by most types of clothing and swimsuits, but this not always the case.

Body contouring following major weight loss is often done in stages. Your conditions, goals, health, safety and comfort as well as the surgical judgment of your plastic surgeon will define a surgical plan for you. While it may have taken you two years or more to lose all the excess weight, it may take just as long for the results of your body contouring to be complete.

In addition to preparing yourself for stages of contouring and recovery following procedures, you must accept that a single procedure to treat a specific area may not achieve your results. Uneven contours can develop following your body contouring surgery, and in some cases, skin elasticity is so poor that relapses of sagging skin are possible.

Preparing for surgery
Your plastic surgeon will carefully explain your body contouring plan. Prior to any surgery, you will be given specific instructions that may include:

• Pre-surgical considerations, diagnostics testing and medications
• Day of surgery instructions and medications
• Specific information related to the use of anesthesia
• Postoperative care and follow-up

In addition, you will be asked to sign consent forms to assure your plastic surgeon that you fully understand the procedure or procedures you will undergo and any associated risk or potential complications.

Possible risks of body contouring following major weight loss include bleeding, infection, fluid accumulation, delayed or poor wound healing, skin loss, blood clots, excessive or widened scars, numbness and other changes in skin sensation, and irregular or asymmetric contours or scars. Any surgery carries risks associated with anesthesia. These risks and others will be fully discussed prior to your consent.

It is important that you address all your questions directly with your plastic surgeon. It is natural to feel some anxiety, whether excitement for the anticipated outcomes or preoperative stress. Discuss these feelings with your plastic surgeon.

What to expect
Body contouring procedures may be performed in your plastic surgeon's accredited office-based surgical facility or an ambulatory surgical facility or a hospital, possibly with an overnight hospital stay. Procedures are most commonly performed under general anesthesia, although local anesthesia with sedation may also be used in some cases. These decisions will be based on the requirements of your specific procedures and considerations of patient and surgeon preference. Your plastic surgeon and the assisting staff will fully attend to your comfort and safety.

Following Surgery
Once your procedures are complete, dressing or bandages may be applied to your incisions. Areas of the body that have been treated may be wrapped in an elastic bandage to minimize swelling and to support your new contours as you heal. Small, thin tubes may be temporarily placed under the skin to drain excess fluid or blood that may collect. Before you are released, you and an accompanying caregiver will be given specific instructions that may include:

• How to care for the surgical site and drains
• Medication to apply or take orally to aid healing and reduce the potential for infection
• Specific concerns to look for at the surgical site or in your general health
• When to follow up with your plastic surgeon

Progress and Healing
Initial healing will include swelling at the incision sites. Discomfort is common and can be controlled with medication. You will be instructed to return to light walking as soon as possible to minimize the potential for blood clots and other complications.

In many cases, you will be instructed to avoid bending, straining or lifting for several days to weeks. Where tightening of the abdomen or thighs is evolved, your plastic surgeon may also instruct you to avoid standing fully upright and stressing any internal sutures as they heal, and to sleep with pillows elevating your knees. Follow all instructions carefully ? this is essential to the success of your outcome.

Initial wounds healing may take 7-14 days after which time sutures will be removed if necessary. You will be ready to return to work and normal activity in a few weeks, so long as you do not engage in any heavy lifting or vigorous exercise.

Healing will continue for many weeks as swelling resolves and incisions lines continue to improve. Numbness and a firm feeling over the skin's surface will improve over time. Once you have completely recovered from one series of procedures, it may be time to begin preparing for additional procedures to target others areas of the face or body. You must practice diligent sun protection until the healing process is fully complete. It may take a year or more following a given procedure for incision lines to refine and fade to some degree. Continue to follow your plastic surgeon's instructions and attend follow-up visits as scheduled.

Results and Outlook
Healing will continue for many weeks as swelling resolves and incisions lines continue to improve. Numbness and a firm feeling over the skin's surface will improve over time. Once you have completely recovered from one series of procedures, it may be time to begin preparing for additional procedures to target others areas of the face or body. You must practice diligent sun protection until the healing process is fully complete. It may take a year or more after a given procedure for incision lines to refine and fade to some degree. Continue to follow your plastic surgeon's instructions and attend follow-up visits as scheduled.

Your Surgeon, Your Choice
Choosing to have cosmetic or reconstructive plastic surgery is an important decision; so is selecting a plastic surgeon. Your surgeon should have operating privileges at an accredited, local hospital for the same procedures you plan to have performed?even if that surgeon wants your procedure be performed in an accredited office-based surgical facility or at an ambulatory center.

?Body Countouring After Massive Weight Loss? Video
Learn more about body contouring with ASPS members and hear firsthand from patients how these procedures positively affect lives. Click here to view video (requires Flash plugin; 13.4 MB)

Information in this section was provided courtesy of the ASPS

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 Body Lift (Abdominoplasty, thigh lift and buttock lift)

A body lift is a combination of several procedures that usually includes an abdominoplasty (tummy tuck), thigh lift and buttock lift. Like the face, the remainder of the body suffers the consequences of time, gravity and in some cases significant weight loss. While some areas are affected more than others, skin wrinkling and loss of tone occur throughout the body. To achieve a balanced and pleasing aesthetic result, many patients seeking a tummy tuck may also need both a thigh lift and buttock lift.

A body lift is a very powerful body-rejuvenating procedure that perhaps is underutilized in the Unites States. The ideal candidate for this operation is an individual with excess skin along the lower abdomen and relaxed abdominal wall muscles who also has cellulite or loose and wrinkled skin along the thighs and buttocks.

This single operation can have a dramatic effect on a person's body. Along with tightening of abdominal wall muscles and removal of excess skin from the abdomen, thighs and buttocks, the procedure often incorporates liposuction to achieve balance between the torso and thighs. The scar required for the procedure is placed very low on the abdomen, generally in the pubic area, runs higher on the thighs to preserve the aesthetic appeal of the thigh, and continues along the lower back, just above the buttocks. The scar, which usually heals very well, is hidden by most contemporary underwear and bikini swimwear.

Information in this section was provided courtesy of the ASPS

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 Abdominoplasty (Tummy Tuck)

If you are considering abdominoplasty, this page will give you a basic understanding of the procedure ? when it can help, how it is performed, and what results you can expect. It can't answer all of your questions, since a lot depends on the individual patient and the surgeon. Please ask your surgeon about anything you don't understand.

Abdominoplasty, known more commonly as a ?tummy tuck,? is a major surgical procedure to remove excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall.

The procedure can dramatically reduce the appearance of a protruding abdomen. But bear in mind, it does produce a permanent scar, which, depending on the extent of the original problem and the surgery required to correct it, can extend from hip to hip.

The Best Candidates for Abdominoplasty
The best candidates for abdominoplasty are men or women who are in relatively good shape but are bothered by a large fat deposit or loose abdominal skin that won't respond to diet or exercise. The surgery is particularly helpful to women who, through multiple pregnancies, have stretched their abdominal muscles and skin beyond the point where they can return to normal. Loss of skin elasticity in older patients, which frequently occurs with slight obesity, can also be improved.

Patients who intend to lose a lot of weight should postpone the surgery. Also, women who plan future pregnancies should wait, as vertical muscles in the abdomen that are tightened during surgery can separate again during pregnancy. If you have scarring from previous abdominal surgery, your doctor may recommend against abdominoplasty or may caution you that scars could be unusually prominent.

Abdominoplasty can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

Uncertainty and Risk
Thousands of abdominoplasties are performed successfully each year. When done by a qualified plastic surgeon trained in body contouring, the results are generally quite positive. Nevertheless, there are always risks associated with surgery and specific complications associated with this procedure.

Post-operative complications such as infection and blood clots are rare but can occur. Infection can be treated with drainage and antibiotics but will prolong your hospital stay. You can minimize the risk of blood clots by moving around as soon after the surgery as possible. Poor healing, which results in conspicuous scars, may necessitate a second operation. Smokers are advised to stop, as smoking may increase the risk of complications and delay healing.

You can reduce your risk of complications by closely following your surgeon's instructions before and after the surgery, especially with regard to when and how you should resume physical activity.

Planning Your Surgery
In your initial consultation, your surgeon will evaluate your health, determine the extent of fat deposits in your abdominal region, and carefully assess your skin tone. Be sure to tell your surgeon if you smoke, and if you're taking any medications, vitamins, or other drugs. Be frank in discussing your expectations with your surgeon. He or she should be equally frank with you, describing your alternatives and the risks and limitations of each.

If, for example, your fat deposits are limited to the area below the navel, you may require a less complex procedure called a partial abdominoplasty, also know as a mini-tummy tuck, which can often be performed on an outpatient basis. You may, on the other hand, benefit more from partial or complete abdominoplasty done in conjunction with liposuction to remove fat deposits from the hips, for a better body contour. Or maybe liposuction alone would create the best result.

In any case, your surgeon should work with you to recommend the procedure that is right for you and will come closest to producing the desired body contour. During the consultation, your surgeon should also explain the anesthesia he or she will use, the type of facility where the surgery will be performed, and the costs involved. In most cases, health insurance policies do not cover the cost of abdominoplasty, but you should check your policy to be sure.

Preparing For Your Surgery
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins, and medications.

If you smoke, plan to quit at least one to two weeks before your surgery and not to resume for at least two weeks after your surgery. Avoid overexposure to the sun before surgery, especially to your abdomen, and do not go on a stringent diet, as both can inhibit your ability to heal. If you develop a cold or infection of any kind, your surgery will probably be postponed.

Whether your surgery is done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery and to help you out for a day or two after you leave the hospital, if needed.

Where Your Surgery Will Be Performed
Many surgeons perform both partial and complete abdominoplasties in an outpatient surgical center or an office-based facility. Others prefer the hospital, where their patients can stay for several days.

Anesthesia
Your doctor may select general anesthesia, in which case you'll sleep through the operation. Other surgeons use local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed and your abdominal region will be insensitive to pain. (However, you may feel some tugging or occasional discomfort.)

The Surgery
Complete abdominoplasty usually takes two to five hours, depending on the extent of work required. Partial abdominoplasty may take an hour or two.

An incision just above the pubic area
is used to remove excess skin and fat
from the upper and lower abdomen.

Next, the surgeon separates the skin from the abdominal wall all the way up to your ribs and lifts a large skin flap to reveal the vertical muscles in your abdomen. These muscles are tightened by being pulled close together and stitched into their new position. This provides a firmer abdominal wall and narrows the waistline.

Skin is separated from the abdominal
wall all the way up to the ribs.

The skin flap is then stretched down and the extra skin is removed. A new hole is cut for your navel, which is then stitched in place. Finally, the incisions will be stitched, dressings will be applied, and a temporary tube may be inserted to drain excess fluid from the surgical site. In partial abdominoplasty, the skin is separated only between the incision line and the navel. This skin flap is stretched down, the excess is removed, and the flap is stitched back into place.

The surgeon draws underlying muscle and tissue
together and stitches them, thereby narrowing
the waistline and strengthening the abdominal wall.

After Your Surgery
For the first few days, your abdomen will probably be swollen and you're likely to feel some pain and discomfort that can be controlled by medication. Depending on the extent of the surgery, you may be released within a few hours, or you may have to remain hospitalized for two to three days.

After surgery, the patient has a flatter, trimmer abdomen.
Scars are permanent, but will fade in time.

Your doctor will give you instructions for showering and changing your dressings. And though you may not be able to stand straight at first, you should start walking as soon as possible. Surface stitches will be removed in five to seven days, and deeper sutures, with ends that protrude through the skin, will come out in two to three weeks. A support garment may replace the dressing on your incision.

Getting Back To Normal
It may take you weeks or months to feel like your old self again. If you start out in top physical condition with strong abdominal muscles, recovery from abdominoplasty will be much faster. Some people return to work after two weeks, while others take three or four weeks to rest and recuperate.

Exercise will help you heal better. Even people who have never exercised before should begin an exercise program to reduce swelling, lower the chance of blood clots, and tone muscles. Vigorous exercise, however, should be avoided until you can do it comfortably. Your scars may actually appear to worsen during the first three to six months as they heal, but this is normal. Expect it to take nine months to a year before your scars flatten out and lighten in color. While they'll never disappear completely, abdominal scars will not show under most clothing, even under bathing suits.

Your New Look
Abdominoplasty, whether partial or complete, produces excellent results for patients with weakened abdominal muscles or excess skin. And in most cases, the results are long lasting if you follow a balanced diet and exercise regularly.

If you're realistic in your expectations and prepared for the consequences of a permanent scar and a lengthy recovery period, abdominoplasty may be just the answer for you.

Information in this section was provided courtesy of the ASPS

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 Thigh Lift

The effects of time and gravity can cause the skin of the inner and outer thigh to lose tone. This loss of tone can cause the skin to sag or lose the smooth appearance of an earlier age. This condition can be exaggerated by weight loss. In general, the inner thighs are affected earlier than the outer thighs.

Along with sagging skin, the thighs can be an area of fat collection. Excessive fat can produce an unpleasant contour. For many individuals, women in particular, the fatty deposits do not respond to weight loss or exercise. Liposuction alone can improve the contour of the thighs when skin tone is good and excessive fat is the primary problem. The thigh lift procedure usually involves both liposuction and the removal of excessive skin from either the inner or outer thigh or both.

Information in this section was provided courtesy of the ASPS

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 Upper Arm Lift (Brachioplasty)

An arm lift, also known as brachioplasty, is a surgical procedure to remove loose skin and excess fat deposits in the upper arm. With age, upper arm skin can become loose and flabby.

Plastic surgeons will discuss brachioplasty with patients who want to tighten this skin and look as good as they feel. In some cases your plastic surgeon may suggest that liposuction be used alone or in conjunction with an arm lift to remove excess fat in the upper arms.

Information in this section was provided courtesy of the ASPS

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 Buttock Lift

A buttock lift is a procedure designed to tighten the skin of the buttock area. The procedure can be performed alone or in combination with other operations such as a thigh lift and abdominoplasty.

The ideal candidate for this operation is an individual with excess skin along the buttocks with associated cellulite. The procedure may incorporate liposuction to achieve balance between the torso, thighs and buttocks. The incision required for the procedure is placed very low on the back, just above the buttocks. The scar, which usually heals very well, is hidden by most contemporary underwear and bikini swimwear.

Information in this section was provided courtesy of the ASPS

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 Breast Lift

If you are considering a breast lift, this page will give you a basic understanding of the procedure: when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't understand.

Over the years, factors such as pregnancy, nursing, and the force of gravity take their toll on a woman's breasts. As the skin loses its elasticity, the breasts often lose their shape and firmness and begin to sag.

Over time, a woman's breasts begin to sag
and the areolas (nipples) become larger.

Breast lift, or mastopexy, is a surgical procedure to raise and reshape sagging breasts ? at least, for a time. No surgery can permanently delay the effects of gravity. Mastopexy can also reduce the size of the areola, the darker skin surrounding the nipple. If your breasts are small or have lost volume (for example, after pregnancy) breast implants inserted in conjunction with mastopexy can increase both their firmness and their size.

The Best Candidates for Breast Lift
A breast lift can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

The best candidates for mastopexy are healthy, emotionally stable women who are realistic about what the surgery can accomplish. The best results are usually achieved in women with small, sagging breasts. Breasts of any size can be lifted, but the results may not last as long in heavy breasts.

Incisions outline the area of the skin
to be removed and the new position of the nipple.

Many women seek mastopexy because pregnancy and nursing have left them with stretched skin and less volume in their breasts. However, if you are planning to have more children, it may be a good idea to postpone your breast lift. While there are no special risks that affect future pregnancies (for example, mastopexy usually doesn't interfere with breast-feeding), pregnancy is likely to stretch your breasts again and offset the results of the procedure.

Uncertainty and Risk
A breast lift is not a simple operation, but it is normally safe when performed by a qualified plastic surgeon. Nevertheless, as with any surgery, there is always a possibility of complications or a reaction to the anesthesia. Bleeding and infection following a breast lift are uncommon, but they can cause scars to widen. You can reduce your risks by closely following your physician's advice both before and after surgery.

Skin formerly located above the nipple is brought down
and together to reshape the breast. Sutures close
the incision, giving the breast its new contour.

Mastopexy does leave noticeable, permanent scars, although they will be covered by your bra or bathing suit. Poor healing and wider scars are more common in smokers. The procedure can also leave you with unevenly positioned nipples, or a permanent loss of feeling in your nipples or breasts.

Planning Your Surgery
In your initial consultation, it is important to discuss your expectations frankly with your surgeon, and to listen to his or her opinion. Every patient ? and every physician, as well ? has a different view of what is a desirable size and shape for breasts.

The surgeon will examine your breasts and measure them while you are sitting or standing. He or she will discuss the variables that may affect the procedure, such as your age, the size and shape of your breasts, and the condition of your skin, and whether an implant is advisable. You should also discuss where the nipple and areola will be positioned; they will be moved higher during the procedure, and should be approximately even with the crease beneath your breast. Your surgeon should describe the procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. He or she should also explain the anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved.

Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.

Preparing For Your Surgery
Depending on your age and family history, your surgeon may require you to have a mammogram (breast x-ray) before surgery. You will also get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.

While you are making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.

Where Your Surgery Will Be Performed
Your breast lift may be performed in a hospital, an outpatient surgery center, or a surgeon's office-based facility. It is usually done on an outpatient basis, for cost containment and convenience. If you are admitted to the hospital as an inpatient, you can expect to stay one or two days.

Anesthesia
Breast lifts are usually performed under general anesthesia, which means you will sleep through the operation. In selected patients ? particularly when a smaller incision is being made ? the surgeon may use local anesthesia, combined with a sedative to make you drowsy. You will be awake but relaxed, and will feel minimal discomfort.

The Surgery
Mastopexy usually takes one and a half to three and a half hours. Techniques vary, but the most common procedure involves an anchor-shaped incision following the natural contour of the breast.

After surgery, the breasts are higher and firmer,
with sutures usually located around the areola,
below it, and in the crease under the breast.

The incision outlines the area from which breast skin will be removed and defines the new location for the nipple. When the excess skin has been removed, the nipple and areola are moved to the higher position. The skin surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around the areola, in a vertical line extending downwards from the nipple area, and along the lower crease of the breast. Some patients, especially those with relatively small breasts and minimal sagging, may be candidates for modified procedures requiring less extensive incisions. One such procedure is the ?doughnut (or concentric) mastopexy,? in which circular incisions are made around the areola, and a doughnut-shaped area of skin is removed.

If you are having an implant inserted along with your breast lift, it will be placed in a pocket directly under the breast tissue, or deeper, under the muscle of the chest wall.

After Your Surgery
After surgery, you will wear an elastic bandage or a surgical bra over gauze dressings. Your breasts will be bruised, swollen, and uncomfortable for a day or two, but the pain shouldn't be severe. Any discomfort you do feel can be relieved with medications prescribed by your surgeon.

Within a few days, a soft support bra will replace the bandages or surgical bra. You'll need to wear this bra around the clock for three to four weeks, over a layer of gauze. The stitches will be removed after a week or two.

If your breast skin is very dry following surgery, you can apply a moisturizer several times a day. Be careful not to tug at your skin in the process, and keep the moisturizer away from the suture areas.

You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This numbness usually fades as the swelling subsides over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.

Getting Back To Normal

Healing is a gradual process. Although you may be up and about in a day or two, don't plan on returning to work for a week or more, depending on how you feel. And avoid lifting anything over your head for three to four weeks. If you have any unusual symptoms, don't hesitate to call your surgeon.

Your surgeon will give you detailed instructions for resuming your normal activities. You may be instructed to avoid sex for a week or more and to avoid strenuous sports for about a month. After that, you can resume these activities slowly. If you become pregnant, the operation should not affect your ability to breast-feed, since your milk ducts and nipples will be left intact.

Your New Look
Your surgeon will make every effort to make your scars as inconspicuous as possible. Still, it's important to remember that mastopexy scars are extensive and permanent. They often remain lumpy and red for months, and then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops.

If your expectations are realistic, chances are
you'll be satisfied with your breast lift.

You should also keep in mind that a breast lift won't keep you firm forever; the effects of gravity, pregnancy, aging, and weight fluctuations will eventually take their toll again. Women who have implants along with their breast lift may find the results last longer.

Your satisfaction with a breast lift is likely to be greater if you understand the procedure thoroughly and if your expectations are realistic.

Information in this section was provided courtesy of the ASPS

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 Breast Augmentation

By inserting an implant behind each breast, surgeons are able to increase a woman's bust by one or more bra cup sizes. If you're considering breast augmentation, this page will give you a basic understanding of the procedure ? when it can help, how it is performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please ask your surgeon if there is anything you don't understand about the procedure.

Breast augmentation surgery increases the size of the breasts through the insertion of inflatable implants, creating a more feminine, appealing contour and shape. Breast implants may be filled with saline or silicone ? patients are encouraged to discuss the pros and cons of each material with their doctor.

Breast augmentation, technically known as augmentation mammoplasty, is a surgical procedure to enhance the size and shape of a woman's breast for a number of reasons:

• To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small.
• To correct a reduction in breast volume after pregnancy.
• To balance a difference in breast size.
• As a reconstructive technique following breast surgery.

The Best Candidates For Breast Augmentation
Breast augmentation can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

Breast augmentation is usually done to balance a difference in
breast size, to improve body contour, or as a reconstructive
technique following surgery.

The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you are physically healthy and realistic in your expectations, you may be a good candidate.

Types of Implants

A breast implant is a silicone shell filled with either silicone gel or a salt-water solution known as saline. Because of concerns that there is insufficient information demonstrating the safety of silicone gel-filled breast implants, the Food & Drug Administration (FDA) has determined that new gel-filled implants, at the present time, should be available only to women participating in approved studies. Some women requiring replacement of the implants may also be eligible to participate in the study.

Saline-filled implants continue to be available to breast augmentation patients on an unrestricted basis, pending further FDA review. You should ask your doctor more about the specifics of the FDA decisions.

Uncertainty And Risks
Breast augmentation is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure. The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or ?scoring? of the scar tissue, or perhaps removal or replacement of the implant.

Incisions are made to keep scars as inconspicuous as possible:
in the breast crease, around the nipple, or in the armpit.
Breast tissue and skin is lifted to create a pocket for each implant.

As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood.

A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted. Some women report that their nipples become over-sensitive, under-sensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients.

There is no evidence that breast implants will affect fertility, pregnancy, or your ability to nurse. If, however, you have nursed a baby within the year before augmentation, you may produce milk for a few days after surgery. This may cause some discomfort, but can be treated with medication prescribed by your doctor.

Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the man-made shell to leak. If a saline-filled implant breaks, the implant will deflate in a few hours and the body will harmlessly absorb the salt water.

The breast implant may be inserted directly under the
breast tissue or beneath the chest wall muscle.

If a break occurs in a gel-filled implant, however, one of two things may occur. If the shell breaks but the scar capsule around the implant does not, you may not detect any change. If the scar also breaks or tears, especially following extreme pressure, silicone gel may move into surrounding tissue. The gel may collect in the breast and cause a new scar to form around it, or it may migrate to another area of the body. There may be a change in the shape or firmness of the breast. Both types of breaks may require a second operation and replacement of the leaking implant. In some cases, it may not be possible to remove all of the silicone gel in the breast tissue if a rupture should occur.

A few women with breast implants have reported symptoms similar to diseases of the immune system, such as scleroderma and other arthritis-like conditions. These symptoms may include joint pain or swelling, fever, fatigue, or breast pain. Research has found no clear link between silicone breast implants and the symptoms of what doctors refer to as ?connective-tissue disorders,? but the FDA has requested further study.

While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast with an implant. Additional views will be required. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant.

While the majority of women do not experience these complications, you should discuss each of them with your physician to make sure you understand the risks and consequences of breast augmentation.

Planning Your Surgery
In your initial consultation, your surgeon will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. If your breasts are sagging, your doctor may also recommend a breast lift.

Be sure to discuss your expectations frankly with your surgeon. He or she should be equally frank with you, describing your alternatives and the risks and limitations of each. You may want to ask your surgeon for a copy of the manufacturer's insert that comes with the implant he or she will use so you are fully informed about it. And, be sure to tell your surgeon if you smoke and if you're taking any medications, vitamins, or other drugs.

Your surgeon should also explain the type of anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved. Because most insurance companies do not consider breast augmentation to be medically necessary, carriers generally do not cover the cost of this procedure.

Preparing For Surgery
Your surgeon will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.

Where Will Your Surgery Be Performed
Your surgeon may prefer to perform the operation in an office facility, a freestanding surgery center, or a hospital outpatient facility. Occasionally, the surgery may be done as an inpatient in a hospital, in which case you can plan on staying for a day or two.

Anesthesia
Breast augmentation can be performed with a general anesthesia, so you will sleep through the entire operation. Some surgeons may use a local anesthesia, combined with a sedative to make you drowsy, so you'll be relaxed but awake and may feel some discomfort.

The Surgery
The method of inserting and positioning your implant will depend on your anatomy and your surgeon's recommendation. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple), or in the armpit. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible.

Working through the incision, the surgeon will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). The implants are then centered beneath your nipples.

Some surgeons believe that putting the implants behind your chest muscle may reduce the potential for capsular contracture. Drainage tubes may be used for several days following the surgery. This placement may also interfere less with breast examination by mammogram than if the implant is placed directly behind the breast tissue. Placement behind the muscle, however, may be more painful for a few days after surgery than placement directly under the breast tissue.

You will want to discuss the pros and cons of these alternatives with your doctor before surgery to make sure you fully understand the implications of the procedure he or she recommends for you.

The surgery usually takes one to two hours to complete. Stitches are used to close the incisions, which may also be taped for greater support. A gauze bandage may be applied over your breasts to help with healing.

After Your Surgery
You're likely to feel tired and sore for a few days following your surgery, but you'll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by medication prescribed by your doctor.

After surgery, breasts appear fuller and more natural
in tone and contour. Scars will fade with time.

Within several days, the gauze dressings, if you have them, will be removed, and you may be given a surgical bra. You should wear it as directed by your surgeon. You may also experience a burning sensation in your nipples for about two weeks, but this will subside as bruising fades. Your stitches will come out in a week to 10 days, but the swelling in your breasts may take three to five weeks to disappear.

Getting Back To Normal
You should be able to return to work within a few days, depending on the level of activity required for your job.

Follow your surgeon's advice on when to begin exercises and normal activities. Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery.

Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely.

Routine mammograms should be continued after breast augmentation for women who are in the appropriate age group, although the mammography technician should use a special technique to assure that you get a reliable reading, as discussed earlier.

Your New Look
For many women, the result of breast augmentation can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance.

Regular examination by your plastic surgeon and routine mammograms for those in the appropriate age groups at prescribed intervals will help assure that any complications, if they occur, can be detected early and treated.

Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. If you have met your goals, then your surgery is a success.

Information in this section was provided courtesy of the ASPS

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 Breast Reduction

If you are considering breast reduction, this page will give you a basic understanding of the procedure ? when it can help, how it is performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't understand.

Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight ? from back and neck pain and skin irritation to skeletal deformities and breathing problems. Bra straps may leave indentations in their shoulders. Unusually large breasts can also make a woman or teenage girl feel extremely self-conscious.

Breast reduction, technically known as reduction mammaplasty, is designed for such women. The procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of her body.

Candidates For Breast Reduction
Breast reduction is usually performed for physical relief rather than cosmetic improvement alone. Most women who have the surgery are troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort.

In most cases, breast reduction isn't performed until a woman's breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort. The best candidates are those who are mature enough to fully understand the procedure and have realistic expectations about the results. Breast reduction is not recommended for women who intend to breast-feed.

Uncertainty And Risk
Breast reduction is not a simple operation, but it's normally safe when performed by a qualified plastic surgeon. Nevertheless, as with any surgery, there is always a possibility of complications, including bleeding, infection, or reaction to the anesthesia. Some patients develop small sores around their nipples after surgery; these can be treated with antibiotic creams. You can reduce your risks by closely following your physician's advice both before and after surgery.

The procedure does leave noticeable, permanent scars, although they will be covered by your bra or bathing suit. Poor healing and wider scars are more common in smokers. The procedure can also leave you with slightly mismatched breasts or unevenly positioned nipples. Future breast-feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples.

Some patients may experience a permanent loss of feeling in their nipples or breasts. Rarely, the nipple and areola may lose their blood supply and the tissue will die. The nipple and areola can usually be rebuilt, however, using skin grafts from elsewhere on the body.

Planning Your Surgery In your initial consultation, it's important to discuss your expectations frankly with your surgeon, and to listen to his or her opinion. Every patient, and every physician, has a different view of what is a desirable size and shape for breasts.

The surgeon will examine and measure your breasts and will probably photograph them for reference during surgery and afterwards. The photographs may also be used in the processing of your insurance coverage. He or she will discuss the variables that may affect the procedure ? such as your age, the size and shape of your breasts, and the condition of your skin. You should also discuss where the nipple and areola will be positioned; they will be moved higher during the procedure, and should be approximately even with the crease beneath your breasts.

Your surgeon should describe the procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. The surgeon should also explain the anesthesia he or she will use, the facility where the surgery will be performed, and the costs. Some insurance companies will pay for breast reduction if it's medically necessary; however, they may require that a certain amount of breast tissue be removed. Check your policy, and have your surgeon write a ?predetermination letter? if required.

Preparing For Your Surgery
Your surgeon may require you to have a mammogram (breast x-ray) before surgery. You'll also get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Some surgeons suggest that their patients diet before the operation.

Breast reduction doesn't usually require a blood transfusion. However, if a large amount of breast tissue will be removed, your physician may advise you to have a unit of blood drawn ahead of time. That way, if a transfusion should be needed, your own blood can be used.

While you're making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.

Where Your Surgery Will Be Performed
Breast reduction surgery may be performed in a hospital, an outpatient surgery center or an office-based surgical suite. If you are admitted to the hospital, your stay will be a short one. The surgery itself usually takes two to four hours, but may take longer in some cases.

Type of Anesthesia
Breast reduction is nearly always performed under general anesthesia. You'll be asleep through the entire operation.

The Surgery
Techniques for breast reduction vary, but the most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. The surgeon removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. He or she then brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast. Liposuction may be used to remove excess fat from the armpit area.

In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position, resulting in a loss of sensation in the nipple and areolar tissue.

Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. In some cases, techniques can be used that eliminate the vertical part of the scar. And occasionally, when only fat needs to be removed, liposuction alone can be used After surgery, you will be wrapped in an elastic bandage or a surgical bra over gauze dressings. A small tube may be placed in each breast to drain off blood and fluids for the first day or two. You may feel some pain for the first couple of days, especially when you move around or cough, and some discomfort for a week or more. Your surgeon will prescribe medication to lessen the pain.

The bandages will be removed a day or two after surgery, though you'll continue wearing the surgical bra around the clock for several weeks, until the swelling and bruising subside. Your stitches will be removed in one to three weeks.

If your breast skin is very dry following surgery, you can apply a moisturizer several times a day, but be sure to keep the suture area dry.

Your first menstruation following surgery may cause your breasts to swell and hurt. You may also experience random, shooting pains for a few months. You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This usually fades over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.

Getting Back to Normal
Although you may be up and about in a day or two, your breasts may still ache occasionally for a couple of weeks. You should avoid lifting or pushing anything heavy for three or four weeks. Your surgeon will give you detailed instructions for resuming your normal activities. Most women can return to work (if it's not too strenuous) and social activities in about two weeks. But you'll have much less stamina for several weeks, and should limit your exercises to stretching, bending, and swimming until your energy level returns. You will also need a good athletic bra for support.

You may be instructed to avoid sex for a week or more, since sexual arousal can cause your incisions to swell, and to avoid anything but gentle contact with your breasts for about six weeks.

A small amount of fluid draining from your surgical wound, or some crusting, is normal. If you have any unusual symptoms, such as bleeding or severe pain, don't hesitate to call your doctor.

Your New Look
Although much of the swelling and bruising will disappear in the first few weeks, it may be six months to a year before your breasts settle into their new shape. Even then, their shape may fluctuate in response to your hormonal shifts, weight changes, and pregnancy.

Your surgeon will make every effort to make your scars as inconspicuous as possible. Still, it's important to remember that breast reduction scars are extensive and permanent. They often remain lumpy and red for months, and then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops.

Of all plastic surgery procedures, breast reduction results in the quickest body-image changes. You'll be rid of the physical discomfort of large breasts, your body will look better proportioned, and clothes will fit you better.

However, as much as you may have desired these changes, you'll need time to adjust to your new image ? as will your family and friends. Be patient with yourself, and with them. Keep in mind why you had this surgery, and chances are, like most women, you will be pleased with the results.

Information in this section was provided courtesy of the ASPS

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