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.
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.
Brazilian buttock lift is basically liposuction with fat transfer to the buttocks. Instead of discarding the “unwanted” fats, these are injected into the patient’s backside and hips to achieve a more feminine figure.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says a good result should present high symmetry between the left and right side, not just of the buttock, but also of the entire torso of the patient when viewed from the back.
After and before photos of a patient who have had Brazilian buttock lift. Hers was a special case due to her scoliosis.
In one of his recent Snapchat videos, Dr. Smiley has presented a rather special case of Brazilian buttock lift.
The female patient has scoliosis that her torso slightly “curves” to the right. Hence, her fat rolls and skin fold along this side were more prominent compared to the left side of her back.
In the video, Dr. Tarick Smiley said he almost always treats the lower back and flanks as donor/liposuction sites because of the areas propensity to accumulate “unwanted” fats that can show through tight clothing.
However, performing liposuction on the lower back and flanks of the patient with scoliosis could “highlight” the asymmetry between the left and right side of her torso unless “appropriate adjustments are made” during surgery, he explained.
To achieve a more symmetric result, Dr. Smiley removed more fat volume from the right side of the torso than its left side.
“It is important for any surgeon performing Brazilian buttock lift to have an eye for detail. Essentially, this is a combination of science and art,” he said.
After removing sufficient fat volume from the donor sites, Dr. Smiley purified it with the use of a centrifuge, a device that separates biomaterials based on their weight.
For instance, the lightest material is the oil, which floats above the fluid after centrifugation; this is discarded to achieve a high survival rate of fat graft (at least 70 percent).
Then, Dr. Smiley injected the purified fat into the patient’s backside, allocating about a third of the volume to reshape the hips and the remaining amount was used to improve the buttock’s shape and projection.
Moreover, Dr. Smiley smoothed out the visible indentations on the buttocks with meticulous fat injection techniques.
Capsulectomy breast implant exchange is the best solution for capsular contracture, a complication in which a thick scar capsule forms around a prosthetics, as explained by leading Beverly Hills plastic surgeon Dr. Tarick Smiley on his recent Snapchat posts.
In a series of Snapchat videos, Dr. Smiley presented a patient whose right breast had capsular contracture, leading to the implant to ride higher; it also resulted in hardness of the breast tissue. The left breast, meanwhile, had no such problem although it appears pendulous.
To achieve good results from capsulectomy breast implant exchange, Dr. Smiley also performed areola reduction and wise breast lift technique.
After and before photos of a patient who have had revision breast augmentation to correct her capsular contracture
In the videos, the celebrity plastic surgeon is seen removing the entire scar capsule, which has encapsulated the implant.
“It is important to remove the entire capsule to prevent the problem from recurring. In primary breast augmentation, the capsular contracture rate is 4 percent, but in revision it goes up to 15 percent,” he said.
“However, removing the entire capsule and with the use of meticulous techniques, we can lower the capsular contracture rate to 4 percent,” he added.
Aside from lowering the risk of recurrence, Dr. Smiley said that removing the entire scar capsule also allows for smoother, more natural results from revision breast augmentation.
“The thick scar capsule squeezes the implant inside sometimes to the point that it becomes deformed, with some of its edges showing through the skin as bumps,” he said.
To further reduce the risk of capsular contracture recurrence, Dr. Smiley always irrigates the implant pocket with antibiotic solution, and only performs his surgeries in accredited surgical facilities.
“One of the main causes of capsular contracture is implant contamination at the time of surgery. However, this can be minimized since our accredited surgical facilities have air ventilation system designed to curb contamination. Also, they are fully equipped with sterilization devices,” he further explained.
Moreover, Dr. Smiley requires all his patients with smooth round implants to perform breast implant massage everyday to maintain the “thinness” and softness of the scar capsule, which naturally forms around any implanted device.
“Capsular contracture is made up of excess collagen fiber. We could prevent this from happening with daily breast implant massage in which the idea is to push the prosthesis into the outermost corners of its pocket,” he added.
Meanwhile, Dr. Smiley finished off the surgery by performing a breast lift, which corrected the patient’s pendulous breasts.