Cosmetic breast surgery that combines two or more procedures has become a common routine nowadays. In some situations, this is even a more preferable approach than having two separate surgeries in order to produce more natural results.
Today, the most common “combo” procedures are breast augmentation with lift, and breast reduction with lift, according to the California Surgical Institute website.
Breast augmentation with lift prevents a specific deformity called Snoopy due to its close resemblance to the profile of the classic cartoon dog.
When implants are used in sagging breasts without a simultaneous breast lift, their bottom edge might become visible beneath the lax skin, and thus there will be an appearance of two pairs of submammary fold.
But with a simultaneous breast lift, the implants will not “herniate” as the internal support and the actual breast tissues are reinforced with sutures. In addition, the south-pointing or low-lying nipple area is positioned higher to further achieve a proportionate result.
Breast lift is also commonly incorporated with breast reduction, a procedure that produces a smaller “cup size,” which in turn can provide instant relief from back pain, rounded shoulders, postural problems, and other ill effects of overlarge, heavy breasts.
Large breasts are susceptible to the effects of gravity (i.e., causing their skin to lose their elasticity), thus it always makes sense to incorporate some type of breast lift during the surgery.
Meanwhile, breast lift does not always entail a simultaneous breast reduction unless the patient specifically requests for a smaller cup size as well.
Cosmetic breast surgery involving combination procedures aim to produce a more natural-looking and youthful appearance—i.e., conical shaped, 45:55 breast ratio (i.e., most of the volume should be in the lower pole), proportionate nipple diameter relative to the breast size, and “ample” distance between the areola and the submammary fold.
A slight lateral bulge is also deemed ideal, although all efforts are made to prevent it from becoming excessive and thus giving an illusion that the breasts are too wide apart.
Also, it is ideal to produce a ski-slope appearance in the upper pole. In fact, one study has suggested that the ideal breast profile should have a 45:55 ratio, with the areolar complex serving as the delineating mark between the lower and upper breast poles.
Of course, good symmetry between the left and right breasts must be achieved during cosmetic breast surgery. For this reason, some patients may need different sized implants, or require more tissue removal or additional elevation on one side.
Liposuction and fat transfer has a significant impact on how plastic surgery today is performed. The modern approach is to replace likes with likes and make every effort to use the patient’s own tissue, as opposed to synthetic prosthetics. Hence, patients nowadays are not limited to choosing facial, breast, and buttock implants because their very own fat can be used as a “volumizer.”
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says liposuction and fat transfer is particularly helpful in buttock augmentation. Instead of using solid silicone implants to reshape the patient’s derriere, the procedure has allowed doctors to deliver more natural and softer results.
Liposuction and fat transfer has been used to achieve this more sultry, more feminine “backside.”
Buttock augmentation via fat transfer is more commonly referred to as Brazilian butt lift. (This is a misnomer since the procedure does not actually lift the buttocks; it only reshapes and augments them with the patient’s own fat usually derived from the hip-flank region, abdomen, and lower back.)
While liposuction and fat transfer has also been successfully performed in breast augmentation procedure, the use of implants remains the gold standard because of their more predictable results and they give more control over the size and projection of the postop breasts.
Breast augmentation via fat transfer is less likely to deliver more than a cup size increase. Attempting to inject large amounts of fats without taking into account the “pressure and strain” experienced by grafts—a particular concern in women with a rather tight skin—will result in low survival rate and less than optimal results, warns Dr. Smiley.
Fortunately, the aforementioned risks are less of an issue in Brazilian butt lift, he explains.
Aside from Brazilian butt lift, the celebrity plastic surgeon says that fat transfer is also helpful in facial rejuvenation procedures, particularly in facelift surgery, which can only address sagging skin and tissue laxity and has no or very little effect on facial volume or fat loss.
With fat transfer, Dr. Smiley says he can correct the flat or aging cheeks, deep tear trough, laugh lines, and hollowed eye socket—without using dermal fillers, facial implants, and other synthetic materials.
But even without the intention of correcting facial volume loss or flat buttocks, Dr. Smiley says that liposuction as a stand-alone procedure could also benefit from fat transfer. For instance, after liposuction he always examines the treated area (which includes sweeping his hands over the skin) while the patient is still in the operating table to feel any dents that could be smoothed out by fat transfer.
Mommy makeover revision surgery becomes necessary because of three basic reasons: inadvertent pregnancy, significant weight fluctuations, and botched results from the initial procedure.
A mommy makeover surgery is any combination of body contouring procedures that generally focus on improving the appearance of abdomen and breasts, areas that are highly susceptible to the effects of pregnancy.
Leading body contouring expert Dr. Tarick Smiley says all efforts are made to avoid the need for mommy makeover revision, adding that it always starts with proper patient selection—i.e., the patient must be near her ideal weight and is done having children.
Nevertheless, “inadvertent” pregnancy and drastic weight fluctuations do happen, which can change if not reverse the results of tummy tuck, breast augmentation, and breast lift, which are the three most common mommy makeover procedures performed by the celebrity plastic surgeon.
Oftentimes, mommy makeover revision is possible provided that the patient’s weight has been stable for at least six months and/or she has fully recovered from the “trauma” of childbirth (it takes about 6-12 months); however, a longer waiting period is deemed necessary if one chooses to breastfeed.
It is important to note that the hormones that trigger the body to produce milk have some effect on skin elasticity or shrinkage; hence, the patient must wait at least six months after weaning, says Dr. Smiley.
All efforts are made to avoid additional scars in mommy makeover revision, so the surgeon would simply use the previous incision sites. However, some patients may have to accept a longer scar to achieve the optimal breast shape or to preserve the natural curves and contours of their tummy.
For instance, a patient who previously had a mini tummy tuck (its scar is typically 4-6 inches in length) but later gained weight or became pregnant may need her scar extended from hip to hip, which is the standard technique, to achieve a flatter abdomen and a narrower waistline.
Also, a patient who had a modified form of breast lift (less scarring) may have to accept the scars from the standard technique (it uses an anchor-shaped incision for additional lifting effect) if she requires a more extensive revision.
In the event of botched mommy makeover surgery, Dr. Smiley says it is of critical importance to wait at least six months before a revision is attempted. The idea is to wait for the skin to relax and the implants (in the case of breast augmentation surgery) to settle.
Performing revisions too soon is like “hitting a moving target,” hence the results are harder to predict, he explains.
Each doctor has his own list of breast implant capsular contracture prevention; however, there are generally accepted guidelines such as the use of completely sterile equipment during operation to avoid low-grade bacteria and contamination.
Normally, the body creates a thin, flexible scar capsule around any synthetic material. Capsular contracture after breast augmentation surgery occurs when for some reason the scar tissue grows and thickens exponentially, leading to visible deformity and pain.
Should capsular contracture occur, the thick scar capsule is removed together with the implants.
Meanwhile, renowned Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted Snapchat videos in which he explained some of his guidelines that are believed to minimize the risk of capsular contracture.
In one of his Snapchat videos, he was seen irrigating the implant pocket—i.e., behind the muscle where the prosthesis would be positioned—with antibiotic solutions prior to implantation. The goal, he said, was to sterilize the area to minimize risk of infection tied to capsular contracture.
To further minimize risk of capsular contracture, Dr. Smiley advocates breast implant massage for the rest of the prosthesis’ life.
In another Snapchat video, Dr. Smiley explained that the “core idea” behind breast implant massage, or medically referred to as implant displacement exercise, is to ensure that the scar capsule will remain soft, flexible, and thin.
The leading plastic surgeon typically recommends starting breast implant massage about a week after surgery. Despite some initial discomfort, he said that vigorous displacement of the prosthesis could provide benefits such as lower capsular contracture rate and more natural look and feel.
Studies involving breast implant capsular contracture prevention have suggested that most cases occur within the first three weeks, thus at this stage all efforts must be done to maintain the scar capsule’s flexibility and to avoid poor wound healing and other sources of infection.
Because poor wound healing and infection are closely tied to capsular contracture, Dr. Smiley said he only operates on healthy patients who will fully cooperate with him, particularly when it comes to “preparations” such as complete avoidance of tobacco products, second-hand smoke, aspirin, and aspirin-like products a few weeks leading up their surgery.
The goal is to achieve one’s optimal health prior to surgery, thus reducing or even avoiding potential risks, said Dr. Smiley.
Breast implants and leaking are the two main issues that concern patients seeking breast augmentation surgery. It is important to note that these devices, while they are notably durable, are not designed to last a lifetime.
Rupture happens when the filler material (saline or silicone gel) leaks out from the implant shell or silicone “bag.” According to some surveys, “spontaneous” was the most common reason for implant failure, followed by removal surgery and fat injection.
One survey has suggested that the average duration of rupture of saline was 5.6 years, and 12 years for silicone implants.
But the truth is, the lifespan of breast implants is highly variable. Some patients need their prostheses replaced within a few years after surgery, while others do not encounter any problem even though their implants are two decades old.
Nevertheless, most US implant manufacturers suggest that their products should last an average of 10 years, so they often based their product warranty on this assumption.
Contrary to popular belief, vigorous exercise does not affect the implant’s stability. In fact, most Inland Empire plastic surgery experts suggest that motion is effective in preventing capsular contracture in which copious amount of scar tissue forms around a synthetic device.
Meanwhile, breast implants and leaking symptoms will differ between saline and silicone implants.
Saline implants, which are filled with a sterile saltwater solution, will immediately deflate in the event of rupture. For this reason, the affected breast will appear smaller than the other, so diagnosis of the “problem” is easier, safer, and faster.
On the other hand, silicone implants may rupture “silently,” meaning there is no palpable or visible sign. Because they are filled with a highly cohesive gel that almost feels like the natural breast tissue, it is difficult, if not impossible, to tell whether they are leaking.
The consensus is that MRI is the best tool to diagnose a ruptured silicone implants. For this reason, the US Food and Drug Administration recommends regular screening at least every two years for the rest of the implant’s life. However, some doctors only encourage such practice if there is a good reason to suspect that the device is leaking.
Over time, silicone gel leak may irritate the surrounding tissue, which could eventually lead to capsular contracture, hardening or firmness of the tissue, lumps, or even pain.
However, the fifth generation silicone implants, also referred to as gummy bear implants, are highly resistant to leak because their filler material has a strong cross-linking (i.e., form stable and very firm, although still soft once inside the breast pocket).