Samuel Shatkin, Jr., MD

The procedure for breast augmentation is generally customized for every patient. Considerations will vary depending on the laxity of skin and the current amount of breast tissue as well as the size the patient wishes to achieve. The breast implants need to be centered behind the nipple. If the nipples are facing forward, and not downward, breast augmentation can be performed without a lift, however the patient would need to accept the appearance of the "mature" breast if some laxity exists preoperatively. A consultation will be the best way to determine your condition and needs.

Generally, patients should try to reach their ideal weight before any surgery. If a patient has some intra-abdominal fat, it may reduce the amount of tightening of the muscle layer. From the photos, it appears as if you would be a candidate for the surgery. During a consultation, the Plastic Surgeon will assess the muscle weakness and be better able to determine whether one is ready for surgery. One simple trick to see if the protrusion of the abdominal area is related to loose muscles or from excess intra-abdominal fat is to see how it appears lying on your back. If the fullness still protrudes, then you are dealing with visceral (intra-abdominal) fat. If the abdomen is flat or concave when you lie down, then you are dealing more with loose muscles.

Sometimes the pulling on the tight closure can cause some separation.  This can happen and when it does, your surgeon will probably treat it conservatively as the body closes the wound and the healing occurs.  It is important to follow up with your surgeon to assure that proper management is provided.

Generally, for those individuals that are bothered by thinning hair, I recommend using some or all of the non-invasive methods to assist in stabilizing hair loss.  This would include topical as well as oral  supplements.  In addition, we are seeing nice results with the use of laser therapy.  We have our patients come in for the 20 minute treatment 2-3 times a week for the first 3 months.  We also use PRP injections which we perform with nitrous anesthesia which provides growth factors to stimulate hair growth.

With weight loss usually comes volume depletion and sagging.  It appears that you may have both.  When there is some sagging, I first as the patient if they desire more volume or are they happy with the volume of  their breasts when wearing a bra or bathing suit.  If they are happy with the size, then they would likely benefit from only having a mastopexy (lift) without implants.  If they want to be larger, then either an implant (for larger volume increase) or fat transfer/injection (for modest increase) would be needed.  Often both the lift and enlargement may be ideal depending on the patient preference.

For young adults dealing with thinning of the hair consistent with Male Pattern Baldness should be proactive.  The goal is to slow the thinning process.  Use of Finasteride is one option, also we have had success using PRP injections and Laser Scalp treatments. 

Patients with rolls of their back after weight loss demonstrates a combination of some residual fat as well as skin laxity.  The back skin is generally much thicker than other areas of the body and will show well delineated rolls where the skin is adherent to the underlying muscle and fascia.  To improve these areas, liposuction can be performed both above and below the deep crease to reduce the fat and contouring the area of the lower back above the buttock can improve the overall shape and contour.

Based on your photos, the drains are in place and should help to eliminate any excess fluid or blood that accumulates.  It does not appear that you have a large collection.  Even after fluid or blood collection following drain removal, the body can absorb small amounts of fluid.  If there is a large amount, your surgeon may elect to aspirate with a needle done in the office.

It is difficult to appreciate your concerns from the photo you submitted.  Generally, it can take several weeks for swelling to subside after liposuction and tummy tuck.  I recommend proper compression garment after surgery to assist in the swelling reduction and skin contraction. If there is still swelling concerns, I recommend returning to your plastic surgeon for evaluation.

When the discussion comes up in our consultation about location of incisions, i explain to the patient that the inframammary (below the breast) incision is the most direct approach to placement.  It allows direct visualization of the entire pocket and is a scar that typically heals well.  This is my go to location for implant insertion.  When an incision is placed in the axilla, generally they heal well, but if the scar is unsightly, it may be see in a bathing suit or sleeveless breast.  Incisions on the breast itself would not be visualized with clothing.