Christopher Pannucci, MD, MS

Hi randomstuff088,

Rectus plication, also known as 6 pack muscle tightening, is an important part of most tummy tucks. Anatomically, the rectus muscles are supposed to sit next to each other, right and left, in the vertical midline. With weight gain and/or pregnancy, this junction is often stretched out. This right to left gap or weakness allows your intra-abdominal contents to bulge forward, producing an upper and/or lower abdominal bulge. Rectus plication tightens this right to left gap, restoring your original anatomy.

Your body has an amazing capacity to heal. For surgeons using dissolvable sutures, the expectation is that your body will produce enough scar tissue at 3 months when the sutures dissolve that the sutures are no longer needed. For surgeons using permanent sutures, the thought is that no matter how much scar tissue body produces, the sutures will always keep the rectus muscles in the position placed in the operating room, as the stitches themselves will stay on a permanent basis. In a hybrid model, many surgeons will put a layer of permanent sutures, followed by a layer of absorbable sutures. This puts well vascularized fascia over the top of the permanent stitches, to minimize any risk of infection or problems if you develop an open wound.

Hope this helps.

Best,
Christopher Pannucci MD
Board Certified Plastic Surgeon
Plastic Surgery Northwest
Spokane, Washington

Hi kendrakay97,

Yours is a great question. In general, women presenting for breast reduction consultation via insurance will have:
1. Symptoms, including back and neck and shoulder pain, bra strap grooving, trouble finding clothes that fit, awkwardness in social situations, and others
2. A documented history of multiple visits to primary care physician regarding large breasts.
3. Potentially a documented history of multiple uses of physical therapy, massage therapy, and/or chiropractic therapy.

In order to have a useful visit with the surgeon, the above criteria should generally be met. During your visit with the surgeon, he or she will estimate the approximate removal weight, and will package a complete history and physical exam, along with anticipated removal weight, and documentation of numbers 1 through 3 above, when the insurance preauthorization letter sent. All of these together are no guarantee that the insurance will provide coverage for the surgery, but it certainly helps to of all your documentation intact for that original submission.

Hope this helps.

Best,
Christopher Pannucci MD
Board Certified Plastic Surgeon
Plastic Surgery Northwest
Spokane, Washington

Hi SKjar,

Varicose veins represent a potentially modifiable risk factors for blood clots, including deep vein thrombosis and pulmonary embolus. Your surgeon will likely consider your overall risk, considering factors like age, body mass index, planned procedures, varicose veins, and others. You might ask your surgeon if they are using a 2005 Caprini score, or similar risk stratification tool, as suggested by the American Society of Plastic Surgeons.

Ultimately, your surgeon should be able to estimate your approximate risk for blood clots, based on your individual factors, and consider the potential risk reduction of a preemptive procedure to obliterate your varicose veins prior to schedulable aesthetic surgery. You and your surgeon can decide whether the anticipated risk reduction is worthwhile to you (since there is a tradeoff of having an additional procedure for varicose veins), and make the best decision moving forward for surgery (yes/no) and preemptive varicose vein obliteration (yes/no).

Hope this helps.

Best,
Christopher Pannucci MD
Board Certified Plastic Surgeon
Plastic Surgery Northwest
Spokane, Washington

Hi katmamaof4,

Scars mature over the course of months, and the scars that you are seeing at 12 weeks from revision are by no means your final scars. Over time, scars tend to go from pink or purple to a lighter color, generally settling out to a thin white line scar by approximately 1 year. If you feel like you are scarring abnormally, I would suggest you reaching out to your surgeon. Alternatively, watchful waiting is generally appropriate for scars which appear to be healing normally. Your final results won't be seen for a year or more.

Hope this helps.

Best,
Christopher Pannucci MD
Board Certified Plastic Surgeon
Plastic Surgery Northwest
Spokane, Washington

Hi sabujohn,

The photos show that the bulk of your breast sits below the level of the fold with the breast meets the chest wall. As such, the first decision point would be if you wanted to remain the same size, with an improved shape, or be slightly smaller. In the setting of a goal smaller, a small breast reduction would allow active reshaping of the breast tissue internally, making the areola smaller, and removing the substantial amount of excess skin that you have. Alternatively, in the setting of a lift, the same maneuvers could be undertaken with the goal of keeping the breast around the same size but an improved position.

Unfortunately, both these options will produce scars, specifically a scar around the nipple, a vertical scar, and under the breast scar that you cannot see without a mirror. Given your goals of a "slight lift", it will be important to meet with a board certified plastic surgeon advance to explicitly discussed your goals, and the trade off between final breast size and shape and scarring.

Hope this helps.

Best,
Christopher Pannucci MD
Board Certified Plastic Surgeon
Plastic Surgery Northwest
Spokane, Washington