Breast reduction
Large breasts were at one time considered extremely aesthetic and very sociable, but in todays world it is often a source of embarrassment. It also brings with it the problems of ill-fitting clothes, inability to wear modern, designer kind of hep clothing as well as the problem of back pain, bra strap marks on the shoulder, sweating and fungal infection below the breast line, and a general decreased self esteem.
Large breasts may be from teenage itself or more commonly after childbirth and lactation. The major complaint women have after childbirth and feeding is that the breast have now sagged down, and started to look very bad. The only treatment for these problems is surgical reduction known as reduction mammoplasty or breast reduction. No other non surgical procedure is successful, may it be use of ultrasound technology or radio frequency based devices. It should be understood, that there is an absolute increase of breast tissue as well as skin, which needs to tackled, and surgery is the only option
Procedure
Breast reduction involves an actual removal of excess breast tissue as well as skin, and shaping the breast to a more aesthetic and shapely figure as per the pre-operative discussions with the patient. Commonly this involves two types of procedures. One is a wise pattern with inverted ‘T’ scar pattern; the other is vertical short scar pattern. The latter technique is now well established, has a smaller scar, but takes significantly more time to give the final breast shape
The ‘T’ scar technique
This involves a scar on the breast in the shape of an inverted T. The advantages of the technique is
this technique is easier to teach and more predictable results
the final shape is immediately visible after surgery, with little changes in the long term period
there is little potential of scar spreading
The disadvantages of this procedure is
long scar ( though the scar is hidden below the breast, so is visible only on lying down
there is chance of tissue breakdown along the junction of the limbs of the inverted T(this is not common, and though there is rapid healing)
The vertical short scar technique
The procedure involves only a vertical scar without the horizontal component. As a result of which the skin excision is limited to the region around the areola (upper part). This procedure has been popularized by Dr Ruth Graf (Brazil)(with whom the author has trained with)
The advantages of this procedure is
shorter scar
The disadvantages of this procedure is that
more difficult to teach
it takes almost 6 months to show the final breast shape
there may be need to revise the surgery in almost 30% of patients
the skin shaping is as not as good, because lesser skin is removed from the lower half of the breast
chances of scar stretching in the region of the areola
Possible problems with breast reduction
The patient will be required to stay in the hospital for 1 day after the surgery. The possible problems associated with the procedure are
lactation ability is lost on most patients. Ability to feed is the exception in most cases
sensibility of breast tissue will take almost 6 months to recover
chances of asymmetry are there
in large reductions, some tissue loss is possible, however this does not majorly effect the final result
like any procedure, there may be chances of seroma or a hematoma formation
Results
Breast reduction is an extremely satisfying procedure, because the results are predictable to a large extent in the preoperative period. How much tissue needs to be removed is decided, and therefore the patient has a clear picture of what her breasts are going to look like after surgery. There is a need to wear specially designed pressure garments to support the breast tissue for a period of 3 weeks. Breast asymmetries can also be tackled at the time of the surgery.
Wednesday, March 18, 2009
Monday, March 16, 2009
something about liposuction
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Something about……
Liposuction
Liposuction continues to the most common plastic surgery procedure all over the world, and also in India. It is basically a permanent removal of fat cells by the use of a suctioning device. It is a safe procedure, with minimum down time, and fast recovery. It has been shrouded in small controversies, and bad results, but this has been due to the procedure being done by untrained personnel, and other medicos who are not Cosmetic Surgeons. So it is important that a potential client look through the profile of their treating physician and asses really whether that person is actually capable of delivering all that he promises. Do not be led away by claims that they can remove 10 kgs or 12 kgs of fat and make you superthin. Please remember that the safe limits of liposuction are between 3-5% of the total body weight.
Procedure
The procedure involves infiltration of fluid into the areas to be liposuctioned. This has multiple benefits. It helps to loosen the fat, reduces the bleeding dramatically, and allows pain control after surgery as well. Usually I would infiltrate fluid in a ratio of 1:1 with the amount of fat that I plan to aspirate, ie, if I feel that I will aspirate about 1000 cc of fat from an area, I would like to infiltrate less than 10000 cc of the fluid in that area. I actually infiltrate much less than that, only about 0.5 :1 ratio. This has the benefit that I never face the risk of fluid overload ( potentially dangerous condition, where there is too much water in the body, and the lungs get filled with water). The other benefit is that, what is aspirated is pure fat, and not water mixed with fat. This gives an exact estimate of the amount of fat taken out. We surgeons have a bad habit of including the amount of fluid aspirated into the total volume taken out also, so that we can boast of having done large liposuctions. What is important is not the amount taken out, but how much of actual fat there is.
The procedure is done with small incisions over selected areas of the body, after first discussing with the patient, and planning the site of the incision. These incisions generally are not visible and heal very well. They are only about ½ cm in length. There may not be a need to admit the patient in the hospital, so that the patient can go home the same day.
Precautions
After a liposuction, there is a need to wear specially designed pressure garment, over the areas liposuctioned to allow better skin redraping. This may take upto 6 weeks. Any anticoagulant use such as aspirin should be stopped 1 week prior to surgery; smoking should also be stopped 2 weeks before to 2 weeks after surgery for best results
Newer technology
Power liposuction, vibro-liposuction, VASER, and laser liposuction are some of the newer innovations in this field.
In Power and Vibro Liposuction the mechanical effort to carry out liposuction is reduced by the use of special machines, which produce a to and fro rapid motion, thus reducing mechanical fatigue and making the procedure faster. However these are significantly more expensive than conventional liposuction
VASER is the use of internal ultrasound device to melt fat. The advantage is that this is significantly faster, and allows the surgeon to work closer to the skin, and thus better skin draping is achieved, and thus better figure control is achieved. However this is a very expensive device, and expects the surgical cost to double if you ask for a VASER.
Laser lipo allows very good redraping action on the skin; however its role in actual fat reduction is a bit controversial. Thus this has not found use in general practice.
Please remember that liposuction is not a weight reducing procedure, but a figure correcting/ or a body contouring procedure.
Something about……
Liposuction
Liposuction continues to the most common plastic surgery procedure all over the world, and also in India. It is basically a permanent removal of fat cells by the use of a suctioning device. It is a safe procedure, with minimum down time, and fast recovery. It has been shrouded in small controversies, and bad results, but this has been due to the procedure being done by untrained personnel, and other medicos who are not Cosmetic Surgeons. So it is important that a potential client look through the profile of their treating physician and asses really whether that person is actually capable of delivering all that he promises. Do not be led away by claims that they can remove 10 kgs or 12 kgs of fat and make you superthin. Please remember that the safe limits of liposuction are between 3-5% of the total body weight.
Procedure
The procedure involves infiltration of fluid into the areas to be liposuctioned. This has multiple benefits. It helps to loosen the fat, reduces the bleeding dramatically, and allows pain control after surgery as well. Usually I would infiltrate fluid in a ratio of 1:1 with the amount of fat that I plan to aspirate, ie, if I feel that I will aspirate about 1000 cc of fat from an area, I would like to infiltrate less than 10000 cc of the fluid in that area. I actually infiltrate much less than that, only about 0.5 :1 ratio. This has the benefit that I never face the risk of fluid overload ( potentially dangerous condition, where there is too much water in the body, and the lungs get filled with water). The other benefit is that, what is aspirated is pure fat, and not water mixed with fat. This gives an exact estimate of the amount of fat taken out. We surgeons have a bad habit of including the amount of fluid aspirated into the total volume taken out also, so that we can boast of having done large liposuctions. What is important is not the amount taken out, but how much of actual fat there is.
The procedure is done with small incisions over selected areas of the body, after first discussing with the patient, and planning the site of the incision. These incisions generally are not visible and heal very well. They are only about ½ cm in length. There may not be a need to admit the patient in the hospital, so that the patient can go home the same day.
Precautions
After a liposuction, there is a need to wear specially designed pressure garment, over the areas liposuctioned to allow better skin redraping. This may take upto 6 weeks. Any anticoagulant use such as aspirin should be stopped 1 week prior to surgery; smoking should also be stopped 2 weeks before to 2 weeks after surgery for best results
Newer technology
Power liposuction, vibro-liposuction, VASER, and laser liposuction are some of the newer innovations in this field.
In Power and Vibro Liposuction the mechanical effort to carry out liposuction is reduced by the use of special machines, which produce a to and fro rapid motion, thus reducing mechanical fatigue and making the procedure faster. However these are significantly more expensive than conventional liposuction
VASER is the use of internal ultrasound device to melt fat. The advantage is that this is significantly faster, and allows the surgeon to work closer to the skin, and thus better skin draping is achieved, and thus better figure control is achieved. However this is a very expensive device, and expects the surgical cost to double if you ask for a VASER.
Laser lipo allows very good redraping action on the skin; however its role in actual fat reduction is a bit controversial. Thus this has not found use in general practice.
Please remember that liposuction is not a weight reducing procedure, but a figure correcting/ or a body contouring procedure.
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