The tummy-tuck, or abdominoplasty is one the procedures I perform most frequently. My San Francisco tummy tuck patients are some of my happiest. The procedure can not only remove excess skin and fat from the lower abdomen, it can directly tighten the muscles of the abdominal wall. However, not everyone who comes into the office for a cosmetic plastic surgery consultation needs a full tummy-tuck.
A “full” tummy-tuck provides improvement to the muscular foundation of the abdomen. This is especially important after pregnancy and weight loss. Both cause stretching of the abdominal wall from the inside out, and can result in laxity and even separation of the muscles that provide support to the abdominal contents.
There are situations when a full tummy tuck may not be necessary. If the problems with fullness, muscle laxity and excess skin are confined to the lower abdomen, a mini-tummy-tuck might provide the appropriate amount of correction. In other words, if the skin above the umbilicus (belly-button) is tight and the contour of the abdomen in this area is acceptable, a mini-tummy-tuck can provide sufficient correction. Laxity below the umbilicus can be corrected with this smaller surgery resulting in a quicker recovery and lower costs.
Liposuction can be used to contour the abdomen also. For liposuction to be successful the muscle and skin must be tight. Disproportionate fat located between the muscle and the skin causes fullness that can be localized. Most commonly this is found in the lower part of the abdomen. Liposuction can selectively remove this excess fat and improve the overall contour of the abdomen.
If you are interested in improving the contour of your abdomen, additional and information on liposuction, the mini-tummy-tuck and the tummy-tuck is available on my website and in the video above. Both provide general information about the procedures; however specific guidance for you can only be made after a thoughtful and thorough consultation appointment. For a recommendation based on your specific needs and goals, call (925) 943-6353. As a Board Certified Plastic Surgeon located in San Francisco’s East Bay city of Walnut Creek, I have all the options available and can choose the simplest plan with the greatest probability of getting the best possible results.
In my Walnut Creek Plastic Surgery practice I use both silicone gel implants and saline implants. The ratio of Silicone to Saline Implants is about 50:50. For my San Francisco Bay Area Breast Augmentation patients I make the decision of which to use based on patient preference and the relative advantages and disadvantages of the two implants. Below I have tried to summarize where we stand with Silicone Gel Implants as of the Summer of 2009, including the fourth generation Gummy Bear implants.
The FDA approved silicone gel implants as safe and effective two and one-half years ago. While they were available long before this, this was before the FDA had its current approval process. The number of breast augmentations increases yearly, and since FDA approval the use of silicone gel implants has continued to increase.
Currently in the United States there are two fillers available for breast implants. Both have been used for decades. The Saline filled breast implants received FDA approval in 2000, and Silicone Gel filled breast implants received approval in 2006.
A newer Silicone Gel filled breast implant is still awaiting FDA approval. Sometimes referred to as Gummy Bear (or Gummi-Bear) implants because of the nature of the filling, these implants are a polymerized silicone gel that retains its shape similar to the candy treat. While soft and deformable, these implants have a memory, and like a stress ball, return to their original dimensions. The biggest advantage of these implants is that they cannot leak.
While the implants are very similar, and in some ways superior to the currently available breast implants, the FDA has yet approve them for unrestricted use. The same implants have been approved in Canada for two years and in Europe for a decade with good results.
Three companies manufacture these “4th generation’ breast implants. Allergan Aesthetic’s brand name Natrelle “gummi-bear” implants are called 410′s from their catalogue number. Mentor calls theirs the Contour Profile Gel (CPG) implants. Silimed, also makes these types of implants; however, Silimed implants are not currently available in the US.
The shell covering all these implants is silicone. It is well tolerated in the body. Silicone is used to make many devices that are implanted in the body – from breast implants to catheters to artificial joints.
The main advantage to silicone filled breast implants is the way they feel. The implant is soft and more difficult to feel inside the breast. Saline implants ripple (wrinkle) more frequently and this can be felt (and sometimes seen) through thin skin. Gel implants are less likely to have palpable rippling.
The disadvantage is that it is more difficult to tell if a silicone gel implant has a leak. If the gel is contained inside the normal pocket of scar around the implant, everything may look and feel completely normal. Silicone gel implants are also more likely to get capsular contracture (tightening of the scar around the implant) especially if placed in front of the pectoralis muscle.
As an investigator for both US implant manufacturers I can say that the choice of which to use depends on many variables. It is important to discuss with your Board Certified Plastic Surgeon the goals for your breast augmentation. The relative risks and benefits can be evaluated, and the best implant for you can then be determined.
