Q: Since having my children, my breasts started to sag and seem to be smaller. I want breast implants in order to be larger but a friend told me I needed a breast lift first. What is the difference, and how would I know which one I need?
A: Breast ptosis or "sagging" is a result of having too much skin relative to the amount of volume. Involution of the breast after giving birth or breast feeding, may result in an overall loss of volume, as well as a "stretched out" skin envelope. A combination of age and gravity may do the same thing. A mastopexy (breast lift) involves removing some of the skin in order to restore the shape and higher position of the breasts. A breast augmentation (implants) involves increasing the volume or size of the breast with a Saline filled implant. Whether an augmentation alone would provide good results depends on the amount of ptosis present. One easy way to determine that is to place a ruler or other straight object in the fold under your breasts parallel to the floor. If your nipple is below the upper edge of the ruler, then implants alone are unlikely to solve the problem. Some type of skin reduction (mastopexy) would have to be done alone to restore shape and breast position, but would not increase the size of the breast.
Q: I'm considering a breast enlargement, but am concerned about the unattractiveness of the scars. Is there any possibility or procedure that allows for the enlargement without placing scars on my breasts?
A: Yes! There are three incisions that are very common for breast enlargement. Those would include the most common incision in the fold underneath the breast. Another incision is placed around the areola or dark skin around the nipple. Of course, both of these incisions are placed on the breast. A third incision, which I commonly make, is placed in the armpit within a fold. This incision has the advantage of being placed in an area remote from the breast and an area that is rarely seen. Furthermore, there have been no reports in the literature of anyone developing a hypertrophic or keloid scar in the armpit. Another approach is through the belly button, although this is still somewhat controversial. I hope you find this answer satisfactory. I would be happy to discuss it further with you or any of the patients inquiring.
Q: I watch what I eat and exercise daily, but I still have problem areas. Would liposuction work for me?
A: Contrary to what many people believe, liposuction is not useful in treating obesity. The ideal candidate for liposuction is someone who maintains a stable weight, exercises regularly, and is within 10% of their ideal body weight. Fat distribution is gender specific and tends to accumulate in the lower abdomen, hips, and outer thighs in women and the entire abdomen, love handles, and chest in men. Liposuction is useful in contouring these problem areas. Over the past 5 years, liposuction has become increasingly safe and effective. Liposuction is one of the most frequently performed procedures. With the advent of ultrasonic liposuction, greater volumes may now be removed. A combination of traditional liposuction and ultrasonic liposuction have given good results.
Q: Over 5 years ago, I was diagnosed with breast cancer and underwent lumpectomy followed by radiation therapy. I am pleased to announce that I have had no evidence of recurrence of the cancer. My right breast is significantly smaller than my left breast as a result of the surgery. Is there anything I can do to correct this?
A: As lumpectomy followed by radiation therapy is becoming more and more common for the treatment of breast cancer, and asymmetry between the breasts sometimes occurs following the surgery. Sometimes it is significant enough to require correction. Fortunately, this is not a common problem. There are several solutions: breast augmentation, breast lift, or combination of the two. Fortunately in 1998 President Clinton passed legislation mandating insurance companies cover reconstructive surgery for women who have been surgically treated for breast cancer.
Q: Should we exfoliate the skin?
A: It seems almost antiquated to discuss the issue of sloughing the skin, but it is a beneficial part of skin care. Alpha hydroxy acids (AHAs) and beta hydroxy acid (BHA) are the amazing cosmetic skin care ingredients at this time. What these acids can do is thin the skins scaly outer layer as well as hasten cell turnover which makes skin more resilient. These acids help dissolve the bond, or "glue" that holds dead cells on the surface of the skin, helps repair the aging cellular level and helps in forming the underlying tissues for greater elasticity as well as encouraging more tissue activity. The crucial information you need to ask yourself. What ingredients are in your skin care products? What is the concentration level of alpha hydroxy acid or beta hydroxy acid? AHAs work best in a 5% to 8% concentration, with a pH level of 3 to 4; BHA works best in a 1% to 2% concentration, with a pH of 3. If your products are not doing this for you, you're wasting your money and your skins' time!
Q: I have these white things under my skin. What can be done about them?
A: First, we would have to determine what these "white things" are. They could be milia, or closed comodones, or even a combination of the two. Milia, are small deposits of sebum between the follicle and the corneurm, and closed comodones are small bumps under the skin where bacteria breed and are very difficult to extract. We would first treat the area with glycolic acid to "melt" the sebum and dilate the follicle. Then extractions can be done. It is very important to make sure that the Esthetician doing extractions is advanced and has an extensive amount of experience in doing extractions. Follow up facials may be necessary as it may take several visits to clear up the problem. Come and see us and we will be glad to help.
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