Longview Plastic Surgeons

Do You Lose 50 Cc's with Behind the Muscle Silicone Implant Placement?

I am getting silicone breast implants on Friday and am really scared of going too big. I am currently a "B"; I want to be a "C". I have chosen 350cc in hopes they will look like the 300-325 implant I tried at my doctor's office.

Essentially the question is that of: How do I choose the correct implant to get the look I am wanting? This is the most important question when it comes to breast augmentation. In order to better address this question, we need to establish 2 main points:

First: Implants do not come in "cup" sizes. They either come prefilled (in case of silicone gel implants) with certain volume or unfilled (in case of saline implants) with a range of fill capacity. In either case, the fluid volume is measured in terms of cc's (very much like a can of soda has 355 cc's or ml of fluid). This is important as many patients request for a certain "cup" size. For example, "I am currently a B cup but would like to be full C cup." So what implant should be used to achieve this? Before we answer this question, let us consider another important fact: most women are fully aware of the fact that bra cup sizes vary by the manufacturer, so with one manufacturer, one may fit into a B bra but may require a C bra with a different company make. In other words, there is variability even within "cup" sizes which makes using "cup" size as a measurement even more frought with potential errors.

Second: For most women, they are more interested in achieving a certain "look" rather than a certain "cup" size which I applaud. After all, as long as the new size "looks" good to you - do you really care whether you require a certain cup sized bra? I think most women would agree with this statement. With this in mind, the real conversion that needs to be take place is: once you've identified the "look" you desire, how do you and your surgeon go about picking the right implant to achieve that "look?"

There are many different ways to get a glimpse of the "look" that you are after. Many offices use gel sizers, others use rice bags, etc. They will all work. So once you've decided on a look that you are seeking, we need to choose the implant to give you that look. Now, because the sizer or the rice bag was placed ON TOP OF YOUR BREASTS, as opposed to under the muscle, I think it makes sense to think a LARGER implant than the sizer is needed to achieve the comparable look - after all, the implant needs to expand the muscle and at times, it needs to "fill out" the extra skin envelope of the breast (as is true for most women after pregnancies) before it starts to expand the breast. So the real question is: what is the conversion factor? If you liked the look of a 300cc gel sizer, then depending on how much extra skin you have, I personally add at least 30cc's to saline implants, and 50 cc's to silicone gel implants, thereby filling saline implants to a total volume of 330-340cc or choosing silicone gel implants of 350cc. At times, if you had chosen a sizer of 400cc, then I would fill saline implants up to 450cc or choose 475cc silicone gel implants - meaning the larger the desired look, greater the conversion factor. By the above discussion, you have already noted that silicone gel implants "fit" smaller than saline counterparts and give lesser projection.

I have been very pleased with the above conversion method - more importantly, my patients have been pleased with their outcomes, as they got the look they were seeking. It's not perfect, but comes pretty close.

Hopefully this helps.

Christopher Chung, MD

Longview Plastic Surgeon

Who Should Consider a Tummy Tuck?

How do I know if a tummy tuck is a good option for me?

There are 3 main anatomic components to consider in determining whether a tummy tuck surgery is a good option for a patient:

• Skin
• Muscle
• Fat

If there is excess skin (often noted by patient) and laxity of the abdominal muscle (noted by the surgeon), then one can consider tummy tuck surgery, as this procedure will reduce the lower abdominal skin excess (by resecting the skin from suprapubic region to just past the umbilicus in an elliptical fashion) and will tighten the abdominal wall musculature. This condition is usually present after pregnancies or significant weight loss.

On the other hand, if fat is the main component present, with minimal skin excess, then tummy tuck surgery is not the right option to consider. In such condition, if the fat is resistant to proper exercise and dieting regimen, then liposuction can be considered.

At times, all 3 components may be present - that is - excess skin, lax muscle and fat. Although it is tempting and often requested by patients to address all 3 components via tummy tuck surgery and liposuction of the abdomen, for anatomic and physiologic considerations (blood supply preservation to promote proper healing), aggressive liposuction of the central abdomen is usually not performed in conjunction with a full tummy tuck surgery. However, liposuction of the flanks/hips can be performed concurrently with tummy tuck surgery to enhance the overall abdominal contour.

At times, a surgeon may recommend a mini-tummy tuck surgery (which would only remove part of the lower abdominal skin) with more aggressive liposuction. Because the tummy tuck surgery is more limited in a mini-tuck, it maintains more blood supply and thereby a more aggressive liposuction can be performed concurrently. However, less skin will be removed.

Other important points of consideration include scarring. Scarring is often extensive (hip to hip), and although scars may improve with time, they are permanent. It is a trade-off - for the reduction in skin, a scar is given.

Although every measure of proper principles of plastic surgery may be enforced, there is always an element of unpredictability when it comes to scar maturation, some of which is inherent to the individual patient. Truthfully speaking, some people just simply scar better than others. Previous scars may offer some clue as to the scarring nature - e.g. - if someone ALWAYS develops hypertrophic or keloid scars - then it is most likely that poor scarring will be expected post tummy tuck surgery as well.

There are measures to facilitate better scarring post surgery - whether it is in the form of laser, massage, steroid injections, silicone sheets, OTC ointments, etc - be sure to speak to your surgeon about the various options. Also, realize that scar maturation process may take up to a year (or even longer) before the final appearance of the scar is evident, but this is not to say that appropriate interventions may not be instituted at various times to improve the overall outcome.

Another question regarding scarring that often surfaces is the placement of the scar. Ideally, we would all like to give the shortest, lowest, and symmetrical scar as possible. However, scar placement is often dictated by the anatomic considerations - i.e. - the nature of skin redundancy. A person may have more fullness or excess on one side than the other, one side may be higher or lower than the other, one side may extend further around than the other, etc, etc, etc. And depending on what is seen (and hence what is needed), the surgeon will determine the scar placement (its width and location).

Personally, I illustrate on the patient where the scar is to be placed, how long it is expected to be, and if applicable telling the patient that one side may be higher or longer than the other side (showing the patient why this is needed). I think patients need to know what to expect in terms of their scar, as this is such an important element of tummy tuck surgery. And because of the disclosure and extensive discussion prior to surgery, scarring becomes less of an issue in my practice, as we minimize "surprises."

Christopher Chung, MD

Longview Plastic Surgeon

Plastic Surgeon Vs. Cosmetic Surgeon - What's the Difference?

Can somebody tell me what the difference is, if any, between a cosmetic and plastic surgeon?  I am also unclear about how facial plastic surgeons compare to otolaryngologists or oculoplastic surgeons...can anyone help there?

In order for a physician to be a plastic surgeon, one must complete an approved Residency training program in Plastic Surgery. Plastic surgery involves a spectrum of different components, including cranio-facial surgery (e.g. cleft lip or palate), burn surgery, hand/microsurgery, maxillo-facial trauma, general and breast reconstructive surgery, and cosmetic surgery (facelift, tummy tuck, liposuction, etc.). Because the field of plastic surgery is so broad and extensive, the training required to become a plastic surgeon is between 6-8 years after medical school.

Some plastic surgeons, especially in more rural areas, offer the full spectrum of plastic surgery, but most tend to specialize - i.e. - tailor their practice with greater emphasis on one or two areas of plastic surgery. But whether a plastic surgeon chooses to specialize in hand surgery or cosmetic surgery, they are still "plastic surgeons" as deemed by the American Board of Medical Specialities (ABMS).

In reality, any licensed physician can offer cosmetic services, as this is not illegal. The term "cosmetic surgery" is not a recognized discipline by the American Board of Medical Specialities, i.e. - there is no Board Certification by ABMS in Cosmetic Surgery. There are numerous opportunities to "train" in cosmetic surgery (usually 6 months to 1 year) - but none leading to a board certification by ABMS. So if someone is a "cosmetic surgeon" - s/he could be an ENT surgeon, a Dermatologist, a General Surgeon, an Opthalmologist, a General Practioner, or a Plastic Surgeon.

This may come as a bit of shock for most people, as many people equate plastic surgery with cosmetic surgery. As a plastic surgeon specializing in cosmetic surgery, I do not pass any judgement on physicians of different disciplines practicing cosmetic surgery, as long as they are well trained and honest about their credentials (as I would expect of plastic surgeons as well). I do have a problem with cosmetic surgeons misleading patients into thinking that they are plastic surgeons, taking advantage of the common misconception that public has about synonymity of plastic surgery with cosmetic surgery.

Finally, there are a multitude of terms out there, including facial plastic surgery, oculo-plastic surgery, etc. These terms are often coined by ENT surgeons (for facial plastic surgery) and opthalmologists (for oculo-plastic surgery), as they often represent further training of the aforementioned disciplines, i.e. an ENT may extend their training in plastic surgery of the face. These training opportunities are usually offered only to certain disciplines (e.g. an oculo-plastic surgery fellowship is offered to only opthalmologists).

Bottom line: Ask questions about your doctor's credentials, training, and board certification. There are many confusing terms, all trying to denote some degree of extra expertise or specialty, but at times it's misleading - whether it'd be intentional or unintentional.

Christopher Chung, MD

Longview Plastic Surgeon