Emily C. Wirtz, MD

Depending upon where your final scar will be, some, all, or none of the tattoo may be removed. I would suggest you wear your favorite undergarment/bathing suit bottom to your consultation to show your doctor where your scar should ideally be placed. If low in the bikini line, then likely the whole tattoo would be removed. I hope this helps you in your decision making process!

Thanks for your question. This is a big decision, and I appreciate you taking your time to be thoughtful about the size you choose. The best way to choose is to try on sizers in the office. Some offices may even offer a sizer that you can wear at home and inflate to different volumes (ours is called the Dazzle) to try on in your usual clothes and take for a test drive. A 50 cc difference distributed over your whole breast is not a big change in size, so when my patients express anxiety about possibly going 'too small' I will encourage them to lean into the slightly larger size to avoid the most commonly reported post-op regret of not going bigger. Your anatomy is also important - and picking an implant that fits your 'base width' or measurement of the breast width should also be taken into account, and is something to discuss with your surgeon. You have great anatomy for a breast implant, and I wish you the best luck on your journey!

Thank you for your question. Your umbilicus is hooded, which suggests that you have skin laxity above your belly button and a small amount of excess fatty tissue also. The correction you see with your back arched puts your umbilicus on tension, and mimics what a skin removal surgery (abdominoplasty, reverse abdominoplasty or mini abdominoplasty) could accomplish. I tend to agree with the surgeons you have seen, as you do not appear to have a significant amount of skin excess to justify a full abdominoplasty. Your umbilicus is also positioned high on your abdomen, so would also make sufficient skin removal and scar placement for a traditional full abdominoplasty less than ideal. Options that may improve the appearance include liposuction with the addition of a skin-tightening modality such as renuvion or smart lipo to assist with upper abdominal skin contraction. A mini-tummy tuck involving a floating navel will help to tighten the skin and can result in a more vertically oriented umbilicus, but it will also move the umbilicus lower on your abdomen. Best of luck in your journey!

Thank you for your question and for including the photograph. It looks like your mons pubis - the soft tissue covering your pubic bone, has been pulled too tight. Usually I like to keep about 7 cm between the vulvar cleft and the incision for the abdominoplasty to prevent issues like this from occurring. I would recommend a revision to try to advance the tummy skin and the abdominal scar lower to reposition the mons tissue lower. After 4 years, this may not fully reverse the issue but is likely the best way to reverse this problem. You can also consider some fat transfer to increase the bulk of the labia majora, but this will not lower the vulvar cleft. I encourage you to seek out your surgeon to explain your concerns and see what options you may have.

Breasts progress through a very normal and relatively predictable change in shape from the immediate post op period through the first year after surgery. At first, breasts are swollen, ride high on the chest wall and may resemble an augmentation. This settles in the first 1-3 months, and the breast resumes a more natural slope with the majority of the breast tissue at the level of the areola and below. Usually these changes stabilize between 3-6 months post-op and any additional changes are slight. This suggests that the results you see today are as close to the final result that you will be after your surgery. If the appearance of your breasts today are not satisfactory to you, you may want to consider sharing your concerns with your surgeon and discussing options. Addressing these concerns will likely require a discussion about surgical options.