Choosing implant size in breast augmentation

Choice of size is a difficult, but important factor in breast/breast enlargement surgery. 
To my experience, it can go two ways, but from a practitioners point of view it is much more frequent to see patients asking for bigger implants than having it the other way round.
I think a contributing factor is especially that many patients orientate on “celebrity”-examples of patients who have had more than one breast augmentation and in that case tend to look “over”operated indeed.
It is impossible to try a breast implant on like a shirt. You dont get this opportunity in breast augmentation. Several factors need to be considered.
1. Dissatisfaction with breast size is the number one cause for re-operation in breast augmentation surgery. Nevertheless, it is not a revision for a surgical complication because everything may have gone very well.
2. You cannot plan a cup size,a cup size is just a letter. It is more important to gather together photographs of your likes and dislikes when it comes to breast size, shape and form. Different brands of manufacturers will have different cup sizes for the same breast.
3. Sizing implants slipped into your bra can give you a relative estimate of breast implant volume.The tend to look a bit “stuck-on”. Most surgeons, who frequently perform this operation will have a set of sizing implants available for you to examine and place in a bra.
Go for the feeling in size and not for the look.
4.Remember that in breast augmentation there are factors that cannot be changed, like for instance the width of your sternum. Breast enlargement gives you a bigger breast and a certain
Change in shape. However, you cannot buy a breast “of the shelf”
5.The choice of projection and implant shape, be it teardrop or round, will depend on the shape of your breast before the operation and position on the implant. I frequently observe that patients translate a solution from a friend they might know and who has had a breast augmentation to themselves.This does not work this way. Every body is different and everybody is individual.

Read more about  breast augmentation here.

Dr.Alexander Amir Aslani, MD, EBOPRAS

Hospital:
Director and Chief Surgeon
Department of Plastic, Aesthetic and Reconstructive Surgery
Hospital Quiron Malaga
Avda.Imperio Argentina, 1
E-29004 Malaga
Spain
www.quiron.es

Private practice:
Cirumed Clinic
Avda.Ramon y Cajal 7-4°
E-29601 Marbella/Malaga
Spain
Phone:+34 607 307 515
info@cirumed.es
www.cirumed.es

Combine cesarean section with abdominoplasty ?

This is an interesting idea that, to my knowledge, still enjoys certain pouplarity in the United States.

The idea sound appealing, because the concept is to use the cesarean incision to perform the abdominoplasty in one go. Nevertheless, our  experience with combining a ceasarean with abdominoplasty in the same session is slightly controversial. It may be done, but the  rates of certain complications are , although not uniformly confirmed in scientific literature, slightly raised.

Especially the incidence of seroma, which is a fluid collection and not an uncommon finding after abdominoplasty , is slightly raised. Nevertheless seroma is ususally not a grave issue after abdominoplasty and succesfully managed conservatively in most cases.

For certain patients with very large birth weightsthe combionation is still be an option, because their muscle distension seems to be quite extensive.

On the other hand, scientific literature clearly opines that there is no higher incidence of grave complication such as deep-vein thrombosis when perfoming an abdominoplasty together with a cesarean section.

Whether to the tummy tuck together with the cesarean section or not is something that I indivisually discuss with my cooperating gyneoclogist depending on each individual case. It is, and will remain a controversial topic in the future, and best restricted to patients who have finished their family planning. Classical abdominoplasty complications, especially seroma, are definitely raised in comparison to sole abdominoplasty.

Read more about abdominoplasty here.

Dr.Alexander Amir  Aslani, MD, EBOPRAS

Hospital:
Director and Chief Surgeon
Department of Plastic, Aesthetic and Reconstructive Surgery
Hospital Quiron Malaga
Avda.Imperio Argentina, 1
E-29004 Malaga
Spain
www.quiron.es

Private practice:
Cirumed Clinic
Avda.Ramon y Cajal 7-4°
E-29601 Marbella/Malaga
Spain
Phone:+34 607 307 515
info@cirumed.es
www.cirumed.es

Dr.Ramin  Pakzad, Consultant gynecologist , Director, Clinica Banus, Marbella, ,Spain, Clinica GynBanus Marbella

Can abdominoplasty and hernia repair be done in one operation ?

They can and they normally should.

A lot depends on the extent of the hernia, and BMI guidelines for repairing larger hernias together with a tummy tuck a normally somewhat stricter.

Case example patient after massive weight loss, abdominoplasty and hernia repair

The scar shown is the most frequently used extended cesarean type.

The postoperative picture shows the appearence 5 months post op and does normally face much further in the follwoing year.

The scar should ideally be located as low as possible.

Especially in patients seeking abdominoplasty  after bariatric surgery (gastric band) it is not uncommon to also find hernias of varying sizes, mostly umbilical hernias which can be repaired together with the abdominoplasty (tummy tuck) without problems.

In some cases, and larger hernias, I use the deepithelialised dermis of the resected skin as a kind of natural mesh (so called coriumplasty) to reinforce the abdominal wall.

If hernia repair and abdominoplasty is done together, this may lead to a slightly raised risk of serome (fluid collection). This is not a grave compliacation but nevertheless happens more often after beformentioned combination.

Dr.Alexander Amir  Aslani, MD, EBOPRAS

Hospital:
Director and Chief Surgeon
Department of Plastic, Aesthetic and Reconstructive Surgery
Hospital Quiron Malaga
Avda.Imperio Argentina, 1
E-29004 Malaga
Spain
www.quiron.es

Private practice:
Cirumed Clinic
Avda.Ramon y Cajal 7-4°
E-29601 Marbella/Malaga
Spain
Phone:+34 607 307 515
info@cirumed.es
www.cirumed.es

Combine botox with fillers ?

Is something that is highly advisable for different regions, for instance botox for the forehead and for restylane for the nasolabial fold. I do not recommend to combine it for the same region, as often requested for forehaed wrinkles who maybe longstanding and deep and may very well need both botox as well as a filler.

Nevertheless in the forehead it is preferable to first apply botox and secondarily treat with for instance restylane, because it is first advisable to see how the effective the botox is before “filling” the wrinkle. This avoids overdoing and gives the botox a chance to show its full effect.

It is by no means wrong to provide botox for instance with restylane, but stepping the botox treatment up can save considerable amount of substance.

Read more about botox here.

Dr.Alexander Amir  Aslani, MD, EBOPRAS

Hospital:
Chief Surgeon and Head of Department
Department of Plastic, Aesthetic and Reconstructive Surgery
Hospital Quiron Malaga
Avda.Imperio Argentina, 1
E-29004 Malaga
Spain
www.quiron.es

Private practice:
Cirumed Clinic
Avda.Ramon y Cajal 7-4°
E-29601 Marbella/Malaga
Spain
Phone:+34 607 307 515
info@cirumed.es
www.cirumed.es

Reconstructive rhinoplasty after trauma

If patients approach a nose correction after having had an accident, the procedure can be a lot more complicated. Depending on the nature of nasal trauma, in case of multifragmented fractures the osteotomies (which is the correction of the position of the bones) may be less stable than in a primary rhinoplasty. Also, posttraumatic rhinoplastiy esfrequently involve work on the nasal septum as well because septal deviation frequently follows nasal trauma.

This results in a slightly higher risk of secondary dislocation of bones and possibly patients undergoing such a reconstruction may look at waering the nasal splint, which normally needs to be worn for 7 days, for about three days longer. Some  irregularities irregularities may be camouflaged without a full rhinoplasty operation, but with fillers. I prefer to first apply a permanent filler and secondarily a permanent one.

Read more about rhinoplasty here.

Dr.Alexander Amir  Aslani, MD, EBOPRAS

Hospital:
Chief Surgeon and Head of Department
Department of Plastic, Aesthetic and Reconstructive Surgery
Hospital Quiron Malaga
Avda.Imperio Argentina, 1
E-29004 Malaga
Spain
www.quiron.es

Private practice:
Cirumed Clinic
Avda.Ramon y Cajal 7-4°
E-29601 Marbella/Malaga
Spain
Phone:+34 607 307 515
info@cirumed.es
www.cirumed.es

Breastfeeding after breast augmentation?

Is not normally a problem after straightforward breast enlargement, since the majority of techniques does not interfere with the breat tissue itself, but works underneath the breast  muscle or the breast gland.

Exception applies to breast augmentationthrough with an incision through the nipple, which may necessitate dissection through the breast gland. breast augmentation or breast enlargement through a nipple incision is particurlarly popular in Spain

But even with this  breast augmentation technique it is not normally a problem.

Read more about  breast augmentation here.

Dr.Alexander Amir  Aslani, MD, EBOPRAS

Hospital:
Chief Surgeon and Head of Department
Department of Plastic, Aesthetic and Reconstructive Surgery
Hospital Quiron Malaga
Avda.Imperio Argentina, 1
E-29004 Malaga
Spain
www.quiron.es

Private practice:
Cirumed Clinic
Avda.Ramon y Cajal 7-4°
E-29601 Marbella/Malaga
Spain
Phone:+34 607 307 515
info@cirumed.es
www.cirumed.es

Is mammography necessary before aesthetic breast surgery ?

The decision depends also on the preference of the individual surgeon; it is not absolute necessary.

In our Cirumed specialist group , we solved the question in the way that a highly qualified gynecologist furnishes patients before breast enlargement, breast uplift or a breast reduction with a so-called 4-D- ultrasound.

Dr.Ramin Pakzad, extremely experienced in the field of  breast disease and especially in the area of the breast cancer treatment and is our partner in these cases and since I can absolutely depend on the accuracy of his assessments, I prefer the ultrasound diagnostics done by him.

That provides me and my patient the security of a thorough preoperative diagnostics and saves young patients partly extensive -x-ray exposure.

A possible history of breast cancer within the family will also endorse the indication for preoperative breast screening. There are different approaches to breast screening before aesthetic surgery like breast augmentation, but we regard this one as best. Suspective findings in the age group seeking for breast augmentation are lessthan 0.5%, but nevertheless they occur.

Although the chance of a positive finding is very low especially in young patients, who are the majority of patients requesting breast augmentation, it still merits the effort. “If we are able to spot 1:1000 breast cancer cases just by the coincidence of screening for a breast augmentation operation, it was totally worth it”, says Dr.Pakzad, who teams up with Dr.Aslani and two oncologists forming a breats cancer unit in the Malaga area.

The 4-D-ultrasound technique does also play a significant role in spotting ruptured implants after breast augmentation.

Dr.Alexander Amir  Aslani, MD, EBOPRAS

Hospital:
Chief Surgeon and Head of Department
Department of Plastic, Aesthetic and Reconstructive Surgery
Hospital Quiron Malaga
Avda.Imperio Argentina, 1
E-29004 Malaga
Spain
www.quiron.es

Private practice:
Cirumed Clinic
Avda.Ramon y Cajal 7-4°
E-29601 Marbella/Malaga
Spain
Phone:+34 607 307 515
info@cirumed.es
www.cirumed.es

Dr.Ramin Pakzad Pakzad, Consultant gynecologist , Director, Clinica Banus, Marbella, Malaga Spain, Clinica GynBanus Marbella