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.
Hello, I'm an 18 year old female and ever since I was about 14 I've been concerned that my breasts are tubular. However, when my nipples are erect (as pictured) they look perfectly fine in my opinion. It's almost as if the tissue gets pinched back and creates a rounder shape. But I don't have naturally erect nipples, they're quite puffy. In your professional opinion, are they tuberous? Because I'm young, do I still have a chance of developing more rounded breasts in the future?
Tubular breasts is a descriptive term that indicates certain features that are variably present to variable degrees. Some call it constricted breasts because the base of the breast is tight and as a result the breast tissue tends to herniated into the nipple causing the "puffiness" in the areola . The tuberous breast is small and often asymmetric. The difference between this scenario & small breasts is that small breasts are symmetrically smaller with respect to the circumference & center of the breast..
You appear to have constricted breasts But you do not fit all of the criteria. Your nipple may have some tendencies of a tuberous breast however your breast is fairly normal on the whole . If you look carefully, the lower slope of the breast is a straight line instead of a gentle convex curve , with the right breast more tuberous than the left. . As in tuberous breasts , which the contraction literally prevents the breast contents from bulging forward and assuming a hemispheric shaper, yours have a bit of that characteristic .Also you do have some herniation of tissue into the areola along with a tight/"constricted" lower pole of your breast. . You have to remember that breasts come in all shapes and sizes. Very few are "perfect." Your breasts are going to develop the way they will and they will continue to change as you grow, age, become pregnant, etc. As you mature there is a chance of some improvement but It is unlikely that the general breast shape will change as much as you get older
If you decide to correct this, it can be achieved through an augmentation where the inferior pole and the infra-mammary crease is released to prevent double bubble formation.. At the same time, herniated tissue behind the areola can be removed and this is done through the peri-areolar incision , and then doing some scoring on the inside of the lower pole. If only the areolar puffiness bothers you, it would be a relatively straightforward procedure to tighten the areolar area. This could typically be done under local anesthesia
if you wished.
Tuberous breasts are generally defined by the following:
• short distance from the nipple --> infra-mammary fold
• dilated and/or "prominent" areola
The issue with the tubular or tuberous breasts is that the lower aspect of the breast from nipple to breast crease is short (yours fits) and the nipple and areola are wide and allow the breasts to protrude through this area making them more prominent
• loss of rounding to the lower pole with obvious constriction
In the tuberous breast the skin of the lower half of the breast remains attached to the chest wall & does not grow with the remainder of the breast during puberty.
One of the most common abnormalities of breast shape is called a tubular breast. Such breasts, also known as tuberous breasts or constricted breasts, result from congenital variation in the development of the breast tissue that can affect one or both breasts. Although there is considerable variation, tubular breasts all share some common features.
Tubular breasts are characterized by some or all of the following:
• Narrow and elongated shape
• Little or no breast tissue in the lower half of the breast
• An areola (pigmented area around the nipple) that appears disproportionately large
• Protrusion of the breast tissue behind the nipple and areola that makes the nipple and areola look puffy
• A wide space between the breasts
• Tendency for the location at which the underside of the breast joins the chest (known as the inframammary fold) to be relatively high on the chest, thus causing the breast to droop and look long and constricted.
Keep in mind, that there is no such thing as a "normal" or "perfect" breast shape. The shape and appearance of women's breasts vary widely; what matters is whether or not you are happy with your breasts, not whether or not they are "tubular"
Surgical Correction
Surgery to correct tubular breasts is challenging. The most commonly performed procedures almost always augment the breast, either with an implant or using a woman’s own tissue. In addition to adding volume to the breast, the base of the breast must be widened to a normal size, the inframammary fold lowered and the internal constrictions that caused the tubular shape must be released with internal incisions. In addition, the areola is usually reduced in size.
Breast implants have traditionally been used to provide the volume needed to correct a tuberous breast. Although implants continue to be widely used, both perforator flaps and fat grafting can be used as alternatives to breast implants. By using your own tissue, complications unique to breast implants (implant leakage or rupture, rippling, and capsular contracture) can be avoided. Reconstruction using your own tissue means a having a reconstruction with tissue that is yours for life and without having to worry about needing to replace implants from time to time.. Since there is a great deal variability in the severity of tubular breast deformities, the approach or approaches best suited to you will depend upon the condition of your breasts and your goals for reshaping them.
Question:
I feel that my implants are way too small (I got 300 cc under the muscle). I feel like my surgeon did not properly advise me on choosing a size. I wear the same bra size! Any suggestions?
Answer:
Many, many women wish they had chosen larger Breast Implants. Most often the reason is that they were "afraid they would look too big" and expressed this fear to their surgeon.
But you can always have surgery to increase the implant size, but if you just got the implants, my first advice is to wait a few months before considering a revision. The position and shape of the breasts does change in the initial postoperative period, so it is wise to allow some time for this. Also, if you have 300 cc implants in and wear the same bra size, you probably were wearing the wrong size bra either before or after the augmentation. I always tell patients we cannot guarantee a cup size because each brand of lingerie fits differently, and you can be completely different cup sizes depending on the brand. Generally speaking, 150-200 cc of added volume adds roughly a cup size, but each body shape and bra type is different so this is not a strict conversion. No surgeon should promise cup size, since there are no standards in size.
If you are not happy with your current size, exchange procedures for bigger implants are very successful and there is much less pain and discomfort than the original procedure. Most of the time, the same incision can be utilized (no new scar) and all the pain and discomfort from the original stretching and pulling does not occur with the exchange procedure. Don't go doctor shopping. Why? Your surgeon is in the business of helping you fulfill your dreams and will try hard to get you where you want to be
Doubt about proper breast size is at the top of the list. Right after the procedure I often hear that a patient may feel the implant is too big, and sometimes that the implant may be too small. As a rule these feeling diminish and patients become quite pleased.
Therefore you need to wait at least 6 months to see how you really look, then make a decision.This is because the soft tissues need to accommodate to the implants. Initially, implants are placed in a pocket behind muscle, gland, fat, and skin. If the tissues are pliable, the implant can push the tissues forward easily, If things are tight, particularly the muscle, it might take a couple of months for the tissues to stretch and loosen up so the implant can do its work. When implants are placed below the muscle, they may appear 10% to 20% smaller because of the flattening effect of the muscle. Thus, implant sizers placed in a bra can create a look that's larger than the final size.
Many times patients have said they wish to be a small "C" and will present pictures that are clearly closer to a "D" cup. There are a number of possible pitfalls when choosing the appropriate breast implant size. Usually people refer to volume but there are several other things to classify implant types . The implant width is probably the most important factor to know when determining an particular implant for an individual. The second most important thing is the profile. The profile refers to how much the implant sticks out from the chest. The higher the profile the more unnatural (stripper) the implant will look. The enlarging effect of an implant is also affected by the height, weight and chest width of the woman, so all of these factors need to be considered before surgery.
IPL stands for Intense Pulsed Light. It basically lets you know that this is ”light based treatments” and not a true laser.
That is scattered light which is generated from Xenon flash lamps and is not actually a laser. Lasers have light of a single frequency (color), IPL has many frequencies mixed together. Laser light remains collimated (narrow-focus).
IPL spreads out like "regular" light. Lasers use one specific type of light and IPL devices use many. For this reason, IPL machines are marketed to be able to do a bit of everything, sun spots, facial redness and collage stimulation. The single wavelength of light used by lasers means they are more specific to the condition being treated.
The IPL is great for redness and brown spots, does very little for wrinkles, but can be used to tighten the skin if has the power to go into the infrared spectrum and use it for everything from leg veins treatment to acne scars and blond hair removal(no laser can do this) & telangiectasias . ACNE can be corrected too. Specifically, pigmented lesions such as freckles, sunspots, and age spots are treated .One of the signs of aging is irregular brown and sometimes red discoloration of the skin. These changes (called dyschromias) are due to sun damage, and are the usual reason women begin to wear foundation type makeup.
IPL uses a bright light in front of which filters are placed which filter out most wavelengths except those taken up by pigment and blood vessels, depending on the filter used. The light energy penetrates just below the skin's surface, damaging either the melanin (skin pigment) or blood vessels , the energy of the intense pulsed light can be focused on a specific target within the skin. The range of light is typically between 500-1500 nm . light is concentrated in certain wavelengths.The body's natural skin repair mechanisms then remove the damaged tissue and produce a smoother skin appearance. It will usually take 3-5 treatments to see a significant result and treatments can be spaced out every 3-4 weeks.
The light energy in IPL is absorbed by the colors that we don't like, causing the generation of heat that damages or destroys the structure that holds the color - the sun spot or dilated blood vessel. concentrating light which is preferentially absorbed by dark and red spots and avoiding damaging the top layers of the skin. The body sees the structure as damaged and takes it away. This leaves the skin tone more even and homogeneous. IPL brightens the skin and gives it a youthful glow. This is a remarkably consistent result of IPL . Another, but more subtle goal of IPL, is to add small amounts of collagen back into the skin near its surface. This will not reduce wrinkles, but it does have an effect on the texture of the skin.
So, a patient can expect 3 things from IPL:
1. It evens out skin color.
2. It brightens the skin and give it a youthful glow.
3. It adds back small amounts of collagen near the surface of the skin to give a slight improvement in texture.
IPL can be quite effective in reducing redness and pigmentation over a series of 3-5 treatments. Ethnic skin with pre-existing pigmentation problem should exhaust other modalities such as bleaching cream and/or microdermabrasion prior to IPL for there may be a risk of worsening pigmentation.
The advantage to IPL systems is that downtime is usually very minimal. Immediately following the procedure the skin may look much worse. Patients may experience slight darkening of pigment before they lighten. You will look like you suffered from a sunburn . The procedure itself is usually described as feeling like a rubber band being popped on the skin. Patients are able to resume normal activities immediately after treatment and are not likely to experience side effects other than mild redness or swelling at the treatment site. The good news is usually 8-14 days later the spots will disappear and your skin tone should have a much clearer vibrant apperance. Most people can return to work the same day. You may feel the need to wear a bit of makeup on the skin to cover the areas that appear to be dark
IPL treatments can rejuvenate aging skin, help patients with rosacea, and can also treat certain types of skin cancers. Number of treatments required to achieve desired results and length of results varies from individual to individual and can be dramatically altered by sun exposure. Dark spots that have been diminished with IPL can return to their original appearance or darker if not protected from the sun.
IPL-RF is Intense Pulse Light with Radio Frequency. I have found that this gives a far superior result than the stand alone IPL treatments.
I am a little worried because I had a breast augmentation three weeks ago ( high profile silicone 350 CC's). they are too high , will they come down eventually? Should I consider another surgery, and if so, when? I have read that breast massages are very good to let them down, but I also read this is not recommended in texturized implants. Can you give me an advice?
Answer:
Implants may be slightly higher in the initial phase for several weeks, but they will come down if the pocket has been properly dissected. Many surgeons will use a compression band to combat this and also recommend downward massage efforts in the weeks following surgery.
It is often the case that after breast augmentation, the implants seem to be too high. Your breast size is larger now and this results in that the breast feel too high, especially with high profile implants. Without doubt, they will come down and appear more natural with time. This is objectively true as gravity takes effect and the weight of your implants settle in.
Since you are only three weeks out I would not begin to worry just yet
The native inframammary fold appears high with a short and (at least mildly) tight inferior pole. The markings on the chest wall suggest that the inferior pocket was created for proper implant positioning. Certainly at 3 weeks post-op it is common to have implants positioned high since they have not had enough time to settle into place. If smooth surface implants were placed, there is certainly a good chance that these implants would settle into a lower position over several months, with potential stretching of the of the inferior pole skin occurring afterward; and this could be enhanced by implant displacement exercises and the use of a compression band over the upper pole.
agree, your implants are too high on your chest wall. Having said that, I would be patient, the implants will "drop" or settle into place over time. I would wait at least 3 months and 6 months would be better. If the implants are still too high, than you will need to have them repositioned into a lower position.
It seems that you have a "high crease", the distance between your nipple and the inframammary crease is too short. The surgeon should have lowered your crease during the procedure, if it does not happened. I would be surprised if you do not need a secondary procedure to correct this.
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.
