Before and After: Abdominoplasty or ‘Tummy Tuck’

 
 
 
 
 
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This lovely patient is 41 years old and has lower abdominal laxity and skin changes consistent with having two children. She was interested in abdominal rejuvenation.

During her evaluation, her diastases were evaluated as well as any previous surgeries and possible hernias. Skin tone and skin laxity were also assessed. With diet and exercise, she was able to get down to her ideal weight. This allowed us to remove more skin during the abdominoplasty and perform a tighter plication. With our enhanced recovery protocols, the patient was back to work within 7 days. ⁣Typically these procedures require drain but there are some patients who are a candidate for drainless abdominoplasty. Please come see me, and find your best option!⁣ Watch out for upcoming posts this week on some behind-the-scenes for this procedure! ⁣

What is the 14 Point Plan?

 
 
 
 
 
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During your consultation, an important question that you need to ask your surgeon is whether or not they follow the 14-Point-Plan. ⁣

What is the 14-Point Plan

The 14-Point-Plan is designed to minimize the number of bacteria that can contaminate breast implants at the time of surgery. It was first published in 2013 and has since been widely adopted all around the world. Bacterial contamination of breast implants at the time of surgery has been shown to cause capsular contracture – hardening, pain, and deformity following breast implant surgery. ⁣

The 14-Point-Plan outlines strategies that can be incorporated into breast implant surgery that reduce the number of bacteria that can contaminate the breast implant surface. ⁣

Here you can see a funnel is being used to place the breast implant into the dissected pocket.⁣

Finding the Right Surgeon for Breast Augmentation

Whether your breasts are sagging, asymmetrical or too small for your body size, breast augmentation can help you regain a feeling of attractiveness, positive self-image and confidence. But the success of the procedure depends on good communication and the expertise of your plastic surgeon. A skilled surgeon will not only enlarge your breasts to the desired size, but also apply measures and techniques that minimize the risks and complications of the procedure.

What makes someone the right surgeon for breast augmentation?

1. Board-certified

Board certification indicates that the surgeon has undergone rigorous training and testing. It is also proof that the surgeon is competent and experienced enough in performing the procedure. Find a surgeon certified by the American Board of Plastic Surgery (ABPS) or the American Board of Cosmetic Surgery (ABCS) and check the status of his or her license before you schedule a consultation.

2. Experienced

Your breast augmentation surgery is more likely to be successful when performed by a plastic surgeon who conducts the procedure on a regular basis. Remember, the right surgeon will not only determine the type and shape of breast implants to use, but will also align the procedure to meet your goals. Plastic surgeons get better at the procedure with time and frequency.

3. Runs an accredited facility

While breast augmentation is typically an outpatient surgery, it should be done in a facility with the highest standards of safety, quality and patient care. Accreditation is proof that the facility is committed to best practices, and a qualified surgeon will work at or run an accredited and accommodating facility.

4. Candid and compassionate

Breast augmentation is a cosmetic procedure that should be tailored to the needs of the patient. To find a surgeon who can perform the surgery in a way that is in line with your goals and expectations, look for someone who takes the time to get to know you.

At the same time, a surgeon should give you correct, straightforward guidance on the best approach to achieving your aesthetic goals—and tell you the honest truth, not what you want to hear. Pick a surgeon who is open, frank and caring.

So how do you find the right surgeon?

1. Get recommendations

Recommendations by people you trust are a great way to find a competent plastic surgeon. Speak with friends, relatives or colleagues who have had the surgery to give you some references. Ask them to share their experiences with their surgeons, what they liked about the experience, and whether their procedures met their aesthetic goals and expectations.

2. Use the internet

Searching the internet is an easy way to find plastic surgeons performing breast augmentation in your local area. For instance, if you reside in Tampa, type keywords such as “plastic surgeon in Tampa,” “best breast augmentation surgeon in Tampa,” “breast implant surgery Tampa,” or “breast augmentation center in Tampa” and see what comes up in your search results. Open the links that appear in your search results and check out details like names and addresses of the surgeons.

3. Narrow down your options

From the recommendations and internet searches, you should have around 5-10 options to choose from. Further research will help you identify the top 2-3 surgeons. To narrow down your options, check out patient reviews posted on patient forums. You might also look for patient testimonials, before and after photos, gallery of patient cases, and case studies to help you get a clearer picture of the work and outcomes achieved by every surgeon in your list.

4. Book an appointment

Now that you have found 2-3 surgeons you believe can perform breast augmentation that meets your aesthetic goals, you should schedule a consultation session with each of them before choosing one. The meeting should help you determine if you are comfortable with and trust the surgeon, and to get a sense of whether or not the surgeon understands what you want from the surgery.

During consultation, the surgeon will thoroughly explain all aspects of the procedure and answer all your questions. This is when you should ask questions, raise your concerns, and find out what to expect before, during and after the procedure. You can also ask to look at before and after photos, patient testimonials, reference to previous patients, and case studies from the surgeon.

5. Make your decision

From your list of 2-3 plastic surgeons, consider choosing the one with whom you most easily communicated and established a rapport during consultation. The right surgeon is the one who made you feel more confident about your surgery through an open and honest discussion about your overall health, lifestyle, aesthetic goals, and your questions and concerns.

At Politis Plastic Surgery, we believe that working with a skilled and experienced board-certified surgeon is the best way to achieve your aesthetic goals through breast augmentation. Dr. Effie Politis is a candid and compassionate surgeon who can help you on your journey to a happier, more confident you. She performs breast augmentation frequently and with remarkable outcomes for her patients. For more information about plastic surgery, visit the site Politis Plastic Surgery website.

Bioengineered Breast: Hybrid Breast Reconstruction

 
 
 
 
 
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𝘋𝘦𝘷𝘦𝘭𝘰𝘱𝘪𝘯𝘨 𝘢 𝘩𝘺𝘣𝘳𝘪𝘥 𝘤𝘰𝘯𝘤𝘦𝘱𝘵 𝘪𝘯 𝘪𝘮𝘮𝘦𝘥𝘪𝘢𝘵𝘦 𝘴𝘵𝘢𝘨𝘦 𝘣𝘳𝘦𝘢𝘴𝘵 𝘳𝘦𝘤𝘰𝘯𝘴𝘵𝘳𝘶𝘤𝘵𝘪𝘰𝘯. ⁣⁣⁣

I was first introduced to the concept of “bioengineered breast” in 2009 by Dr. Pat Maxwell and colleagues. He originally coined this term to describe an enhanced breast form consisting of a combination of cohesive gel breast implant, regenerative scaffold, and regenerative cells. ⁣⁣⁣

The implant and the soft tissue covering it can both be enhanced to achieve the optimal female breast form.

Enhancing the soft-tissue cover not only supplements volume and shape but also further alters how the recipient’s host tissue responds to the foreign body implant. ⁣⁣⁣

This powerful combination of constructs better allows us to achieve the ultimate goal of breast reconstruction: to recreate a breast that appears and feels like the natural breast. ⁣⁣⁣

This patient had large breasts and underwent bilateral skin-sparing mastectomies. She opted for one-stage reconstruction to minimize downtime. This was achieved using a hybrid concept after the mastectomy flap perfusion was evaluated. ⁣⁣⁣

I was able to pair an anterior acellular dermal matrix sheet with a posterior stable Galaflex base to provide the patient with both softness and stability. ⁣⁣⁣

She plans on having fat grafting during her nipple-areolar reconstruction to further augment her soft tissue envelope and soften her breast borders.⁣⁣⁣
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Removing Ruptured Historic Dow Corning Implants

 
 
 
 
 
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Removing ruptured historic Dow Corning implants in my patient after 30 years. She presented clinically with hardening of her left breast (capsular contracture). ⁣⁣
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Further workup including clinical and imaging examinations revealed extracapsular rupture which means the implant and the shell surrounding were compromised and needed to be removed. ⁣⁣
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These implants were taken off the market by the FDA in the 1980s. After the silicone implant moratorium in 1991, extensive premarket approval studies were required by the implant companies prior to the ban being lifted. This has resulted in extensive research and also produced much higher quality silicone cohesive or “gummy” implants with a much more stable shell and gel to shell fill ratio. ⁣⁣
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Today’s implants no longer demonstrate “gel bleed” and the increased silicone crosslinking adds stability and a higher safety margin. ⁣⁣
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The companies also provide short and long term warranty coverage and as board-certified plastic surgeons, we enter all implantable devices into a databank for better tracking. ⁣⁣

See a board-certified plastic surgeon to discuss treatment options regarding breast implants and safety profiles.⁣⁣
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#tbt #implantremoval #explant #capsularcontracture #siliconeimplants

Reconstructive Surgery on Cutaneous Malignancies

 
 
 
 
 
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As plastic surgeons, dermatologists typically refer us cases involving skin cancers dealing with the head/neck which require advanced closure techniques to minimize scar burden and resulting deformities. ⁣⁣

We are trained in “cutaneous oncology” in terms of evaluation and treatment of skin cancers, as well as coverage of resulting defects. ⁣⁣
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Micrographic surgery (Mohs surgery) is performed by our dermatology colleagues and is a technique based on complete tumor excision with maximal normal tissue preservation. ⁣⁣
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We often work with Mohs trained dermatologists who remove skin cancers that meet requirements. ⁣⁣
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We assist them in covering the resulting defect after tumor excision with margin clearance. Mohs surgery ensures margin and tumor clearance in areas requiring maximal tissue preservation (nose, lips, eyelids). ⁣⁣
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In some cases, Mohs is not indicated and we are able to perform the oncologic portion as well as the reconstructive portion. ⁣⁣
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In this patient, I was able to visualize tumor margins and perform a margin analysis (to ensure negative margins) prior to central tumor removal. ⁣⁣
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Once the margins were deemed negative via a pathologist on site who performs frozen sections, the remaining tumor is removed and the defect can be closed in the same setting. ⁣⁣
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Please note this patient did not receive Mohs surgery. ⁣⁣
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I performed the excision, achieved margin control, and then also performed
the reconstruction with local tissue rearrangement.

 
 
 
 
 
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Previously, we presented an example of reconstructive surgery I perform for cutaneous malignancies (skin cancers) involving face, scalp, and neck. ⁣

Removal of cancer in an aesthetic unit (with margins) and closure of the defect with scars in an inconspicuous location. ⁣

Principal in replacing like tissue with like tissue (color match and tissue thickness are taken into consideration) and tissue is moved or rotated or advanced with its corresponding blood supply. ⁣

This is where the art of plastic surgery comes into play. We are trained to respect aesthetic subunits and cover like tissue with like tissue to ensure minimal distortion, and best color match and thickness. ⁣

When considering coverage options, we need to be aware of how to best rotate or re-arrange adjacent tissue to cover the defect with a design that respects blood flow or tissue perfusion to ensure healing. ⁣

Sometimes adjunct procedures are needed to get the best results (eg. revisions including debulking, dermabrasion, etc). ⁣

This lady underwent partial chin defect coverage with bilateral V-Y advancement flaps and a single revision. ⁣

Healing time is 4-6 weeks. ⁣

Revisions are small office procedures with minimal downtime and healing in 1-3 weeks. ⁣

Additionally, I advise my patients on sun avoidance and scar maturation postoperatively. ⁣

It can take 6-8 weeks for scars to regain most (but never all) of their tensile strength. Scars often look worse before they look better. ⁣

We recommend sun avoidance or covering the scar for 1 year (physical block or sunblock and physical block).⁣

No scar revisions prior to one year. It usually takes one year for scars to really settle and look as close to normal as possible. ⁣

I also remind patients there is no “scarless” surgery but we try to optimize the size and placement of scars according to local and aesthetic units.

What’s a Nefertiti Lift?

 
 
 
 
 
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Platysmal bands treated with toxin prevents jawline and neck aging. Also known as the Nefertiti Lift.⁣⁣⁣

In addition, this patient underwent filler to nasal tip and dorsum for contouring (straighten dorsal aesthetic lines and tip support).⁣⁣⁣

Liquid HA filler rhinoplasty to create supratip break (augment tip projection) and create a straighter nasal dorsum. ⁣⁣⁣

Kybella Patient: A revisit

 
 
 
 
 
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If you remember a few posts ago, we’ve shared with you about our 49-year-old female patient with submental (under chin) excess fat deposit. ⁣

Here she is, before treatment and a month later!⁣

She was treated with 3 vials of Kybella for the unwanted fat under her chin.⁣

Kybella is an injectable that permanently dissolves fat without surgery, incisions, or downtime. It chemically destroys the fat cells permanently. Typically require several treatment sessions but again helps patients avoid downtime associated with surgery. It is a great option for improving the cervical mental angle by destroying the under chin pre-platysmal fat. ⁣⁣

Kybella typically requires 3-6 treatments spaced a month apart. ⁣

What are breast implants?

A breast implant is a medical device (prosthesis) inserted under breast tissue or chest muscle to change the size, contour or shape of the breast. In plastic surgery, breast implants are used to increase breast size, replace breast tissue removed due to trauma or cancer surgery, or to correct severe birth defects and deformities of the breast and the chest wall.

There are three main types of breast implants used in plastic surgery: saline implants, silicone implants and structured implants.

Saline breast implants

Saline breast implants are filled with saline solution. They are placed by means of a less invasive surgery through smaller incisions. During the surgery, empty saline implants are inserted into implant pockets and then filled with saline solution. The incisions made for this insertion are smaller and shorter compared to the relatively longer incisions required to place pre-filled implants.

Saline breast implants offer an increased breast size with a realistic texture and smooth contour. However, they are associated with cosmetic problems such as the wrinkling of breast skin and the implant being more noticeable to the eye and touch, particularly in women with less breast tissue. For women with enough breast tissue, saline implants produce aesthetically better results.

Silicone gel breast implants

The current models of silicone gel breast implants are filled with a high-strength, highly cohesive silicone gel which reduces the likelihood of filler leakage to the body. These form-stable implants can retain their shape even when their shells are broken. They are also less likely to wrinkle and tend to feel a bit more like natural breasts. However, they require slightly longer incisions for placement and they can spread into the breasts, causing lumps. Breasts augmented using silicone gel implants require regular ultrasound or MRI images for assessing the condition of the implants.

Structured breast implants

Structured implants incorporate both saline and silicone gel implant technologies. They use the saline solution as the filler while having the natural feel of silicone. Their internal structure consists of a series of nested shells that support the upper pole and two lumens (cavities) where the filler material is added.

During surgery, a structured implant is inserted while empty and then filled with saline once placed, requiring a smaller incision than a pre-filled implant. And if one of the lumens ruptures after the procedure, it just leaks and empties, leaving the other lumen intact and the implant only partially deflated. This feature allows for ease of removal and replacement.

How are breast implants placed?

When choosing a plastic surgeon for breast implant surgery, finding someone experienced reduces the risk of complications after the procedure. Before the surgery, you will have an appointment with the surgeon for a medical evaluation. Your consultation will allow you to share your goals and expectations with the surgeon, and learn how to prepare for the procedure.

Breast implant surgery is usually carried out under general anesthesia. The plastic surgeon makes a cut in the skin below or next to the breast. The implant is positioned either behind your chest muscle or between your breast tissue and chest muscle. The doctor then closes the incision and covers it with a dressing.

The procedure usually takes 60 to 90 minutes. You may be able to return home the same day, or you may need to remain in the hospital overnight if the operation is scheduled late in the day. You will be given pain medication to help manage the discomfort after the anesthesia wears off. Your breasts will be covered with compression garments, and drainage tubes will be applied in order to drain the surgical area. Expect to need rest for a few days after the surgery and avoid heavy lifting for at least 6 weeks.

Are breast implants safe?

Breast implants are quite safe and rarely cause issues. Though it is possible for the implants to rupture and leak, they rarely cause medical problems. When saline implants rupture, the salt solution is safely absorbed by the body. For silicone gel implants, the gel either remains in the shell or leaks out following a rupture that results in no obvious symptoms.

How are breast implants maintained?

Breast implants are, by design, not intended to last a lifetime. They may have to be replaced if there are complications or if the breasts change in size and shape over time. If you have silicone gel-filled implants, you will need an MRI scan three years after your implant surgery, and then MRI scans every two years to check for silent ruptures. Ruptured implants should be removed or replaced.

At Politis Plastic Surgery, we offer breast implant surgery to enhance the natural appearance of your breasts, create fuller curves, and give you a more aesthetically pleasing shape. We understand that your breasts are a defining feature of your body and enhance your femininity, sexuality and beauty. Through breast augmentation, you can change the size and shape of your breasts and, in turn, your self-confidence.

Are you considering breast augmentation?

Schedule a private consultation today with Dr. Effie Politis and have your questions answered and concerns addressed. For more information on breast implants and breast augmentation, visit the Politis Plastic Surgery website.

“Breast in a Day” Surgical Technique

 
 
 
 
 
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Another ‘Breast in a Day’ case, but executed differently since she has much larger ptotic breasts (sagging breasts). ⁣

She basically had a mastectomy performed through a Wise pattern skin mastopexy and I kept the nipples on an inferiorly based adipodermal flap. ⁣

I reduced her mastectomy envelope, reduced and repositioned her nipple areolar complexed, and placed a cohesive Natrelle Inspira SCF 520cc implant in the prepectoral position with anterior Galaflex sheet. ⁣

“Wise pattern or inverted-T mastopexy has traditionally been used in patients with severe excess of skin relative to breast parenchyma (tissues of the breast essential for functioning) in a patient with severe ptosis. Incisions are made around the areola with extensions for the vertical limbs as in a vertical mastopexy.” (Qureshi, Myckatyn, & Tenenbaum, 2018)⁣

“The Wise-pattern incision addresses any redundant mastectomy skin envelope and avoids excessive and unsightly scarring on the “social” aspect of the breast mound.” (Newman, 2016)⁣

“The pattern allows removal of skin in both vertical and horizontal dimensions allowing for lifting and coning of the breast into a less ptotic shape.” (Todd, 2016)⁣