December 31st, 2009 Dr. Mele
Earlier this month I had the opportunity to discuss abdominoplasty, more commonly know as the tummy tuck, live in San Francisco on KRON4′s Body Beautiful. The show is half an hour long, so I will break it up into smaller themed segments. Look for it here in the near future.
Tummy tuck before and after pictures. All three layers (skin, fat and muscle) of the abdomen are improved. Click on picture for more examples.
Many common tummy tuck questions came up during the show and even more questions were raised afterwards from the audience and in the emails that followed. The most common question asked was, “Who needs a tummy tuck?” I would like to share some of the reasons people have tummy tucks here.
First the disclaimer, when I answer general questions the answers are generally true; however, sometimes specific situations arise with an individual that leads to a different answer. While what you read on the San Francisco Plastic Surgery Blog, or on my personal web site (DrMele.com) is carefully designed to provide you with the information needed to learn about plastic surgery, it is important to actually see a Board Certified Plastic Surgeon before any specific course of action can be recommended. Every patient is different, and consequently every operation is different. A vital ingredient for a beautiful plastic surgery result is individualizing the plan to suit your specific needs.
Who needs a Tummy Tuck?
A tummy tuck tightens the abdominal wall. It improves three layers: the skin, the fat, and the muscle. The ideal candidate for a tummy tuck is in good shape and not too far from their goal weight. In order to be a candidate, you should need help in at least one of the following three areas that the surgery improves.
Loose skin can be caused by pregnancy and weight loss. Both stretch the abdominal skin. If the skin is stretched too much, it cannot recoil. After pregnancy or weight loss, the skin may remain stretched and begin to hang. Unfortunately, in this situation, more weight loss does not help. Instead it leads to more loose skin.
A tummy tuck removes this loose skin from the lower abdomen, and tightens the skin that remains. This results in a smoother contour and better fitting clothes.
Excess Fat and Stretch Marks
Whenever I am removing excess lower abdominal skin, I can remove two other problems: excess fat and stretch marks. Excess fat that is below the belly button, is removed along with the excess skin. Women tend to put most the excess fat between the muscle and the skin, making it easy to remove. Men more often put excess fat behind the muscle, where it is not accessible. This internal fat must be lost with diet and exercise, and cannot be surgically removed.
Any stretch marks that are in this skin, are also removed. If the stretch marks are confined to the central abdomen below the belly button, the majority, if not all of them, can be removed with a tummy tuck.
Babies and internal fat are behind the muscle layer of the abdominal wall. Because of this, pregnancy and weight gain also stretch the muscle layer. The muscle, and its case, can become overstretched to the point that the abdomen cannot be sucked in, not matter how strong the muscle layer. Tummy tucks allow me to tighten the case of the muscle and provide a smooth flattened foundation that can support the gut and keep it contents from pushing forwards.
If someone is significantly overweight, it is the internal fat that prevents me from being able to optimally tighten the abdominal wall. If the abdominal wall cannot be maximally tightened, abdominal fullness will remain. In this situation, additional weight loss will improve the results.
The first two segments of the video are now posted on the San Francisco Plastic Surgery Blog. Here is the link to Tummy Tuck (Abdominoplasty) San Francisco Video – Part 1 of 3; here is the link to Tummy Tuck (Abdominoplasty) San Francisco Video – Part 2 of 3; and here is the link to Tummy Tuck (Abdominoplasty) San Francisco Video – Part 3 of 3.
December 19th, 2009 Dr. Mele
As health care reform is being rushed to a vote before Christmas, it is hard for anyone to say what the bill includes. However, as of this morning, it does not include a tax on cosmetic surgery. I want to personally thank those of you who read my previous post, and made the time to contact your representatives. While there is no organized Cosmetic Surgery Lobby, your voice was heard, and it has made a difference.
Organizations such as the American Society of Plastic Surgery, the American Society for Aesthetic Plastic Surgery, the American College of Surgeons helped motivate their members. These surgical societies and the American Medical Association continue to work to incorporate real changes to help improve access, patient safety and equity into the process of healthcare reform.
Corporations like Allergan (from whom I purchase Natrelle Breast Implants, Botox Cosmetic and Juvederm) also went on record to oppose this unfair tax. More can be read here in MarketWatch.
While these large organizations helped to get the word out, what made the difference ultimately was you. You got involved. You called you Senators and Representatives, and for that I say, “Thank You.” The nature of the excise tax on Cosmetic Surgery was revealed and rejected, but there are more than 2000 other pages included in the Senate version of the healthcare reform bill.
While the bill is nobly entitled, “The Patient Protection and Affordable Care Act,” it has of late become “The Anything That Will Get Us 60 Votes Act”. The push to a vote before Christmas has lead to radical daily changes, and confusion about what “Patient Protection and Affordability” means.
I am interested in the outcome for many reasons. I am a Physician and my livelihood is directly effected by whatever is included in the yet to be finalized version of this bill. I am a health care provider, and I want to be able to take care of my patients in the ways that my training has determined are the best. I want the freedom to use my experience to choose the path with highest chance of success and lowest risk of injury. Unfortunately, rules and policies can only deal with large groups, and the decisions I need to make daily are on the level of the individual. Sometimes the needs of the one are different than the needs of the masses, and trying to get approval for a necessary test or surgery can be daunting when it is not the “normal” treatment.
I am interested in the outcome because I am in Private Practice. I not only provide medical care, but I purchase health care insurance for myself and my family. Medical coverage that as an individual, I cannot negotiate. Medical coverage that is provided in a take it or leave it fashion.
I am also interested in the outcome of The Patient Protection and Affordable Care Act, because I am a parent. Good health is one of the most important attributes we can have in a quality life. After good genes, quality healthcare is the key to good health. It is important that health care is made available. Public policy/support is a big piece of the solution, but equally important is the ability for your doctor to make a decision based on your situation. I cannot make my decisions based on what is right for the majority, I have to make them based on what is right for you, the individual. The individual is being lost in policy. Be it an insurance policy or a public policy the tyranny of the majority has found its way into medicine, and the policy being formed today will outlive all of us.
Many good ideas are left to be explored, and some aspect currently included need revision or unintended consequences may result. The selective excise tax on cosmetic surgery was not a good idea, and (for now) has been eliminated. Please continue to be involved, and contribute. The locomotive of reform has a full head of steam, and we need to keep it on track. Its shape changes every day, and the “true plan” has not yet been revealed. It is our healthcare that is being reformed, and it needs our attention.
Every time I hear another redundant news article on Tiger Woods, I wish instead I was being informed about something that actually will effect my life. The healthcare reform bill will effect my life. It will effect how healthcare is delivered in the United States, and will effect all our lives … directly.
December 8th, 2009 Dr. Mele
After children (or weight loss) the breasts lose volume and the abdominal wall is lax.
The Mommy Makeover remains one of the most frequently requested combinations of cosmetic plastic surgery procedures. Often performed to repair the damage after childbirth, the Mommy Makeover most commonly combines Breast Augmentation
with the Tummy Tuck
Depending on what needs to be fixed, however, other procedures can be substituted. Sometimes a Breast lift is added to, or used instead of the Breast Augmentation. If the breasts remain too large after childbirth, a Breast Reduction may be more appropriate. The Mini Tummy Tuck can sometimes replace the full Tummy Tuck, and Liposuction is often used as an adjunct.
The combination of breast enhancement and abdominoplasty is usually performed after childbirth, but is also common after significant weight loss. In both instances the problems are similar. The breasts may lose volume and support, and the abdomen is often left with excess skin and muscle laxity. The Mommy Makeover restores lost volume and support to the breasts and tightens the abdominal wall (skin and muscle).
The woman pictured to the left is lucky. Although she has lost volume in her breasts after childbirth, her nipples remain high above the inframammary fold (the bottom of the breast). This means a breast lift is not needed. Instead, the lost breast volume was restored. Breast implants were placed behind the pectoralis muscle with a natural result.
Her abdominal wall had been stretched, resulting in loose skin and weakened abdominal muscles. There is a small amount of fat behind the lower abdominal skin, but this will be removed when the skin is tightened. Overall she is in good shape, and a good candidate for a Mommy Makeover.
Starting at the Top – Breast Augmentation
Before Mommy Makeover, the breast have lost volume and are smaller than before pregnancy.
After Mommy Makeover, breast volume has been restored to a pre-baby state.
Breast augmentation was performed to restore volume. The goal was to restore the lost volume, and just a little bit more. Smooth round implants where placed behind the muscle via a periareolar (below the nipple) approach. This gives a nice teardrop shape the the breasts. By selecting the appropriate size, a very natural appearance can be obtained.
Around the Middle – The Tummy Tuck (Abdominoplasty)
Before Mommy Makeover, the abdominal muscles and skin are over stretched.
After Mommy Makeover, the abdominal muscles and skin have been tightened.
The Bottom Line – Restoring Proportions
After children (or weight loss) the breasts lose volume and the abdominal wall is lax.
After Mommy Makeover, the abdomen is flat and the breast's proportions are restored.
The art of plastic surgery has a lot to do with proportions. By giving volume to the breasts and taking volume from the abdomen, an aesthetic balance is achieved. But, there is more benefits than just looking nice. Clothing fits better and the energy wasted on feeling self conscious can be used for more productive endeavours. Having children is something to be proud of, not looking like you’ve had children … priceless.
December 1st, 2009 Dr. Mele
The base width diameter (BWD) of the breast is an import measurement for selecting the best breast implant. For my San Francisco Bay Area breast augmentation patients to achieve the best breast augmentation, the width of the breast must correlate with the width of the implant.
I am often asked what is the best breast implant profile or best breast implant volume for a certain bra size. The answer depends on many specifics, but the base width diameter (BWD) of the breast is one of the most important measurements used to determine the optimal breast implant diameter.
This patient desired restoration of her lost breast volume. Note the patient's left breast is higher than her right breast prior to breast augmentation.
After breast augmentation. Breast implant diameter was selected to enhance cleavage without overly enhancing width.
There is more to choosing the best breast implant than just picking an implant with a diameter that matches the chest, but it is a great place to start. While no implant is the perfect breast implant, choosing one that is proportional to the body is the best way to get a full and natural result.
It’s like Goldilocks. If the beast implants are to wide, they will hang over the sides and you will be bumping into them with your upper arm. If the breast implants are too narrow, they will tend to fill the outside of the breast and leave a space between the beasts. If the implants are just right, the breast can be filled over the entire base width and create a naturally full cup.
After choosing the appropriate beast implant diameter, the volume can be adjusted by choosing the appropriate profile. Low profile breast implants are flatter than high profile breast implants. The larger the volume desired, the higher profile selected and the more projection obtained.
Prior to breast augmentation. The breast maintains a low projection but more volume is desired.
After breast augmentation. Enhanced projection is obtained by using a higher profile implant.
When I trained as a Plastic Surgery fellow at Saint Francis Memorial Hospital in San Francisco, California, only moderate profile saline breast implants were available for breast enlargement. Today, saline breast implants come in three different profiles: Low, Moderate and High. The variation in projections is even greater for silicone breast implants with five profiles available. When the form-stable gummy-bear beast implants are finally approved, even more choices will be available.
Choice is good. When you are choosing, be certain to pick a Board Certified Plastic Surgeon who can help you make the most of your options.
For more information on how to choose the correct breast implants see these links:
How to Choose the Correct Breast Implants: Size
How to Choose the Correct Breast Implants: Silicone vs. Saline