Ewa Majdak-Paredes MD, PhD, FRCS(Plast)

Thank you for your query.

There is always a risk that you might not be able to breastfeed after breast reduction despite the fact that the breast ducts are preserved. The production of breast milk depends on intact ducts and innervation to the ducts (amongst other factors). The surgery might interfere with innervation to the ducts and as a result patients are at risk of not being able to breastfeed anyway. That said, many women who had breast reduction surgery manage to breastfeed (about 60%). Some women who have not had any surgery to the breast are unable to produce milk. It is therefore difficult to estimate how many women who had breast reduction surgery would not have been able to breastfeed anyway.

If you feel strongly about breastfeeding, your midwife or doctor should encourage you and help you with breastfeeding as you might be perfectly okay.

Hope this helps.

Thank you for your enquiry.

Looking at the photos there may still be residual excess skin. It might be that you have vertical tissue excess and might benefit from Fleur-de-Lis (vertical excision) in addition to the full abdominoplasty. If you had abdominoplasty and liposuction, it would have been extremely risky and unsafe (in my opinion) to add the vertical excision to this because the risk of compromised blood supply resulting in wound breakdown, skin necrosis etc, would have been high. Your outcome would have been very poor. It may be that you need the vertical excision done as a second stage once things settle from your first operation. I would wait at least 6 months before considering any further surgery.

If it was important for you at the time to have extensive liposuction it was entirely appropriate to delay the horizontal excision (Fleur-de-Lis pattern) and do it as a second stage.

I am also wondering if you lost more weight after surgery? If so, then further weight loss might affect the result of your first surgery. I also noticed that the skin quality is not the greatest (it is natural in many women) and I can see the stretchmarks. This means that after extensive liposuction the skin might not spring back. As a result, one might have a bit more loose skin.

Regarding notes, I would say that it is a standard practice to keep medical records and volume should be recorded in the standard operation note.

If you feel that you could return to your surgeon and chat to them then they might provide some answers as well. If you feel that you would rather not then it important to check your surgeon to make sure they are board certified.

Hope this helps.

Thank you for your question. 

Looking at your photos, you are a candidate for a tummy tuck which will remove the excess skin and subcutaneous tissue and stretchmarks from below the belly button but the stretchmarks above the belly button will become a little bigger I am afraid. Regarding your breasts, again you are a candidate for an uplfit and, should you wish to consider breast enlargement then you should have enough fatty tissue for fat grafts to your breasts. Regarding whether or not you would have enough fatty tissue in your flanks for fat grafts, I think you would but your plastic surgeon will explain and decide with you which areas of your flanks to use safely at the time of tummy tuck for harvesting fat grafts as doing liposuction to certain areas at the time of tummy tuck might compromise the blood supply to your tummy wall and cause complications. What I sometimes do is that I harvest fat grafts from the lower part of your tummy (the part that will be removed with a tummy tuck) prior to removing that area if that makes sense. Regarding the breast sitting towards the sides of your chest, you seem to have laterally positioned breast meridians. This can be changed to more medial position, if you like, during the uplift. Your plastic surgeon would be able to advise you on this and explain what can or cannot be achieved.

Hope this helps.

Thank you for your question. 

Looking at this medical photograph attached I feel that this is an acceptable result. However, you might have some specific queries about which specific parts of labia are still bothering you for which sometimes it might be best to get a second opinion to get an idea whether or not there is anything else can be done surgically to improve the appearance. Of course, one needs to balance potential benefits against trade offs of surgery as revision surgery has always higher risk of complications. Regarding a specific nerve damage in labiaplasty revision, perhaps one should interpret this as that adding extra scarring from revision surgery can carry a risk of painful scarring and discomfort. Also, there is always the fact that we might sometimes have a specific expectation in mind which sometimes is difficult to achieve which then leads to dissatisfaction. I would suggest a second opinion might be worth pursuing, but it is important to firstly to try and define which specific areas of labia are still bothering you. Then you might wish to discuss those with another board certified plastic surgeon to see whether or not further surgery can address and improve those.

I hope this helps. 

Thank you for your question. 

Whether or not your plastic surgeon prefers to do labisplasty when you are not having your period is totally at their discretion. Personally, I prefer to do labiaplasty when patients are not on their period or just at the very end of their period simply to make patient’s experience a bit nocer. But, having a period when labiaplasty is planned is not a contraindication at all. Imagine bleeding after vaginal delivery and having stitches in the area as a result. I would say labiaplasty during period is very similar. 

Regarding how to look after the area after labiaplasty during period, again, it would be best to check with your surgeon but I recommend to my patients using pads not tampons simply to avoid friction which might disrupt fine stitches and soap and water. Very simple. Also, avoiding bathing. Shower is okay. 

Hope this helps. 

Thank you for your question.

I gather you decided to have your implants removed and not exchanged. If that is the case then you are right by saying that the body should naturally eventually dissolve the capsule. Whether or not to have capsule removed at the time of implant explanation is a tricky question. Pros of leaving the capsule would include preserving volume and vascularity to the breast tissue. However, I have seen an occasional seroma (wound fluid) forming afterwards in the capsule which required further treatment. Seroma is just a small risk which does not mean it is likely to happen. Cons of removing capsule comprise loosing a bit more volume which is not always desirable because the breast tissue would normally stretch and become naturally thinner after having implants. Thus, not removing more volume might be desirable otherwise your breasts might be more saggy and smaller than you expected. On balance, I would leave the capsule. Also, if you feel that your skin and breasts have stretched after having implants removed you might consider further surgery e.g. lipomodelling etc. 

Hope this helps.

Thank you for your question.

Looking at your photos, there are several options. Firstly, an uplift which would lift up your nipples but might not get rid of the loss of volume in the upper portion of your breast which you are demonstrating on the photo. Secondly, an uplift in combination with fat transfer to the upper portion of your breasts simply to replace loss of volume. Thirdly, an uplift with silicone breast implants to replace loss of volume and create upper pole fullness and cleavage but I would try to avoid silicone breast implants in your case as implants might be heavy and cause skin breakdown, stretchmarks, future surgery etc. Also, bear in mind that ED syndrome might make you more prone to recurrent loss of volume, sagging skin, wrinkly breasts, stretch marks etc. And therefore some of these problems you are demonstrating on the photos might recur in the future and you might require further surgery. The only permanent effect you might have would be from an uplift. Nipples usually stay where they are put during mastopexy. That might be sufficient to improve the shape and appearance of your breasts. The other thing is that you are young and if you wanted to have children in the future then any surgery on your breasts might compromise your ability to breastfeed. Just something to consider. 

Hope this helps.

Thank you for your question.

I am sorry about your concerns regarding your recent bilateral breast augmentation. I am not entirely sure as there are no preop photos attached but it seems to me you might have had a degree of mild tuberous breast deformity as the lower (below the nipple) areas of your breasts seem a bit tight (i.e. constricted). If that was the case then augmentation is generally a lot more more tricky and sometimes some of this tightness within the breast tissue needs to be released at the same time as well. In addition to that, perhaps your implants sit a bit high and the projection seems a bit high as well. If you were considering revision surgery (i.e. change of implants, adjustment of the breast pocket or release of tight breast tissue  if need be etc.) I would delay this for at least 6 months following your initial surgery as your initial scars have not yet completely settled. And yes, you need to choose an experienced Board Certified Plastic Surgeon to advise you on the best way to go forwards in terms of revision surgery. 

Hope this helps. 

Thank you for your question and all photos attached.

Looking at the photos but without the benefit of examining you, I feel that you might actually be a candidate for full abdominoplasty. Although if you are planning to have more children then mini-abdominoplasty or simply waiting till your family is completed might also be valid options for you to consider. Bear in mind that regardless of what type of tummy tuck you will eventually have the stretch marks above your belly button or above the mini-abdominoplasty scar will get a bit bigger.

Hope this helps.

Thank you for your question.

It is very early days post-surgery. It usually takes at least 3-6 months for the breast shape to declare itself after surgery. Usually breast implants would naturally drop a bit (with gravity) to the lower part of the breast after that time and as a result the breast shape should look more natural then. I would therefore wait and see before considering any revision surgery. Any concerns, I am sure your surgeon would be happy to see you back to discuss your specific concerns. 

Hope that helps.