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Monthly Archives: September 2013

Breast Reduction; Before or After Bariatric Surgery?

Posted on: September 25, 2013
By: DrDelgado

San Francisco, CA-For the severely obese patient, the question is sometimes posed; “is it a good idea to have breast reduction surgery before or after bariatric surgery?” The result of a study on this very question was published in Plastic and Reconstructive Surgery, which is the official journal for the American Society of Plastic Surgeons.

Obese women find it almost impossible to exercise when they have large pendulous breasts. Many hope that by having a breast reduction mammoplasty that they will be able to exercise and lose weight on their own and avoid bariatric surgery.

Mommy Makeovee

This is a 35-year-old resident of Mill Valley, California who presented to the Novato office in Marin County for evaluation of a tummy tuck (abdominoplasty). She had a large weight loss due to diet and exercise. She underwent a full tummy tuck, breast reduction and liposuction of her flanks. Her surgery was performed at Marin Cosmetic Surgery Center in Marin County, California.

Bariatric surgery is a catch-all phrase for weight reduction surgery for obese patients. There are two main ways that this is done. The first would be Malabsorption such as gastric bypass surgery which restricts the amount of food going into the stomach and small intestines thereby limiting absorption of calories. The second would be Restriction where there is a surgical reduction of the size of the stomach and the small intestine, limiting the physical amount the stomach can hold.

In the study reported in the Journal, 29 women with a body mass index of about 54, 15 of the women had breast reduction surgery first and felt that their breasts looked much better; however even though exercising was easier, all 15 of the women still needed bariatric surgery in order to reach their weight loss goals. Most of the women were not sorry that they had breast reduction surgery because of the immediate relief from back, neck and shoulder pain, but they said that they would recommend to other women to wait until after their bariatric surgery so that an additional reduction mammoplasty surgery may be avoided. The women found that, with the weight loss provided by bariatric surgery, their breasts were reduced further in size, causing more sagging breast skin. Most of these women said if the cost of secondary breast reduction was something they could afford or if insurance would cover it they would proceed.

71% of the 14 women who had bariatric surgery first thought that their breasts looked worse after the weight loss and half of them planned to have breast reduction surgery, with more of them wanting it if they could afford it. So the conclusion of the study reports that women are dissatisfied with the appearance of their breasts after massive weight loss with or without breast reduction surgery prior. So it is recommended that a woman waits for their breast reduction after completing bariatric surgery. Now available at Dr. Delgado’s “Non-Surgical Center of Excellence”, is “CoolSculpting” which is a non-invasive treatment for pockets of remaining fat, this can be addressed at the time of your consultation.

Even though this study was for women, men have similar issues after massive weight loss. Men will find that they have a lot of redundant loose skin hanging from their chest requiring surgical excision, or gynecomastia surgery. Due to the skin being so stretched, it is very likely that the man will need a second stage male breast reduction surgery.

For both men and women, in addition to their breasts needing a reduction after bariatric surgery, most will also need an abdominoplasty or even a total body lift. This can be very disheartening to the patient that has been through massive weight loss only to find that the remaining loose skin leaves them feeling as disappointed in their body as before the weight loss. Hopefully the bariatric surgeon will explain thoroughly to the patient exactly what they can expect after their weight loss so that additional surgeries involving great amounts of skin tightening can be planned on both emotionally and financially. Depending on the patients, specific insurance policy, they may find they have coverage for the bariatric surgery and the breast reduction surgery; however, they may have to pay out of pocket for the body lift. The body lift generally includes the abdomen, arms and thighs, which most insurance companies would consider cosmetic surgery. Every case is individual and needs to be addressed with the insurance company by a top cosmetic plastic surgery specialist who is familiar with the process insurance companies require.

Will Breast Reduction Surgery Remove Stretch Marks?

Posted on: September 2, 2013
By: DrDelgado

Vertical Breast Reduction

This is a 32-year-old resident of San Rafael, California who is seen in the Novato office in Marin County. She is 5 feet 4 inches, 130 pounds, and underwent a short scar vertical breast reduction at the Marin Cosmetic Surgery Center. Her size was reduced from a size F to a size C. The photographs are seen approximately nine months after surgery and the incisions are starting to fade quite nicely.

San Francisco, CA-In addition to discomfort, women with large heavy breasts who are seeking breast reduction surgery, also may have unsightly stretch marks. Stretch marks, also called striae, form within the middle layer of the skin, known as the dermis. They are initially red, pink or purple but usually fade with time to white or silver and become much less noticeable. As disturbing as they may be, they do not pose any health issues.

Women who are planning to have breast reduction surgery, many times will ask if the surgery will remove the stretch marks on their breasts. In some cases, it will, but it depends on where the stretch marks are located, only the skin removed with stretch marks will be improved. There will be scars from the surgery, however all will fade with time from red to faint silver, similar to a tummy tuck procedure as far as removing many stretch marks as the skin is tightened and loose skin is excised.

There are not any miracle products to erase stretch marks. There are many creams advertised for stretch mark removal, but for them to work, it would need to penetrate the epidermis and get into the subcutaneous layer, so you may only see some minor improvement. Sometimes, the stretch marks can be improved and lightened with lasers.

Stretch marks can be caused by; pregnancy and some birth control methods that cause hormonal changes, also weight gain, when the skin gets stretched. In addition, corticosteroid creams and lotions may be the cause, even oral or systemic steroids. There are some medical conditions such as adrenal gland disorders, Cushing’s syndrome (a hormonal disorder caused by high levels of cortisol) and some connective tissues disorders are attributed to the formation of stretch marks.

Dehydration and lack of exercise can be a reason for development of stretch marks on the breasts. Anything that causes rapid changes in the size of the breasts can mean the sudden development of stretch marks, not only for women but also noted for some men if they develop gynecomastia (male breasts).

The Mayo Clinic states that stretch marks can be hereditary; if your Mother has them you may get them too. Accelerated growth for teenagers with developing breasts may lead to stretch marks. Also, according to the Mayo Clinic, there is not any way to prevent stretch marks other than maintaining a healthy weight and avoiding excessive weight gain.

Some women report that, after breast augmentation surgery, stretch marks don’t seem to be as bad. Breast implants can make the stretch marks appear less obvious, however, having an implant that is too large may put too much stress on the skin that already has loss of elasticity and may cause sagging.

Inverted T or Anchor

Inverted T or Anchor

Vertical Scar or Short Scar

Vertical Scar or Short Scar

The different types of reduction mammoplasty surgery will remove stretch marks within the area of excised skin. See the pictures to see the differences. During your consultation with Dr. Delgado who is a breast surgery specialist, he will explain what type of breast reduction surgery he recommends for you and the possibility of removal of some stretch marks.

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