Ask Dr. Schulman...

[css95 0]

Dr. Schulman:

What a great service you are doing, thanks so much.

I am planning a Breast Reduction, I am really worried about the incision

under my breast. Reading different sites they are complaining about their

bra rubbing on the incisions? Are they just talking about right after surgury? Or is this an on going problem? Is there new ways of doing it so this problem goes away? New techniqes are are found all the time.

Thanks for your help.

[Dr. Schulman 2]

Dr. Schulman:

What a great service you are doing, thanks so much.

I am planning a Breast Reduction, I am really worried about the incision

under my breast. Reading different sites they are complaining about their

bra rubbing on the incisions? Are they just talking about right after surgury? Or is this an on going problem? Is there new ways of doing it so this problem goes away? New techniqes are are found all the time.

Thanks for your help.

The incision that you refer to is called an "anchor" or "inverted T" incision. This consists of a vertical (up-and-down) line and a horizontal (the one in the breast crease). Some people complain about the horizontal incision - it is usually this part that has minor healing problems, can be irritated by bras, and are most prone to thick/raised scars. I always tell my patients to avoid underwire bras (besides...you won't need them anymore)

New techniques allow for a breast reduction with only the vertical component - it is often called a "lollipop" incision, just like the one used for breast lifts. This eliminates over 60% of the scar, and avoids the problems associated with the horizontal part of the incision.

I should mention that while more and more reductions are being done with this "lollipop" incision, it is not always possible after massive weight loss. This is because it may not allow for the best breast shape if there is a lot of excess skin - I have always said that weight loss patients have unique bodies that need very specific techniques.

[Candle 11]

Where are all my New York people at?

I'm here! I'm here!:thumbup:

Ready physically, not yet financially.

[StacyinDE 0]

Well, I'm not in New York, but I live close enough to the Amtrak station here in Delaware to make my way up there! :thumbdown:

I have I guess more of a contouring question for you. I just had a TT and breast lift on July 31st. Prior to my TT I had much more of an hourglass figure with marked waist indentations than I do now. I am still really swollen in the midriff area right above my incision line but not really on the sides now. Since I've already had the TT is there any way I can go back and get my waist more defined like it was? I would say I have more of the "boxy" shape you mentioned in a previous post.

Also, I have had some significant wound healing complications in both my abdominal incision and underneath of the left breast. I'm sure you have come across these situations before. What would you say the chances are that I am now predisposed to wound healing complications for future plastic surgeries? This was my 6th surgery ever (and the biggest) and I never had complications (other than anesthesia-related) with any of the previous surgeries and have always healed very well and bounced back quickly. I know you can't give me an exact answer, but I'm curious as to what you have encountered in these situations.

Thank you in advance for your time and assistance!

[Linda Lu 1]

Dr. Schulman, thank you for all of the information you've posted here. Do you know of any plastic surgeons specializing in body contouring after weight loss in the Boston area? I'm considering a breast lift/augmentation and possibly a TT (if I should hit the lottery!).

[Dr. Schulman 2]

Well, I'm not in New York, but I live close enough to the Amtrak station here in Delaware to make my way up there! :thumbup:

I have I guess more of a contouring question for you. I just had a TT and breast lift on July 31st. Prior to my TT I had much more of an hourglass figure with marked waist indentations than I do now. I am still really swollen in the midriff area right above my incision line but not really on the sides now. Since I've already had the TT is there any way I can go back and get my waist more defined like it was? I would say I have more of the "boxy" shape you mentioned in a previous post.

Also, I have had some significant wound healing complications in both my abdominal incision and underneath of the left breast. I'm sure you have come across these situations before. What would you say the chances are that I am now predisposed to wound healing complications for future plastic surgeries? This was my 6th surgery ever (and the biggest) and I never had complications (other than anesthesia-related) with any of the previous surgeries and have always healed very well and bounced back quickly. I know you can't give me an exact answer, but I'm curious as to what you have encountered in these situations.

Thank you in advance for your time and assistance!

A boxy shape can happen sometimes after a TT. Plastic surgeons have many "tricks" to minimize this - including liposuction of the waistline during a TT. Sometimes it is unavoidable in certain body types. A midline vertical incision (fluer-de-lis) with a TT can be a very powerful way to narrow the waist and get a much better shape. This adds a major scar, but can improve the shape so much that many don't mind.

Here is a picture of fleur-de-lis

With this said, it has only been about 6 weeks since your surgery - this is very short, and you have a lot of healing to do. You are still very swollen, and it takes months and months (6-9) for the swelling to resolve. This means that your shape will get better and better over time. If this does not improve, the TT can be revised (with or without the midline incision) - but this is usually unnecessary.

Regarding the wound healing problems, this may indicate that you are a "poor healer". The most common reasons are smoking and poor nutrition (low Protein, low iron). This is why proper nutrition, and ongoing relationship with experienced nutritionist is so important. More likely, the problems were the result of this particular surgery - since you have had smaller surgeries in the past without problems, probably means that you heal fine - "poor healers" usually have delayed healing from even very small procedures.

[StacyinDE 0]

Dr. Schulman,

Thank you so much for taking the time to answer my questions, and for all of the information you provided me with! It is greatly appreciated!

[maryrose 2]

Re: Ask Dr. Schulman...

Dr. Schulman, thank you for all of the information you've posted here. Do you know of any plastic surgeons specializing in body contouring after weight loss in the Boston area? I'm considering a breast lift/augmentation and possibly a TT (if I should hit the lottery!).

__________________

Linda Lu

Linda Lu,

Hope you don't mind my piping in here, but if you live close to the Lowell/Chelmsford area, you might want to check out Dina Eliopolous, Chlelmsford, MA. I had a reduction in June and I am totally thrilled with the results. The whole office staff has been wonderful from beginning to end. Dina is really a peach and has a great reputation.

Edited September 12, 2008 by maryrose
fixed ticker

[speck 1]

What is the best treatment for surgery scars?

Thanks

[Dr. Schulman 2]

Re: Ask Dr. Schulman...

Dr. Schulman, thank you for all of the information you've posted here. Do you know of any plastic surgeons specializing in body contouring after weight loss in the Boston area? I'm considering a breast lift/augmentation and possibly a TT (if I should hit the lottery!).

__________________

Linda Lu

Linda,

Sorry for not answering this....i am usually pretty good at answering promptly, but this one snuck by!

I am not familiar with any PS in Boston. I would suggest checking at some of the large medical centers where you shouls find an experienced PS.

[Dr. Schulman 2]

What is the best treatment for surgery scars?

Thanks

It takes scars about 12 months to "mature." This means that the scar will continue to change for this time. Usually, it changes for the better.

I recommend using a combination of compression and silicone. Compression over scars definitely helps - this is why I tell my patients to keep surgical tape (the paper tape) over the scars for 2 months. Also, there are several topical products available. Don't waste your money on Mederma. Get a product that is silicone based. I use something called Kelocote - it is a silicone gel and steroid. It works pretty well. You should be able to find it online and it is relatively inexpensive.

[pashmina 0]

Hi Dr. Schulman,

It's great to see you started a thread here, and one that seems to be helping many! It's been a few months since I had my consult with you, and I've lost considerably more weight. I'm aiming now for a February or March surgery date so that I have more maintenance time. I'm definitely ready for the TT, but have two questions. One, what can be done about thigh cellulite aside from the inner lift? I don't think that procedure would remedy the genetically cursed cottage cheese lumps I have all the way down to just above the knees, and I just don't trust the silly ads in the AM NY or morning Metro. Is Lipo the way to go here?

Second, and I don't think I'm the only one with this concern, what can be done about the fatty area I think they affectionately call 'mons'? This is the area above the genitalia, but below the 'apron'. It gets fat just like everywhere else does. Is that something lipo combined with the TT takes care of?

Thanks so much in advance, and I'll be seeing you at the Obesity Walk next week!

[Dr. Schulman 2]

Hi Dr. Schulman,

It's great to see you started a thread here, and one that seems to be helping many! It's been a few months since I had my consult with you, and I've lost considerably more weight. I'm aiming now for a February or March surgery date so that I have more maintenance time. I'm definitely ready for the TT, but have two questions. One, what can be done about thigh cellulite aside from the inner lift? I don't think that procedure would remedy the genetically cursed cottage cheese lumps I have all the way down to just above the knees, and I just don't trust the silly ads in the AM NY or morning Metro. Is Lipo the way to go here?

Second, and I don't think I'm the only one with this concern, what can be done about the fatty area I think they affectionately call 'mons'? This is the area above the genitalia, but below the 'apron'. It gets fat just like everywhere else does. Is that something lipo combined with the TT takes care of?

Thanks so much in advance, and I'll be seeing you at the Obesity Walk next week!

I am glad you have lost more weight - it will only make your results even better after the TT. Cellulite can be improved with liposuction, but it needs to be done very carefully. Cellulite is not fat, it is fibrous bands that connect the skin to the deep tissue. The bumpiness is because these bands make little "fat compartments." Small and carefull liposuction can make this better because it breaks up the bands. If aggressive liposuction is done, it will get worse. I agree that the ads in those magazines are very misleading and I some might argue that the pics are digitally altered.

The mons can be corrected with a monsplasty or lift, combined with lipopsuction. It works very well. I routinely fix this area when I do my TT or LBLs.

See you at the walk.

[Linda Lu 1]

Thanks Mary Rose...that is nearby for me!

[Linda Lu 1]

Linda,

Sorry for not answering this....i am usually pretty good at answering promptly, but this one snuck by!

I am not familiar with any PS in Boston. I would suggest checking at some of the large medical centers where you shouls find an experienced PS.

Thanks Dr. Schulman!