A large number of patients in my practice some to see me because of the changes to their bodies after having children. This usually entails some type of breast and abdominal work, or affectionately known as "Mommy Makeover"
In general, the first question is always where we stand weight-wise. Liposuction may be appropriate for localized areas of fat, but if there is a need to lose a significant amount of weight, we start with our weight loss program. Once we are satisfied that the weight is in line, we look at the quality of the breast tissue. The decision to treat with either a breast augmentation alone or with a lift as well (or by itself).
And finally, the tummy. If there is just stretched skin in the lower abdomen, then a mini-abdominoplasty may be all that's needed. For more extensive skin excess, and laxity of the abdominal musculature, then a full abdominoplasty may be indicated.
So, the Mommy Makeover is a great way to get back (or maybe improve) to the pre-baby body.
Tuesday, April 6, 2010
Tuesday, March 23, 2010
My Tummy Tuck Philosophy
Abdominoplasty (Tummy Tuck) is one of the most common operations I perform. Whether you have fat and skin, have just lost a lot of weight, or only have stretched skin from pregnancies, this operation may be just the thing. Traditionally, tummy tucks were done in the hospital, with release after a day or two. Nowadays, this is an outpatient procedure, and you go home shortly after surgery. My colleague, Dr. Jabs has recently published a tummy tuck blog, and so I thought I might give you my personal philosophy of tummy tuck as well.
When I was first learning this operation, in the mid 1980s, we did not use liposuction with it, people stayed on bed rest for at least a day postop and everyone got at least two drains. I even knew of Plastic Surgeons who would keep their patients in restrictive dressings for weeks (and one who even used plaster!) Fortunately we've come a long way!
Around ten years ago, I attended a conference where surgeons from Brazil presented a long experience with using liposuction and a different plane of dissection for raising up the skin, which was very exciting to me. By limiting the amount of "undermining" done (and in the old days we did a LOT of undermining), liposuction could be employed to improve the overall contour. I also began to use tissue glues to reduce flap movement and found that there was very little drainage, so that eventually, I felt confident in being able to perform this operation without the use of drains. This has resulted in very little postop pain, and because the lymphatic system is minimally disturbed, rarely are there any fluid collections. I also perform this surgery under local (tumescent) anesthesia with TIVA (total intravenous anesthesia). Because of this, there are no paralyzing medications used, and therefore the risk of deep vein thrombosis and pulmonary embolism is greatly reduced. People are encouraged to be up and walking immediately, and this speeds up recovery and decreases complications as well.
So,the modern tummy tuck is a very satisfying operation, with much less down time and fewer complications than in the past.
When I was first learning this operation, in the mid 1980s, we did not use liposuction with it, people stayed on bed rest for at least a day postop and everyone got at least two drains. I even knew of Plastic Surgeons who would keep their patients in restrictive dressings for weeks (and one who even used plaster!) Fortunately we've come a long way!
Around ten years ago, I attended a conference where surgeons from Brazil presented a long experience with using liposuction and a different plane of dissection for raising up the skin, which was very exciting to me. By limiting the amount of "undermining" done (and in the old days we did a LOT of undermining), liposuction could be employed to improve the overall contour. I also began to use tissue glues to reduce flap movement and found that there was very little drainage, so that eventually, I felt confident in being able to perform this operation without the use of drains. This has resulted in very little postop pain, and because the lymphatic system is minimally disturbed, rarely are there any fluid collections. I also perform this surgery under local (tumescent) anesthesia with TIVA (total intravenous anesthesia). Because of this, there are no paralyzing medications used, and therefore the risk of deep vein thrombosis and pulmonary embolism is greatly reduced. People are encouraged to be up and walking immediately, and this speeds up recovery and decreases complications as well.
So,the modern tummy tuck is a very satisfying operation, with much less down time and fewer complications than in the past.
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