Mammograms and Breast Health

Mammograms and Breast Health

October is Breast Cancer Awareness Month, and many women have questions or uncertainties about how to minimize their risk of breast cancer.  Most women recognize the importance of mammograms to evaluate their breasts.  However, mammograms are currently coming under a lot of scrutiny in the last few years and causing a lot of confusion for women since the U.S. Preventive Services Task Force (USPSTF) came out with it’s guidelines in 2009. Based on their interpretation of scientific data so far, in ‘average risk’ women, mammogram screening should begin at age 50, with repeat examinations every other year.  Other recommendations from this report include the elimination of self breast exam by women, the confirmation of the importance of clinical breast examination by a physician on a yearly basis, and the limitation of usage of digital mammography or MRI only for high risk patients that are younger and/or have dense breast tissue.  There has been much contentious debate on both sides between physicians of many different specialties, and it has even become a political football between Democrats and Republicans! Regardless, many physicians have reticence to change their practice because of the medical-legal environment in this country.

It’s important to stress that the USPSTF has made recommendations only, and they stress that these recommendations are for physicians to help guide their patients towards the most appropriate care they can receive.  The patient still has the ultimate decision regarding mammograms, and that with her physician’s guidance, she can make the most informed decision.

Woman contemplating surgery of the breasts should be properly informed about any surgical procedure and how to best prepare for it, including the possible utilization of mammograms. I work with my prospective patients and their primary care physicians to best inform them of risks, benefits, and alternatives to mammograms prior to a procedure. In general, however, my policy is that no mammogram is necessary in low breast cancer risk, premenopausal women, who are less than 50 years of age. This is especially true if she has very large and dense (non fatty) breasts. An alternative for women who have a family history that is significant for breast cancer, but are younger, or have dense breasts is MRI or a digital mammogram.

Once you have been properly informed of the risks, benefits and alternatives to getting a mammogram, you have a right to have a mammogram if you want or refuse.

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THE IMPORTANCE OF CERTIFICATION IN PLASTIC SURGERY

This past spring I completed my recertification process by taking an examination held by the American Board of Plastic Surgery.  I am happy to report that I passed that exam and completed all requirements to become recertified for another 10 years!  Please review my letter of recertification and test result letter.

This brings me to a very important issue that is becoming more relevant these days.  Cosmetic plastic surgery is being marketed, advertised and performed more now than ever before, and an ever larger percentage of those surgeons are unqualified, incompetent, and not certified by the American Board of PlasticSurgery.  Dropping incomes of other physicians and a general drop in the economy has lured unqualified doctors to start performing cosmetic procedures in an attempt to boost income.  These physicians are not properly trained for the procedures they are performing and some are not even surgeons.  To make matters worse, certain groups are lobbying state governments to legally expand their scope of practice to include cosmetic surgery.  An example of this is the passage of a law by the State of California that allows dentists to perform facial cosmetic surgery.  It is not a coincidence that media is reporting on more and more disasters occurring to unwitting people having cosmetic plastic surgery by cheap, unqualified surgeons.

The public can protect itself by performing due diligence before deciding on a surgeon and having plastic surgery.  Prospective patients should go on multiple consultations with surgeons certified by the American Board of Plastic Surgery or the American Board of Facial Plastic Surgery.  Prescreening should include ensuring proper Board certification and checking for complaints to their respective state medical boards.  View their websites and their before and after photographs to get a feel for the surgeon.  Websites that don’t clearly show the surgeon’s name on the front page are usually multispecialty centers, and usually have young, inexperienced, or non-certified doctors.  Prominent displays of pricing on the website are also suspect.  Most of the prominent or newsworthy plastic surgery disasters occurred to people who chose an inexpensive surgeon.  Remember, this is not like buying a name brand product that is identical in all the different stores that sell that product; in that situation price shopping is appropriate.  Having safe and high quality plastic surgery by an experienced and skilled surgeon is not inexpensive, and choosing a doctor because he is one third to one half the price compared to the other surgeons is not recommended.

Having a safe and comfortable experience in plastic surgery and getting a satisfying result is obtainable by taking the time to do your homework and not being lured by cheap prices.  Your doctor should be certified by the appropriate Board, be in good standing with the State medical board, have an excellent reputation in the surgery you are interested in, have a lot of photographs, and perform the surgery in a AAA, AAAA, or Medicare accredited ambulatory surgery facility.

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FDA Update on Silicone Gel Breast Implants

FDA Update on Silicone Gel Breast Implants

Dr. William Maisel, Chief Scientist and Deputy Director of the Agency’s Device Division, has declared silicone gel breast implants safe and effective after a two day meeting to review all the data since silicone gel breast implants were FDA approved in 2006.  Dr. Maisel said that he knew silicone gel implants were safe before going into this meeting, but stated that this meeting was a review of all new information that has been generated in the last 5 years since the approval in 2006.  These post approval studies have been ongoing since then by both Mentor and Allergan Natrelle, and the focus of these studies was to determine durability and the potential for rare complications.

Adjunct studies conducted between 1992 and 2006 produced evidence that silicone gel implants were safe and effective, but like saline implants, had frequent local problems associated with them, including capsular contracture, implant malposition, rupture, and the need for revision surgery.  During this period it was determined that there was no evidence of a cause and effect relationship between silicone gel implants and connective tissue diseases, breast cancer, or other systemic illnesses.  However, the FDA wanted to continue obtaining long term data on implant durability and to continue surveillance on the possibility of rare complications through post approval studies.

These post approval studies involved questionnaires for patients, doctor’s examination, and MRI follow up on a regular basis.  The data obtained from these studies so far confirmed that silicone gel implants are safe and effective as previously stated.  However, the follow up rate on these patients was less than anticipated, due to poor compliance with doctor appointments and obtaining an MRI, a costly and time consuming test.  Based on the evidence however, the FDA is satisfied with data so far and, along with the American Society of Plastic Surgery will continue to urge patients and doctors to enroll in these studies.  Previous recommendations to have frequent and early MRI examinations will be modified to ‘regular’ exams whose timing will be up to the patient and doctor.

If you have any additional questions on Silicone Gel Breast Implants feel free to contact our Beverly Hills Plastic Surgery office.

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MINIMIZING COMPLICATIONS AFTER BREAST AUGMENTATION

Nearly three hundred thousand breast augmentation surgeries are performed every year in the United States, and 20 percent of those women will have a revision surgery before the first two years after their initial surgery.  Of those having revision surgery, half will be to fix a problem known as capsular contracture, a tightening of the scar tissue that forms around the implant.  There are a few things you need to know to minimize your risk for all complications after breast augmentation surgery.

1. HAVE SURGERY FOR THE RIGHT REASONS

Breast augmentation will enhance your appearance and give you confidence in the way you look.  It will not make a relationship improve, so don’t get it for someone else’s sake.

2. DO YOUR HOMEWORK

You must be honest with yourself about the aesthetic goal you are trying to achieve.  Breast augmentation will not make your lower half appear smaller or put you ‘in proportion’ if you are larger on the bottom; you will only look heavier with breast implants that are too big.  Remember, this is about looking sexier, and bigger is not necessarily better.

You should look at websites that provide honest and truthful information regarding breast augmentation and plastic surgery in general:

www.plasticsurgery.org

www.surgery.org

www.breastimplantsafety.org

It would also be helpful to ask your friends or family members who have had breast augmentation about their experience.  They can provide valuable information about their experience.

3. PICK YOUR SURGEON CAREFULLY

The doctor you choose can make a big difference in your risk for complications.  Being certified by the American Board of Plastic Surgery and a member of the American Society for Aesthetic Plastic Surgery is just the beginning. Your surgeon should be a breast implant specialist with a reputation for breast augmentation.

4. COMMUNICATE YOUR GOALS

Be specific about what you want and would like to achieve with breast augmentation.  There is no accurate way to achieve a bra cup size for many reasons, so simply stating what cup size you want will not be as helpful as bringing in photos of women who have your desired proportions.  To confirm your aesthetic goals, ‘sizing’ should be performed in your doctor’s office where a special bra worn and implants are placed for you to see your new proportions. This will help your surgeon know how to best meet your goals.  Just as important as your ability to honestly communicate your goals, the doctor needs to listen.  If the doctor is rushing you or doesn’t seem to acknowledge what you are saying, go somewhere else.

5. LISTEN TO YOUR SURGEON

Your surgeon’s recommendations are probably going to help you get your desired result, or as close as possible, while minimizing complications.  This is especially important regarding recommendations with the size of your breast implants.  The most common mistake is to place excessively large implants relative to your body’s anatomy.  This frequently leads to unpredictable tissue stretch, implant malposition, and capsular contracture.

6. DON’T DRINK ALCOHOL OR SMOKE TWO WEEKS BEFORE AND ONE WEEK AFTER SURGERY

Cigarette smoking reduces oxygen levels in your tissues and increases the inflammatory response of your body, two things that reduce your body’s ability to heal and increase the likelihood of capsular contracture.  Alcohol increases oozing immediately after surgery, increasing the risk of fluid (serum) or blood accumulation around the implants, and thereby increasing the risk of capsular contracture.

7. AVOID DENTAL OR GYN PROCEDURES FOR THREE MONTHS AFTER SURGERY AND TAKE ANTIBIOTICS PRIOR TO ANY PROCEDURE PLANNED AFTER THREE MONTHS

These procedures cause bacteria to be liberated into the blood stream which can contaminate breast implants during the healing period.  Although theoretically implant infection is a risk, it is usually capsular contracture that can occur.

Minimizing your risk for complications will make your experience of having breast augmentation much more satisfying with less discomfort, and is possible by heeding these simple rules.  If you have more questions, please call Dr. Minniti for a consultation regarding breast augmentation at your convenience.

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Beverly Hills 24 Hour Recovery Breast Augmentation

Beverly Hills 24 Hour Recovery Breast Augmentation

After 45 years since breast augmentation surgeries were first performed, science has determined how to best perform this surgery. Breast augmentation is the most common plastic surgical procedure being performed in women today, at just over 296,000 procedures a year in 2010. Unfortunately, national averages for revision breast implant surgery are also very high, being reported at 10 to 20 % within 3 years from original surgery!! The reasons are many, but include that many surgeons are not doing the best for their patients by letting them pick the implant size, even if it is not the appropriate sized implant for their bodies’ anatomy – and this occurs on an all too frequent basis. Another reason is that the average surgeon is not adhering to surgical principles that have been scientifically shown to not only vastly reduce complications that lead to revision surgery, but also drastically decrease recovery time and discomfort.

Dr. Minniti has a two step process to make breast augmentation an easy and quick surgery to have and recover from. Whether you are a young collegiate busy with school activities, a mom with kids and a home to manage, a professional with a business to attend to, or an athlete, these techniques will allow you to enhance your breasts perfectly.

Step One – Pre-operative Planning
The best first step in a flawless breast augmentation is patient education regarding appropriate implant size. Patient goals are not ignored, but tempered within the realm of her body’s anatomy. Tissue thickness, tissue stretch, breast width, and ribcage shape and size play the most important role in determining implant size. Implant profile should be either low or intermediate to achieve a long lasting, complication free result.

Step Two – The Surgery
There are two important goals in achieving a perfect surgery that will lead to minimal pain, and no bruising. The first is meticulous surgical technique. A gentle touch using the electrocautery device allows me to perform the surgery with respect for the tissue and preventing unnecessary injury or trauma. Creating the appropriately sized pocket for the implant in this way will lead to minimal inflammation and no bleeding. This translates into less discomfort and no bruising. The second part is called the ‘no-touch’ method of implant placement. A special funnel delivers the implant into the pocket without the implant ever touching anything: gloves, drapes, or the patient’s skin. This dramatically reduces the possibility of implant contamination, the major cause of thickened and firm scar tissue build up around the implant called capsular contracture. Any last minute adjustments necessary are done in the same meticulous way, using the electrocautery under direct vision and without the need to tear tissue.

Dr. Minniti’s use of scientifically proven techniques and his extensive experience allows him to perform breast augmentation surgery with as little as 24 hours of recovery to normal activities. He has performed over 3000 of these surgeries with great success and a much lower rate of revision, about 2%. Don’t hesitate to call for a consultation if you are interested in breast augmentation with the lowest risk and the highest satisfaction.

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Beverly Hills, Dr Minniti, Breast Lift!

Many women would like to see their breasts look more youthful, higher, and more ‘perky’, and many have considered a procedure called the breast lift, also known as mastopexy. Most women, to a greater or lesser extent, are concerned about scarring from the procedure, which affects their decision about whether to move forward with the procedure, and if so, which type of breast lift to have performed.
There has always been an interest among plastic surgeons to improve the way we perform breast lifts and breast reductions to get the best results in terms of breast shape and appearance of the incisions. Although most women find the vertical incision most undesirable (the incision that runs from the areolar to the bottom of the breast), plastic surgeons have been more interested in reducing or eliminating the inframammary incision. This is because plastic surgeons know that a vertical incision usually heals so well and inconspicuously, unlike the inframammary incision, which has a tendency of being thickened, discolored, or raised.
Surgeons in Europe and South America have popularized the ‘lollypop’ or vertical breast lift that eliminates the inframammary scar completely. However, American surgeons have great difficulty getting the same great results as the traditional inverted T/ anchor lift. Worse, there are more problems that are difficult to correct associated with this purely vertical breast lift. Refinements that include utilizing short inframammary incisions have now made the vertical breast lift an excellent option for most women, with much less problems associated with a purely vertical breast lift. For many women though, these limited incision lifts are not small enough or limited enough.
Dr. Benellito conceived of a breast lift that involved removing a ring of skin around the areola and sewing the remaining breast skin to the edge of the remaining areola. It has been modified in a few ways through the years, but still remains to be a GREAT PROCEDURE FOR SMALL BREASTS, and almost always in conjunction with implants. When this procedure is misapplied to larger or more droopy breasts, it forces the surgeon to remove an ever larger ring of skin, creating results that are usually ugly, and sometimes disastrous: irregularly shaped areola, abnormally wide areola, pleating of the skin around the areola, thickened scars, abnormally flattened breast mound shape, and persistent breast sagging. The number one reason for malpractice lawsuits against plastic surgeons in the state of California involves this surgery – the Benelli or donut lift.
The crescent lift is also a minor lifting procedure that some doctors offer women. Once again, it can be misapplied to larger more droopy breasts. The effects of this are also not pleasing: expanded, off-round areola, thickened scar, flattened breast mound, and persistent sagging. In my practice, any small, minimally sagging breast will get a circumareolar lift because the results of a crescent lift are inferior to those of a circumareolar lift.
My expertise is in breast surgery, and having performed countless breast lifts, I’ve come to the conclusion that in the larger or more sagging breast, a truly good result is only gotten with a combination of a full or formal lift and reduction. That is because a large breast will always ‘bottom out’ no matter how tight the skin is made after a lift alone procedure. If the aesthetic goal is to maintain volume, than an implant can be utilized with this lift/reduction procedure. Although seemingly contradictory, the breast implant provides volume and shape that is more reliable for a long term good result, at the expense of removing the more natural feeling breast tissue.
Although this more formal or extensive type of lift means there will be more incisions, when done well the resulting scars are usually inconspicuous.
Visit a few well trained, American Board of Plastic Surgery certified doctors who perform A LOT of breast surgery. Look at their photos and talk to them about what’s right for you.

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Beverly Hills, Breast Lift.

Many women would like to see their breasts look more youthful, higher, and more ‘perky’, and many have considered a procedure called the breast lift also known as mastopexy. Most women, to a greater or lesser extent, are concerned about scarring from the procedure, which affects their decision about whether to move forward with the procedure, and if so, which type of breast lift to have performed.
There has always been an interest among plastic surgeons to improve the way we perform breast lifts and breast reductions to get the best results in terms of breast shape and appearance of the incisions. Although most women find the vertical incision most undesirable (the incision that runs from the areolar to the bottom of the breast), plastic surgeons have been more interested in reducing or eliminating the inframammary incision. This is because plastic surgeons know that a vertical incision usually heals so well and inconspicuously, unlike the inframammary incision, which has a tendency of being thickened, discolored, or raised.
Surgeons in Europe and South America have popularized the ‘lollypop’ or vertical breast lift that eliminates the inframammary scar completely. However, American surgeons have great difficulty getting the same great results as the traditional inverted T/ anchor lift. Worse, there are more problems that are difficult to correct associated with this purely vertical breast lift. Refinements that include utilizing short inframammary incisions have now made the vertical breast lift an excellent option for most women, with much less problems associated with a purely vertical breast lift. For many women though, these limited incision lifts are not small enough or limited enough.
Dr. Benellito conceived of a breast lift that involved removing a ring of skin around the areola and sewing the remaining breast skin to the edge of the remaining areola. It has been modified in a few ways through the years, but still remains to be a GREAT PROCEDURE FOR SMALL BREASTS, and almost always in conjunction with implants. When this procedure is misapplied to larger or more droopy breasts, it forces the surgeon to remove an ever larger ring of skin, creating results that are usually ugly, and sometimes disastrous: irregularly shaped areola, abnormally wide areola, pleating of the skin around the areola, thickened scars, abnormally flattened breast mound shape, and persistent breast sagging. The number one reason for malpractice lawsuits against plastic surgeons in the state of California involves this surgery – the Benelli or donut lift.
The crescent lift is also a minor lifting procedure that some doctors offer women. Once again, it can be misapplied to larger more droopy breasts. The effects of this are also not pleasing: expanded, off-round areola, thickened scar, flattened breast mound, and persistent sagging. In my practice, any small, minimally sagging breast will get a circumareolar lift because the results of a crescent lift are inferior to those of a circumareolar lift.
My expertise is in breast surgery, and having performed countless breast lifts, I’ve come to the conclusion that in the larger or more sagging breast, a truly good result is only gotten with a combination of a full or formal lift and reduction. That is because a large breast will always ‘bottom out’ no matter how tight the skin is made after a lift alone procedure. If the aesthetic goal is to maintain volume, than an implant can be utilized with this lift/reduction procedure. Although seemingly contradictory, the breast implant provides volume and shape that is more reliable for a long term good result, at the expense of removing the more natural feeling breast tissue.
Although this more formal or extensive type of lift means there will be more incisions, when done well the resulting scars are usually inconspicuous.
Visit a few well trained, American Board of Plastic Surgery certified doctors who perform A LOT of breast surgery. Look at their photos and talk to them about what’s right for you.

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J. GERALD MINNITI, M.D., F.A.C.S. PLASTIC SURGEON, PRIVATE PRACTICE 10 YEARS 500 PLUS ABDOMINOPLASTIES EXPERIENCE

J. GERALD MINNITI, M.D., F.A.C.S.

PLASTIC SURGEON, PRIVATE PRACTICE 10 YEARS

500 PLUS ABDOMINOPLASTIES EXPERIENCE

The purpose of an abdominoplasty or tummy tuck is to improve the appearance of the abdomen, pubic area, and the front of the hips. Persons who would benefit from this procedure include post partum women and persons who have had significant weight loss after obesity.

The goal of a properly planned abdominoplasty is to address the three composite layers of the region from deep to superficial: abdominal muscle wall, subcutaneous fat, and skin.  Each potential candidate for abdominoplasty presents with her own individual anatomic problem(s) that would need to be addressed accordingly by the surgeon.  Liposuction is commonly utilized in surrounding areas including the posterior hips and waist, and can also be an effective tool to further sculpt the abdominal region as part of the abdominoplasty.

Potential candidates should have a thorough history and physical examination taken, and blood work performed prior to surgery.  Any person with a history of blood clots or a family history of blood clots, taking hormone replacement therapy, has a BMI of more than 30, or is actively smoking, are not safe candidates for abdominoplasty.  Candidates should prepare two weeks off from work or childcare.  Commencement of exercise is usually 4 weeks after; abdominal exercise may commence 8 weeks after.

An anesthetic infusion pump placed at the time of surgery will provide local anesthesia to the muscle wall after the surgery for significant reduction in discomfort.  Suction drains will also be utilized for up to 7 days to evacuate fluids from under the skin of the abdomen and encourage healing in the region.  A compression garment will provide support to the abdomen, hip and waist area for up to one month.

Sensation to the abdominal region may be altered or diminished for up to a year after surgery.  In certain individuals, small areas of the abdomen may remain partially numb permanently.  Most complications are minor and include thickened scarring, and temporary fluid collections under the skin called seromas. These problems are the most frequent and can occur up to 10% of the time.

More significant complications include poor healing of the skin leading to opening of the incision, discoloration of the skin, and even loss of skin and fat.  All of these complications are a direct result of inadequate circulation to the abdominal skin after the surgery.  Fatal or life threatening complications include blood clots that form in the veins of the lower body and travel to the heart and lungs, called pulmonary emboli.  Risk of this nationwide has been estimated at one person in 2000, however properly selected individuals will have a much lower individual risk.

In general, the abdominoplasty procedure combined with liposuction of the surrounding region will have a dramatic impact in the appearance of the midsection and is a procedure with a high satisfaction rating by patients.  If you are interested in improving the appearance of your midsection, have lost significant weight and have loose skin, or have had disruption of the belly muscles including hernias due to pregnancy, please call for a consultation with Dr. Minniti, one of Beverly Hills premier cosmetic plastic surgeons who is an expert in this procedure.

J. Gerald Minniti, M.D., F.A.C.S.

120 South Spalding Drive Suite 330

Beverly Hills, CA 90212

310-275-0040

http://www.drminniti.com/

drminniti@drminniti.com

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Hard Facts About Liposuction and the ‘Latest Improvements’ to Liposuction

Hard Facts About Liposuction and the ‘Latest Improvements’ to Liposuction

More than ever before, consumers want to know what is the latest and greatest in plastic surgery, and this is at least partially driven by the incredible ease and ability for anyone that has a computer to obtain information on the Internet.  Both doctors and medical companies are keenly aware of this and are trying to capitalize on this hunger! Further, in an effort to boost ratings, television news coverage of the ‘latest and greatest’ in plastic surgery has spawned 5 minute news segments that amount to nothing more than infomercials for the doctor or the product.

Aside from the FDA approval last year of Dysport, the first and only competitor to Botox Cosmetic, the subject that keeps coming up repeatedly and seems to be most popular is laser liposuction or laser lipolysis. I have been involved in plastic surgery for 17 years and even in that relatively short time I have seen history repeat itself.  Medical companies eager to sell expensive laser machines to doctors, make elaborate presentations that include claims of superior results over regular liposuction, better financial reimbursement for using their machine, and photographs showing incredible results.  They further entice certain doctors with free usage of a machine to ‘see how you like it’.   This practice is almost a carbon copy of what happened 15 years ago with ultrasound assisted liposuction machines.  At that time, claims of smoother results and skin tightening were also the main selling points.  However, honest academic plastic surgeons willing to take the time to scientifically compare ultrasound assisted liposuction to standard liposuction saw no difference in results when analyzed by other plastic surgeons not aware of which patient received which treatment!  What they did see was higher rates of complications including seromas, skin burns, irregularities and prolonged numbness.

There is now a greater ability for medical companies that produce laser liposuction machines to entice and encourage plastic surgeons to purchase their devices because of the high technology involved with these machines.  Even highly educated plastic surgeons can have a difficult time understanding the latest in software upgrades, multiple laser wavelengths, and sensors available on some of the newest machines.  In the end, many doctors sign on the dotted line, having been overwhelmed with information making them feel like they can’t perform surgery without it!

There have been some recent scientific papers looking at the ability of laser machines to ‘shrink’ skin.  One paper showed fairly significant improvement over standard liposuction, but when this was repeated by another surgeon and published, there were less impressive improvements.  Regardless, the most important thing is to show improved results, and no paper has shown that yet.  To be fair, it is very difficult to design a study that can clearly demonstrate that and have participants willing to be enrolled.  In the mean time, I would like to address point for point the reality of laser lipolysis.

ABILITY TO SHRINK SKIN

As previously stated above, some doctors have looked at this and shown that it does shrink skin, at least based on the approximation of points tattooed on the surface of the skin.  However, standard liposuction also caused skin contraction as well, and no one can say if there is any relevance in the clinical world as to whether laser liposuction can be applied with better results to people otherwise deemed less than ideal candidates for standard liposuction.  When I present this to the sales representative of the companies, they typically show me the photos of incredible results, like hanging bellies flattened by their machine. 

LESS INVASIVE

This is complete deception on the part of the companies who make and market laser liposuction machines.  Unfortunately this is being perpetuated by some of the surgeons who market the machines that they have purchased.  The truth is it is no less invasive than standard liposuction, and it is to be used in conjunction with standard liposuction, as mandated by the FDA prior to its approval!  This is because the companies could not show the FDA any measurable results when used as a stand-alone device without standard liposuction.  In fact, there is an argument to be made that it is more invasive than standard liposuction with the addition of laser energy to the undersurface of the skin and fatty layers, with all the potential complications that can occur.

NO NEED FOR GENERAL ANESTHESIA

As you might expect from the previous point that I addressed regarding invasiveness, laser liposuction does not lend itself to awake surgery anymore than standard liposuction.  The choice is up to you and your surgeon. Most surgeons that perform this surgery on ‘awake’ patients give them heavy doses of oral medications that make them very drowsy. Regardless of drowsiness, there will still be moderate pain perceived in numbing the area to be treated, and the possibility of more pain occurring intermittently during the procedure if the area is not completely numbed, which occurs more often than not.

CONCLUSION

I am a surgeon that has been given the privilege of utilizing a few different laser liposuction machines, and I have not seen a significant or consistent improvement in results with any of them over standard liposuction.  The science is still out on how effective laser liposuction is compared to standard liposuction.  The most important improvements to liposuction may not be technological, but technique dependant:  the lessons learned about smaller canulas for more consistent fat removal, awareness of the zones of adhesion, adequate compression, and the surgeon’s skill and experience.  Finally, the best results are obtained by having your surgery performed by properly trained board certified plastic surgeons that have vast experience performing liposuction. 

ABILITY TO SHRINK SKIN

As previously stated above, some doctors have looked at this and shown that it does shrink skin, at least based on the approximation of points tattooed on the surface of the skin.  However, standard liposuction also caused skin contraction as well, and no one can say if there is any relevance in the clinical world as to whether laser liposuction can be applied with better results to people otherwise deemed less than ideal candidates for standard liposuction.  When I present this to the sales representative of the companies, they typically show me the photos of incredible results, like hanging bellies flattened by their machine. 

LESS INVASIVE

This is complete deception on the part of the companies who make and market laser liposuction machines.  Unfortunately this is being perpetuated by some of the surgeons who market the machines that they have purchased.  The truth is it is no less invasive than standard liposuction, and it is to be used in conjunction with standard liposuction, as mandated by the FDA prior to its approval!  This is because the companies could not show the FDA any measurable results when used as a stand-alone device without standard liposuction.  In fact, there is an argument to be made that it is more invasive than standard liposuction with the addition of laser energy to the undersurface of the skin and fatty layers, with all the potential complications that can occur.

NO NEED FOR GENERAL ANESTHESIA

As you might expect from the previous point that I addressed regarding invasiveness, laser liposuction does not lend itself to awake surgery anymore than standard liposuction.  The choice is up to you and your surgeon. Most surgeons that perform this surgery on ‘awake’ patients give them heavy doses of oral medications that make them very drowsy. Regardless of drowsiness, there will still be moderate pain perceived in numbing the area to be treated, and the possibility of more pain occurring intermittently during the procedure if the area is not completely numbed, which occurs more often than not.

CONCLUSION

I am a surgeon that has been given the privilege of utilizing a few different laser liposuction machines, and I have not seen a significant or consistent improvement in results with any of them over standard liposuction.  The science is still out on how effective laser liposuction is compared to standard liposuction.  The most important improvements to liposuction may not be technological, but technique dependant:  the lessons learned about smaller canulas for more consistent fat removal, awareness of the zones of adhesion, adequate compression, and the surgeon’s skill and experience.  Finally, the best results are obtained by having your surgery performed by properly trained board certified plastic surgeons that have vast experience performing liposuction.

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Breast Implant Sizing, Beverly Hills

Breast Implant Sizing

As a prospective patient seriously entertaining the idea of breast augmentation, there are many things that begin to run through her mind.  First for most women is the assessment and assumption of risk of the surgery, and for most this risk is reasonable given the fact that it is safer than driving in a motor vehicle.  After getting past that, many other smaller nuances begin to enter her mind, all having to do with the aesthetics, or how the breasts will look.  I find as a board certified plastic surgeon that specializes in breast augmentation, that one of the most difficult things for a patient to decide on is her breast implant size (not to be confused with bra size).  Some surgeons simply leave this part of the planning unavailable to the patient and choose for them, because they figure that it is too much information for the patient to handle.  To some extent it true, and patients get way to overwhelmed by trying to decide what implant size is right for them; by leaving the patient out of the equation the surgeon can make a quick and easy decision and be done with it.  However, I believe that if the patient is presented with a clear understanding of what is appropriate and safe, and what isn’t, than the patient can make an informed decision and continue to be partners in the planning process.

PHYSICAL CONSIDERATIONS

In general, an implant cannot be physically too small for a women’s body, therefore this leaves only the patient’s aesthetic considerations for choosing a smaller implant size.  The opposite is not true however. There is a physical limit that should be respected based on the prospective patient’s anatomy when choosing a larger implant.  The surgeon’s assessment of her skin and breast tissue elasticity and thickness, as well as the breast based diameter and height should be assessed and will make a significant impact on the maximum sized implant to be used.  To a lesser extent, the surrounding subcutaneous tissues can influence the size of implant chosen as well.  By measuring all these different parameters, the surgeon can determine the maximum sized implant that can be placed, not only in terms of its volume, but more importantly, its diameter and projection.

AESTHETIC CONSIDERATIONS

As useful as it might seem, there is no standardized chart that the surgeon and patient can browse through that gives the correct implant size for a given bra size.  That is because there is no single correct implant size, shape or projection that will give the same bra size for every woman.   In fact, any given implant could lead to multiple bra sizes in many different women!

I use a four step process to determine what is the right implant size and projection for the patient.  It begins with a clear conversation about the bra size the prospective patient has currently and what size she anticipates having. This conversation also includes a discussion about other friends/family who have the bra size she wants to achieve.  The patient then has an opportunity to view multiple patient photos as well as artistic photos of nude models, choosing photos that are appealing.  She is then given a special sizing

bra and shirt, and multiple different sizing implants are placed in the bra so that she may see how she looks with larger appearing breasts.  Given this information and having had the opportunity to examine the patient, I determine the best possible range of implant sizes and projections for the patient.  Lastly, the patient then has the opportunity for final input and an implant is chosen.

CONCLUSION

There is no foolproof way of precisely determining the most appropriate sized implant for each patient, and I believe that this may be due to the fact that a woman’s perception of herself may change after the surgery.  In general, most women will be surprised to find that they ‘could have gone bigger’.  (I wish I had a dollar for every time I have heard that!)  Fortunately, ninety nine times out of a hundred they are still pleased as punch about their new figure.  Conversely, some women are regretful and feel that they went too big, but this occurs less than once in a hundred times.  The vast majority of women will go through the process happily with the right sized implants for them!  For the best results possible, always choose a board certified plastic surgeon that specializes in breast augmentation.  If you have further questions, don’t hesitate to call Dr. Minniti’s office for a consultation with him and his staff.  You will get the most compassionate and careful evaluation and Dr. Minniti will deliver the best breast augmentation possible.

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