June 24th, 2009 Michael A. Jazayeri M.D.
Abdominoplasty (tummy tuck) is one of the most requested surgeries from my Orange County patients.
Seroma is one of the most common problems which may occur after abdominoplasty. In my practice, approximately 10% of patients develop seroma.
Seroma is a collection of fluid under the skin. It can develop early (while the drains are in) or late (after the drains have been removed). If the seroma is small (one ounce or less), it usually absorbs with time. If the seroma is large, however, it must be removed. This is done by aspirating the seroma through the abdominal skin with a syringe and needle. Multiple aspirations, once a week, may be required for several weeks. In majority of patients, this treatment will alleviate the problem. Rarely, other steps (even surgery) may be required to treat the seroma.
The main reason seromas occur is due to the abdominal skin rubbing against the underlying surface. It is this rubbing motion which promotes seroma formation. It is for this reason I emphasize to my patients to avoid excessive movement of the abdominal area while the drains are in and for one week after the drains have been removed. In my experience, majority of patients who develop seroma started their activities too fast and did too much.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience. His office is located in central Orange County. If you like to schedule a complimentary consultation, please call 714-834-0101.
Posted in Tummy tuck | 2 Comments »
June 17th, 2009 Michael A. Jazayeri M.D.
Capsular contracture means tightening of the capsule. Any non-absorbable foreign body which stays inside us will eventually form a capsule around it. In effect, since the body can’t expel the foreign body, our bodies ignore it by hiding it inside a “cocoon”.
The same principal applies to breast implants as well, no matter what style of implant or manufacturer is used.
In my Orange County practice, on a yearly basis, I see a handful of patients who develop capsular contracture after breast augmentation. When I say a handful, I am describing the patient which has visible and non-visible effects from the contracture. The percentage, therefore, is low. However, the incident of contracture increases with the age of the implant.
The most common system used for describing capsular contracture is the Baker-Gordon Classification:
Grade I-the implant and the breast feel soft, and look natural
Grade II-the implant feels slightly firm (not-objectionable), and the breast looks natural
Grade III-the implant feels hard and the breast looks abnormal
Grade IV-the implant feels hard, is painful to touch, and the breast looks abnormal
Once grade III and IV contracture has occurred, the only solution is surgical correction.
There are two surgical options to correct the deformity: capsulotomy and capsulectomy. Capsulotomy means cutting the capsule. Radial cuts are made in the capsule, resulting in expansion of the capsule. Capsulectomy involves removing the capsule. As can be expected, capsulectomy is a more involved process, and as careful as a surgeon is, a small amount of breast tissue is attached and thus removed in the process. This can result in a higher chance of skin thinning, compared to capsulotomy. I, therefore, reserve capsulectomy for a very thick capsule which does not “yield” easily, or in someone who develops recurrent capsular contracture after capsulotomy.
In my experience, most early capsular contracture is usually due to two factors: post-operative bleed inside the breast 1-7 days after surgery, and patient non-compliance.
It is critical the patient refrain from any rapid upper body activity or heavy lifting the first month, and especially the first week. I have had patients who picked up their child the next day after surgery, or vacuumed the house within the first week (talk about being tough!) and developed a hematoma (collection of blood) inside the breast. If the hematoma is small, it will absorb with time. If the hematoma is large, then surgery is required to remove it. Regardless, patients who develop post-op bleeding are at much higher risk of developing capsular contracture. This may be due to the inflammatory, “attacking” response of the body to clear the blood clot.
Patients who are non-compliant with their implant massage also are at higher chance of developing contracture. My theory is that the body is not used to the new pocket created for the implant, and the massage is critical to keep the pocket from closing. It typically takes 2-3 months for the body to form the capsule. That is why it is critical to massage the implants often during the first three months.
Capsular contracture with aging of the implant is out of our control. Neither the patient nor I can predict when the contracture will occur and how to prevent it. Having said that, majority of patients enjoy their “new” breasts for many years to come!
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience. His office is located in central Orange County. To schedule a complimentary consultation, please call 714-834-0101.
Posted in Breast Augmentation, Breast Implants | 3 Comments »
June 4th, 2009 Michael A. Jazayeri M.D.
BREAST LIFT-WHY IS IT NEEDED?
Some of my Orange County patients are surprised and sometimes shocked to find out in addition to a breast augmentation, they require a breast lift (mastopexy) as well. Since most of my practice is referrals from previous Orange County patients, the patient compares herself to her friend. This is a common quote: “But my friend didn’t need a lift, why do I need one?”
One cannot compare apples to oranges, and the same applies to one’s body. Your body is different than your friends, sister, neighbor, etc. Your friend did not receive a breast lift because she did not require it.
It is important to keep in mind the position of the nipple relative to the breast implant. For a breast augmentation to look cosmetically pleasing, the nipple has to be at the center (the highest point) of the implant. Otherwise, the breast shape will look strange. This is an important point to remember: a breast implant without a lift will look much worse and unnatural than a breast which is naturally saggy and loose.
Therefore, if a patient has nipple and skin ptosis, both must be corrected to achieve an aesthetically pleasing result. The only way to do this is by moving the nipple up so that it is at the center of the implant, and then removing the excess skin, so the skin is not loose and hanging.
Scarring is always a concern for patients. However, having done hundreds of mastopexies, I can say the risk of noticeable scarring (scars which are thick and raised) is rare.
Michael A. Jazayeri, M.D. is a Orange County board certified plastic surgeon with over 10 years of experience. His office is located in Orange County, CA. To schedule a complimentary consultation, please call 714-834-0101.
Posted in Breast Augmentation, Breast Implants, Breast Lift | 1 Comment »
