Plastic surgery can be quite confusing. Procedures constantly change. How can you distinguish fact from fiction? Here you’ll find answers to patient questions. Dr. Bogue understands that one of the keys to successful surgery is an educated patient.
Below you will find the latest Q&A from Dr. Bogue on RealSelf.com – a website designed to connect patients and plastic surgeons. Further down on the page, you will find answers to common questions patients ask Dr. Bogue. You may also fill out our Contact form and ask your own question for Dr. Bogue today!
Q&A – Breast Augmentation
Q: How do I know what implants are right for me?
Ans: Implant sizing is a combination of your breast anatomy and your goals from an augmentation. By measuring your breast dimensions, a range of implant sizes will be determined. From this range of implants, a size is chosen to meet your goals. Our in-office Mentor sizing system can aid you in predictably choosing the implant that’s best for you.
Q: Saline implants versus silicone gel implants – what’s the difference?
Ans: Saline filled implants consist of a silicone rubber shell that is filled with saline (salt water) at the time of surgery. Silicone gel implants come pre-filled from the manufacturer and are simply placed into the breast as is. Saline tend to ripple more and feel less “natural”, however rupture is obvious as the breast deflates. Silicone is softer and more natural, but requires MRI imaging to monitor the integrity of the implant over time. No implant lasts forever and any implant may require removal and replacement in the future.
Q: Are silicone gel implants safe?
Ans: Silicone breast implants were approved by the FDA after extensive studies in 2006. A review of multiple disease processes showed no link between a ruptured gel implant and a systemic illness. Information regarding the safety of silicone gel implants can be found here
Q: Under the muscle or over the muscle?
Ans: The choice of implant placement depends upon the amount of soft tissue (breast and fat) that exists in the upper portion of the breast. In thin women or women with a lack of breast tissue, placing the implants underneath the muscle camouflages the appearance of the implant giving a more natural slope to the breast. Placing implants under the muscle can lead to a movement of the implant when the muscle is contracted and for some very active women, this can be a detriment.
Q: Can implants correct different sized breasts?
Ans: Breast asymmetry is very common. In certain cases, this can be dramatic. Varying the implant size from one breast to the other is one way of improving symmetry.
Q&A – Breast Reduction & Breast Lift
Q: How do I know if I need a lift or a reduction?
Ans: The procedures for a breast lift and a breast reduction are quite similar. If you are happy with the size of your breasts when wearing a supportive bra, then a breast lift is the procedure of choice. If you feel your breasts are too large, even when properly supported, then a breast reduction is a better option
Q: Does insurance cover a breast reduction?
Ans: The answer to this question depends largely on what type of insurance you have. Many insurance companies will cover the cost of a breast reduction if several criteria are met. These criteria often include associated symptoms such as back or neck pain, shoulder notching from bra straps, rashes, and multiple physicians documenting breast size as a causative factor for these symptoms. Even with all of this documentation insurance companies may deny coverage.
Q: How long does a breast lift last?
Ans: A breast lift can last decades. Essentially a breast lift tightens the skin, elevates the nipple, and repositions the existing breast tissue. Some women benefit from the addition of an implant to give fullness in the upper pole of the breast. Gravity is always a concern and the surgery does not prevent further sagging due to gravity over time.
Q: When are implants used with a breast lift?
Ans: Breast implants are commonly used at the same time as a lift (called an Augmentation Mastopexy). Patients typically present in one of two ways:
- Women for whom size is most important, but need a lift to center the nipples on the breast mound.
- Women for whom shape is most important, but desire fullness in the upper portion of the breast for which their native breast tissue cannot achieve.
Q&A – Breast Reconstruction
Q: Are there different types of reconstruction?
Ans: Yes, the techniques use tissue expanders and implants, autologous (your own tissue) reconstruction, or a combined approach involving both techniques.
Q: Why is a tissue expander part of reconstruction?
Ans: After mastectomy, the breast skin is typically left intact, but the skin is quite delicate. A tissue expander creates a pocket breast implant and allows gradual expansion of the space without damaging the overlying skin. In certain cases, a one-stage reconstruction without expansion is possible.
Q: Is there something called an acellular dermal matrix?
Ans: Acellular dermal matrix (ADM) is a portion of human skin that has been donated, and treated in a process that removes all of the cells. What remains is a sheet of collagen. This collagen covers the lower portion of a tissue expander, positions the reconstruction on the breast fold, and reduces the risk of complications such as capsular contracture.
Q: Is the SPY system part of the reconstruction process?
Ans: The SPY system is a blood circulation camera. In surgery, SPY evaluates the blood circulation in the skin after mastectomy. SPY enables Dr. Bogue to predict who will have problems healing and who may benefit from hyperbaric oxygen therapy after surgery.
Q: Is surgery on the unaffected breast covered by health insurance?
Ans: Yes. Congress passed the Breast Reconstruction Act in 1998, mandating coverage by insurance companies for surgeries on the non-cancerous breast to create symmetry between both breasts. This includes breast augmentations, lifts, and reductions.
Q&A – Tummy Tuck (Abdominoplasty)
Q: How do I know if I need a full tummy tuck or a mini?
Ans: A tummy tuck, or abdominoplasty, removes excess skin and fat, can tighten the underlying muscles, and improves abdominal contour. A mini tummy tuck is limited to improvements in the skin underneath the belly button. If there is excessive skin above the belly button, a full abdominoplasty is recommended.
Q: What exactly is 'muscle repair'?
Ans: The rectus muscles run vertically along either side of your belly button. After pregnancy or large weight gain, the edges of these muscles can separate – a physical sign called a diastasis. The muscle repair is a tight set of sutures that bring the edges of these muscles together creating a tightening of the abdominal wall reducing bulges and providing an internal corset.
Q: Can a tummy tuck cure stretch marks?
Ans: Stretch marks are scars deep within the skin that are not responsive to creams and lotions. The only cure for stretch marks is to remove the involved skin. Often times a tummy tuck can remove the majority of stretch marks, particularly those located below the belly button.
Q: Can liposuction be done at the same time as a tummy tuck?
Q: What does the scar look like from a tummy tuck?
Ans: The scar from a tummy tuck is located in the lower abdomen, just above the pubis. It extends upwards in an oblique fashion towards the pelvic bones. The length of the scar depends upon the amount of skin removal required. In a body lift, this scar will extend all the way around the waist to the back.
Q&A – Mommy Makeover
Q: What is a mommy makeover?
Ans: A mommy makeover is essentially the combination of a tummy tuck with some sort of breast procedure (usually a breast lift with or without implants). It is called a mommy makeover because the procedures are directed towards correcting the changes associated with pregnancy.
Q: Can the surgery be done all at once?
Ans: Usually both procedures are done at one time. An overnight stay in the hospital is required. Additional procedures such as thigh lifts or arm lifts will lead to a second operation to keep thing under a safe amount of time.
Q: How does my weight affect the outcome of a mommy makeover?
Ans:Any cosmetic procedure should be delayed if you are actively trying to lose weight. Achieving an ideal body weight prior to surgery leads to safer anesthesia, more predictable results, and longer lasting results.
Q: How soon after pregnancy can I have a mommy makeover?
Ans: It is advisable to wait at least 6 months after giving birth, or longer if you are breastfeeding or losing the baby weight through diet and exercise. If you plan on having more children, waiting is advised.
Q: Can I have kids after a mommy makeover?
Ans: Yes, you can have more children. There is nothing performed in a mommy makeover to prevent you from getting pregnant or carrying a child. However, the results from the procedure are likely to suffer from the changes associated with pregnancy and may require a revision.
Q&A – Non-Invasive Procedures
Q: Why are these procedures called “non-invasive” If they require an injection?
Ans: Procedures such as Botox or fillers are considered “non-invasive” because they do not result in a scar or require and incision. The skin is often cooled or a local anesthetic is applied to decrease any discomfort. These are performed in the office and often during the same consultation.
Q: How long do these treatments last?
Ans: Botox begins to work in 3 to 7 days has an effect that will last up to 6 months. The return of muscle function is gradual and can be seen as early as 4 months. Restylane lasts for 6 months while Juvederm can last for 12 months or longer.
Q: Is there downtime to Botox or fillers?
Ans: Injectable treatments may cause some redness at the site of injection.