Mommy Makeover

Breast Surgery

• Numbness: Swelling after surgery usually results in loss of feeling in the breast and nipple area during the first several weeks. This impairment should be temporary and last no longer than a few months. In some cases, the loss of feeling can last longer following accidental injury to sensory nerves during surgical dissection.
• Hypertrophic scar: Hypertrophic scarring refers to developing a thickened scar over the surgical incision line. Treatment of hypertrophic scars is available and includes steroid injection, laser therapy, and silicone pressure therapy.
• Breast/Nipple asymmetry: Depending on the severity of preoperative breast asymmetry, surgery may result in minimal differences in breast size, shape, and nipple position. However, the asymmetry should be improved from the preoperative state.
• Nursing difficulty: Common belief is that breast lift surgery can adversely affect breastfeeding potential. However, breastfeeding is typically not affected because the milk glands are not separated from the nipple during surgery. Despite this, patients are advised not to expect to breastfeed if they should decide to have more children.
• High-riding implants: Patients frequently notice high-riding implants in the early postoperative period. The implants will drop into their desired, aesthetically pleasing position within 2 to 4 weeks. The tendency for the implants to sit high is countered by wearing a breast band, which your plastic surgeon will provide. The breast band will be worn for approximately 2 to 4 weeks until the implants fall into their desired space.
• Capsule formation: Capsule formation refers to the normal formation of a scar around an implant. This scar should remain thin, but when thickened, it is termed capsular contracture and can result in distortion of the overlying breast. Capsular contracture is rarely observed with saline implants and has been minimally observed using new-generation silicone implants.
• Deflation: Deflation of implants occurs at a rate of 1% per year. So in 10 years, there is a 10% chance of having an implant deflate.

Tummy Tuck

• Numbness is inevitable due to the separation of the skin and underlying fat from the abdominal muscles. Since the sensory nerves to the skin travel in the muscle layer before crossing over into the skin, they are unavoidably disrupted when elevating the skin and underlying fat of the muscle. The nerves will regrow with time, and patients note the return of sensation on average by one year following surgery.
• Hypertrophic scar: Hypertrophic scar refers to developing a thick scar on the skin. Based on the extent of redundant skin excised, patients may experience increased tightness surrounding skin incisions. They should expect a longer period for incision redness to dissipate (on average, 3 to 6 months). Treatments for hypertrophic scars include steroid injection, laser therapy, and silicone pressure therapy.
• Residual contour irregularities: Contour irregularities can persist following tummy tuck surgery due to uneven distribution of fat cells throughout the retained abdominal skin. Although liposuction can be used during abdominoplasty/tummy tuck to correct uneven fat distribution throughout the abdominal skin, this must be performed conservatively to avoid devitalizing the abdominal skin. You should expect your overall contour to improve from your preoperative state.

Risks: Risks are unwanted events that may occur during or following surgery. These events are recognized as “complications,” but their occurrence is minimized by appropriate patient selection, proper surgical decision-making, effective surgical technique, and careful preoperative and postoperative patient management.

Breast Lift/Augmentation

• Hematoma: Hematoma refers to the accumulation of blood in the breast pocket in the early postoperative period. Hematomas provide an ideal medium for the growth of bacteria. If you have an infection elsewhere in your body, the bacteria will travel through the bloodstream and find the hematoma. Additionally, hematomas can promote incision breakdown and even overlying breast skin compromise.
• Seroma: Seroma formation refers to the accumulation of plasma fluid in surgical pockets due to the disruption of lymphatic vessels. Patients may be prone to seromas if they have a low blood count or protein deficiency. Seromas can be a nuisance to patients requiring several aspirations in the office before their resolution. Additionally, these plasma-filled pockets may harbor bacterial growth resulting in an infection.
• Infection: An infection can occur following breast surgery. The infection may disrupt incision lines and leave the patient with an open wound. Prolonged antibiotics are required to fight the infection and prevent further infection extension. Patients requiring breast implant placement are at a slightly increased risk of infection as the implant acts like a foreign body and is more prone to infection. Patients requiring breast implant placement are placed on antibiotics before surgery to minimize the risk of infection. Infections are less likely in patients who don't smoke cigarettes or those who quit smoking for at least one month before surgery.
• Skin edge death/open wound: The skin incision can be disrupted if the skin edge dies or if there is a local infection. Counseling patients best avoid this complication of the terrible consequences of nicotine in cigarettes. Nicotine constricts small vessels found in the skin, which are critical for healing the skin's edge. As a result, patients are urged to quit smoking for at least one month before surgery. In addition, uncontrolled diabetes can lead to the undesired sloughing of the skin. Diabetic patients are urged to be vigilant about controlling their blood sugar levels before surgery. Patients who develop an open wound will require prolonged antibiotics and local wound care with frequent dressing changes. Delays in healing will compromise the aesthetics of your surgical incision line.
• Asymmetry of breast shape: Asymmetry in shape is very different than asymmetry of size (described above) and occurs when the implant pockets have not been dissected accurately. If the breast pockets are dissected too medially, this can lead to the breast pockets connecting, resulting in a condition called symmastia.
• Pneumothorax: A pneumothorax refers to the inadvertent puncturing of the lining that covers your lungs. This rare event can occur since implants are placed under the pectoralis muscle. When dissecting under the muscle, only a few millimeters of tissue separates the breast pocket from the lung lining. If the lung lining is punctured, the surgeon must place a catheter into the lung cavity and seal the lung lining at the end of surgery. You will require overnight hospitalization and catheter removal the following day before going home.
• Deep vein thrombosis (DVT) may occur in the legs immediately following surgery. DVT refers to the clotting off of leg veins which may result in compromised blood flow return from the legs; a more critical consequence may develop from this clot if it is dislodged and travels to the lungs, causing a pulmonary embolus. Although rare, pulmonary emboli are the leading cause of death following surgery. DVTs are avoided with routine pneumatic compression boots during surgery and by encouraging patients to walk as soon as possible following surgery.

Tummy Tuck

• Hematoma: Hematoma refers to the accumulation of blood in the early postoperative period, which pools into a dissected surgical pocket. Hematomas provide a perfect medium for harboring the growth of bacteria. So if you have an infection anywhere in your body, the bacteria will travel through the bloodstream and grow in the hematoma; this can lead to an infection and an open wound. To avoid a hematoma, drains are placed in surgery so that any fluid accumulation can be drained. Drains are usually kept in place for 1 to 2 weeks.
• Seroma: Seroma formation refers to the accumulation of plasma fluid in pockets created by the surgical elevation of the soft tissue and the disruption of lymphatic vessels. This fluid accumulates due to a low blood count and protein deficiency, which may be present in tummy tuck patients. This fluid can be a nuisance to patients requiring several aspirations in the office before their resolution. More importantly, these plasma fluid pockets may harbor bacterial growth and result in a clinical infection. Drains, which are placed in surgery, effectively prevent seroma formation. Consequently, seromas may become apparent following the premature removal of drains.
• Infection: An infection can occur after tummy tuck surgery. The infection will disrupt the incision line and may leave the patient with an open wound. Prolonged antibiotics are required to fight the infection and prevent further infection extension. Infections are usually avoided by using drains, which will prevent hematoma formation. In addition, infections are less likely in patients who don't smoke cigarettes or in patients who quit smoking for at least one month before surgery.
• Skin edge death/open wound: The skin incision can be disrupted if the skin edge dies or if there is a local infection. Counseling patients best avoid this complication of the terrible consequences of nicotine in cigarettes. Nicotine will clog all the small vessels found in the skin, which are critical for healing the skin's edge. Tummy tuck patients are usually mandated to quit smoking for at least one month before surgery. In addition, uncontrolled diabetes can lead to the undesired sloughing of the skin. Diabetic patients are urged to be vigilant about controlling their blood sugar levels before surgery. Patients who develop an open wound will require prolonged local wound care with frequent dressing changes. Unfortunately, any delays in healing the skin edges will compromise your aesthetic outcome.
• Asymmetry in abdominal contour can occur and is secondary to several factors, including 1) Uneven skin redundancy that should be improved following redraping, trimming, and repair; 2) Stretch marks are areas of the skin that have lost their elasticity and are prone to re-stretching. The surgeon attempts to remove as many of the stretch marks as possible. However, if there are stretch marks left and they are uneven (more on one side than the other), this will result in asymmetric restretching of the skin and a resultant asymmetric contour. Any residual asymmetry in contour can usually be repaired by performing a revision mini tummy tuck surgery.
• Deep vein thrombosis (DVT) may occur in the legs immediately following surgery. DVT refers to the clotting of leg veins, which may result in compromised blood flow return from the legs; a more critical consequence may develop from this clot if it is dislodged and travels to the lungs, causing a pulmonary embolus. Although rare, pulmonary emboli are the leading cause of death following surgery. DVTs are avoided with routine pneumatic compression boots during surgery and encouraging patients to walk as soon as possible following surgery.