Mommy Makeovers San Francisco Bay Area

Posted May 21, 2017 in Breast Augmentation, Breast Lift (Mastopexy), Breast Reduction, Breast Reduction (Women), Home, Liposuction, Mini Tummy Tuck (Mini Abdominoplasty), Mommy Makeover, Tummy Tuck (Abdominoplasty)

The most common Mommy Makeover combination is the one depicted above: Breast Augmentation and a Tummy Tuck. Breast Implants restore lost breast volume, while the Tummy Tuck flattens and tightens the abdominal wall.

The most common Mommy Makeover combination is the one depicted above: Breast Augmentation and a Tummy Tuck. Breast Implants restore the lost breast volume, while the Tummy Tuck flattens and tightens the abdominal wall.

Mommy Makeovers remain one of the most popular body shaping combinations for women. The combination of Breast Enhancement and Belly Embellishment is often performed after childbirth and/or weight loss, with the goal of reestablishing more shapely and youthful proportions. While Breast Augmentation with a Tummy Tuck is the most common combination, it is important to pick the procedures most appropriate to your needs. Below, I discuss the options for rejuvenation of the breasts and the belly.

Breast Enhancement

Breasts often change with pregnancy and breast feeding. Variations are common, but typically breasts increase with pregnancy and then end up smaller after lactation ceases. The problems come when the postpartum breasts are too small, too saggy or remain too large (less common but, can be just as annoying).

Breast atrophy after pregnancy is very common. Breast Implants can restore lost volume and restore the proportions that enhance the breasts' shape both in and out of clothing.

Breast atrophy after pregnancy is very common. Breast Implants can restore lost volume and restore the proportions that enhance the breasts’ shape both in and out of clothing.

It is best to wait at least three months after lactation ceases before having any breast procedure. This allows the breasts to settle down to a consistent shape, providing more predictable and safer surgery. Depending on your experience and goals, options for Breast Enhancement include:

Belly Embellishment

Bellies, too, get stretched out during pregnancy. Subsequent pregnancies tend to increase injury, especially if close together. Working out and abdominal exercises help, especially if you are in good shape before pregnancy and maintain a healthy weight during pregnancy. Even under the best circumstances, a big healthy baby can trump a flat healthy belly. The options for tummy rejuvenation include:

After pregnancy, or weight loss, the abdominal muscles, skin and fat can all be compromised. Fortunately, the Tummy Tuck can repair all three areas. Be certain to find a Board Certified Plastic Surgeon with experience for your belly rejuvenation.

After pregnancy or weight loss, the abdominal muscles, skin and fat can all be compromised. Fortunately, a Tummy Tuck repairs all three areas. An experienced Board Certified Plastic Surgeon is the best choice for your Mommy Makeover.

Liposuction can also be used in combination with either of the Tummy Tucks, and the fat removed with Liposuction can be repurposed to enhance other curves, like the buttocks when combined with a Brazilian Butt Lift. If you are wondering which procedure is best for you, an in-person consultation is the best way to find out. I have a page on my main website that explains some of the decision points when trying to decide: Liposuction or Tummy Tuck?

Mommy Makeover Consultations

To explore all your body rebuilding options, call (925) 943-6353, and schedule a personal consultation appointment in our San Francisco Bay Area plastic surgery clinic. A Board Certified Plastic Surgeon is your best guide for explaining what Cosmetic Plastic Surgery can offer. Since we offer a wide variety of procedures, we can offer you the best choices for your Mommy Makeover.

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BIA-ALCL is Breast Implant Associated Anaplastic Large Cell Lymphoma

Posted April 09, 2017 in Home, Patient Safety

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

Since the last BIA-ALCL update, all the plastic surgery societies and breast implant manufacturers have responded with information sheets. I am encouraged by the free flow of information within the Plastic Surgery profession and the industry that supports us.

ASAPS by the Numbers

The ASAPS has distributed a quick summary of the numbers related to BIA-ALCL. Here are a few.

How Many BIA-ALCL Cases Have Been reported?

Of the estimated 7 million women with breast implant throughout the world, 359 reports have been filed. Since the reports can be filed by patients, physicians or manufacturers, it’s important to note the MDRs (Medical Device Reports) are not individual cases, and multiple reports may be filed for a single case of BIA-ALCL. In contrast, there are currently 139 case reports of BIA-ALCL in the literature. It is also important to realize that this is a very small number in relation to the millions of breast implant patients. Lastly, the number is expected to rise because we are learning how better to identify and diagnose patients with the disease.

Smooth vs. Textured

Of the reported cases, over 90% occurred in patients who had textured implants at the time of their diagnosis. In the US database, there is a single case of a patient with smooth breast implants developing BI-ALCL; however, they had a textured tissue expander prior to the smooth breast implant placement. Unfortunately, the other 27 cases of BIA-ALCL reported in the world databases do not include past breast implant information, so while we can say that BI-ALCL is predominantly a problem with textured breast implants, it is unknown if a case has developed in a person who had exclusively smooth breast implants. Currently, 12.7% of US patients receive textured implants. This includes both textured round and all anatomically “shaped” breast implants, and includes both saline filled and silicone filled breast implants.

How Many BIA-ALCL Deaths Have Been Reported?

Of the 359 cases reported, 9 patients have died. Two patients died from stem cell transplants, one died from development of a second unrelated lymphoma, and 6 patients died from direct extension of the tumor. Early detection is key. Of the deaths, none of them received complete surgical excision at any point in their clinical history, none received targeted therapy, and most were significantly delayed in diagnosis or receiving any treatment (1-2 years from onset of symptoms). On the other hand, 93% of all patients are disease free at 3 years follow up. BIA-ALCL has an excellent prognosis when diagnosed early.

How Do We Diagnose BIA-ALCL?

Early diagnosis is key to successful treatment, so how do we accomplish this? Unilateral (one-sided) swelling or mass should lead to a thorough evaluation. This is common in the months following your breast augmentation. The possibility of BIA-ALCL should be considered in a patient with late onset, peri-implant seroma (fluid collection). The majority of patients present on average 8 years after implantation, but range extends from 2 to 28 years.

Ultrasound imaging followed by fine needle aspiration of seroma fluid should be obtained. Collected fresh seroma fluid should be sent to a qualified lab for immunohistochemistry testing for cluster of differentiation (CD30) testing.  Anaplastic Lymphocyte Kinase (ALK) testing of the seroma fluid can help differentiate BIA-ALCL from systemic forms of lymphoma that may appear in the breast.  

Current BIA-ALCL Treatment

Most patients with BIA-ALCL are cured by removal of the implant and capsule surrounding the implant, however a small number act more aggressively and may require additional treatments. For 2017, the National Comprehensive Cancer Network defines optimal treatment which is total capsulectomy and implant removal for the majority of patients with disease confined to the capsule (35% of patients) or a resectable mass (40% of patients). Advanced disease with lymph node metastasis (14% of patients) or organ metastasis (1% of patients) may require further treatment with chemotherapy using either CHOP anthracycline based-protocol or targeted therapy with brentuximab vedotin. Radiation therapy is only reserved for locally unresectable disease.

BIA-ALCL Perspective

BI-ALCL is not breast cancer. Here are some additional numbers, and some links, to keep the worry about BIA-ALCL in perspective:

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Video – Breast Augmentation on KRON 4 – SF Bay Area’s News Station

Posted March 11, 2017 in Breast Augmentation, Home, Videos

According to the latest American Society of Plastic Surgeons’ Statistics, Breast Augmentation remains the most popular Cosmetic Plastic Surgery procedure in the United States.

Breast Augmentation provides fullness and support. Not only can a Breast Implant enlarge a small breast, but it can restore shape and volume to a breast that has changed due to pregnancy, weight loss or aging.

Breast Augmentation provides fullness and support. Not only can a Breast Implant enlarge a small breast, but it can restore shape and volume to a breast that has changed due to pregnancy, weight loss or aging.

Breast Augmentation on Body Beautiful

Breast Augmentation was also the first topic discussed on this week’s Body Beautiful. Body Beautiful is a live show, dedicated to the latest in Cosmetic and Plastic Surgery procedures, that airs on the San Francisco Bay Area’s News Station, KRON 4.

The Breast Augmentation Video below covers the basics of Breast Implants and Breast Augmentation and illustrates the procedure with multiple Breast Augmentation Before and After Pictures.

Breast Augmentation Video (Breast Implants)

Breast Augmentation Consultations

Breast implants come in a large variety of sizes and shapes. The best size for you is subjective; however, a Board Certified Plastic Surgeon can supply you with professional guidance in selecting the Breast Implant that will best provide the result you are looking for.

Breast implants come in a large variety of sizes and shapes. The best size for you is subjective; however, a Board Certified Plastic Surgeon can supply you with professional guidance in selecting the Breast Implant that will best provide the result you are looking for.

If you are considering Breast Augmentation or have Breast Implants and are looking for Breast Augmentation Revision, give me a call at (925) 943-6353 for a personalized consultation and specific recommendations tailored to your needs.

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SF Plastic Surgery Discussed Live Today on KRON 4

Posted March 08, 2017 in Arm Lift (Brachioplasty), Breast Augmentation, Breast Reduction, Breast Reduction (Men), Chin Implants/Augmentation, Facial Augmentation, Home

Dr. Mele and Body Beautiful host Janelle Marie in the KRON 4 Bay Area News studio.

Dr. Mele and Body Beautiful host Janelle Marie in the KRON 4 Bay Area News studio.

Board Certified San Francisco Bay Area Plastic Surgeon, Dr. Joseph Mele, MD, FACS, will be discussing cosmetic plastic surgery, live at noon today (8 March 2017) on KRON 4. Topics include:

  • Breast Augmentation (breast implants)
  • Gynecomastia Reduction (male breast reduction)
  • Arm Lifts (brachioplasty)
  • Chin Augmentation (chin implants)

But you never know what will come up on live television.

Tune in or DVR us at Noon Today

If you have the chance, tune in today at noon and get the latest plastic surgery news, live, on your television. If you are reading this too late to tune in, don’t worry. Segments of the show will be posted to the San Francisco Plastic Surgery Blog and to my web shortly after airing.

You can check out past episodes here by selecting “Videos” in the “Search By Category” drop-down menu in the margin, or on DrMele.com.

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Top Plastic Surgery Procedures – SF Bay Area

Posted March 05, 2017 in Brazilian Butt Lift, Breast Augmentation, Breast Lift (Mastopexy), Breast Reduction, Brow Lift, Eyelid Lift (Blepharoplasty), Facelift (Rhytidectomy), Home, Liposuction, Neck Lift (Rhytidectomy), Plastic Surgery Societies, Rhinoplasty (Nasal Surgery), Tummy Tuck (Abdominoplasty), Wrinkle Reduction (Non-surgical)

The 2016 ASPS National Plastic Surgery Statistic were released this week.

The 2016 ASPS National Plastic Surgery Statistic were released this week.

This week the American Society of Plastic Surgeons (ASPS) published the United States’ national Plastic Surgery Statistics for 2016. It is always interesting to me to see how the national statistics correlate with my own Cosmetic Plastic Surgery practice here in the San Francisco Bay Area. Last year, the correlation was pretty close.

Top Ten Cosmetic Plastic Surgery Procedures

As a group, surgical procedures grew 4% from 2015 to 2016. The top five Cosmetic Plastic Surgery procedures are almost the same. Facelifts edged out Tummy Tucks for the fifth spot, but the popularity of the two procedures remains very close. Here are the top five procedures as reported by the ASPS:

  1. Breast Augmentation (Augmentation Mammoplasty)
  2. Liposuction (Suction Assisted Lipectomy)
  3. Cosmetic Nasal Surgery (Rhinoplasty)
  4. Eyelid Lift (Blepharoplasty)
  5. Face Lift (Rhytidectomy)

The next five procedures, in order of popularity were: Tummy Tuck (Abdominoplasty), Breast Lift (Mastopexy), Neck Lift (Rhytidectomy), Forehead Lift (Brow Lifts) and Breast Reduction (Reduction Mammoplasty).

Brazilian Butt Lifts Grow The Fastest

The fastest growing procedure last year was the Brazilian Butt Lift (BBL). The BBL is not really a buttocks lifts, but more a buttocks enlargement. During the procedure, fat grafting is used to enlarge the buttocks and selectively enhance its shape. The results can be quite dramatic and the resultant shape is usually much nicer than that obtained from buttocks implants.

The Brazilian Buttocks Lifts is again the fastest growing cosmetic plastic surgery procedure. Significant improvement in the size and shape of the buttocks is possible by removing disproportionate fat from other areas, the lower back in this example, and selectively inserting the excess fat into the buttocks.

The Brazilian Buttocks Lifts is again the fastest growing cosmetic plastic surgery procedure. Significant improvement in the size and shape of the buttocks is possible by removing disproportionate fat from other areas, the lower back in this example, and selectively inserting the excess fat into the buttocks.

The number of Brazilian Butt Lifts increased 26%, from 14,705 to 18,489 in 2016. The procedure was also the fastest growing procedure of 2015 when it grew 28%, from 11,505 to 14,705. In fact, for the US population, the number of BBL’s has doubled from 2013 to 2016, and shows no signs of slowing in 2017.

Minimally Invasive Plastic Surgery Procedures

Minimally invasive plastic surgery procedures grew 3% in 2016. The top five procedures remain:

  1. Botulinum Toxin Type A (Botox®, Dysport®, Xeomin®)
  2. Soft Tissue Fillers (Restylane®, Juvederm®, Radiesse®)
  3. Chemical Peels (TCA, Phenol)
  4. Laser Hair Removal
  5. Microdermabrasion

Cosmetic Plastic Surgery Consultations

If you live near the San Francisco Bay Area and are considering Cosmetic Plastic Surgery, be certain to seek out an experienced and Board Certified Plastic Surgeon in your area. To schedule a private consultation, tailored to your specific needs, call (925) 943-6353, today.

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2017 BI-ALCL Update (Breast Implant Associated – Anaplastic Large Cell Lymphoma)

Posted February 26, 2017 in Breast Augmentation, Home, Patient Safety

The 2016 diagnostic algorithm for BI-ALCL, shown in the flowsheet above, is still the recommended treatment. If you experience breast implant enlargement, breast inflammation, breast pain, a breast lump, a breast sore or feel like there is fluid around your breast implant, follow up with your plastic surgeon or primary medical doctor ASAP.

The 2016 diagnostic algorithm for BI-ALCL, shown in the flowsheet above, is still the recommended treatment. If you experience breast implant enlargement, breast inflammation, breast pain, a breast lump, a breast sore or feel like there is fluid around your breast implant, follow up with your plastic surgeon or primary medical doctor ASAP. (Click image for larger view.)


It’s been about six months since the last San Francisco Plastic Surgery Blog ALCL update. Recently, more information on the subject has become available, and it is about to be published. Two articles stand out. The first is from the United States, and the second is a global review of what is known to date. Both were recently e-published, ahead of print, in the American Society of Plastic Surgeons’ (ASPS) journal, “Plastic and Reconstructive Surgery.” Here are the latest facts…

What is BI-ALCL?

ALCL Histology

Breast Implant Associated – Anaplastic Large Cell Lymphoma (BI-ALCL) is a T-cell lymphoma that arises around breast implants. It is an extremely rare tumor, which makes it difficult to study; however. earlier data suggests that it is primarily associated with textured breast implants.

The Latest Plastic Surgery News

The first article by Doren et al, entitled: United States Epidemiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma, reviews all cases of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BI-ALCL) in the United States since the first documented case in 1996 up to and including cases reported in 2015. The study is retrospective, so it is not an ideal study for determining the incidence of the disease; however, it’s the best guess we have to date, and the conclusions seem fair. Although rare, all cases of BI-ALCL with adequate history have involved a textured breast implant. The incidence and prevalence of BI-ALCL was determined based on a literature and institutional database review of BI-ALCL cases and textured breast implant sales figures from implant manufacturers’ annualized data.

2017 United States BI-ALCL Data

One hundred pathologically confirmed BI-ALCL cases were identified in the United States. Mean age at diagnosis was 53.2±12.3 years. Mean interval from implant placement to diagnosis was 10.7±4.6 years. Forty-nine patients had breast implants placed for cosmetic reasons, 44 for mastectomy reconstruction, and seven for unknown reasons. Assuming BI-ALCL occurs only in textured breast implants, the incidence rate is 2.03 per 1,000,000 person-years (203 per 100 million), which is 67.6 times higher than that of breast ALCL (3 per 100 million; p<0.001). Lifetime prevalence was 33 per million persons with textured breast implants.

2017 Global BI-ALCL Data

The second article by Srinivasa et al, entitled: Global Adverse Event Reports of Breast Implant-Associated ALCL: An International Review of 40 Government Authority Databases, reviews all federal database submissions relating to BI-ALCL in 37 countries representing the majority of breast implant markets worldwide with available adverse event reporting. Database queries were performed for Australia, Brazil, Canada, China, Columbia, Japan, Mexico, National Competent Authorities of the European Member States, New Zealand, South Korea, and United States. Demographics, device characteristics, pathology, treatment modalities, and outcomes were assessed when available.

The United States MAUDE database included 459 entries in total for the search terms “Anaplastic” and “ALCL” as of September 2015. Excluding for duplicate entries, the MAUDE database had 258 unique cases of BI-ALCL of which 130 had pathologic markers performed. Implant surface was textured significantly more than smooth (50% vs. 4.2%, p=0.0001). Treatment, when reported (n=136), included explantation (n=125, 91.9%), chemotherapy (n=42, 30.8%), radiation (n=25, 18.4%), and/or stem cell transplant (n=9, 6.6%), and 5 deaths were reported. For the 40 countries queried, 340 unique cases were reported for lymphoma associated with breast implants.

They concluded that worldwide federal reporting of BI-ALCL has significant limitations in providing data regarding clinical history, treatment, and oncologic follow up. Country-specific total implant and textured implant sales data is needed in order to determine critical incidence and prevalence analysis. Detailed BI-ALCL patient registries such as American Society of Plastic Surgeon’s PROFILE and centralized tissue banking are necessary in acquiring accurate complete data for sound decision making. The good news for American’s here is that the American Society of Plastic Surgeons are leading the way in accurate and appropriate reporting.

What To Do If You Think You Have BI-ALCL

The most common presentation of BI-ALCL is a collection of fluid that occurs around your breast implants years after surgery. BI-ALCL is not the most common cause of these late seromas, but sending a sample may be the fastest way to make the determination. Other presentations include a mass attached to the capsule, tumor erosion through the skin, regional lymph node involvement, or sometimes it is discovered during revision surgery. Risk estimates ranged from one in 500,000 to one in 3 million women with implants.

The typical presentation of ALCL is a large seroma (fluid collection) around the breast implant causing obvious enlargement and asymmetry of the breast augmentation.

The typical presentation of ALCL is a large seroma (fluid collection) around the breast implant causing obvious enlargement and asymmetry of the breast augmentation.

If you suspect there is a problem with your Breast Implants, whether related to BI-ALCL or not, contact an experienced Board Certified Plastic Surgeon in your area. If your original Plastic Surgeon is still in practice near-by, this would be the best place to start. They have your clinical information, and a head start in the investigation. If you have moved, or your plastic surgeon has retired, try to get a copy of your medical records. This will help your new Plastic Surgeon get to the facts much faster.

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Breast Augmentation and Pregnancy

Posted February 12, 2017 in Breast Augmentation, Breast Implant Revision Surgery, Breast Reduction, Home, Mommy Makeover

Breast Augmentation and pregnancy, the combination is the source of many questions in my San Francisco Bay Area Plastic Surgery Clinic. The answers center around a few themes: timing, breast feeding and how breasts change.

Pregnancy brings many changes including changes to the breasts. If you are considering Breast Enlargement, or if you already have Breast Implants, and you are contemplating pregnancy, this post is for you.

Pregnancy brings many changes including changes to the breasts. If you are considering Breast Enlargement, or if you already have Breast Implants, and you are contemplating pregnancy, this post is for you.

Breast Augmentation and Pregnancy: Timing

If you are done having children, the timing is ideal. The dramatic changes that can occur with pregnancy and breast feeding are over, and the focus is on getting back the breasts you had, or the breasts you always wanted to have. Details like size and shape tend to change slowly with age, but may swing widely with pregnancy. Having this behind you is a big plus in the direction of predictability. Additionally, details like inverted nipples, enlarged nipples or enlarged areolae can also be addressed. The Mommy Makeover can also be discussed if your belly has been stretched and has not recovered to your satisfactionx.

If you are planning to have children whether to have Breast Augmentation now depends on how soon you plan to get pregnant. If you are actively trying to get pregnant, you should wait. Your breasts may change with pregnancy. The changes may be small or dramatic, there is no way to predict. Even from child to child, there may be variation. If you get Breast Implants, and then things change dramatically, Revision Breast Augmentation may be needed to restore the breasts’ volume or shape.

If you are planning to have children later, it may make sense to have Breast Augmentation now. If you consider the immediate gratification of the Breast Enlargement, and you feel you will have enough time to enjoy the results, before possibly needing a touch-up, then go for it. The decision is not purely black and white. Breast Augmentation Revision is not always needed after pregnancy, and Breast Implant Revision Surgery may be necessary, even without becoming pregnant.

Before: This young woman had Breast Augmentation before pregnancy. After two children, the skin of her breasts relaxed, dropping the breast tissue off her Breast Implants.  After: Her Breast Implants were exchanged to adjust volume and a Breast Lift was performed to reshape and rejuvenate her breasts.

Before: This young woman had Breast Augmentation before pregnancy. After two children, the skin of her breasts relaxed, dropping the breast tissue off her Breast Implants. After: Her Breast Implants were exchanged to adjust volume and a Breast Lift was performed to reshape and rejuvenate her breasts.

Breast Augmentation and Pregnancy: Breast Feeding

If you have Breast Implants, there is no reason not to breast feed normally. Breast Implants do not taint the milk, and in many cases, the advantage that breast milk gives your infant is significant. Breast Augmentation may decrease the absolute volume of milk produced. The exact mechanism is unknown, but the easiest way to think about it is that the breast may be tricked into thinking it is already full. The volume of the implant may inversely effect the breasts’ milk production. On the other hand, I have had many women who had Breast Augmentation in their twenties, who later went on to breast feed successfully.

If you are currently breast feeding, and wondering when you can have Breast Enhancement Surgery, it is recommended to wait until the milk has dried up for a minimum of three months. This allows the breasts to finish their post pregnancy changes, and decreases the risks of operating on a lactating breast. However, it is never too soon to have a consultation with a Board Certified Plastic Surgeon, and in the San Francisco Bay Area, there are many to choose from.

Sometimes Breast Augmentation alone is enough to rejuvenate the postpartum breasts, as demonstrated in the above Breast Augmentation before and after pictures.

Sometimes Breast Augmentation alone is enough to rejuvenate the postpartum breasts, as demonstrated in the above Breast Augmentation before and after pictures.

Breast Augmentation and Pregnancy: Breasts Change

We touched on this a little above, but breasts do change with pregnancy. Some change very little, some quite dramatically, and sometimes one changes more than the other. If your breasts change a little, then Breast Augmentation after pregnancy will be very similar to Breast Augmentation before surgery. On the other hand, if the breasts increase rapidly in size for lactation, and then shrink, often to a volume smaller than their original size, adjustments will be needed in your Breast Enhancement. These adjustments depend on the size and shape of your breasts.

Size is perhaps the easier of the two to understand. If breast lose volume, more stuffing is required to perk them back up to the desired size. In cases when the breasts enlarge, but do not shrink back down to the original size, it may be advantageous to have a Breast Reduction, especially when the sizes are uneven. When the breasts shrink too much, Breast Implants are used to restore volume and improve both the shape of the breasts and the fit of clothing.

The shape of the breasts is determined not just by their volume, but mostly by the breasts’ skin. When the volume of the breast shrinks, but the skin doesn’t, excess sagging occurs. Breast Augmentation alone may not be enough. A combination of Breast Augmentation and Breast Lift is needed in as many as 40% of women after pregnancy. The Breast Lift is used to reshape the breast and remove the skin excess, while Breast Implants can restore volume and increase the bust.

Breast Augmentation Consultations

If you are considering Breast Augmentation, give me a call at (925) 943-6353, and schedule a private, personalized consultation appointment. It is never too early to get the facts, and there is no better way to get a plan tailored to your needs than with an in-person consultation with an experienced, Board Certified Plastic Surgeon.

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Vaping And Cosmetic Plastic Surgery | E-Cigarettes | SF Bay Area

Posted January 15, 2017 in Breast Augmentation, Breast Reduction, Facelift (Rhytidectomy), Home, Smoking and Plastic Surgery, Tummy Tuck (Abdominoplasty)

Smoking around the time of surgery can lead to increased complications.

Smoking leads to more complications after surgery.

There is ample evidence proving that smoking tobacco cigarettes increases the risk of complications after plastic surgery. Most plastic surgeons recommend that smoking be stopped four weeks before and four weeks after cosmetic surgery to reduce complications and improve healing. If you are a smoker, this may seem excessive, but even four weeks is a compromise. For example, it takes eight weeks for the immunosuppression that accompanies smoking to substantially resolve.

Since patients and doctors alike want the best results with the lowest risk of complications, stopping smoking before plastic surgery is aligned with the patients’ ultimate goal of being better, faster. In fact, even if you are not considering plastic surgery, not smoking significantly improves your health and decreases the outward signs of aging.

Smoking And General Surgery

Smoking doubles the risks associated with general surgery (operations like hernia repair, appendectomy and gall bladder removal). The glass-half-full way to look at this is that if you smoke, you can cut the risks of surgery in half by stopping smoking four to eight weeks before surgery.

General Surgery Vs. Plastic Surgery

General surgery procedures and plastic surgery procedures are different. Many general surgery procedures are emergencies, so there is little chance to stop smoking before surgery. Additionally, most general surgery operations are performed on internal organs, rather than the skin. Since general surgeons are not usually rearranging the skin, the circulation to the skin is less likely to be disturbed with general surgery procedures. The mastectomy is the most obvious exception to this rule.

Smoking And Plastic Surgery

Smoking increases the complications of plastic surgery by 600%. Plastic Surgery is Skin Surgery, so most procedures involve rearranging skin, tightening skin, stretching skin or removing excess skin. The sentinel procedures for smoking studies in plastic surgery have been Face Lifts, Breast Reductions and Tummy Tucks.

How long does it take for your body to recover from smoking? The above timeline gives just a few examples and includes the average time it takes for the health benefits to be seen.

How long does it take for your body to recover from smoking? The above timeline gives just a few examples and includes the average time it takes for the health benefits to be seen.

Face Lifts, Breast Reductions and Tummy Tucks

Face Lifts, Breast Reductions and Tummy Tucks require the formation of skin flaps. Skin flaps are sections of skin that are moved based solely on the blood supply within the skin. These vessels are extremely sensitive to smoking. When smoking, the blood vessels in the skin contract, reducing the blood flow, and the ability of the incision to heal. For these procedures, the risk of wound healing problems is not doubled like in general surgery procedure. It is increased by factor of six. Wound healing problems and skin loss are six times more likely for smokers than for non-smokers.

Is Marijuana Safer Than Tobacco?

The banner on the left was meant to convince voters that marijuana should be legalized. The banner on the right is a joke. Any questions?

The banner on the left was meant to convince voters that marijuana should be legalized. The banner on the right is a joke. Any questions?

No. In many ways, smoking a weed is smoking a weed. Both lead to increased coughing, and for most facial plastic surgery and body work, this causes real problems like bleeding and torn sutures. It is believed that the high from marijuana is directly related to the damage done to the alveoli. Just like smoking, this leads to an increased heart rate to compensate for the decreased oxygen delivery and lower than normal oxygen concentrations in the blood. Since normal oxygen delivery is better for wound healing, smoking makes healing worse. Marijuana may decrease nausea, and so does tobacco, but there are better and safer meds for the nausea associated with anesthesia. Marijuana also has psychological effects not present with tobacco, which can further interfere with the medications given around the time of surgery.

Is Vaping Safer Than Tobacco?

An actual Lucky Strike advertisement, trying to make is seem like doctors recommend them. Granted, less information about the long term effects of smoking was known then. The message of the ad is that their cigarettes are less irritating than other cigarettes; however, they still make you cough, and coughing leads to additional surgical complications. Less terrible seems to be a redundant theme in smoking advertising, begging the question that it is still terrible.

An actual Lucky Strike advertisement, trying to make is seem like doctors recommend them. Granted, less information about the long term effects of smoking was known then. The message of the ad is that their cigarettes are less irritating than other cigarettes; however, they still make you cough, and coughing leads to additional surgical complications. Less terrible seems to be a redundant theme in smoking advertising, begging the question that it is still terrible.

The long-term effects of inhaling nicotine vapor are unclear. It may be less likely to cause cancer and heart disease, but research is still early. Early in smoking’s history, it was touted as the new health craze. It is good to know the history, so that we don’t repeat it.

While there seem to be fewer noxious chemicals with e-cigarettes, questions remain about exactly what all the substances in e-cigarettes are, and what they do. The American Society of Plastic Surgery has recommended to all its members that e-cigarettes be treated the same as cigarettes until they have been proven safe. Definitive research on the effects of vaporized nicotine on the survival of skin and soft tissue flaps is not currently available. Nicotine is vasoactive, and inhaling nicotine vapor may have similar effects on skin circulation as inhaling the nicotine in cigarettes. When it comes to your appearance and your health, why take unnecessary risks?

What Do Most Plastic Surgeons Recommend?

It may seem like I am being hard on smokers, but these are not theoretical risks. I have seen Tummy Tucks go from perfect to purple after half a cigarette. I have replanted fingers successfully, only to have a patient go home, weeks later, smoke and have his finger turn black and fall off. Smoking caused the blood vessels in the skin to contract to the point of not working. These are preventable injuries, and there is no better medicine than prevention.

Most plastic surgeons recommend stopping smoking four weeks before and after any procedure that involves skin flaps. The most common cosmetic skin flap procedures are Face Lifts, Breast Reductions and Tummy Tucks. The risks of wound healing problems is six times higher in smokers when compared to non-smokers having these types of procedures.

When the incision used is only an access point, i.e. no skin flaps, like Breast Augmentation, your risks are only doubled from smoking. Only doubled. Think about that.

While most plastic surgeons will operate on smokers for non-skin-flap type cosmetic procedures, it is still better to stop at least four weeks before surgery. And if you can stop for four weeks, there is no reason to restart. Only 15% of Californians currently smoke cigarettes. This is an all-time low, but with the recent passage of Proposition 64, we will have to see if the decline in smoking will continue.

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Mommy Makeover SF Bay Area

Posted December 26, 2016 in Breast Augmentation, Breast Lift (Mastopexy), Breast Reduction, Home, Liposuction, Mini Tummy Tuck (Mini Abdominoplasty), Tummy Tuck (Abdominoplasty), Videos

Every Mommy Makeover includes enhancement of both the belly and the breasts. The most common combination is Breast Augmentation with a Tummy Tuck (Abdominoplasty). However, other options include:

  • Breast Enhancement
    • Breast Lifts
    • Breast Implants with Breast Lift
    • Breast Reduction
  • Belly Enhancement
    • Liposuction
    • Mini Tummy Tucks
  • Other Body Enhancements
    • Brazilian Butt Lift
    • Lower Body Lift
    • Facial Enhancement

The combination best for you depends on what you need, tempered by safety and predictability.

Mommy Makeover Video Presentation

The television segment included below is all about Mommy Makeovers and includes many of the most popular variations. The Mommy Makeover Video includes Mommy Makeover Before and After Pictures that illustrate what the procedure has to offer.

The following video segment is from my latest appearance on the San Francisco Bay Area’s New Station, KRON 4. The show gives me the opportunity to talk about the latest Cosmetic Plastic Surgery News.

Mommy Makeover Video

Make Your Mommy Makeover Consultation Appointment

When considering a Mommy Makeover, be certain to find a Board Certified Plastic Surgeon in your area who has years of experience with the techniques currently available. If you are in the San Francisco Bay Area and would like to schedule a personalized appointment in my Walnut Creek Plastic Surgery clinic, give me a call today at (925) 943-6353.

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Breast Augmentation Breast Lift Combined (Mastopexy Augmentation) SF Bay Area

Posted December 10, 2016 in Breast Augmentation, Breast Lift (Mastopexy), Home, Videos

Excellent Breast Enhancement is about obtaining the right size and the right shape. If your breast shape is good, more volume is all that is needed, and Breast Augmentation is usually enough to get the results you are looking for.

However, when breasts are the wrong shape, bigger is not always better. For congenital deformities like Poland’s Syndrome or Tubular Breasts, a Breast Implant alone is often not enough. A Breast Lift is added to reshape the breast mound and relocate the misplaced nipple.

Breast Augmentation With Breast Lift Video (Mastopexy Augmentation)

Below is a segment from my latest KRON 4, Body Beautiful show. Several Breast Augmentation With Breast Lift Before and After Pictures are included and narrated, to help illustrate what Breast Augmentation With Breast Lift has to offer. Examples of both the correction of the typical breast deflation with sagging (breast ptosis) typically seen after pregnancy or weight loss, as well as congenital deformities like Poland’s Syndrome or Tubular Breasts are reviewed.

The splash screen of the video above shows Mastopexy Augmentation used for a woman with tubular breasts and very low nipples. Breast Augmentation alone would give her larger breasts; however, the nipple areola complex would still be puffy and the location of the nipple would remain at the bottom of the breast. A more ideal nipple shape and location was obtained by combining the use of Breast Implants for enhanced volume with a Vertical Breast Lift for a better shape. The result is a happy patient.

Breast Augmentation and Breast Lift Consultations

If you are considering Breast Augmentation or a Breast Lift, be certain to choose an experienced and Board Certified Plastic Surgeon who understands how to address your specific breast anatomy and your goals. In the San Francisco Bay Area call (925) 943-6353, to schedule a personalized and private consultation appointment.

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