Male breast reduction and tummy tuck performed at the same time offers advantages such as lower cost compared to having them separately. Furthermore, not everyone has the luxury to have two recovery periods.
Dr. Tarick Smiley, one of the leading Beverly Hills plastic surgeons, says that patient safety is the most important aspect of multiple-surgeries operations. Theoretically, the longer operative time under general anesthesia and the more incisions and cutting are made, the higher the risk of complication is.
The first and most critical step to make combo surgery reasonably safe is to conduct strict patient selection. In this respect, Dr. Smiley requires all his patients to pass lab screening to ensure that they can handle the “rigors” of any operation.
Lab screening typically includes blood work and EKG and cardiopulmonary tests.
After passing lab screening, the patients are instructed to “prepare” weeks or even months prior to surgery. The idea is to help them achieve their optimal health through superb diet and regular exercise.
Preparation for surgery also involves complete cessation from tobacco and smoking cessation products and discontinuation of all drugs and supplements with blood thinning properties. For clarity, Dr. Smiley provides his patients written materials that let them know all the things and activities they need to avoid before surgery and afterwards.
To further ensure patient safety, Dr. Smiley says in his recent Snapchat post that he only works with a board-certified anesthesiologist who requires a separate lab screening. Also, this specialist monitors the patient’s vital signs at the time of surgery.
Moreover, all efforts are made to complete the surgery in less than six hours to control the amount of surgical trauma and bleeding.
While combo procedures have a perceived higher risk of complications, Dr. Smiley says having separate surgeries also has problems—e.g., multiple recovery periods, higher cost, and “multiple” risks.
Because bleeding has a large effect on the recovery period and the risk of complications, Dr. Smiley uses different modalities to reduce blood loss. For instance, he injects epinephrine before making incisions.
Epinephrine is a drug that constricts the blood vessels, ultimately reducing the amount of bleeding. Furthermore, it “spreads” the effects of local anesthesia and so the patients rely less on oral narcotics to control their postop discomfort.
Breast augmentation for asymmetry does not only rely on using two different sized implants. Occasionally, the lopsided appearance is not just caused by size disparity between the two sides, but by the difference in the nipple position/width and/or projection of each breast.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says all women have uneven breasts, which is normal to a certain extent; however, it only becomes an “issue” when the asymmetry forces them to change the way they dress or when they hide it by padding out one side.
The success of breast augmentation for asymmetry boils down to good patient-surgeon communication. Moreover, Dr. Smiley says that the right candidate should be able to explain her goals in details.
The celebrity plastic surgeon says that some patients want the smaller breast to be as large as the other side, although others like augmentation on both breasts with the use of different sized implants to close the size gap.
While it is possible to operate on just one breast to make it bigger and more symmetric with the other side, Dr. Smiley warns that breast augmentation does not only deal with the issue of size, but also with the shape and projection of breasts.
Furthermore, the augmented and non-augmented breasts do not behave similarly and are expected to age at different pace. Hence, Dr. Smiley says that most patients will need surgery on both breasts to achieve a good level of symmetry that can persist long term.
Aside from using different sized implants, a good number of patients also require areola reduction and/or elevation to further improve symmetry between the two sides. This ancillary procedure requires incisions around the areola’s perimeter, with the resulting scar lying precisely at the dark-light skin junction for its optimal concealment.
Breast augmentation for asymmetry requires a meticulous set of procedures; hence, a surgeon performing this operation must have formal training and relevant experience that have allowed him to develop an eye for detail.
Male breast reduction preparation aims to ward off infection or any other types of complications, and to help patients achieve the best results possible, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Male breast reduction, or medically referred to as gynecomastia surgery, usually involves a small U-shaped incision at the lower border of the areola to remove the excess breast tissue, ultimately correcting the appearance of woman-like breasts. Occasionally, it is combined with liposuction.
Liposuction uses a few small puncture wounds where a flexible tube (cannula) is moved back and forth to remove the “unwanted” fat. These round incisions heal and fade into almost invisible scars.
Anytime the skin is cut open there is always a risk of infection and wound healing problems. For this reason, Dr. Smiley requires all his patients to undergo lab screening to ensure that they are healthy enough for the surgery and can handle the ensuing recovery.
Should lab screening show any medical condition (anemia, bleeding disorder, hypertension, etc.) known to impede healing, Dr. Smiley says he will not proceed with the surgery unless it becomes well under control by diet, change in lifestyle, weight management, and/or medications.
Patients who pass their lab screening are then instructed to “prepare” for the surgery. Dr. Smiley recommends complete discontinuation of smoking and smoking cessation products, and aspirin and other drugs and supplements with blood thinning properties.
For clarity, Dr. Smiley provides his patients written instructions of things and activities they have to avoid two weeks before and after surgery.
But sometimes, male breast reduction preparation can take more than two weeks. For instance, patients who are markedly overweight are generally instructed to shed the extra pounds first before they undergo the knife. The idea is to allow the skin to snap back to the best of its ability, making it much easier to achieve a tighter, more masculine breast appearance.
Nonetheless, some patients who are slightly or even moderately overweight may proceed with the surgery provided that they are healthy and are happy with their weight or are not expecting to lose significant amount of body mass, says Dr. Smiley.
Breast reduction to fix asymmetry is a highly complex procedure. Contrary to popular belief, the lopsidedness is not only caused by the size disparity between the two sides; several factors also come into play like the nipple size and position, difference in the projection of each breast—even the shape of the chest wall may also contribute to the condition.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says every woman has uneven breasts; however, it only becomes problematic when the lopsided appearance prevents someone from wearing a swimwear without feeling too conscious, or tries to hide it by changing the way she dresses (e.g., using pad only on one side).
Dr. Smiley says that no patient should expect perfect symmetry after breast reduction or any other forms of breast enhancement surgery, although a good surgeon will make every effort to make each breast quite similar to each other.
The celebrity plastic surgeon says that breast reduction to fix asymmetry may involve just the larger breast—reshaping and reducing its size to make it more symmetric with the other side.
However, one caveat of leaving the other breast “untouched” is that it will not behave the same way as the surgically enhanced side, warns Dr. Smiley.
To achieve a good level of symmetry that can persist long term (both sides will “mature” and “behave” quite similar), Dr. Smiley says that breast reduction or any form of breast surgery should ideally involve both sides.
With breast reduction, whether or not there is a notable size difference between the two breasts, Dr. Smiley says the vast majority of patients will also require some type of mastopexy, or breast lift in layman’s term.
Breast lift and breast reduction share the same incision sites and thus additional scars are not an issue.
Breast lift not just repositions the downward pointing nipple; it also raises and reshapes the breast tissue with the use of internal sutures, explains Dr. Smiley.
To further improve symmetry, Dr. Smiley says he uses a device that resembles a cookie cutter to delineate the new smaller areola. He also ensures that the scar goes precisely at the dark-light skin junction so it blends well into the background.
Recovery from mommy makeover surgery—a combination of body contouring procedures that can reverse the effects of pregnancy—may vary greatly from patient to patient. Nonetheless, patients are generally advised to avoid strenuous activities and heavy lifting for six weeks to prevent healing problems.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says most of the pain will come from muscle repair performed during tummy tuck, a surgery that contours the frontal and lateral aspect of the waist. The discomfort from breast enhancement such as breast lift and augmentation, meanwhile, is much easier to control.
To minimize the postop pain resulting from tummy tuck, which in turn can promote healing, Dr. Smiley says he always injects Exparel into the abdominal muscle at the very end of his surgery. The effects of this numbing medication can last for up to four days, allowing his patients to reduce their use of narcotics or even avoid them altogether.
In the first few days postop, Dr. Smiley recommends his patients to arrange for help at home so they can focus on their recovery instead of stressing over routine chores like childcare, cooking, driving kids, etc. Simply put, they need all the help they can get during the initial healing phase.
Taking care of small children (under the age of 2) at home is particularly discouraged during the initial healing stage. For this reason, mommy makeover really requires advanced planning for a more convenient recovery.
Patients should also expect lethargy that can last 4-6 weeks and so they may need to sleep more; additionally, they may lack the energy to do their usual activities, he adds.
In general, young patients bounce back sooner than older patients, although recovery from mommy makeover surgery still boils down to individual healing. For this reason, the celebrity plastic surgeon requires lab screening to ensure that they are healthy enough to handle the surgery and the ensuing recovery.
When going back to “desk” work, Dr. Smiley typically recommends 1-2 weeks off; however, some patients file for a longer leave or choose to work part time until they regain their preoperative energy level, which can take up to six weeks.