Body Contouring

Posted Tuesday, September 11, 2007 to PROCEDURES > Body

Posted by The Original Anti-Aging & Cosmetic Surgery Magazine

Jodi Thiessen spoke with Cincinnati plastic surgeon Gloria Thomas MD about balancing body shape.

Often when recontouring any area of the body, it has an effect on the balance and form as a whole. For instance, when the abdomen is recontoured through liposuction or abdominoplasty, the appearance of the breasts may change ..

Cincinnati plastic surgeon Gloria Thomas MD often combines more than one surgery to combat this problem balancing the whole body. She said this occurrence was brought to her attention by her patients. "A lot of patients told me after a tummy tuck their breasts looked different - saggier or larger - in comparison to the tummy which is so much flatter."

Dr Thomas finds that by performing an abdorninoplasty along with breast contouring such as augmentation, reduction or lift, the entire exterior trunk is redefined. 'The way body symmetry works is if you redefine it, this in turn redefines what is next to it," explained Dr Thomas. "For instance if you tighten one area it draws attention to the area next to it that has had no surgery."

It is a delicate situation to discuss with a patient, as the doctor will not suggest changes but rather listen to what the patient's desires are and recommend which procedures can help. "It is what the patient wants. I never talk anyone into anything," explained Dr Thomas. "They quite often don't know what is available so it is a question of listening and asking."

By performing two contouring procedures together, the benefit to the patient is: there is only one surgery, only one anesthesia and only one recovery time. "A tummy tuck requires approximately 4-6 weeks off work, so you can add breast surgery without prolonging this time," said Dr Thomas.

Abdominoplasty ("tummy tuck")

Assessing a patient's suitability for a procedure to remove excess abdominal fat requires careful consultation. Liposuction may be an option, however for women who have had any pregnancies and stretched their abdominal muscles and skin, or who have had fluctuations in weight causing a loss of elasticity to the skin, an abdominoplasty may be necessary.

An incision is made across the lower abdomen. Excess skin and fat are removed and the upper abdominal skin brought down and secured. Abdominoplasty is performed under a general anesthetic and may require hospital stay. Stitches are removed after 1-2 weeks and patients can return to work after 4-6 weeks.

Breast Augmentation

There are several choices in breast augmentation. Correct choice of implant, positioning of the implant (in front of or behind the muscle) and incision site (under the breast, armpit or around the nipple) will vary in each case, and the surgeon decides with the patient which is most appropriate.

"When we sit down and talk about an operation it is like opening a tool box - you have every technique available," says Dr Thomas. "You have to know all the techniques and utilize them to get the best results."

In general there are no bandages or drains required or stitches to be removed. There is some discomfort following the procedure and this is usually controlled with pain tablets. If performed alone (without abdomen recontouring) return to work is after 4-7 days.

Breast Lift

For patients whose breasts have dropped, a lift may be necessary. This can be combined with both reduction and augmentation. "The consultation process is important and I must ascertain the patient's needs," explained Dr Thomas.

If the lift is done alone, the nipple is elevated, staying attached to the breast tissue and the skin envelope is moved so the nipple sits higher on the breast mound. There will be a scar around the nipple and down from the nipple to the skin fold. There are also techniques of lifting the breast with only an incision around the nipple. If the lift is performed alone, return to work can be after 4-7 days.

Breast Reduction

Women troubled by overly large or sagging breasts may be concerned with not only shoulder and neck pain, but lack of self confidence. And, unfortunately, after a tummy tuck, the breasts can often appear even larger than before.

The amount of reduction required is discussed during the consultation process. Dr Thomas said: "If a patient comes in and says 'I have large breasts and I want you to reduce them.' I ask "how small?" If she wants to be a B cup yet she has a big frame I may recommend a lesser reduction. However, if she says she is a marathon runner and doesn't care to have a lot of breast - I honor that request."

A number of techniques exist for reducing the size of breasts. The most common is the inverted T-scar. The excess breast tissue is excised in such a way as to presence the blood supply to the remaining breast tissue and nipple. The nipple is repositioned higher and the skin is closed in an inverted-T pattern.

Nothing on the body works in isolation. By utilizing several techniques, contouring the form as a whole can produce more satisfying results and maintain body symmetry.

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