Breast Implants and Liposculpture and Stretch Marks After Pregnancy?

I am 32 and I am planning to have a breast augmentation (something discreet) and a liposculpture within the next two weeks, but also I would like to get pregnant of my second baby in about 10 months. I did not get any stretch marks at all from my first pregnancy, but I am really concerned that the breast implants or the Lipo will cause them when I get pregnant again. Any opinions?


Brenda,

Stretch marks - Unlikely to be caused by surgery, but expected after pregnancy

Stretch marks ("striae") are a common occurrence after rapid weight gain or stretching of the skin, as in puberty or pregnancy
A breast augmentation and liposuction would be very unlikely to create stretch marks, so long as the breast implants were not so large that they caused massive stretching and tearing of the dermis of the breast skin. By a "discrete" breast augmentation, I assume you are aiming for a natural, subtle result. This would be highly unlikely to create any striae.

Stretch marks result from when the skin "stretches" beyond its ability to spring back and actually tears the deeper layer of the skin. The most common circumstances are pregnancy or significant weight gain. Why some women get stretch marks and others do not is largely a product of genetics and who their parents are. Unfortunately, not much else. You can control this to some degree by limiting or controlling your base weight, but with pregnancy, there is not much you can do.

Thus, taking away tissue in procedures such as liposuction, the likelihood of stretch marks is almost zero. Breast augmentation can result in striae, but in your case a "discrete" augmentation is very unlikely to cause this, especially when pregnancy did not result in abdominal stretch marks.

The biggest question is why undergo body sculpting and breast augmentation procedures less than a year before you intend to get pregnant again? If you were my patient, I would recommend that you weight until the next pregnancy is complete to begin your "transformation."

Unfortunately, I have had patients who did not develop stretch marks during their first pregnancy, but then did with second or third child. Thus, the surgery you need today may not be the one you need next year! If you weren't pursuing another child then I would say go for it; otherwise patience can be a valuable virtue.

You are lucky that you did not have stretch marks following your first pregnancy. This may be because of your age and genetics. Hopefully, you will continue to enjoy a body free of stretch marks. However, changes occur with each and every pregnancy, and you may discover some new striae after your next pregnancy.

Capsular Contracture ,What is the Best Way to Treat it at Home?

Capsular Contracture ,What is the Best Way to Treat it at Home? 

    I would like to know if deep tissue massage regularly is the best way? using a massage machine that vibrates and pulsates at different levels regularly? also what about medicine? I appreciate any advice towards my question, thanks.

Answer:

 Capsules form around breast implants within days of their placement. The capsules are basically scar tissue that surrounds the implants .The formation of scar around the breast implant is normal as a breast implant capsule.. When it is excessively thick and/or tight scar tissue around the breast implant tight it is known as a capsule contracture. We do not know why or how this happens. For a variety of reasons muscle like contractile cells can appear in the capsule wall. When they contract we see/feel a hard breast (capsular contracture) with variable degrees of surface outline distortion, from the outside the breast implant is deformed from the capsule that is progressively shrinking. That is usually seen at months or years after surgery. The longer the contracture has been present the harder it is to treat and the more aggressive the treatment/surgery that is required. 

  

  and the severity of the capsule can be assigned to one of three categories:

 Category 1: Breast is more firm than usual, but not visibly different or painful
 Category 2: Breast is firm and visibly different in shape or appearence 
 Category 3: Breast is firm, visibly different, and painful 

      The best way to prevent capsular contracture is to do breast massages both medially and superiorly 3x per day. You should do this for at least the first year after breast augmentation and continue it daily thereafter for the duration of the implants to minimize closure of the capsule. Massage is usually recommended immediately following the surgery and can be continued for months to years , but is absolutely no scientific evidence that it helps prevent contractures.

    If the capsular contracture has only be present for a few days or weeks it may be amenable to non-surgical treatment such as deep massage. It really depends on how long you have noticed it…If it is just starting, then I have had patients have success with alternating deep massage. Home massage, however will not likely make a difference if the capsule is already significant or contracted.

     Endermologie (the combination of rollers and suction pressure applied to the skin surface) can be a good way to get the massage movement deep enough under the skin to stretch and soften the capsule.

    Singulair and Vit E can be used but likely have very little effect. Singulair is a widely used asthma medication that can sometimes help. This is an off label use of this medicine. but this does not necessarily work in every patient. Time likely will either help relax the capsule somewhat or keep it relatively unchanged 

      There is nothing you can do to treat established capsular contracture at home. Overly aggressive pressure maneuvers may cause damage to your implants. Finally surgery is an option to correct this by removing the capsule entirely or releasing it in areas to accommodate the implant.

Breast Lift

BREAST LIFT

Many women, particularly those who have had children, will notice that their breast tissue will droop and “deflate” following breast-feeding. This phenomenon is not limited to mothers, however, as changes in weight as well as hormone fluctuations can cause these same issues. Some women, in fact, are born with breasts that may not be as “perky” as they would like. Many patients who complain of this breast deflation, or “breast ptosis” in medical terms, benefit from an elevation of the breast tissue, known as a breast lift or 





mastopexy 

Breast lift achieves the following:

  Brings the breast to a more attractive position 
  Reduces the size of Areola 
  Helps the breast to become more perky . 

There are several ways to go about providing true or apparent lifting of the breast tissue.

 Wise Pattern Breast Lift: 
The standard and effective technique to lift the breast is known as a Wise pattern mastopexy Classically, breast lifts were done through a pattern similar to classical breast reductions, resulting in a scar around the nipple, down the center, and underneath of the breast, which you can think of as an anchor type of configuration. While this operation works well for many patients, it provides a lot of scarring, and can, in certain patients, give rise to a breast that lacks proper projection. Efforts were subsequently made to try and improve the deficiencies of this operation, and a plastic surgeon named Dr. Lejour developed a breast surgery that eliminated the scar under the breast and improved postoperative breast form. This is called the vertical mastopexy.

 Vertical Breast Lift:
 The vertical mastopexy has become one of the mainstays of the breast lift here in my practice. This operation works well for most women who do not have massive breasts, and allows some degree in reduction of the size of the breast if this is what you are looking for. Alternatively, the vertical breast lift can be combined with a breast implant in order to increase the breast size. In either situation, the scars from this vertical breast lift look like a lollipop- around the nipple and down the center of the breast. The concept behind the vertical mastopexy is the rearrangement of the breast tissue itself to a higher position, rather than creating a skin sling to suspend the breast tissue. This breast tissue rearrangement is felt to give a more pleasing shape and a longer lasting result.

 Benelli Breast Lift:
 For those patients that require only minimal lifting and who may be adverse to the longitudinal scar of the vertical breast lift, an alternative may be what is called a purse-string, or Benelli mastopexy. This operation is performed by resection of an eccentric area of skin around the nipple, which can be thought of as an oval shaped doughnut where more skin is resected above the nipple than below it. Following a small amount of dissection in the breast tissue to strengthen the breast lift, this incision is closed with a purse-string suture that “cinches” the breast envelope centrally and upward to provide a lift. The scar resulting from this breast lift operation is only around the nipple along the transition between the pigmented areola and the skin of the breast. This operation does have the limitation of lifting the breast tissue only one to two centimeters, however, and so only patients with minimal ptosis may be candidates for this procedure.

 The Use of Breast Implants With Your Breast Lift: 
With any breast lift procedure, the result may be enhanced with the ancillary use of a breast implant to increase volume and fullness. 
A breast implant may be used with the classic breast lift, the vertical breast lift, or the Benelli breast lift procedure. Placement of large breast implants during these procedures is discouraged because of the following safety issue. When dissection of the breast tissue is performed in order to achieve a higher and more youthful appearance, careful attention must be given to the blood flow to the breast tissue that is being rearranged. Large implants placed under this dissection can put undue tension on the lifted breast tissue, causing compromise of the nipple. breast implants that are not excessively large may be used at the time of your initial breast lift operation as a single procedure. Discussion regarding your individual anatomy and expectations will allow a plastic surgery plan to be tailored to your specific situation. The quality of scar can also be improved if your surgeon is committed and places deep suture to avoid widening of the scars

Scarless Breast Lift

Scarless Breast Lift

I'm sort of on the verge of needing a breast lift and wondering if the scars are not worth the trade-off... what kind of incisions or techniques leave the least amount of scarring?

Marian

Answer :

This is a great, and very common question. The principle thing that I would recommend to you is to avoid compromising the form of your breast for fear of the scarring. Any qualified plastic surgeon will be able to minimize the scarring with suture techniques, and although there are no guarantees, you should hopefully end up with fine white lines for your scars that progressively fade with time. You are better off having a great breast form and a little more scarring than a breast shape that is inadequate or unattractive with one scar less.

If you are indeed borderline, it is likely that you will require less, rather than more incisions to re-create a youthful breast form. Several options with or without breast implants are available to you, with varying degrees of correction and size changes. The key is choosing the right operation for you, and that involves a careful discussion with a caring and qualified plastic surgeon.

There is not some thing as a scarless breast lift.  The real question is do you need a lift and if so how much. Some patients with very minor or grade one ptosis with obtain a lift and increased fullness with breast augmentation alone. Others require minimal lift which can sometimes be done with only a periareolar incision and and implant. In the majority of cases a better lift is achieved with  the addition of at least a vertical incision

This is a brief outline of the scars that can be expected after a breast lift, in order of increasing amounts of preoperative breast sagging:

1.  Scar Around the Top Half of the Areola:  this is best for patients with no more than an inch of nipple/breast sagging and no need for entire breast reshaping

2.  Scar Around the Entire Areola:  this is best for patients with about an inch of nipple/breast sagging and need for minimal tightening of the breast skin

3.  Scar Around the Areola and a Vertical Scar Down the Breast:  this is best for patients with a moderate degree of breast/nipple sagging, some loss of superior breast fullnes, and need for moderate reshaping of the breast. 

4.  Scar Around the Areola, Down the Breast, and in the Breast Crease:  this is best for patients with significant breast/nipple sagging, total loss of fullness of the superior breast, and need for total reshaping of the breast.

In select patients, the scar burden necessary to perform a breast lift can be minimized by simultaneous placement of a breast implant.  A breast implant is able to affect a small degree of breast lift and restore superior breast fullness without the need for larger scars associated with a traditional breast lift.

Breast lift achieves the following:

·        Brings the breast to a more attractive position

·        Reduces the size of Areola

·        Helps the breast to become more perky(Agile)

It is important to know  If the skin and fat above the nipple in the upper poles of the chest are adequate then a subglandular placement with silicone implant would probably give you the most natural look and feel  . Subglandular placement is acceptable if you have at least 2cm of tissue pinch in the upper pole.

If you have minimal ptosis (or sagging) of your breast, a subglandular placement might give a nice result with fewer scar lines or incision lines, If you have significant sag then I would  typically recommend a submuscular implant with a complete breast lift, though you will have more scars.

   A dual plane mastopexy with a reasonable size implant can give your nipple a lift and move your breasts off your chest wall.  It will also give you fullness in the upper quadrant. 

Why do breasts sag?                                                                                                                                                      There is too little volume or too much skin. Many women, particularly those  who have had children, will notice that their breast tissue will droop and “deflate” following breast-feeding. This phenomenon is not limited to mothers, however, as changes in weight as well as hormone fluctuations can cause these same issues. Some women, in fact, are born with breasts that may not be as “perky” as they would like.

Greater degrees of excess skin require greater amounts of skin removal, resulting in larger scars. 

I believe  in taking an aggressive approach to scars in this situation, with progressive suturing techniques and postoperative scar treatments as a complimentary service to my breast lift patients, so that they will never feel like the improved shape was not worth the scars they have.

 I also strongly believe that the technique for breast lifting should be determined by the patient's goals for breast shape, and the shape they are starting with. Each different technique (I do 4 different types) will tend to produce a characteristic change in the shape of a breast, and so the technique needs to be matched appropriately to the patient, using her examination and her goals as guides- otherwise you may end up with a small scar, but a funny or unfavorable breast shape.

The degree of lifting and the amount of scars required to restore to you a youthful and toned breast depends on how much droopiness you have. The key relationships are where the nipple lives relative to the crease under the breast and whether it points forward or downward. The farther down, the farther it needs to come up to look good and the more incisions it takes to get there. The other key issue is the degree of horizontal skin laxity or excess skin present.

.

Some patients have a periareolar or "Benelli" lift, with an incision just around the areola, in hopes of avoid the incisions of a conventional Wise pattern lift. When a large breast lift is attempted through such an incision, characteristic problems can occur, with gathering of the incision, decreased areolar circulation (some patients can actually have nipple death), and large resultant nipple-areolar complexes. It is in my opinion a mistake to attempt too great a lift through too small an incision Periareolar.When lifts require an implant , They are good for patients whose needs for lifting are less with their nipples above the crease and pointing forward to start with. If overextended, this lift will result in a flat, baggy looking breast with a large areola with poor scars around it. Vertical lifts, "L" lifts, short"T" lifts and full"T" lifts are the next level and can be done with or without implants. They have more scar but provide a better looking conical projecting breast in the hands of an excellent sculpting surgeon. Nobody wants scars but everybody wants the best shape and the scars are a trade-off for that. They fade with time and generally most all patients will trade their best shape for the scars to get there

here simply is no way to perform a breast lift surgery without some type of scar. The only thing that can be done is to try to optimize the position or quality of the scars that are made. In general, the best scars are seen when incisions are placed under the least amount of tension.The good news is that most of the scars fade nicely and are specifically placed to be as inconspicuous as possible

The idea of a scarless surgery is an attractive one ,  It is better to think of it as minimizing the length of any scar and optimizing its position in order to obtain the best result.