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Liposuction
Liposuction is a surgical technique used to sculpt the body by removing excess fat with a suction cannula. Although, liposuction is not a substitute for dieting and exercise, it can remove unwanted fat deposits, which do not respond to traditional weight-loss methods. Liposuction is also termed “Lipoplasty or suction-assisted lipectomy”. This revolutionary procedure was developed in Europe in the late 1970's. It quickly gained wide spread popularity since the earlier techniques were plagued with extreme scaring due to surgical excision of skin and fat. Listed below are a few of the advantages of liposuction:
* Undetectable incisions (3 mm hidden incisions).
* Minimal discomfort.
* Quick recovery.
All great innovations have “kinks” to be worked out. The early problems were excessive blood loss and significant irregularities in the skin. These issues have been greatly reduced by the use of:
* Smaller suction cannulas - to give the surgeon better control.
* Tumescent liposuction - an injectable solution which greatly reduces blood loss.
Liposuction today is a safe procedure when it is performed by a qualified plastic surgeon.
Who is a candidate?
Today, liposuction is being performed on people who are overweight. This is no longer a contraindication for surgery, but realistic expectations are important. Dr. Delgado will explain this in great detail. The results can be impressive with a reduction of 2 to 3 clothing sizes. The skin should have relatively good elasticity to recontour to the new shape. Cellulite is not a contraindication to surgery, but liposuction will not improve this condition. The skin irregularities will, in general, persist. You should be in good mental and physical health. Your age is not a major consideration, but older patients may have poor skin elasticity and may not achieve the same results as a young patient with better skin elasticity.
The most common areas treated in females are the inner and outer thighs, knees, hips, abdomen, and arms. The most common area of liposuction in males are the chin, waist, and the abdomen. Most patients have several areas of lipodystrophy and these can usually be removed simultaneously.
Before Liposuction Surgery
A personal consultation is the first step for every patient considering liposuction. During this appointment, Dr. Delgado will ask you to discuss the problematic areas. He will use digital photography and computer imaging to discuss the areas of lipodystrophy and any asymmetries that may be present. He will display a realistic image of the changes that liposuction can make for your body image. He will show the ideal shape of the body and what adjustments are needed to accomplish your goals. He will discuss the variables that effect the procedure, such as skin elasticity and cellulite.
Dr. Delgado will conduct a physical examination and take your medical history. He may request a blood count in advance. Dr. Delgado provides a precise preoperative booklet that provides pre- and post-operative instructions, including medications in advance of your surgery. All aspirin and aspirin containing products, including anti-inflammatory products must be stopped two weeks before and two weeks after surgery. Dr. Delgado’s preoperative instructions will have a complete list of these medications to avoid. Tylenol may be taken during this time. Also, you will be given a list of homeopathic preparations as well as vitamins to take prior to and after surgery. This is done to promote healing and limit bruising.
Anesthesia
Most liposuction is done under general anesthesia. However, in some cases when small amounts of fat is extracted, local anesthesia with IV sedation can be used. Dr. Delgado and the anesthesiologist will discuss this with you to help make the best decisions.
Procedure
Liposuction is performed in a hospital or an out-patient surgical center. If the patient has over five liters of fat aspirated, or over 4-5 hours of surgical time, the patient will stay in the hospital over night. Before anesthesia is given, a surgical marking pen is used to draw a detailed “map” in the areas being liposuctioned. This architectural plan enables the doctor to make the accurate changes from the standing to the lying position. After anesthesia is given, Dr. Delgado will inject tumescent fluid, which consists of salt water and a vasoconstricting agent to reduce bleeding. This solution distends the fat layer. Very small incisions are made in non-conspicuous areas, such as the navel or buttocks crease. A narrow cannula is inserted and used to vacuum the fat layer that lies deep underneath the skin. The cannula is pushed back and forth through the fat layer, breaking up the fat cells and suctioning them out. The suction is provided by a vacuum pump. The incisions are closed and a compression garment is placed on the patient.
After Liposuction Surgery
The first few hours after surgery will be spent in the recovery room. When you are fully awake, you are able to go home with the assistance of a friend or family member. If you stay overnight, you will be monitored carefully and Dr. Delgado will check your dressings and discharge you the following morning.
To help control the swelling and to aid the skin to contract, a compression garment is worn over the treated areas for four to six weeks. The discomfort after liposuction is described more as soreness, opposed to pain. Pain medications are prescribed to control any discomfort for the first few days, but you may still feel stiff and sore for a few days.Bruising may be present for seven to ten days. The initial swelling resolves in two weeks, but residual fluid takes six to eight weeks to disappear. The sutures are removed in seven to ten days. You may return to work in a few days after surgery, depending on the amount of liposuction being performed. We encourage light walking as soon as possible to reduce swelling and prevent blood clots from forming in the legs. Strenuous exercise should be avoided for approximately four weeks.
Risks and Complications
Like all surgical procedures, complications can occur, such as infection, bleeding, and the risk of anesthesia. However, with a qualified plastic surgery team and state of the art surgical facility, the risk of complications are extremely rare. The most common problems are skin contour irregularities that are unusually due to poor skin quality or cellulite. In some cases, there may be under correction, which can easily be adjusted with a “touch-up” procedure usually using local anesthesia. If over correction is done, fat injections can be done.
Swelling and bruising are not complications and resolve in time. Sometimes bruising can be prolonged, and at times a light discoloration may remain. If you gain weight in the future, the fat may distribute itself in the body differently. Usually if this occurs, less fat will deposit in the areas that were liposuctioned.
Outcome
You will notice a significant difference in your body after liposuction. The results are permanent with minimal scaring. You may be more comfortable in a variety of clothing, and have a higher sense of self-esteem.
How is the liposuction procedure performed?
Liposuction may be performed in one of two ways, by the tumescent technique or by Ultrasonic Assisted Lipoplasty (UAL). By liposuction methods involve small incisions being made near the area to be treated, a high pressure vacuum to remove the fat, stitching the treated areas, and a protective garment to contain swelling.
The tumescent technique involves saline solution and local anesthetic being injected prior to suctioning. These fluids make the area swollen, which enhances the separation of fat cells from other tissue. This liposuction technique is more precise, results in less blood loss, and allows more fat to be removed.
Ultrasonic Assisted Lipoplasty (UAL) is a more recent liposuction technique. UAL liquefies the fat by ultrasound. This allows for a smoother and more efficient suctioning of fat.
What can I expect during my initial consultation?
If you are considering liposuction, Dr. Delgado will first meet with you to discuss and evaluate your health, as well as discussing your expectations following the procedure. He would provide computer imaging to help you visualize your results. You will be required to provide Dr. Delgado with you complete medical history. This includes all medications you have taken and are currently taking, allergies, previous surgeries, and any other pertinent health information.
Is there anything I need to do to prepare for liposuction?
If you smoke cigarettes, stop smoking. Obviously, smoking causes a number of health problems. If you are undergoing a liposuction procedure, or any cosmetic procedure, smoking can greatly increase the risk of complications related to bleeding and other circulatory problems.
On the day of your liposuction procedure, you may not eat or drink anything eight hours prior to the procedure. Any medications you take must be evaluated and approved by Dr. Delgado.
How long does the liposuction procedure take?
The amount of time your liposuction procedure will take depends on the size and number of areas being treated. Most liposuction procedures are completed in two to four hours. Dr. Delgado will be able to give you a more precise time estimate during your consultation.
Is anesthesia used during a liposuction procedure?
If you are only having a small area treated, you will have your liposuction procedure performed under local anesthesia. If you will be having several areas or a large area treated, your liposuction procedure will be performed under general anesthesia, intravenous sedation, or epidermal anesthesia.
Will I be able to return home on the same day as my liposuction procedure?
In most cases, patients are able to return home on the same day as their liposuction procedure. However, like most surgery, you will not be able to drive yourself home. If you choose to have a large area treated, Dr. Delgado may suggest you stay the night for observation.
Following my liposuction procedure, how long must I wait to return to work?
Most liposuction patients are able to return to work within a week. You will also be able to function regularly within this time. However, you should probably wait several weeks before you return to more strenuous activities or exercise.
What areas of the body can be treated with liposuction?
Liposuction can treat any part of the body that contains fat. Most patients use liposuction to remove fat deposits on the thighs, hips, abdomen, and neck.
Will there be scars following my liposuction procedure?
Yes, virtually every type of surgery leaves scars. Dr. Delgado understands that you want these scars located in the most inconspicuous areas so they can be covered with regular clothing. Dr. Delgado will discuss with you where you will have these scars placed in order to cause you minimal inconvenience.
How old should I be before I undergo liposuction?
Dr. Delgado suggests his patients are at least eighteen years of age. Most people continue developing into their early twenties. If you choose to undergo liposuction at too young an age, you may need to have the procedure repeated. During your initial consultation, Dr. Delgado will evaluate whether your body is developed enough to undergo liposuction.
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Breast Reduction
Breast Reduction or reduction mammoplasty is a surgical procedure that reduces the size and shape of the breasts by removing excess skin and underlying breast tissue. It also reduces the size of the nipple-aerola complex which frequently becomes enlarged as the result of breast development. The results are breasts that are higher, smaller, and more shapely.
For these reasons, most insurance plans provide coverage for breast reduction procedures.However, it can be a purely cosmetic procedure for women are self-conscious about their breast size. The procedure is permanent, although breast size can change due to weight gain or loss.
Who is a candidate?
Women with disproportionately large breasts are a good candidate for breast reduction. This is done for both cosmetic improvement and symptomatic relief. In general, woman with size DD or greater are the most common candidates. However, for a petite woman, size C or D may be too large for their body frame.While women from any age can benefit from the procedure, it is most commonly performed after the breasts are fully developed, unless a young girl experiences significant deformity.
Fact: 97% more breast reductions were performed in 1999 than in 1992, and 11% more than in 1998. 78,169 breast reductions were performed in 1999.
Before Surgery
A personal consultation is the first step for every patient considering a breast reduction. During the appointment, Dr. Delgado will ask you to discuss your concerns about your appearance. He will use computer imaging to discuss your size, asymmetry, and display the locations of the incisions. He will also discuss where the areolas will be positioned; they will be moved higher during the procedure and should be approximately even with the crease underneath the breast. He will discuss the variables that will effect the procedure; such as age, size, the shape of your breast, and the condition of your skin. He will conduct a routine breast examination and ask about your medical history. He may ask you to have a mammogram. He will discuss factors that will determine the possibilities for and the extent of the surgery. Dr. Delgado provides precise preoperative booklet that provides pre and post operative instructions, including medications in advance of your surgery. All aspirin and aspirin containing products, including anti-inflammatory must be stopped two weeks before and two weeks after surgery. Dr. Delgado’s preoperative instructions will have a complete list of these medications to avoid. Tylenol may be taken during this time. You will also be given a list of homeopathic preparations as well as vitamins to take prior to and after surgery. This is done to promote healing and limit bruising.
Anesthesia
Breast reduction is done under general anesthesia. The procedure is typically performed in an outpatient surgery center or a hospital.
Operative Procedure
Before anesthesia is given, a surgical marking pen is used to draw out a detailed “map" on the breasts and chest. This architectural plan enables the doctor to make the accurate changes from the sitting to the lying position. After anesthesia is given, incisions are made around the areola and downward to the crease underneath the breasts. Regardless of the incisions, the nipple areola complex will be moved upward and the skin tightened. Dr. Delgado will remove the excess glandular tissue, fat, and dense skin, shaping and sculpting the breasts to form their new size and contour. Many times liposuction is used for removing excess fat around the site of the chest. The latest breast reduction incision is shaped like a lollipop. The older technique is the inverted T-incision which produced much larger scars. The other advantage of the lollipop incision is that the breast tissue is reconstructed in a conical shape which has a long-lasting effect. The inverted T-incision holds the breast shape by changing only the skin envelope. In time the skin stretches out and the shape is lost.The surgery takes approximately three and a half to four hours. Fine sutures are used to close the incision. Often drains are placed in to remove any excess fluid over the next few days. The breasts are wrapped in a compression dressing, and a bra is placed.
After Surgery
The first few hours after surgery will be spent in the recovery room. When you are fully alert, your will be able to go home with the assistance of a friend or a family member. At this time, it is important to sleep with the head and back elevated to reduce the swelling in the area. If drains are placed, they will be removed in three to five days and at that time, the dressings will be removed and replaced. Instructions are given in the preoperative pamphlet as to wound care. The sutures are removed in approximately two weeks.Your breasts will be uncomfortable for a day or two, but the pain should not be severe. Pain medications are taken for the first day or two in order to be comfortable during your recovery. By the third day, pain medications usually are not needed. However, some patients have a low pain threshold and therefore may take pain medications up to five days. The swelling and bruising lasts approximately one week, but the general recovery is approximately two weeks. Once the bruising and tenderness are gone, the patient can return to normal activity. It is an absolute priority that patients avoid lifting objects for at least two weeks post operatively. Most patients may drive a car and return to work or social activities after one week. Strenuous exercise is avoided three to four weeks following surgery.You should avoid sex for the first weeks or so after surgery, since this can increase swelling and discomfort.
Risks and Complications
As with any operation, a breast reduction carries the normal risk of infection, bleeding, and the risk of anesthesia. However, with a highly trained surgical team, these complications are extremely rare.Breast reduction does leave scars from the nipple areola complex down to the base of the breasts. Sometimes sensitivity in the nipple and breast area is reduced. The feeling may not return for as long as six months. Most woman having breast reductions are able to breast feed, however a small minority may be incapable of nursing.On rare occasions there may be a slight difference in size from one breast to the other, or the nipple areola complex will have some differences
Breast Reduction Results
Even though you can appreciate a significant reduction in breast size after surgery, it takes a couple of months for the breasts to settle into their new shape. This may fluctuate with weight gain, hormone influences, or pregnancy. You will appreciate a better balance with your body and your clothes will fit more proportionally. It is very important to watch the progress of the scars. If there are any rope-like “configuration” to the scars it should be addressed immediately. Even though there are scars with breasts reduction, breast reduction patients are usually the happiest patients who experience plastic surgery.The advantage of having a breast reduction will reduce the weight of the breast, and therefore the body begins to adjust to a lighter gravitational pull. This will reduce the symptoms that a patient experiences, such as the back and neck pain, and the postural changes. The changes brought about by breast reduction are among the most helpful and dramatic.
Will insurance cover the costs of the surgery?
Breast reduction is often considered to be a reconstructive surgery, rather than an elective plastic surgery. As a result, the chances of your insurance covering part or even all of the breast reduction surgery costs are more likely. There are many factors that contribute to determining whether or not your procedure will be covered by your insurance company, including the unique terms within your insurance policy, how much breast tissue is going to be removed, and the potential health risks you could face by having or not having breast reduction. To learn more about this, visit our guide: "Will Insurance Cover My Breast Reduction?"
Is breast reduction permanent?
Yes, your breasts will always be smaller than they would be without breast reduction. However, the remaining fat cells may eventually swell and will enlarge if you gain weight or become pregnant.
How is breast reduction performed?
Breast reduction is performed by surgical removal of skin and tissue.
Where are the incisions made?
The size of the breasts determines the technique used and the amount of tissue to be removed. The incision could be a "lollipop" or an inverted T. The incision is around the areola and down to the crease of the breast
Is there bruising after breast reduction?
The breast reduction procedure does have moderate swelling and bruising but resolves in 7 to 10 days.
How long will I be out of work?
Most breast reduction patients are able to return to work within 2 weeks, while some patients may return in as little as 5 days. The exact amount of time will depend on your personal anatomy.
When will I be able to see the results of my breast reduction?
After your breast reduction surgery, you will immediately notice the difference in your breast volume. If you have breast reduction to alleviate back pain, you should be able to notice this relief almost immediately as well.
Who is a good candidate for a breast reduction?
The ideal candidates for breast reduction are patients over the age of 18 with realistic expectations. If you are self-conscious about the size of your breasts or if you suffer from neck, back or shoulder pain due to excessive breast size, you may be a candidate for breast reduction surgery.
Some women have loose skin from childbirth, weight loss, or genetic reasons. In these cases we may place the implant partially under the muscle, above the nipple, and partially above the muscle below. This will insure that the loose skin is fully stretched. However, if the skin of the breast is very loose or ptotic, a lift in conjunction with the enlargement may give the best results. Some women do not want breast lifts due to the additional incisions, and will accept the trade-off of a lower breast mound.
Who should I talk to about breast reduction?
If you are considering breast reduction surgery or would like to learn more about breast reduction, contact us today to schedule a consultation. An experienced breast reduction surgeon will discuss your goals and explain how we can help.
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