However, I never forget what happened one night when I was a second year general surgery resident rotating at the intensive care unit (ICU).  One evening, I received news about an 18 year old female who was pregnant with her first child.  During or after delivery and the details were not clear, she stopped breathing and sustained several minutes of oxygen deprivation to the brain.  She was subsequently intubated and transferred to the ICU.  Fortunately the child was healthy.  Over the next two days, due to the unknown time of oxygen deprivation and since the patient did not respond appropriately to external stimuli, multiple studies were performed to asses her brain function.   All studies came to the same conclusion:   brain death.

In the evening, when the last set of test results was noted, I approached the family regarding organ donation.  I explained to them her brain damage was severe and irreversible and she will never be able to function or breathe on her own.  The family deliberated for 30 minutes in a private room and decided against organ donation.  They asked me to disconnect her from the breathing machine.

While they were in the room, I hoped the family chose organ donation, since I did not want to face her death.  She was so young!  It also would have benefited another patient who desperately was in need of an organ donor.

With the family in the room, holding hands and with their heads down in prayer mode, I disconnected her from the breathing machine.  It was eight or nine o’clock at night and the ICU was quiet.  This time it was eerily silent.  Although I could have left the room, I did not.  Here was a family I hardly knew, a patient I had known for two days.  After tonight, I probably would never see any of them again.  Yet, I couldn’t leave.  It didn’t feel right for me to leave.

Here I was, a second year surgical resident, helpless.  Neither surgery nor medical technology could save this patient now.  I watched the monitor showing her heart beat gradually slowing down….3 beats per minute…2 beats per minute…one beat per minute…flat line.

No words were spoken to me, but I knew the family appreciated my presence.  I left the room and went to the bathroom and started crying.

I realized something no medical school book or teacher could have taught me.  I was given the privilege and power not only to save lives, but to take life away.  I better not mess up and I better take my responsibilities seriously!

I often think of this patient, just to make sure I don’t forget what it means to be a physician.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon and a member of American Society of Plastic Surgeons.  His office is located in central Orange County.  If you like to schedule a complimentary consultation, please call 714-834-0101.

As have been stated in my previous blog, mommy makeover surgery addresses the changes which occur after pregnancy.  These changes primarily affect the breast and the abdomen.

The breast can be enhanced with an implant (breast augmentation) with or without a breast lift.  A breast lift may be required to reposition the nipple and tighten the loose skin.

Although some patients are lucky enough only to require liposuction, most patients will require a tummy tuck (abdominoplasty) to address the loose skin, stretch marks, and the weakened abdominal muscles which occur after pregnancy.

So, can both surgeries be combined together?  The answer, in most cases, is yes!

There are two limiting factors preventing both procedures to be performed at the same time: the patient’s financial situation, and the total time the patient is under anesthesia.

Mommy Makeover surgery is among the more expensive procedures performed by plastic surgeons.  The surgery may take 4-6 hours and the cost of anesthesia/operating room, implant and surgeon’s fee will add up quickly.  Having said this, if the patient can afford the cost, there are many benefits to having the procedures combined.  First, there is one recovery period, both from anesthesia and from the surgery.  For patients who work, one recovery period is financially advantageous.  Second, combining both surgeries will result in a 10-15% reduction in overall cost.  Surgery centers typically charge more the first hour and the price decreases after that.  Therefore, staging the surgeries will result in more added cost to the patient.

The second limiting factor is the anticipated anesthesia time.  The current recommendation by the American Society of Plastic Surgeons is to limit anesthesia time for elective, outpatient surgery to six hours.   Therefore, if the surgeon feels the surgery may take longer, it is best to stage the procedures.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience.  His office is located in Orange County, California.  To schedule a complimentary consultation, please call 714-834-0101.

Mommy makeover is the catch phrase for cosmetic surgery involving the breast and abdomen, the two areas most commonly affected by pregnancy.

The breasts typically “deflate” after pregnancy and breast feeding and almost always will require a breast augmentation to regain the lost volume.  If there is sagging of the nipple and loose skin, a breast lift (mastopexy) may be needed as well.

Some patients (the lucky ones!) have little effect on their stomach area after pregnancy.  However, most patients will develop loose skin, stretch marks and weakness of the abdominal muscles, resulting in a “beer belly” appearance.  Typically a standard or extended abdominoplasty is required, although some patients can achieve an excellent result with a mini-tummy tuck.

In most cases, both breast and abdominal surgery can be performed together, if the anesthesia time can be kept under six hours (this is the recommended time limit for outpatient elective surgery by the American Board of Plastic Surgery).  Performing both surgeries together has the benefit of one recovery term (this is especially critical for patients who work) and lower cost.

Mommy makeover surgery is amongst the most expensive cosmetic surgery procedures performed.   This is due to the prolonged surgery and anesthesia/operating room time required to adequately address and correct the changes discussed previously.  Whether the time and cost is worth it is a personal question only the patient can answer.  However, if you have realistic expectations and are doing the procedure for YOU and YOU ONLY, it is one of the most rewarding surgeries I perform.  Imagine reversing the effects of pregnancy, what a wonderful concept!  Many patients have told me their sex life has improved since the surgery because they feel more confident about themselves.  The smile on the partner’s lips is always a big give-away!

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience.  His office is located in Orange County, California.  To schedule a complimentary consultation, please call 714-834-0101.

“Will my nipple sensation change after surgery?” This is a common question asked by my Orange County patients seeking breast augmentation.

Unfortunately, there is no way to know how your nipple sensitivity will change after augmentation.  I tell my patients you have an equal chance of becoming more sensitive than less sensitive.

Contrary to popular belief, the addition of a breast lift does not increase the risk of nipple sensory change.  In other words, the risk for nipple sensory change is the same for breast augmentation with or without a lift.

The chance of decreased or absent nipple sensation, however, will increase with a larger implant.  The main nerve which gives sensation to the nipple comes from the lateral (outer) side of the chest muscle and travels under the breast until it reaches the nipple.  A large implant will, therefore, have a higher chance of putting pressure and stretching this nerve.  A larger than recommended breast implant may cause stretching and sagging of the skin, lead to enlargement of the areola, and increase the chance of nipple numbness.

It is important to be patient.  Many of the unusual sensations in the nipple and breast will improve with time.  It may take up to one year for the breast to settle and for the nerves to reach equilibrium.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience.  His office is located in Santa Ana, California.  To schedule a complimentary consultation, please call 714-834-0101.

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.

The goal of breast augmentation is to enhance the size of the breast and mainly provide fullness to the upper portion of the breast.

Currently, there are two types of implant available: saline and silicone.  For a detailed discussion about these implants, please click here.

The implant can be placed above or below the pectoralis muscle (by flexing the muscle one can make the breasts move up and down), and many factors will determine which approach is better.  Generally, I prefer to place the implant under the muscle because of more protection, less palpability, and less interference with mammography in the future.

For breast augmentation, majority of plastic surgeons perform the surgery either through an incision around the areola or underneath the breast crease.  The advantage of the inframmamary fold incision (at the breast crease), is that the scar is not visible unless the patient is lying down.  Also, the dissection causes minimal injury to the breast tissue when the implant is placed under the muscle.  The final result is independent of the type of incision used, and is dependent on the surgical skill of the surgeon.

My goals is to recommend an implant which is proportional to the patient’s body, and make the implant look, feel, and behave as naturally as possible.

If the patient has loose skin in the lower portion of the breast and the nipple position is low relative to the center of the breast, a breast lift (mastopexy) is then required.  This breast ptosis (sagging of breast tissue) becomes even more critical to correct with an augmentation.  Remember, for the best result, the nipple must be positioned at the center (the highest point of the implant); otherwise the breast shape will look unnatural.  Therefore, it is imperative to correct any ptosis present.

I perform three types of mastopexy, and each is chosen to give the best result for an individual patient. 

The first is a peri-areolar mastopexy (donut lift).  In this procedure, a circle of skin is removed around the areola and the skin in closed in a circle.  This results in the incision being around the areola. 

The second type is a vertical mastopexy.  Not only is a donut lift performed, but some skin is removed in a vertical fashion from the breast as well.  The final incision looks like a lollipop.  There is an incision around the areola, and an incision going down from the areola towards the base of the breast.

The most aggressive lift is used for patients who have a lot of loose skin and the nipple is at the lowest portion of the breast.  The incision is a vertical mastopexy with the addition of an incision underneath the base of the breast.  This type of mastopexy is also called an anchor lift, since the final incision looks like an anchor.  In all cases, the size of the areola can be reduced, if needed.

My goal is to obtain the best result with the minimum amount of scarring.  Patients are always afraid of the final shape of the scars.  Fortunately, unsightly scars are rare.  I have performed hundreds of breast augmentation and lift procedures, and the risk of noticeable scar formation is less than 1% in my experience. 

For better visualization, I have attached a link to our web-site which explains these procedures through 3-D animation.  Please click here.

I have attached before and after photos to illustrate the effectiveness of these procedures.

Dr. Jazayeri is a board certified plastic surgeon with over 10 years of experience.  To schedule a complimentary consultation at our Santa Ana office, please call 714-834-0101.

The essence of mommy makeover is to improve the appearance of the breast and abdomen.  Since these two areas are the most affected after a pregnancy, the term mommy makeover was coined for this combination procedure.

Regarding the breast surgery portion, the options are breast augmentation, breast enhancement with or without a breast lift (mastopexy), breast lift alone, and breast reduction (in cases of very large, heavy breasts).  During your complimentary consultation, I will recommend the best procedure(s) to address these issues. 

The abdominal portion entails an abdominoplasty, also known as tummy tuck, with or without liposuction of the flanks (love handles), or liposuction of the abdomen alone.
An abdominoplasty is indicated if loose skin, stretch marks, and a “beer belly” appearance are present, due to weakness of the abdominal muscles.

These procedures can usually be performed together, although the final determination depends on the anticipated amount of anesthesia time required.  The recommendation by the American Society of Plastic Surgeons is to keep anesthesia time up to 6 hours for elective, out patient surgery.  The advantage of performing both procedures together is avoidance of two recovery period, and the overall reduction in surgery room/anesthesia cost.

In my experience, mommy makeover surgery is one of the most rewarding procedures I perform.  It is a pleasure to see the regained confidence and happiness in the face of my patients after this surgery.  Needless to say, the smile on the face of the husband or significant other is always a plus!

Please remember although the term mommy makeover is used, this surgery also applies to patients who have had significant weight loss on their own or after gastric bypass surgery (bariatric surgery).  You do not have to be a mother to take advantage of these procedures!

If you are interested in a mommy makeover procedure, please feel free to contact my office and schedule a complimentary consultation.  Our office number is 714-834-0101.

I have attached a before and after photo to demonstrate the effectiveness of this procedure.

Dr. Jazayeri is a board certified plastic surgeon, with over 10 years of experience.  Our office is centrally located in Orange County, in the city of Santa Ana.  We provide plastic surgery services to the following cities: Aliso Viejo, Anaheim, Brea, Buena Park, Costa Mesa, Cypress, Dana Point, Fountain Valley, Fullerton, Garden Grove, Huntington Beach, Irvine, La Habra, La Habra Heights, La Palma, Laguna Beach, Laguna Hills, Laguna Niguel, Laguna Woods, Lake Forest, Los Alamitos, Mission Viejo, Newport Beach, Orange, Placentia, Rancho Santa Margarita, San Clemente, San Juan Capistrano, Santa Ana, Seal Beach, Stanton, Tustin, Villa Park
Westminster and Yorba Linda.

If you like to schedule a complimentary consultation, please contact our office at 714-834-0101