*REDUCTION MAMMOPLASTY
(Breast reduction)
LIPOSCULPTURE-LIPOSUCTION
Up 
Liposculpture means a reshaping of the body outline , using
a technique known as liposuction. Deposits of fat at certain
areas of the body are removed, mostly for aesthetic purposes.
This procedure can be used for face, neck, arms, trunk, abdomen,
gluteal zone, hips, thighs, knees, calves of the legs, ankles,
etc. Liposuction is not a substitute for weight reduction
, it is a procedure that eliminates fat deposits, (fat tissue),
that diets and exercise have not been able to remove.
Fat aspiration can be done by the traditional suction (TRADITIONAL
LIPOSUCTION) , by ultrasound (ULTRASONIC), or the new procedure,
that uses a HIGH VIBRATION CANULA.
The
mechanical means to eliminate fat are not so important as
the techniques used by the surgeon. We have got the best
results by a superficial unattachment of the skin, in such
a way that an internal scar is produced, which contracts
the skin very effectively.
Liposuction
can be used as a principal procedure to improve the body outline,
or combined with other surgeries like facial lifting, abdomen
surgery, thighs lifting, in order to give firmness and tension
to lax skin and support structures. The best candidates for
liposuction are patients with a relatively normal body weight,
who also have excess fat in some areas of the body.
After a liposuction, body outline improves a lot, because
of the firmness and elasticity of the skin that result from
the procedure. Some hanging skin does not adapt to the new
outline and may need additional surgical techniques., to eliminate
and give tension to excess skin. At any rate, lipectomies
are done currently less than before.
Irregularities of the body outline , due to structures different
from fat deposits can not be improved by a liposuction.
ANESTHESIA
It depends on the number and extension of the zones to be
treated.. It can be local, local plus sedatives, , epidural
or general. In all cases, the procedure starts by infiltrating
“Klein’s Solution” , which makes bleeding
almost inexistent. Blood loss is kept extremely low.
POSTOPERATIVE
PERIOD
Liposuction implies few risks, if the procedure is done
by an specialist, in a good clinic. Results are not immediate.
After the suction, an edema (inflammation) is formed, which
must be treated with some compressive clothes, like socks,
bands, etc, a lot of massages for linfatic drainage, and
exercise. Results can not be clearly seen 24 hours or even
a week after surgery, but the new decreased volume creates
a retraction of the skin, making the new outline perfectly
visible in two or three months.
We have a program of massages, linfatic drainage, exercise
and diet , if necessary. This way, results start to be noticed
a month after surgery.
The most frequent complication of liposuction is the appearance
of small irregularities in the skin, which disappear after
massages.
Shrivelling of the skin may occur, and lasts just a short
time. Even when the skin is previously infiltrated (Klein’s
Technique ) or tumescent liposuction, hematomas frequently
appear. Infections are very rare, but possible. Because
of this , liposuction should be practiced at an operating
room, specially when treating large areas of the body.
ABDOMINOPLASTY
OR ABDOMINAL LIPECTOMY Up
INTRODUCTION
It is a surgical procedure that removes excess skin and
fat tissues from medium and low abdomen, and gives tension
to the muscles located in the abdominal wall. It is not
a surgical treatment of overweight. Obese patients that
want to lose weight must postpone any surgery until they
are perfectly capable of keeping their weight loss. There
are several kinds of abdominal surgeries. It can be combined
with other surgeries of the body outline, including liposuction,
and can be practiced at the same time, together with other
chosen surgeries.
Purposes of this surgery are:
- eliminate excess skin and fat
- strengthen muscles at the abdomen
- get a flat stomach and reshape the waist
ANESTHESIA
General anesthesia is usually needed.
PROCEDURE
It depends on different types of patients. Main choices
are:
- Young patients , with a good cutaneous tone and without
muscle diastasis,(without separation between muscles): Abdominal
liposuction.
-
Young patients with a good cutaneous tone, but with separation
between muscles: Miniabdominoplasty plus liposuction. .
Abdominal muscles are strengthened and abdominal fat is
removed by a liposuction.
-
Patients with a big excess of skin and fat and with muscle
separation:: Classical abdomen surgery.
This
surgical procedure consists on lifting abdominal skin and
fat, strengthen rectus muscles , which get separated after
pregnancy, producing a very common distended abdomen, and
reshaping the waist with some stitches at the sides. Cuts
are designed in a way that make the scar hide behind the
inner wear of patients.
There are some patients that have a very big cutaneous “apron”
and need a much larger surgery. In these cases scars are
located down in the abdomen but they are longer and horizontal,
and sometimes can be seen, depending on the inner wear design.
We usually combine a liposuction with abdominoplasty, so
that abdominal fat is reduced , including the waist area.
This surgery requires one night at the hospital , and patients
are suggested to rest for 7 to 10 days.
DOWNFALLEN BREASTS (Ptosis)
Up
Many women are requesting us a treatment of their breast,
a “breast improvement” after having a child.
This treatment is more popular everyday. They complain about
their breast, which looks shape less, fallen and somewhat
empty. During pregnancy and lactation mammary gland gets
a lot bigger . Skin also increases its mass. After these
periods of a huge hormone production, mammary glands involutionate
and get atrophied. But the skin does not withdraw in the
same proportion. Also, the breast ligaments system gets
relaxed and gains distension. As a result , breasts fall.
According to the position of the breasts, in relation to
the areola and submammary furrow , there are three types
of ptosis (downfallen breasts):
The
procedure to be chosen by us depends on the position of
the areola-teat structure, the residual volume of the mammary
gland, and the amount of excess skin.
In most cases we practice a combined procedure: Resection
of excess skin and breast enlargement. Patients and specialists
are always very concerned about scars. I personally try
to do my best , in order to get the smallest scar that is
possible. What can we do?
If the patient wants or is OK with a bigger breast size,
the best technique consists on removing skin around the
areola, producing a single scar around the areola.
A prothesis of silicone is then put in place This procedure
achieves a very natural result and appearance. Silicone
implants give a new volume to the breast. Filling the breast
makes it regain volume, specially at the low neck zone.
Therefore, there is less need to remove skin. I prefer to
put the prothesis on in such a way that it is covered by
the pectoral muscle (upper half). This way , the shape of
the breast is very natural, low neck also becomes much prettier
, and risks of prothesis encapsulation are smaller..
If the woman does not want a larger breast, a different
procedure is needed.
Mammary glands are reshaped from the inside., placing them
in their original position, projecting them and giving them
a younger look.
Depending on the areola location, we remove skin around
it, or, in more difficult cases, we have to do a vertical
scar from the areola to the furrow. This scar is visible
during the first months after surgery, but then it is hardly
noticed. This is a variation of techniques for Reduction
Mammoplasty, but without removing any gland mass.
Surgery requires general anesthesia, lasts from 90 to 120
minutes and usually requires also one night at the hospital.
After surgery , patients must wear a fastener , 24 hours
a day, for one month, in order to help the gland cicatrize
in its new position.
AUGMENTATION OR ENLARGEMENT MAMMOPLASTY
( Breast enlargement surgery)
Up
The purpose of this procedure is increasing breast size,
to get pretty and natural breasts , according to patients’
wishes and their particular body features.
PROTHESIS
Silicone prothesis are currently the most reliable type
of prothesis. Soy prothesis were removed from the market
because of serious doubts about their side effects and complications.
I prefer silicone prothesis with a rugged wall because of
their better consistence and because they achieve the best
results, concerning both appearance and sense of touch.
Anatomic silicone prothesis “rebuild” sometimes
, in some circumstances, the breast and give it a proper
shape. I never advice the use of the serum ones, these may
become deflated and never give the breast a natural appearance.
Because of arguments about prothesis , many researches have
been carried out.
These indicate that women with prothesis are not more likely
to get cancer or immune system diseases than women without
prothesis.
Women with prothesis can get pregnant and have a normal
lactation time. It has not been proved that silicone gets
into the milk in any way.
The main possible complication after surgery is the capsular
contracture.
Fortunately, I have noticed during my practice that this
effect is extremely rare. It is widely known that some factors
favor the appearance of this hard scar around prothesis:
Hematomas, bacterial contamination, etc… W e prescribe
oral antibiotics for some days, put a rugged wall prothesis
on and start a massages program to soften the capsule which
is formed. All of this helps avoid this complication.
PROCEDURE
In women who have never been pregnant, I put the prothesis
in place through a small cut or incision in the areola.
In first place, scar is concealed by the inferior areolar
border, and is not easily visible. In second place, the
mammary gland is not affected very much, and keeps its function.
Finally , the prothesis is located behind the muscle, getting
a very natural aesthetic result for the upper breast.
Also, the muscle helps avoid the appearance of a capsule
around the prothesis.
Women are usually concerned about getting the proper size
prothesis… it should be noticed , without being too
big. I use in this surgery specially designed indicators
to make sure that sizes of prothesis fit perfectly the dimensions
of women’s thorax.
This procedure requires general anesthesia. It usually lasts
one hour and a half.
It is necessary to stay at the hospital for some hours,
or one night , in some cases.
POSTOPERATIVE PERIOD
Results are immediate. I suggest to rest for three or four
days. After that, women can usually drive and work.. Patients
must avoid efforts or lifting heavy things for 15 days.
From the start, there is no need of any bands, bandages,
etc., and patients can wear the desired brassiere size.
REDUCTION
MAMMOPLASTY
(Breast reduction surgery)
Up
Women with large breasts may have several problems , due
to weight and size of breasts , like back pains, neck and
shoulder pain, and cutaneous irritation.
Breast reduction is practiced to improve these symptoms
, and to improve breast aspect.
Some young girls suffer from an excessive growth of their
breasts. This condition requires a breast reduction surgery.
ANESTHESIA
We use general anesthesia.
PROCEDURE
Until recently , reduction techniques produced a scar, similar
to an inverted T, which prevented doctors from achieving
the best aesthetic results.
If the volume to be extirpated is small , we do that through
a single scar around the areola. If the volume is bigger
and breast is fallen , our technique produces a single vertical
scar , eliminating the scar at the submammary furrow. Breasts
are located in their natural position, their shape is excellent
, and the single vertical scar is practically invisible.
The T shaped scar is needed only when breasts are too big
and require a big volume reduction.
In some cases, we can carry out the reduction by only doing
A LIPOSUCTION.
The resulting shape is not as good , but there are several
advantages, like a fast recovery, and extremely small scars.
( a single 1 cm. Scar in the furrow).
Using this technique, we get a lift in the areola of about
four to six cms.
POSTOPERATIVE PERIOD
This surgery requires a stay at the hospital for one or
two days. After surgery, we suggest not to do hard efforts
or lift heavy things , for about 15 days.
A fastener is needed for one month after surgery, to keep
breasts in their new position, and to help scars heal.
GLUTEOPLASTY
(Gluteal zone surgery) Arriba
Enlargement
of the gluteal zone is very popular in some Latinamerican
countries.. Demand of this procedure grows fast.., specially
because of famous actresses, singers, etc, whose appearance
is imitated by many.
This surgery is practiced both in men and women. The technique
is the same, but there are aesthetical differences. Men
want to strengthen the major gluteal muscle outline, gaining
muscular appearance. Women try to get rounded forms, usually
requiring a liposuction and lipofilling.
Implants are cohesive silicone gel implants. Prothesis are
flatter and more resistant than those used at breasts. This
prothesis stands strong forces and efforts, related to the
major gluteal muscle. (walking, running, jumping).
Prothesis is located beneath the major gluteal muscle, and
is not visible. Incision is made at the fold between both
buttocks, as down as possible, to conceal it..
This procedure requires general anesthesia , so that the
muscle is fully relaxed and we are able to introduce the
prothesis easily.
No drainages are usually needed.
Patients
must be extremely helpful. They must stay in bed, up side
down, for two days, after surgery. (at the hospital). After
that, they can get up but trying not to sit down when possible,
and trying also to protect the operated zones.
After a week, patients can sit down normally , but they
must sleep up side down for two weeks. Physical exercise
must be avoided for 5 to 6 weeks..
All these measures make the scar around the prothesis stable
and prevent the prothesis from moving, which could result
in asymmetry. Prothesis is never rejected or encapsulated
, infection risks are low. However, hygiene is needed and
we prescribe antibiotics for ten days after surgery to minimize
risks.
We usually practice , for women, a glutoplasty combined
with a liposuction in the lumbar zone and waist, in such
a way that the resulting curves at the buttocks are increased
in relation to lumbar zone and waist.
The removed fat is injected in the inferior zone , just
over the gluteal fold, to round the buttock. Prothesis fill
perfectly the two superior third parts of the buttocks,
but not the inferior third part.. Men just need a prothesis
, but women usually need a certain amount of lipofilling.
When a liposculpture is done at hips, thighs, buttocks,
we use the removed fat to inject the central zone of the
buttock, achieving a lifted and youthful look.
Patients with silicone implants in the gluteal zone must
remember to avoid intramuscular injections in this zone,
due to the risk of piercing the prothesis.
Finally, we strongly recommend not to use injected liquid
silicone. Unlike the prothesis , that can be removed at
any time, because of a complication or by patient’s
wish, liquid silicone, which infiltrates all tissues, has
a high risk of complications and it is impossible to extract.
