Dr. Tarick Smiley Plastic Surgery Articles and News

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Post plastic surgery drains are commonly used after tummy tuck, body lift, and other procedures in which seroma or fluid formation is a real concern. The goal is to control swelling, promote healing, and minimize risk of complications.


It is important to note that post plastic surgery drains are not always necessary. For instance, most breast augmentation patients can do without them, particularly if they receive smooth implants.


post plastic surgery drains

However, drains are more commonly used in breast augmentation involving teardrop implants, breast revision, breast reduction, and breast lift as they involve more tissue dissection, which in turn results in higher risk of seroma.


Seromas are caused by injury to the blood vessels and lymphatic channels. Large seromas should be avoided because they can inhibit healing, attract infection, and possibly lead to uneven skin surface, as suggested by Inland Empire plastic surgery expert Dr. Tarick Smiley.


Drains are commonly used in tummy tuck, a procedure in which an apron-like skin hanging from the abdomen is removed with the use of hip-to-hip incision. To further achieve a smoother result, the surgery also incorporates muscle repair in which the pair of muscle below the breastbone that extends to the lower abdomen is sutured in place.


Surgical drains have tubes that lead out of the body and have small bulbs to “hold” the fluids, which are usually emptied 2-3 times a day. Meanwhile, the fluids may appear reddish, yellowish, or brownish with some “bits” floating around; however, they should have no foul smell.


How long will the surgical drains remain in place depend on how much drainage they collect; hence, the patient needs to keep track of the amount every day. Sometimes these are removed as little as three days, while some people have to “wear” them for as long as 15 days.


The drains are removed in the office by simply pulling their tubes out. Most patients describe some discomfort or pain, which dissipates quickly.

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For a small subset of patients, male breast reduction by liposuction is enough to deliver good results. However, the right candidates should have good skin shrinkage and have no excess tissue, which can be diagnosed on physical exam and possibly some type of imaging test such as MRI, chest X-ray, and breast ultrasound.


Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says male breast reduction by liposuction involves unique challenges, which must be recognized beforehand to achieve good results from the surgery.


male breast reduction by liposuction

Before and After Photos


  • More fibrous fat


The male breast contains highly fibrous fat, meaning it has more connective tissue. For this reason, the use of larger cannulas or flexible hollowed tubes for suctioning the fats is not advisable.


Microcannulas are the right choice when treating highly fibrous fats because of their narrow body (outside diameter is typically less than 2.5 mm) that allows them to easily penetrate the tissue.


  • Risk of over correction


Inadvertent over correction can be problematic due to skin irregularities, collapsed areola, and other types of deformity. For this reason, the use of microcannula becomes more important than ever when the surgery involves a highly sensitive area like the male breast.


The goal of liposuction is to remove just the right amount fat to eliminate the appearance of “fullness” without causing the internal structures to collapse. Simply put, there should be sufficient fat beneath the skin after surgery to achieve smooth results and to avoid a gamut of complications.


It is also important to move the microcannula at correct speed to prevent inadvertently removing too much fat in one area. For this reason, a prudent patient will only choose a board-certified plastic surgeon who performs male breast reduction by liposuction on a regular basis.


  • Issues involving skin shrinkage


To achieve smooth results, the patient must have good skin shrinkage, allowing it to shrink-wrap around the new contour. As a result, older people (aged 55 and above) and massive weight loss patients are in general not good candidates for a liposuction-only approach.


  • Patient’s weight


As with any body contouring surgery, liposuction is only reserved for patients of normal, healthy weight. Any attempt to perform the surgery on someone who is significantly overweight or obese can lead to poor cosmetic results and an increased risk of complications.

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There are several factors influencing male breast reduction surgery cost; these include the surgical maneuvers (excision-based techniques, liposuction, or both), clinic location, surgeon’s fee, among others.


Sometimes, insurance coverage for male breast reduction is possible provided that the abnormal enlargement of the breasts, a condition referred to as gynecomastia, poses serious health problems. A good example is a tumor developing alongside with the tissue.


male breast reduction surgery cost

Another situation that makes insurance coverage possible is that gynecomastia comes with extreme pain and discomfort.


Meanwhile, health insurance issuers rarely recognize psychological and emotional benefits as valid reasons for coverage. Simply put, the patient must provide sufficient evidence that his condition poses a serious medical condition.


Because most patients seeking for male breast reduction do not qualify for insurance coverage, they must be in good financial position prior to the operation. The consensus is to have available funds at least twice the actual cost of the surgery as a way to prepare for “unexpected” events like a longer than usual recovery and the need for some type of revision.


In Beverly Hills plastic surgery, the average male breast reduction surgery cost involving excision-based techniques (i.e., removing the excess glandular tissue and possibly some skin and fat) is between $5,000 and $7,000.


For liposuction-alone surgery, which is only reserved for patients with a condition called fake or pseudo gynecomastia, the average cost is between $3,000 and $5,000.


But sometimes, the excess fat extends far into the armpit area, which of course also requires this treatment to achieve smooth results, thus increasing the cost.


Pseudo gynecomastia means the underlying problem is the excess fat. However, the vast majority of male breast enlargements are caused by too much tissue, which is typically removed by creating a U-shaped incision precisely at the lower border of the areola.


While it may be tempting to choose a surgeon offering the lowest price, it is important to note that using this as a benchmark could preclude one from selecting a qualified doctor.


Qualified doctors, i.e., board-certified plastic surgeons who perform the surgery on a regular basis, will not lower the price too drastically because of the cost involving accredited surgical facility and anesthesiologist (and other licensed professionals and staff).


A surgery that is priced way too low can be interpreted as a sign of desperation, i.e., to compensate for the surgeon’s lack of training and experience and attract “less” prudent patients. Also, this could be a sign that a doctor has compromised patient safety, such as performing the surgery at a non-accredited facility.

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Tummy tuck swelling comes in various degrees depending on whether the patient has received simultaneous liposuction and muscle repair. Nevertheless, most people can expect noticeable improvement in their abdominal area after 2-3 months when most of the inflammation has subsided.


Tummy tuck swelling is primarily due to the interruption of blood vessels and lymphatic channels that occurs at the time of surgery.


tummy tuck swelling

More and prolonged swelling is expected when muscle repair is performed, which has become an integral part of tummy tuck as it “holds” the new contour and minimizes to some extent the impact of unintended pregnancy and weight gain, as suggested by leading Orange County plastic surgery expert Dr. Tarick Smiley.


In addition to the actual swelling in the soft tissue, the postop swelling is also caused by fluid accumulation between the abdominal wall and the skin. For this reason, some surgeons recommend lymphatic drainage massage, which involves gentle pressure techniques to eliminate the waste fluids (seroma and hematoma) from the affected area.


Some doctors allow their patients to start their lymphatic drainage massage one week postop, while others feel that waiting at least 2-3 weeks is more ideal.


Furthermore, the use of medical-grade compression garments is believed to control tummy tuck swelling. Some proponents even suggest wearing them round the clock for the first two weeks postop.


The goal of compression garments is to prevent seromas or fluid accumulations and ultimately encourage the skin to heal smoothly and evenly.


As previously stated, most of the swelling will resolve after 2-3 weeks. But if it remains persistent beyond this period, it might be caused by the unintended separation of the sutures that hold the abdominal muscle in place. To prevent this complication that warrants a revision surgery, Dr. Smiley says he prefers making “individual stitches,” as opposed to “one long running suturing” technique, when performing muscle repair.


With the use of individual permanent stitches, the risk of muscle separation is almost eliminated, explains the celebrity plastic surgeon.


Another possible cause of persistent tummy tuck swelling is the presence of fat, which can be diagnosed on physical examination. Again, this can be avoided with proper surgical execution and possibly the use of simultaneous liposuction, says Dr. Smiley.

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While some doctors may not talk about it, plastic surgery constipation is real. In fact, this “nuisance” is quite common after any type of surgery due to a combination of factors such as anesthesia, pain meds, and decreased activity during the healing stage.


Aside from hardened stool, plastic surgery constipation may also cause other equally troublesome symptoms such as nausea, vomiting, bloating, and abdominal pain.


plastic surgery constipation

Photo Credit: Teerapun at FreeDigitalPhotos.net

Plastic surgeons at the California Surgical Institute share their tips on how to prevent constipation; these recommendations are particularly critical after tummy tuck since it could strain the muscle repair. Nonetheless, the risk of disrupting or causing harm to the internal sutures due to constipation alone is very low.


* Drink plenty of water and other fluids containing no caffeine. Apple cider and prune juice might also be helpful in minimizing the risk of postop constipation, as they are known as natural laxatives.


* Eat more fiber-rich foods. Examples include fresh fruits, leafy greens, whole grains and cereals. Meanwhile, it is best to avoid or at least minimize the consumption of foods known to contribute to hardened stool such as dairy products, red meat, and chocolate.


* Eating small, frequent meals throughout the day causes less “disruption” to the digestive process compared to taking large meals.


* Avoid or at least limit the use of narcotic painkillers. When the postop discomfort becomes “more manageable” as the patients move forward to their recovery, they might consider switching to non-narcotic medications such as Tylenol.


* People with a “strong” history of constipation may consider using stool softener and/or fiber laxative after surgery.


* Perform light exercise, i.e., walk. The goal is to improve blood circulation without causing increased heart rate and blood pressure. It is important to note that decreased activity can lead to reduced colon contractions, and ultimately higher risk of constipation.

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While you may be pretty much aware of what to expect in your gynecomastia surgery recovery—e.g., postop swelling and bruising, mild to moderate pain, and tenderness—some things may take you by surprise.


Experts at the California Surgical Institute have explained the things to watch out for. It is important to note that while serious complications are very rare (provided that the surgery is performed by a board-certified plastic surgeon), they do happen. The key to prevent them from causing more problems is to identify them early on.


gynecomastia surgery recovery

  • Constipation


While not commonly talk about, constipation is actually not uncommon after any type of surgery. There are many factors that contribute to this, although it is more closely linked to the use of narcotics pain meds; for this reason, they are best avoided once the pain becomes more manageable.


Other ways to prevent constipation include drinking more fluids than usual, eating high fiber foods, (days leading up to the surgery and after), limiting certain foods (e.g., cheese and meat), and performing light exercise (short walks throughout the day).


  • Infection


While infections rarely occur, when they do happen they could lead to more problems such as poor scarring and sepsis, which can be life-threatening. Typical signs of infection include fever, increasing pain or swelling of the surgical site, warmth and redness, pus or drainage, and foul smell coming from the wound.


Antibiotics can treat most wound infections, although some patients may need surgery to treat this complication.


  • Persistent swelling


Persistent swelling can impede with healing or may even be a sign of infection. This might also be caused by seroma or collection of fluids under the skin surface.


Large seromas must be drained as the fluids may attract infection. Small seromas, meanwhile, often resolve on their own within a few weeks.


It is important to note that gynecomastia surgery recovery tips may differ from surgeon to surgeon, so any prudent patient should stick to his doctor’s specific advice.

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