A Breast Reduction using Liposuction?

Yesterday I performed a Breast Reduction using Liposuction only. To my surprise, the OR nursing staff was unaware this was possible. So I figured if they were unaware it was possible, most people probably are. So lets talk about it.

Why it works: Well, breasts are normally made up of glandular milk producing breast tissue AND fat. In fact, for many women, the breast is a preferred fat storage site. So, we are able to use liposuction to remove the fatty component of the breast. This can be done with one or two very small incisions instead of the typical larger more noticeable breast incisions.

Limitations: There are limitations to the procedure being done this way. First, you cannot get as much skin tightening this way and you cannot lift the breast as well as with a traditional reduction. Secondly, you cannot suction out the glandular breast tissue component, only the fat component. So gauging final breast size is more challenging.

In the end, it is a very effective technique that replaces the significant scaring of a traditional reduction with almost no scars yet still effectively can reduce the breast.

To learn more contact our East Louisville office at 502-721-0330

Lee E Corbett MD

Medical Director Corbett Cosmetic Aesthetic Surgery and Med Spa

 

Breast Implant “Profiles”…what does it all mean

Breast implant profilesBreast Augmentation is the most requested cosmetic surgery in the U.S. every year and has been for many years running. As its popularity continues to increase, the variety of implants has increased as well. I’d like to take a minute to go over the different Profile options as this is confusing for many patients.

For decades implants came  “one size fits all’ however now there are many profile options: Ultra High, High, Moderate, and Low ª. What the ‘profile’ of the implant refers to is its’ width and its’ height or projection.

For example, if you have two implants that are both filled with 350cc, the high profile won’t be as wide as a moderate profile implant, but it will project out more. The higher the profile in the order the more narrow the implant and the more it projects. What this allows for is the more narrow breasted woman to get more volume or the appearance of more volume.

Other than that, there is no difference in the implants at all. They are made the same way, have the same warranty, and the cost is the same. It just allows us to best suit the needs of our patients who all come in different shapes and sizes.

Lee E Corbett, MD

Medical Director Corbett Cosmetic Aesthetic Surgery and MedSpa

ª Mentor, Allergan and Sientra are the three manufacturers of implants and they each have their own profile nomenclature.

I have Saline Breast Implants…How do I know if they’re leaking?

breast implantSaline Breast Implants were the only implant available in the US from 1992 through 1996 for breast augmentation. In my practice, I get a lot of patients with questions about needing to replace or exchange these implants. First let me say that you DO NOT have to exchange your implants just because they are of a certain age. If they’re not broken, don’t fix them.

Now, sometimes they do fail. The failure rate at 10 years is about 2.5%, so it’s low but it does occur. So how do you know? Well, you’ll literally get a “flat tire”. But how this shows itself varies based on why the implant failed. There are 2 points of failure for a saline implant. The first is if the fill valve fails, the second is a shell failure. The fill valve is a one way trap door valve that we plug into to fill the implant. If the valve becomes incompetent, what you will see is that the upper half of the implant loses its volume. The valve is right in the middle of the implant so all the water above this will leak out. The bottom half will stay filled. So basically, your fullness above nipple goes away. If the second problem occurs, the outer shell gets a hole in it, the implant tends to deflate more  readily and the entire implant will empty. Your breast will return to its pre augmented size. It’s typically not hard to detect for obvious reason.

The leaked saline will not harm you. It is nothing but saline IV fluid, the very same stuff we give patients who need an IV. So there is no danger to it.

So that’s the story on saline implants and leaking. If for whatever reason you were worried your implants were leaking, just look in the mirror. If they look the same as always, they aren’t leaking. If they do leak, no need to panic, they are warrantied for your lifetime and an exchange is a quick and easy procedure.

Lee Corbett, MD

Medical Director Corbett Cosmetic Aesthetic Surgery and Med Spa

“Do you have to detach my nipple?”

In my 19 years of practice I have heard this question a lot and I always wonder where this information comes from. At our consultations my patients tell me that they heard or usually read when they consulted Dr. Google, that during a breast lift or a breast reduction the nipples have to be removed from the breasts.

This is unequivocally WRONG. Totally False. Untrue!!

I know you are never supposed to use “always” and “never”, but in this case I’m gonna break that rule and then comes my disclaimer. I “never” detach a nipple during a breast lift and I “never” detach a nipple during a breast reduction. I “always” leave them attached. There, I just broke both rules.

Disclaimer time: There actually is a time when we DO have to detach the nipple. The operation is called a Free Nipple Graft, but we ONLY do this when the breasts are EXTREMELY droopy. What does ‘extremely droopy’ mean. Well, get a tape measure and measure from the top of your breast bone diagonally down to the nipple. That distance should ideally be between 19 and 21 cm. For most patients who need a lift or a reduction the number will be more in the 27-30 cm range. It is only when the number exceeds the 41-42 cm mark that we even discuss detaching the nipple. The other measurement to look at is from the crease under the breast back up to the nipple. Lift the breast and place the tape measure at the crease and then measure back up to the nipple. Ideally that number is 5-7 cm. It’s not until 21-23 cm we that we even start to discuss detaching the nipple.

So, for 99% of women considering a lift or a reduction, detaching the nipples isn’t even remotely a consideration. It just never happens. When we see the kind of numbers I mentioned above, then, and only then, do we discuss the need to detach. Stated another way, in 19 years of practice and having done literally thousands of these procedures, I have never, ever detached a nipple that I didn’t plan on detaching from the get go to extreme breast size and extreme droop.

Lee E Corbett, MD

Corbett Cosmetic Aesthetic Surgery and Med Spa

 

What’s a Mommy Makeover?

At Corbett Cosmetic, a Mommy Makeover is one of our most requested operations. A ‘mommy makeover’ is a generic term for some combination of breast procedure and tummy procedure.

The breast portion can be a lift, a reduction, an augmentation, or a lot of times an implant and a lift are combined. This allows me to restore the fullness to the top of the breast and reposition the natural breast tissue so that is doesn’t droop below the crease that is below the breast.

For the tummy portion, we typically will do a tummy tuck with liposuction, but sometimes Liposuction alone is all that is needed. The decision is based on how much loose skin you have, how much your muscles were stretched by the pregnancies, and how much fatty tissue we are dealing with.

These decisions are pretty simple to make after your consultation. It’s really just a matter of you stating your goals and then I can match the operation best suited for your particular problem.

If you are interested just give us a call at (502) 721-0330 or by e mail at Misty@corbettcosmeticsurgery.com

Lee E Corbett, MD

Medical Director: Corbett Cosmetic Aesthetic Surgery and Med Spa

 

How do I make sure my breast augmentation looks natural? I want “natural”.

This is probably the most common theme I encounter when I meet a new patient who is considering an augmentation. Getting a natural result after a breast augmentation depends on two main factors. First, we have to take into consideration how much breast tissue you have to start with. Secondly, we have to think about what size implant you are considering.

So, lets look at your starting point. If you have no chest, I mean a small A cup, you will have a more round look than you may like. There’s just no way around it. The implants are round and if you have no tissue to cover the implant that’s what you will get. Now, you can opt for the Allergan 410 implants that are contoured. These will give a bit more natural shape as they have less upper pole fullness. The downside to these is price, they cost a lot, and they require a larger incision to place them. But they can help minimize that really round look. Now if you have any amount of breast tissue things get much much easier. Basically your breast will maintain it’s natural shape just more full. So if you pick an implant size that fits nicely behind your breast you will have a natural look.

Size. Size matters! I get a whole lot of women who come in and tell me they want to look ‘natural’ and then they chose this great big implant. You cannot, and I don’t care what your starting point is, you cannot put in a huge implant and look natural. It doesn’t work. You need to choose an implant that fits within your breast’s native boundaries. In other words, if your breast is 15cm wide, we need to stick with an implant that is 15cm or less. Then we need to find one with a volume that balances out your figure. Now, it’s ‘ok’ to get a little greedy. So say you really like a 375cc and the 400cc implant, then pick the 400cc one. The difference is minimal. In general, it takes about 150cc of implant to change a bra size so you can use this as a rough guide as you consider size.

Finally, both saline and silicone and smooth and textured implants can produce natural results. The factors above are much more important than implant type. UNLESS you are very very slender and have very small breasts. Then in my opinion a gel implant is the better choice due to its feel advantage.

Your best bet though is to let your plastic surgeon meet with you, examine you, and you explain your goals. Then together you can make the best implant choice for you.

Lee Corbett, MD
Medical Director of Corbett Cosmetic Aesthetic Surgery and MediSpa

Breast Augmentation Recovery…how long does it take to get better.

With Spring Break and the summer bathing suit season a few months away I am seeing the usual ‘Spring rush’ for breast augmentation, which is the most common cosmetic operation in the US. Recovery period is a common concern for the patients and so I wanted to go over so generalities about return to work, exercise, swelling etc..

The biggest determinants of recovery are 1) placement location 2) Implant size and 3) your starting point. Implants that are placed below the muscle lead to more recovery than above the muscle. When the muscle is lifted and manipulated it swells and gets sore. Under hurts more than over. Larger implants stretch your tissue out more and so the more stretch the more pain. And the final aspect is how tight your skin is to begin with. If you have had pregnancies and your skin has stretched it will feel much less tight than say an A cup woman who has never been pregnant. Again, more stretching means more discomfort.

So how long will you be sore? Well, assuming you go under the muscle as most people do, the first two or three days post op are the worst. These first few days you will need to use your pain meds and muscle relaxants. These will help a lot and keep you comfortable but the side effect is you will be groggy. You will be mobile and able to do basic day to day things but you will be sore if you try to do too much to soon. Most patients, if they have a  desk job, are able to get back to work within 5-7 days. If you have a job that involves heavier lifting, pushing, pulling etc…you might need several weeks to recover. As far a exercise, you can start some light aerobic stuff at 2 weeks, but start slow. Full bore exercise is probably more likely at the 4-6 week point or longer.

Bras and Bikinis. Do NOT run right out and buy a whole slew of new bras and bikinis! It takes at least 6-8 weeks to even start to see what your final size and shape will be. Go buy some inexpensive bras at first to ‘bridge the gap’ from where you started to your end result. Your surgeon will be able to tell you when you can go shopping based on your exam.

Considering Breast Augmentation? Check out our websites at www.CorbettCosmeticSurgery.com or www.KentuckyBreast.com

Lee Corbett, MD

www.kentuckybreast.com

“Are those real?” How do you spot augmented breasts?

I get this question all the time on a social level, from both men and women, and I certainly hear this during my breast augmentation consultations. What makes an augmented breast look natural vs “fake”? The answer to this question is multifaceted.

The first consideration is size of the implant. The more modest the implant size choice the more natural your look. It’s really that simple. If you choose a really large implant it’s not really likely that you wont look augmented. An implant size that just doesn’t fit your frame is a dead giveaway.

The second point is how much breast tissue do you have to begin with. The more of your own tissue that drapes over the implant the more natural you will look. So this becomes a problem for my more petite patients with an A cup breast. When we put the implant in there is nothing to hide the contours of the implants because there is hardly any tissue on top of it. This is the case where you see the “too round to be true” upper pole of the breast. Now I can help with that by shaping the implant pocket to allow for a more smooth transition of the muscle onto the top of the implant and you can help by choosing a smallish implant. But if you see a breast that looks like there is half a grapefruit behind it, you are looking at an augmented breast.

A large gap between the implants. This may or may not be a sign. A lot of women just have widely spaced breasts. So this can be a natural thing. It can look fake when you have a widely spaced breast and then place a large implant. When the breasts are widely spaced there tends to not be a lot of tissue along the breast bone and you get the ‘half grapefruit’ contour there is the implant is larger.

Movement. Natural breasts move more. Augmented breasts still move because the implants are not attached to you. They float around in their pockets and move with you. The problem again is when you use a larger implant. These have no room to move and tend to always point straight out even when you are laying down. When I place the implants, no matter the size, I make the pocket just the size of the implant so that they will always stay on the front of the chest. I know this doesn’t look as real but my patients love this look and they really, really hate when their implants slide to the side and leave a hallow in the middle of their breasts when they are laying down.

When you look at a breast from the side an un-augmented, mature breast will have more volume below the nipple than above. Now an augmented breast can look this way as well because over time implants assume a tear drop shape with more of the filler (gel or saline) settling to the bottom of the implant. Again, it’s all a question of size. If you choose a larger implant it will give you an unnatural fullness at the top of the breast. Size matters.

I found this question in Allure Magazine and added my own two cents to their answers.

Lee Corbett, MD

www.corbettcosmeticsurgery.com

Cohesive Gel & Gummy Bear Implants: What’s the difference?

Breast Implants. There are saline filled ones, silicone filled ones, and silicone gummy bear implants. A lot of my patients are confused about silicone vs gummy bear silicone so I thought I’d try and explain. The term “Gummy Bear” implant has been used for years and most often it is applied to the silicone gel filled implants that both Mentor and Allergan have had on the market since the fall of 2006. The problem is that these implants are not really gummy bear implants. Today’s silicone implants are filled with what the industry refers to as a ‘cohesive gel’. Without getting too technical, what this means is that the individual silicone molecules are so extensive cross linked to one another that the gel is a solid. The older implants from the 1980’s and early 1990’s were filled with a gel that was syrup consistency. Today’s implants are more like Jello. If you cut the outer shell of today’s implant, because the silicone is so cross linked, the gel doesn’t leak out. But that is not what a true gummy bear implant is.

The true gummy bear implants are best known amongst plastic surgeons as Allergan’s series 410 implants. These implants are the true Gummy Bear implants. Mentor also has brought a similar implant to market. Both of the implants have been on the market for about a year or so. Now these implants are even more extensively cross linked than your standard implant. They are more firm than a normal implant, more solid feeling, and will hold their shape better. The ‘problem’ with the 410 series is that they are very expensive. One 410 costs more than two standard silicone implants. In order to place the implants a much larger incision has to be made, almost twice the size of a standard gel implants. Finally, because the implants are shaped, if they were to rotate on you after your surgery, your breast will have an unusual shape and this will require additional surgery to correct the implant orientation.

Both implants are very, very good products and can give you a lovely result. You just need to work with your surgeon to decide which implant is best for you given your starting point and your goals.

Lee E. Corbett, MD
Medical Director: Corbett Cosmetic Aesthetic Surgery and MediSpa

What’s a Mommy Makeover?

I’m preaching to the choir here, but pregnancy takes its’ toll on Mom’s figure. Sometimes it’s minor, but sometimes its not. Your breasts take a hit, especially if you breast fed. Obviously your tummy is forever changed, particularly with twins or triplets. And, in a lot of cases, even after you get back to your pre-pregnancy weight, your shape just isn’t the same.

Here are a few truths that a lot of my patients are surprised to hear. 1) Your skin will not respond to exercise 2) There is a sheath that wraps your stomach muscles called fascia. It gets stretched with pregnancy and it will not respond to exercise. Thus the laxity 3) Your breasts will not get more perky if you exercise your chest muscles. 4) Your shape will be different no matter what your weight.

So…there are Mommy Makeovers. A Mommy Makeover is not a specific operation though. It involves some combination of a breast augmentation or breast lift or both. For your tummy/flanks/hips a tummy tuck or liposuction or both are used. Some combination of these procedures adds up to a mommy makeover.

Mommy makeovers are usually done in a hospital setting because they tend to be longer cases, around 3 to 4 hours. I prefer that my patients take advantage of an over night stay after surgery but this decision depends on the scope of the procedure.

After surgery you should plan on about 3-4 days of downtime, back to work is about 7-10 days, and a return to full activity in about 6 weeks.

Lee Corbett, MD