I’m not sure how this happened. After 5 years and 400 posts, I have only mentioned Kim Kardashian once. Her often uncomfortable pregnancy has been in the news this year, but the latest rumors have her interviewing Plastic Surgeons for a Mommy Makeover after her son is born.
What is a Mommy Makeover?
The most common Mommy Makeover combination is Breast Augmentation and a Tummy Tuck. Breast Implants are used to restore lost breast volume, while the Tummy Tuck flattens and tightens the abdominal wall.
A Mommy Makeover is a combination of cosmetic plastic surgery procedures that help to restore the breasts and body after pregnancy. A Mommy Makeover frequently consists of Breast Augmentation and a Tummy Tuck, but can include other combos.
Mommy Makeover Breast Procedures
In the above Mommy Makeover, a Tummy Tuck is combined with a Breast Lift. When the size of the breast is satisfactory, and the main problem is sagging, a breast lift can restore the breasts’ shape without making them bigger.
With pregnancy, the breasts enlarge in preparation for breast feeding and shrink when lactation ends. This often leaves the breasts smaller and deflated, so Breast Augmentation and Breast Lifts are very commonly used in Mommy Makeovers. Sometimes, however, the breast enlarge and stay large. In this situation, a Breast Reduction may be a better choice. Click for more about the variety of available Breast Enhancing Procedures.
Mommy Makeover Body Procedures
Mommy Makeovers repair both the breasts and belly. Above, a Tummy Tuck is used to flatten and tighten the post baby belly.
Pregnancy also causes weight gain. Even when a healthy weight is maintained, the belly has to stretch to accommodate the baby’s development. After delivery, the abdominal skin and muscles may not shrink back to their pre-pregnancy weight. This is why the Tummy Tuck is the most common body shaping half of the Mommy Makeover. Mini Tummy Tucks and Liposuction can also be used when the body has partially bounced back. Click for more about the variety of available Body Enhancing Procedures.
What Would Kim Kardashian Do?
According to Life & Style Magazine, Kim K is already planning plastic surgery for her post baby body. Radar Online reports, “She wants to get her boobs done, a tummy tuck and liposuction. She’s not planning on getting the work done the same day she gives birth because her pregnancy has been dicey as it is.”
When Is The Best Time For A Mommy Makeover?
Doing Plastic Surgery the day you deliver is not a great idea. Your body is undergoing massive physiological changes as it transitions from pregnancy to postpartum. Plus, this gives your body zero time to recoil, and your baby zero time to breast feed. Moreover, a lactating breast should not have elective surgery. There is a greater risk of complications including: wound problems, infections and milk leaking through the incision after surgery. So when is the optimal time for a Mommy Makeover?
The most important question to answer is, “Are you done having children?” Mommy Makeovers are a big investment in time, recovery and cost, so it is best to wait until you are not planning more children. A Mommy Makeover will not prevent you from having more children, but it will likely be undone by another nine months of stretching.
If you are not planning more pregnancies, most plastic surgeons recommend waiting at least six months before a Mommy Makeover. This allows the breasts and body to recoil, time for your body to transition from taking care of you baby to taking care of itself and for your nutrition to return to normal. Some Plastic Surgeons recommend waiting a year to be certain you are in optimal health.
What Does Kanye Think?
I have not mentioned Kanye previously in my blog, but his mother was mentioned in one of the early San Francisco Plastic Surgery Blog posts. Kanye’s mother, Donda West, an English professor, died at 58-years-old, shortly after an elective cosmetic procedure. In an interview earlier this year, Kanye expressed his grief and guilt over the loss of his mom.
On a positive note, the tragic loss inspired then Governor Schwarzenegger to sign the Donda West Law. The law does not require anything that good doctors don’t already do, and it cannot stop bad doctors from having bad judgment. It does however, codify the need for a proper medical history and physical examination before any surgery is performed.
It remains to be seen how Kanye feels about Kim’s Plastic Surgery Plans, but having good support is important for any elective procedure. It helps to have a team that works well together. Patient, Plastic Surgeon, Family and Friends all have a roll to play, and it’s good to have as many advantages as you can arrange.
Mommy Makeover Consultations
Mommy Makeovers should be performed by a Board Certified Plastic Surgeon, preferably a member of the American Society for Aesthetic Plastic Surgery – a group of Board Certified Plastic Surgeons who have dedicated themselves and their practice to the cosmetic aspects of plastic surgery.
If you are near the San Francisco Bay Area and are considering a Mommy Makeover, or other Cosmetic Plastic Surgery Procedures, give me a call at (925) 943-6353 to arrange a private consultation appointment. The best options will be reviewed and safest and most predictable plan created specifically for your needs.
Like most mental illnesses, Body Dysmorphic Disorder (BDD) is an extreme exaggeration of a normal behavior, in this case, the desires to look good and be accepted. The problem of BDD usually starts at adolescence, and effects both men and women equally.
What is Body Dysmorphia?
The Body Dysmorphic Disorder has been described by psychiatrists for more than one hundred years, and is found in all cultures around the world. It was first codified by the American Psychiatric Association in the 1980’s in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) as dysmorphophobia. BDD is a characteristic of “individuals who are preoccupied with some imagined defect in physical appearance that is out of proportion to any actual physical abnormality that may exist.”
The DSM-5 classifies BDD as a form of Obsessive-Compulsive Disorder (OCD) and requires specific criteria including:
Differentiation From Eating Disorders
Most of us worry about how we look. Preoccupation is defined as thinking about the perceived imperfections at least an hour a day. The unique feature of BDD is the perceived imperfections are small. The physical flaw can range from slight to nonexistent, and the imperfections may not be noticeable to anyone other the the person with BDD. Thinking about obvious flaws is not a form of BDD, but may be classified as form of OCD if it interferes with social interaction.
Repetitive, compulsive behaviors in response to the appearance concerns is another requirement for BDD. Again, these are exaggerations of normal behavior. Behaviors may include excessive grooming, mirror checking, skin picking, reassurance seeking or clothes changing. Mental manifestation may include constantly comparing one’s appearance with that of other people, feeling that others are treating one a certain way because of the perceived flaw or alternatively, that if the flaw were fixed, life would be perfect.
Normal appearance concerns are not treated with medication or therapy. For BDD to be diagnosed, the preoccupation must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. It’s the psychological equivalent of the sporting term, “No harm, no foul.”
Differentiation From Eating Disorders
When the appearance concerns center around being too fat or weighing too much, the problem may be an eating disorder, rather than a body dysmorphic disorder. Concerns with fat or weight in a person of normal weight can be a symptom of BDD, and it is not uncommon for patients to have both an eating disorder and BDD.
Important Features of Body Dymorphic Disorder
There are two specifiers for BDD that are prognostic: Muscle Dysmorphia and the Degree of Insight.
Muscle Dysphoria is a preoccupation that one’s body build is too small or insufficiently muscular. Usually seen in men, this type of behavior is associated with more self-destructive actions and a poorer quality of life. Higher rates of suicidality and substance abuse are found in Muscle Dysphoria than other forms of BDD.
The Degree of Insight is important for both recognition and treatment of BDD. The levels of insight are defined as;
Good or Fair Insight
Absent Insight or Delusional Beliefs
All sufferers of BDD feel their problem is real. Those with good insight, may be able to recognize that their flaw does not bother everyone or that their preoccupation is wasting a good part of their day or causing social problems. Absent Insight or Delusional Beliefs are much harder to treat. Words like slight or imagined used to describe their defects may just leave them feeling misunderstood, invalidated, alienated or insulted. More information is available on the Interaction OCD Foundations web site, and this article by Katharine Phillips, MD, about the Diagnosis and Clinical Assessment in BDD.
How Common Is Body Dysmorphic Disorder?
It is estimated that 1 to 2% of the population has BDD. Fearing the stigma of vanity, most BDD sufferers hide the preoccupation, so diagnosis is not simple. BDD is likely under diagnosed, and often unsuspected, even by Psychiatrists and Plastic Surgeons. Screening questionnaires have be proposed, but these depend on how forthcoming the person with BDD is and, to a large extent, on the patients’ insight. The Body Dysmorphic Disorder Foundation has an example on their web site here: Do I Have BDD Questionnaire.
BDD and Depression
A history of depression may be a tip-off; however, there are a lot more people with depression than with BDD. Interestingly, the same types of medications indicated for depression, can also help with some cases of BDD. Of course, only a trained professional can make the diagnosis and formulate an appropriate treatment plan. Body Dysmorphic Disorder is difficult to recognize and can be difficult to treat, but the first step is awareness of the disorder.
One of the most frequent questions I get during a Breast Augmentation consultation is, “Do I need a breast lift?” The decision is based on anatomy and how we define the ideal breast. The answer is the ternary: yes, no and maybe, and can often be determined by the Pinch Test.
The Pencil Test
Every woman seems to know about the Pencil Test, but the Pinch Test is better for determining if a Breast Lift is needed.
It seems every woman is familiar with the Pencil Test. A pencil is placed along the fold under the breast (the inframammary fold or IMF). The breast is released, and then the pencil is released. If the pencil falls, you pass the pencil test, and there is no breast sagging. If the pencil is held in place, then you fail, and there is sagging. But does this really mean you need a Breast Lift?
Passing the Pencil Test
The woman above passes the Pencil Test. She has no sagging, so Breast Augmentation with Breast Implants is all that is needed to enlarge her breasts.
The Pencil Test is a simple test, but it is too simple to determine whether a Breast Lift is necessary. If you pass the Pencil Test, it is unlikely that you need a breast lift. Like every good rule, there are exceptions. For situations like Tubular Breasts, the Pencil Test is passed; however, the nipple is puffy and too low, so a lift is used to reshape the areolae and reposition the nipple higher on the breast into a more aesthetic position.
Failing the Pencil Test
The woman above fails the Pencil Test. Since her nipples are lower then the fold under her breasts, she also fails the Pinch Test (as described below) and needs a Breast Lift to provide the best aesthetic result.
On the other hand, failing the pencil test does not necessarily mean you need a breast lift. It does place you into the group more likely to need a lift, but the position of the nipple on the breast is equally important in this situation. When the nipple is low, a breast lift is needed. If the nipple is high, Breast Augmentation alone may be corrective. This brings us to the Pinch Test.
The Pinch Test
If you fail the Pencil Test, the Pinch Test helps to sort out if you would benefit from a Breast Lift or not. It is a simple test that determines the height of the nipple with respect to the level of the inframammary fold (IMF). When the nipple is below the IMF, a breast lift is usually recommended. When the nipple is above the IMF, a breast lift is usually not necessary. If the nipple is at the level of the IMF, then you are on the border line, and more discussion with your chosen Board Certified Plastic Surgeon is needed.
How to Perform the Pinch Test
When testing your breasts, it is easiest to used you opposite hand. If you are checking your left breast, place the tips of your right middle and ring fingers in the center of the fold under the breast, in line with your nipple. You should slide your finger tips up to the junction between the bottom of the breast and the abdominal skin without pushing the breast up. Your thumb should remain in front of the breast. Keeping your thumb over the front of the breast, bring the thumb tip toward the tips of the middle finger and lightly pinch the breast.
Passing the Pinch Test
The woman above fails the Pencil Test, but passes the Pinch Test. Breast Implants alone can correct this type of “Fake” sagging or pseudoptosis.
If your thumb tip pinches the breast below the nipple, a Breast Lift is usually not needed. A Breast Implant will provide fullness and support the nipple. So Breast Augmentation alone with take care of this type of sagging, as the Breast Augmentation Before and After Pictures above illustrate.. The Plastic Surgery term for sagging is ptosis. This type of sagging, which does not require a Breast Lift, is called pseudoptosis, or fake-sagging.
Failing the Pinch Test
The woman above fails both the Pencil Test and the Pinch Test, but a good result is still achieved with a combination of Breast Augmentation and Breast Lift. The Breast Augmentation increases volume, while the breast lift corrects the shape.
If your thumb tip touches the breast above the nipple, a breast lift is usually needed. The ideal nipple position is located at the front of the breast. The problem with the nipple located below the IMF is that the Breast Implant will push the nipple further down on the breast. This is not ideal, and the Breast Lift is the remedy.
On The Fence With The Pinch Test
If your thumb tip touches at the level the nipple, you are on the fence. If you are comfortable with the nipple being lower on the breast, a lift may not be for you. If you feel your nipple has always been low, and you’d like it higher, then a Breast Lift is the solution. For borderline cases, a smaller lift, like a Peri-Areolar Breast Lift, is usually sufficient. Only an in-person consultation can tell for sure.
Breast Augmentation Lift Consultations
If you are considering Breast Augmentation, and are wondering if you need a lift, the Pinch Test can help, but only an in-person consultation can provide you the full picture. The best plan for you will be determined, only by a focused medical history and exam, and a discussion of what you expect the procedure to do. If you would like to learn more, call (925) 943-6353 to schedule a private breast augmentation / lift consultation appointment today.
The Eyelid Lift or Blepharoplasty, is one of the most common cosmetic plastic surgery procedures, and there is no better time for Facial Plastic Surgery, like an Eyelid Lift than in the winter months. Winter months mean less sun, and less sun exposure during healing.
Eyelid lifts remove excess skin and fat from the eyelids, revealing a smoother, rested and more alert appearance.
Is Eyelid Surgery Painful?
Blepharoplasty literally means “eyelid changing.” It’s an outpatient procedure, that can be performed safely under local anesthesia or general anesthesia, if you’d rather not be awake. The recovery time is more dependent on how much explaining you want to do, rather than any physical discomfort. It should not be a painful operation. In fact, if you are having a lot of pain after eyelid surgery, you should call your plastic surgeon right away.
Eyelid Surgery Recovery
Most commonly, your eyes feel slightly achy, tired or dry for a few days after surgery. Artificial tears are usually enough to soothe the eyes, and sometimes a moisturizing ointment may help at night. Pain medication is not usually needed, and acetaminophen (Tylenol) is usually enough. The procedure needs to be individualized, so don’t do anything because you read it on the Internet. All medical treatment should be supervised by an experienced, Board Certified professional.
Who Performs Eyelid Surgery?
Before blepharoplasty, the excess upper eyelid skin is resting on the eyelashes, making eye makeup impossible to maintain.
Plastic Surgeons, Ophthalmologists and Otolaryngologists are all trained in eyelid surgery. How much training will depend on their training program and the motivation of the surgeon. I was fortunate to be in a training program strong in cosmetic plastic surgery. My first rotation was in the Bothin Burn Unit. It is a regional referral center, so we received patients with large percentages of their bodies burned from all over Northern California. The workload fluctuated, so when the burn care was finished, I was free to see what other procedures were being performed in the hospital.
Many of San Francisco’s finest Plastic Surgeons were members of our teaching faculty, so there was always something to see, and something to learn. During my time in the burn unit, I helped perform several miles of skin grafts, and countless dressing changes. I learned as much from the burn nurses as my professors.
Even on the burn rotation, I wanted to learn about the cosmetic side of plastic surgery. With some hounding, I was able to participate in cosmetic procedures between burn cases. Even though I was not on the cosmetic rotation, I was able to see more cosmetic plastic surgery procedures, including breast augmentation, tummy tucks, facelifts and blepharoplasties, than many plastic surgery residents see during their entire training. For the self-motivated, there were abundant opportunities to learn. You just had to ask, but the option was available. This is why the type of training a doctor has makes a difference. In other types of training programs, especially non-surgical training programs, the opportunities, and more importantly, the amount or responsibility shared is not the same. I am very thankful for those who volunteered their time to teach us.
What Does Eyelid Surgery Do?
After blepharoplasty, the upper eyelid crease is singular and more defined, while the lower eyelid bags have been removed.
Eyelid surgery removes excess skin to tighten and removes excess fat to smooth the eyelids. Upper eyelids tend to accumulate skin as we age. The excess skin can block vision, grab eye make-up and feel heavy. Lower eyelids can have excess skin too, but extra fat can fill the lower eyelid causing bags. All this contributes to make us look sleepy, inattentive and tired. Eyelid surgery can relive these symptoms and contribute to a rested and alert appearance.
If you are considering Eyelid Rejuvenation, a personal consultation is the next step. Give me a call at (925) 943-6353; we can review your concerns and find the best solution tailored to your eyelids. More information is available here on the San Francisco Plastic Surgery Blog, and my other websites in English and in Spanish, and questions are welcomed via the contact form in the margin.
For your safety, Dr. Mele maintains his Board Certifications with two ABMS recognized boards: The American Board of Plastic Surgery and the American Board of Surgery.
Maintenance of Board Certification or MOC
As another year nears its end, it is time for the yearly Maintenance of Board Certification (MOC) chores. I have two American Board of Medical Specialties (ABMS) recognized board certifications. One is from the American Board of Plastic Surgery and the second is from the American Board of Surgery. Both represent years of training and hard work and the relatively new requirement for the completion of yearly chores.
Achieving Board Certification
Achieving Board Certification is an important milestone in a doctor’s training. It certifies that they graduated from a recognized residency training program and that they have passed a series of written and oral examinations. If you are a plastic surgeon and have gone through the process, the expression, “Plastic surgeons eat their young,” may come to mind. The process is both rigorous and anxiety promoting.
The Qualifying Examination is a written exam that must be passed to qualify for the oral exams. Back in the olden days, we all had to fly to a designated city for the examination, so it was an even more expensive and time consuming commitment. For my plastic surgery board examination, the testing was done in Houston, TX, in the summer. There is some bonding that occurs when a group survives a stressful situation together. Now, with the advent of computer testing centers, rather than one central location for the examination, many cities offer the examination each year. When sitting for the exam, you may be the only one taking the American Board of Plastic Surgery‘s written exam, making it even more impersonal.
The Oral Exams
In order to qualify for the oral exam, not only do you have to pass the written exam, you have to submit six months of your own cases. Every single one of them, with notarized confirmation from the medical staff office of every hospital and surgery center where you hold privileges that every case has been submitted. From these, specific cases are selected for you to bring to the exam. Each case must have all the charting, billing and before and after pictures for the examiners to review. You submit your books upon arrival, and wait to see if they qualify you for the exam. If they are insufficient, you will have to try again next year. If your books pass scrutiny, then the oral examinations proceed.
The oral exams are very personal. There are three groups of oral examiners to negotiate. Two groups test you with standard patient cases. You are given a brief history, physical examination and pictures, and off you go. The questions start with, “What are you going to do doctor?” and progress through your rationale. If you are doing well, one of the other examiners will often interrupt your best plans with, “Well, that didn’t work. Now what are you going to do?” All the while, remaining poker faced, but you know inside they are smirking, at least a little bit. The third oral examination session is similar to the other two, except they are your cases. Everything is fair game, not just your patient care, but your charting, picture taking, billing and outcomes.
Maintenance of Board Certification
Shortly before I graduated, once you passed your oral examination you were done. You were done. You were Board Certified forever. No more fees, no more travel, no more exams. But that is no longer true. Now, there is a price to pay and chores to perform every year, including a written examination every ten years.
The examinations are given at computer based testing centers throughout the nation. All sorts of examinations are given at these centers and most have nothing to do with medicine. The staff at these institutions have strict rules to enforce – rules designed to stop cheating and protect the proprietary information that is contained on the examination. I recently visited one such institution to take my ten-year recertification examination for the American Board of Surgery.
The testing center is located about an hour from my office, so much more convenient than flying to Houston. After showing my ID, my examination slip and signing into the building, I was escorted to the testing center like I was in custody. I dutifully called the plastic surgeon covering for me to let them know I would not me in possession of my phone for the duration of the exam. Before I let them know that I would call as soon as I was finished, I was getting the evil eye. It seems using a cell phone, even in the reception area outside of the examination, is not allowed. Did I mention the exam is anxiety promoting?
Why Maintain Board Certification?
This question is becoming more and more controversial as the fees, exams and other hurdles are raised higher and higher each year. Those in favor claim that board certification is good, and recertification makes sure that your doctor is still good. Those opposed site the ever escalating cost and time required and the lack of evidence that it makes us better doctors. Personally, I don’t mind. It is a hassle, and it does not change the way I practice. On the other hand, it shows my patients that I am committed to being the best, and I don’t mind being tested on it. Plus, when I pass, I have the lovely certificate shown above to show everyone.
My Board Certifications
I completed a General Surgery residency in 1994. I passed my General Surgery Boards in 1995 and have recertified twice. I am good until 12/31/2025, as long as I complete my yearly chores and pay my yearly fees.
I completed a Plastic Surgery residency in 1997. When I finished my training, it took two years to take the certification exams. I passed my Plastic Surgery Boards in 1999, and have recertified once, so I am good until 12/31/2019. Looking forward to the next exam.
American Board of Medical Specialties
There are many boards out there, but the “real” boards are those under the umbrella of the American Board of Medical Specialties (ABMS). This is the longest standing body for Medical Certification in the US. The American Board of Plastic Surgery was born from members of the American Board of Surgery and the American Board of Otolaryngology who did what is now recognized as Plastic Surgery, and remains the only ABMS Board certifying Plastic Surgeons.
Board Certified Plastic Surgeon
So now you know more about how I spend my time away from patient care. Plastic Surgery is not all glamour; there is always more paperwork to do. If you are considering Plastic Surgery, be certain to check your doctor’s training. Good training, and maintenance of that training, are essential for providing the safest and most predictable results.
If you are in the San Francisco Bay Area and would like to schedule an appointment with me, call (925) 943-6353. And if you want to check out my qualifications, here are some links to help you:
Chin Augmentation can make a dramatic impact on facial balance, especially the profile view. A small chin is associated with a meek appearance and can throw off other facial proportions. A small chin can make the nose appear too large for the face, even when nasal size is appropriate.
Chin Implant Video
The most common way to enlarge the chin is with a Chin Implant. This type of Chin Augmentation provides predictable enhancement of the chin, without changing the jaw itself. The following Chin Augmentation Video is from KRON 4’s Body Beautiful. In this segment, I review Chin Implants and provide several examples including Chin Augmentation Before and After Pictures.
Chin Augmentation Video Segment – As Seen On KRON 4 TV
How to Make Your Chin Larger
There are several ways to enlarge the chin and enhance the facial profile. The simplest is with a Chin Implant. A small incision is made under the chin or in the mouth. A precise pocket is created to hold the Chin Implant. Sizers can be used to confirm the appropriate amount of Chin Augmentation, though the size is usually determined during your consultation. The Chin Implant is then opened, washed with antibiotics and carefully placed into the pocket. The incision is closed with absorbable sutures, and you are able to go home the same day.
Types of Chin Implants
Chin Implants come in different sizes, so the amount of chin augmentation can be varied. Chin implants come in different shapes. Some are wider, so that the width of the chin can be increased. Some are taller, so the height of the chin can be adjusted. Some are thicker, so the projection of the chin can be modified. Chin implant shapes can vary from round to square, and some even have dimples. Chin implants can also be made out of different materials. The most commonly used materials are solid silicone and porous polyethylene.
Silicone Chin Implants
Silicone chin implants are smooth, flexible and come in many shapes and sizes.
Silicone Chin Implants are soft, solid and smooth, with the consistency of rubber. Silicone chin implants do not attach to the surrounding soft tissue of the chin. This means they are slightly more likely to shift, bend or buckle. However, there is an advantage to a soft implant that slides easily. Silicone Chin Implants can be introduced through a smaller incision, and can be easily slid out if removal desired. Silicone chin implants are also associated with a slightly higher incidence of bone resorption.
Polyethylene Chin Implants
Polyethylene chin implants are porous, firm and often come as two interlocking pieces to help reduce the size of the incision.
Polyethylene Chin Implants are hard, porous and more firm than Silicone Chin Implants. They stick to the surrounding tissue, helping to hold them in place. These implants are not flexible, and are often manufactured in two pieces, which are locked together once in place. Two pieces allow for a smaller incision for insertion, but in general, polyethylene chin implants require larger incisions than silicone chin implants. Since they incorporate into the surrounding soft tissues, they are also harder to remove.
Chin Augmentation Recovery
Like most surgery, the chin is sore for a few days after surgery. Though chewing should not cause the Chin Implant to move, a soft diet may be recommended for comfort. Ice is very helpful and has fewer side-effects than pain medication. It is not unusual to have some temporary numbness and weakness of the lower lip and chin. Most patients are back to their normal activities in a week or so. Your recovery may vary.
Chin Augmentation Consultations
I find Computer Imaging very helpful for determining how much Chin Augmentation is enough. A picture is taken of your face, and the size of the chin is varied. While computer imaging is not a guarantee of results, it is excellent for facilitating communication. The simulation helps me know the amount of Chin Augmentation that is comfortable for you.
If you are considering a Chin Implant or another Cosmetic Plastic Surgery procedure, give me a call at (925) 943-6353. My staff will schedule a convenient consultation appointment, which is the best way to learn about Chin Augmentation. A private consultation allows me to answer questions specific to your needs. Give us a call, or use the contact form in the margin to get started, today.
Breast Reduction is a powerful procedure. In men, this is known as Gynecomastia Reduction, and is primarily a cosmetic procedure used to change the shape of the male breasts. For women, Breast Reduction is known as Reduction Mammoplasty, and is usually about more than changing the appearance of the breasts. Breast Reduction for Women is most often about relieving pain and suffering.
Breast Reduction Video for Women
Details about the Reduction Mammoplasty are included in the following Breast Reduction Video segment from KRON 4’s Body Beautiful. In this video, I share some of my experience in providing Breast Reduction Surgery, including before and after photos to illustrate what is possible. While pictures are good, the main benefits of Breast Reduction are physical. More about this is outlined below.
Breast Reduction for Women – As Seen On KRON 4 TV
What is a Mammoplasty?
It might sound like I am taking a mold of your mother, but mammoplasty literally means breast changing. Mammoplasties come in two flavors: Augmentation Mammoplasty and Reduction Mammoplasty. Augmentation Mammoplasty enlarges the breast, usually with Breast Implants, while Reduction Mammoplasty decreases the size of the breasts. When plastic surgeons lift the breast without changing their size, it is termed a Mastopexy.
Reduction Mammoplasty Bay Area
Breast Reduction is performed for both Men and Women. Male Breast Reduction is performed via Liposuction, Gynecomastia Reduction or combination of both. Since Liposuction is effective for removing disproportionate fat, Breast Reduction with Liposuction only works for fatty breasts and will not correct the resultant sagging. Most men and women with breast enlargement have enlargement of the glandular tissue. This tougher breast tissue is not removed effectively with liposuction alone.
The Benefits of Breast Reduction for Women
Breast Reduction for Women is most often performed to relieve the symptoms caused by large breasts. Also known as Macromastia or Gigantomastia, large breasts are associated with:
rashes under the breasts
Disproportionately large breasts are hard to fit in clothing and often require custom bras in an attempt to control them. The constant tugging of gravity is only half the problem. Large breasts have their own momentum. They resist moving when at rest, and keep moving when you try to stop. Jogging, and other physical activities, are made more difficult, if not impossible, to do without pain. In most cases, Breast Reduction can cure these problems.
Breast Reduction Consultations
Breast Reduction can be a life changing procedure. Like any surgery, a medical history and physical examination are necessary to provide the safest and most predictable results. If you are interested in learning how Breast Reduction Surgery can help you, give me a call at (925) 943-6353, today. My Walnut Creek Plastic Surgery office is centrally located in the San Francisco East Bay.
The Beast Lift is one of the most frequently performed Cosmetic Plastic Surgery Procedures. For every three Breast Augmentations, a Breast Lift, also know as a Mastopexy, is performed. I had the opportunity to discuss Breast Lifts on the San Francisco Bay Area’s Body Beautiful on KRON 4. If you missed the live broadcast, the segment is embedded below. More Breast Lift Videos are also available on the DrMele.com Bay Area Breast Lift Video Gallery.
Mastopexy | Breast Lift Video Presentation on KRON 4
When Is A Breast Lift Recommended?
Unlike Breast Augmentation, which enlarges the breasts, Breast Lifts change the shape of the breasts. Breast Augmentation and Breast Lifts are complementary, and are often performed together. Breast Lifts are used to lift saggy breasts and to reshape birth defects like moderate to severe forms of Tubular Breast Deformity.
Little Breast Lifts
The smallest breast lifts are performed to reposition the nipple and areolae higher on the breasts. Common types include the Periareolar Lift or Round Block Lift and the occasionally effective Crescent Lift. These types of lifts are not effective for lifting the breast mound, and have the potential to deform the areolae when they are asked to do too much.
Moderate Breast Lifts
More effective breast lifts require incisions elsewhere on the breast. The next largest lift is the Vertical Breast Lift. A Vertical Lift includes the periareolar and a vertical incision, which runs from the lowest aspect of the areolae to the folds under the breasts. This lift is more effective for raising the nipple, controlling the size of the areolae and lifting the breast mound.
Big Breast Lifts
The biggest, and most versatile breast lift includes a horizontal inion that lies in the breast fold, and the incisions used in the Vertical Breast Lift. It goes by many names, but the most common include: The Anchor Breast Lift, The Inverted-T Breast Lift and The Keyhole Breast Lift. The names come from the shape of the incisions and pattern of skin removal. This lift provides superior control of the breast mound compared to the vertical lift, specially for larger breasts.
More About Breast Lifts
If you are looking for more information on Breast Lifts, there are many more breast lift posts here on the San Francisco Plastic Surgery Blog and on my other websites linked above and in the margin. However, the only way to get specific information about the Breast Lift that will work best with your body is to consult a Board Certified Plastic Surgeon in person. If you would like to schedule a private consultation, give me a call at (925) 943-6353.
The Mommy Makeover has become the most popular combination Cosmetic Plastic Surgery. The procedure addresses the two areas that women complain about most after childbirth: the belly and the breasts. While Tummy Tuck with Breast Augmentation is the most popular combination, many variations exist.
Mommy Makeover Video Presentation with Before and After Pictures
I’ve appeared on the Bay Area’s News Station, KRON 4 in the San Francisco Bay Area, numerous times over the last eight years. My most recent Body Beautiful appearance, was all about Mommy Makeovers. The following television segment goes over the highlights of what’s involved. It covers many of the most frequently asked Mommy Makeover questions and illustrates results with before and after pictures.
Mommy Makeover Video Presentation on KRON 4
What Can a Mommy Makeover do for Your Belly?
Mommy Makeovers usually include a Tummy Tuck. The tummy tuck cinches the abdominal wall muscles, removes disproportionate fat and tightens loose skin, reversing much of what pregnancy does to the belly.
Sometimes less is needed, and there are several variations of the Abdominoplasty available including the “Floating Belly-Button” Tummy tuck and the Mini Tummy Tuck. When the skin is still tight, but disproportionate fat is the problem, Liposuction may be all that is needed. Click here for more Tummy Tuck Information.
What Can a Mommy Makeover Do For Your Breasts?
The other half of the Mommy Makeovers is Breast Enhancement. The most common enhancement is Breast Augmentation, which fills loose breast skin and enhances both volume and shape. For the loss of breast volume typical after childbirth, Breast Implants can fill the need.
When volume is not a problem, a Breast Lift may be what’s needed. The Breast Lift or Mastopexy, tightens the breast skin without changing the breast volume. Many different breast lifts exists, and the best Mastopexy for you will depend on how much lifting is needed.
Sometimes breasts increase in volume after pregnancy, and remain too large. Breast Reduction Surgery can help. A Breast Reduction, or Reduction Mammoplasty, will remove excess breast volume and tighten the skin, like a Breast Lift. The result is smaller, firmer and perkier breasts. This is especially helpful in cases where your breasts are heavy and causing pain in the neck, back or shoulders.
For mommies who had Breast Augmentation prior to pregnancy, your breast tissue changes with pregnancy, too. While the breast implant will retain it’s volume, sometimes the shape of the breast is impacted with the normal growth and involution of your breast tissue. When the shape is negatively impacted, Breast Implant Revision Surgery can help shape things up again.
Mommy Makeover Consultations
If a Mommy Makeover is in your future, give me a call at (925) 943-6353. We can review the options that address your concerns, and create a personalized treatment plan that fills your specific needs. More information about Mommy Makeovers and the Plastic Surgery procedures that are utilized, is available by clicking the links included in the post above. More videos are coming soon on Breast Lifts, Breast Reduction and Chin Augmentation. See you next week.
The benefits of music on healing have been well documented. Music in the operating room is no different.
Plastic Surgery and Music combine synergistically on many levels. Both embody the objective details of science and the subjective nature of art. Music can be documented on sheet music, but the performance depends on the artist, and the quality is ultimately judged by the audience. Similarly, the goals of plastic surgery can be described objectively; however, the paths and the outcomes are often subjective.
Plastic Surgery and Music
Personally, I enjoy both. At age 15, I selected medicine for my career. At the time, I played clarinet and sax, and sang everything from English Madrigals to Punk Rock. During my pre-med training at UC Davis, I marched with the Cal Aggie Band-uh, and was Music Director for the campus radio station, KDVS. Through my career as a San Francisco Bay Area Plastic Surgeon in private practice in Walnut Creek, CA, I have continued my love of music. In 2011, my operating room musical selections were quoted in the article The Plastic Surgery Playlist: What Are Doctors Listening to in the OR? I enjoy music every day in the operating room. It provides a calming and cohesive environment for the surgical team and helps patients relax.
How Music Helps Plastic Surgeons
How about live music in the OR? The Louis and Lucille Armstrong Music Therapy Department at Beth Israel Medical Center has been supported by the Louis Armstrong Foundation since 1994.
Music not just an enjoyable stress reliever, it improves surgical outcomes, an effect that can be objectively measured. In a recent Aesthetic Surgery Journal article, the positive influence of music on plastic surgery was proven. The study, from The University of Texas Medical Branch at Galveston, shows that when plastic surgeons listen to music they prefer, their surgical technique and efficiency when closing incisions is improved. This is regardless of the type of music played.
Plastic Surgery Procedure Playlists
I prefer a wide variety of music, and my playlists have been described as eclectic to the point of causing auditory whiplash. Variety is the spice of life, and outcomes are only improved when the plastic surgeon likes the music. For selected procedures, I have preferred play lists. For Blepharoplasty, I prefer classical. For Liposuction, something with a beat is helpful. For longer cases, upbeat music seems to keep the momentum of the operation moving forward.
Keeping Your Plastic Surgery Teammates Happy
Previous studies show little objective correlation between the quality of surgical outcomes and whether patients like the music played during surgery. This makes sense, because when patients are under general anesthesia, there is no recall. Outcomes are not significantly improved when operating room team members other than the operating surgeon are asked to select the music, unless the surgeon likes it. However, subjectively, I feel it matters. A happy Plastic Surgery Team functions better, and has less resistance to doing more, when necessary. For patients, music is especially helpful during the pre- and post-operative experience. On the other hand, one study showed that when patients selected the music for their operation, and their surgeon did not like it, outcomes were worse!
The Evidence is Reproducible
In the 90’s, carrying around a bulky case of CD’s was still worth it for good tunes in the OR.
A study out of Buffalo, New York, published in the Journal of the American Medical Association in 1994, measured surgeons’ blood pressure and pulse rates during surgery. The data confirmed the quickest, most accurate performances, those with the lowest surgeon heart rates and blood pressures, came when surgeons listened to the music of their choosing. It was also demonstrated that it was better to have music selected by the study team than no music at all. In 1994, if you wanted to play music in the operating room it took some effort. You had to lug around your own CD’s, and often bring your own player to the operating room. Today ORs are bluetooth enabled, so all you need is your phone and a streaming service.
It’s Not Just an American Thing
Articles from the leading medical journals in the UK show that surgeon selection of music helps outcomes. In fact, the Guardian lists several doctors’ preferred playlists. Articles from the Lancet showed that compared with standard care, music was associated with a 20% reduction in postoperative pain, a 10% reduction in anxiety and a significant reduction in the use of pain medication. Music did not affect length of hospital stay, but it increased patient satisfaction slightly, so even hospital administrators might see the benefit.
Musical Request During Surgery Accepted
The nice thing about liking a wide variety of music is that your requests for music during Plastic Surgery are easily granted. With a variety of streaming music services like Pandora, Slacker and Spotify, access to music has never been easier. So if you have a favorite band or genre, let me know. For a Plastic Surgery Consultation in the San Francisco Bay Area give me a call at (925) 943-6353.