Ask Dr. Schulman...

[kareyquilts 1]

Dr. Schulman: So glad you're around to ask questions of. You really do help a lot of people! When is the article coming out in the aging magazine? I'm wondering if you could give me some advice. I have a very raised scar on one of my arms from my brachioplasty (the other scar is nice and flat). I am about 10 weeks out. I have been massaging it and using silicone strips and have seen a little improvement. There is also a lot of suture reaction (I'm assuming that is what it is) so that under the skin is very solid and rough feeling. Someone told me that after 3 months if the scar tissue isn't broken down that it will just stay about the same. I was also told by another source (none of them doctors) that cortisone shots in the suture area will help. What's the real scoop? Thanks!

[Dr. Schulman 2]

Dr. Schulman: So glad you're around to ask questions of. You really do help a lot of people! When is the article coming out in the aging magazine? I'm wondering if you could give me some advice. I have a very raised scar on one of my arms from my brachioplasty (the other scar is nice and flat). I am about 10 weeks out. I have been massaging it and using silicone strips and have seen a little improvement. There is also a lot of suture reaction (I'm assuming that is what it is) so that under the skin is very solid and rough feeling. Someone told me that after 3 months if the scar tissue isn't broken down that it will just stay about the same. I was also told by another source (none of them doctors) that cortisone shots in the suture area will help. What's the real scoop? Thanks!

The article should be coming out soon. The next issue of the magazine for Jan/Feb should be out any day now, and it is probably in that issue. I will let you know when I hear more.

Brachioplasty scars always look bad...at least for the first few months. They are usually red and raised (and "angry looking"). If they are hard, likeyou describe, then it may be a sign that you will develop a hypertrophic scar. Steroid injections work really well and you should ask your PS about this. The injections can be given monthly and usually for only 3 injections. It can really flatten out the scars. In the meantime, massaging is great as well as silicone strips. Some people have a hard time with silicone strips so there are some other products that work well. Silicone scar gels (scarphage, kelocote) are easy to apply (and available without a prescription online) Also, some people have had success with a steroid impregnated tape called cordran tape (need a prescription).

[kareyquilts 1]

Thanks, I will talk to my PS. It helps to be able to ask more educated questions.

[pammycakes 1]

Dr. Schulman. My doctor wants me to wear a sports bra after my breast lift. Is there a specific kind that you would recommend?

Thank you for your help

Pam

[Dr. Schulman 2]

Dr. Schulman. My doctor wants me to wear a sports bra after my breast lift. Is there a specific kind that you would recommend?

Thank you for your help

Pam

I doesn't matter too much. I usually suggest a champion brand - they are relatively inexpensive, comfortable, and have velcro or zipper in the front. You may want to pick up a few, because they may get dirty from leaking, blood, etc. For the same reason, I would avoid white color!

[Shalee04 7]

This is a tough situation, but unfortunately it is not uncommon. It can take a long time to completely heal (months). It seems like you have seen some improvement over the past few months, but not a huge amount. It may take a few more months to heal completely. In some cases, we can speed the process up, or even "bypass" the process.

To speed things up, you should ask your PS about a negative pressure wound dresing that uses a vacuum to help speed healing. It is called a wound VAC (Vacuum-Assisted Closure). It has been a huge advance in wound healing. Also, hyperbaric oxygen therapy (just like they give to divers with the bends) is also used to help speed healing of wounds. Both these are commonly used so you should not have a problem finding a PS experienced with this.

To "bypass" the healing, sometimes a wound can be removed and then closed in one operation. If the skin around the area is mobile, your PS may be able to use that tissue to close the wound. This can be done if there is adequate tissue surrounding it and there is no infection. This can also be done in stages (2 or 3 smaller surgeries) if the wound is too big to close in one operation.

I would definitely ask your PS about these things. Topical ointments and creams (like SSD and Dakins) kill bacteria...but they can also kill the cells you need to heal. The result can be very slow healing, like in your case.

Good luck. I think you have tried the basic things, with some improvement. Fortunately there are other options for you to think about.

In the past 2 weeks my wound has seen dramtic improvment and is finally closing in and healing. With that being said I will have to have a small revision becasue of the way this has healed. My question is, in your expert opinion, What are the chances of this happening again, where there is wound compromise, or necrosis??? I have in the past had 2 c-sections and a hysterectomy and never had a problem healing from those????

Thanks

[Nessa38 0]

Hi Dr. Schulman,

I was just wondering at what point during weight lose would you recommend a breast reduction? I have always had very large breasts, currently a 42 G(down from 44G). I get rashes under them now and back pain is just a part of life. I have lost about 37lbs and weigh 239. I guess I am worried once I get down under 200 and still have triple D's or F's my insurance won't pay.

I just don't know if I should try to get a reduction when I hit 200 and take these girls down to like a DD and then when I am finished losing weight they will be a somewhat perky C. I really appreciate any feedback you can give me. Thanks Nessa

[Mississippi Gurl 0]

Hi Dr. Schulman, I have a question about my boobs. I had breast augmentation in 2003. I have only been over weight for about 5 years. At the time of my augmentation I was pretty slim and since that time I have gained about 60 lbs. I am getting lap band in two weeks. I am currently a 42 DD and I hope to go back to a 36 C. My question is this, since I have already had an augmentation, will my boobs just reduce in size with my weight loss or will they become saggy as well.

Also, as I have gained all this weight and my boobs have gotten bigger, it turns out that one boob is bigger than the other one. While hospitalized for pneumonia a few months ago, I had an MRI and noticed that the implant of the larger boob is much lower in my chest than the smaller one. Would this have anything to do with the size difference and will I have to have this fixed for them to be the same size in the end???

Thanks for your advice!!

[V-Queen 0]

I also have a question even though I'm nowhere near goal....YET. I've had four children and overwight so it's a no brainer that my tummy sags and I'll need a tummmy tuck afterwards..what I'm wondering is when you get a TT does it also lift the skin just above the Vagina....Or is that a different or combined surgery? "I'm not sure what that area is actually called??":lol:

[Dr. Schulman 2]

Hi Dr. Schulman,

I was just wondering at what point during weight lose would you recommend a breast reduction? I have always had very large breasts, currently a 42 G(down from 44G). I get rashes under them now and back pain is just a part of life. I have lost about 37lbs and weigh 239. I guess I am worried once I get down under 200 and still have triple D's or F's my insurance won't pay.

I just don't know if I should try to get a reduction when I hit 200 and take these girls down to like a DD and then when I am finished losing weight they will be a somewhat perky C. I really appreciate any feedback you can give me. Thanks Nessa

It is always best to lose all your weight before undergoing body contouring procedures. That being said, it is not always realistic given the pain/rashes/etc. Usually insurance determinations are based on the amount of breast tissue removed (check with your specific carrier). Also, many times the insurance will deny a reduction, BEFORE you lose significant weight. This is because they argue the symptoms of breast pain/back pain should be improved with weight loss. I would wait this out as long as possible.

[Dr. Schulman 2]

Hi Dr. Schulman, I have a question about my boobs. I had breast augmentation in 2003. I have only been over weight for about 5 years. At the time of my augmentation I was pretty slim and since that time I have gained about 60 lbs. I am getting lap band in two weeks. I am currently a 42 DD and I hope to go back to a 36 C. My question is this, since I have already had an augmentation, will my boobs just reduce in size with my weight loss or will they become saggy as well.

Also, as I have gained all this weight and my boobs have gotten bigger, it turns out that one boob is bigger than the other one. While hospitalized for pneumonia a few months ago, I had an MRI and noticed that the implant of the larger boob is much lower in my chest than the smaller one. Would this have anything to do with the size difference and will I have to have this fixed for them to be the same size in the end???

Thanks for your advice!!

It is possible that the weight loss will make your breast sag more than usual - this is due to the weight of the breast implants which will hang down. Also, you can't really tell where the implants are sitting based on the MRI. The MRI is taken withyou laying on your back and the implants are designed to move around. It is better to see where they are when you are standing up - it is possible that they are inthe same location. Breast asymmetry is actually very common. I suspect the larger breast was always a tiny bit bigger, but as you gained weight, the asymmetry got more pronounced. This may improve with your weight loss. It is possible though that there is some implant asymmetry that may need to be fixed at some point down the road.

[Dr. Schulman 2]

I also have a question even though I'm nowhere near goal....YET. I've had four children and overwight so it's a no brainer that my tummy sags and I'll need a tummmy tuck afterwards..what I'm wondering is when you get a TT does it also lift the skin just above the Vagina....Or is that a different or combined surgery? "I'm not sure what that area is actually called??":lol:

That area is called the mons, and a lift/reduction of the area is a monsplasty. This is usually done at the time of a TT. You will have to check with yor particular PS about whether a monsplasty is considered part of the TT. Some PS consider it to be an essential part of a TT and do not charge extra, and others will do it at the same time for an additional fee.

[jfran 0]

Hey Dr. Schulman:

Thanks again for answering all our questions.

In may I am planning to have a medial thigh lift combined with inner/outer liposuction. should I be worried about scar migration? What techniques can be done to prevent or minimize this?

[Dr. Schulman 2]

Hey Dr. Schulman:

Thanks again for answering all our questions.

In may I am planning to have a medial thigh lift combined with inner/outer liposuction. should I be worried about scar migration? What techniques can be done to prevent or minimize this?

Scar migration is always a concern with a medial thigh lift. Ideally, the scar should be hidden in the groin crease (there also may be a vertical scar). Your surgeon should be familiar with techniques to minimize migration. This includes deep sutures to the periosteum of the pubic bone - this helps minimize migrations. This is also what causes so much pain after the surgery, but it is worth it! Discuss this with your PS beforehand. It is fairly common for me to see people who have had this operation elsewhere and are unhappy about 6 months later whent he scar migrates out of the crease.

[tapshoes 2]

What an informative thread! I am slowly coming to accept that PS is in my future - the weight really is gone (well, going) and it isn't a dream!

I apologize if my questions are too..rudimentary. But I truly don't know the answers, so any direction would be helpful.

How do I find a GOOD plastic surgeon? Just because one says he/she has done 'hundreds' doesn't mean that they have. Nor does it mean they were successful. I don't know anyone who has had PS, and sure as hell don't want people to know that I am considering it. How do you know that patient 'before and after' pics are of their patients? How do you know the photo's weren't retouched? How do you find out a surgeon's complication rate if the work is done in an office rather than a hospital? I know you can research through the different medical associations licensure and actions, but if technically there was nothing done 'wrong', doesn't mean that the work was good.

Do I sound cynical/paranoid? I don't mean to, but really, if I am going to have elective surgery, I'd like to make every reasonable effort to ensure I am in the capable hands of a good surgeon, not someone who can make people feel better but is truly a hack in the OR.