Joel Williams, MD

Hi and thank you for your question. If loose skin or extra skin are present, an abdominoplasty is required. Liposuction can be performed as part of the procedure to improve your shape further. A staged procedure as your surgeon recommended would allow a more extensive liposuction to be performed prior to the tummy tuck being done later. I would also point out that visceral fat, or fat around the organs inside your abdomen can not be reduced by liposuction and will limit how flat your tummy will be. Only weight loss will reduce this fat. So..to answer your question, there are advantages to both approaches, but I think some weight loss will really benefit your results either way. Good luck and best wishes,Joel A. Williams, M.D., FACS

 Thanks for your question.  This question comes up every day in the consultation room, and generally speaking, I would almost always recommend patients be at their best weight prior to surgery. Notice I said best weight not ideal weight.  While ideal weight would be better, it's not often realistic.  Likewise, 10 pounds may not impact the results in one patient, but in another, it could be significant.  I have had several patients lose weight after the tummy tuck, and their results only improved.  Bottom line, if you can lose 10 pounds prior to, by all means do it. Will it impact your results?  Only your surgeon can answer that question.   As always, I recommend seeking out a surgeon certified by the American Board of plastic surgery. Best wishes, Joel Williams, M.D., FACS

Hi and thanks for your question.  The answer to your question I think lies in your motivation for wanting extra large implants.  If you are a performer or entertainer, then it becomes more of a business decision.  In that instance, you may be willing to accept the inevitable future consequences and expenses related to correcting the damage caused by oversized implants.  You should also be prepared to accept a staged approach to getting to the oversized look as there are limits imposed by your natural breast dimensions.  If you are not making this business decision, then there are other factors you should consider. Oversize implants make women look heavy, as in overweight. Clothing choices are severely limited meaning "custom made".  Bra choices are similarly very limited.  Sagging and some loss of sensation are also in evitable consequences.  You will also find that the way people relate to you and the way you are perceived will change, and you may find that surprising and maybe unsettling.  It is not a decision to be made quickly or taken lightly.  As in any procedure that is outside of the ordinary, it is highly recommended to seek out someone with the most experience in exactly what you're looking for.  As for price, I would think they would charge more than the average cost.  But if cost is an issue, it may not be the best choice for you as the initial surgery price is just the beginning. Best wishes to you, Joel A. Williams, M.D., F.A.C.S.

Hi and thanks for your question. From the photographs alone, it would not appear that you would absolutely have to have the vertical incision. Of course, an in person exam would be much better at determining this. The vertical incision comes at the expense of havIng A vertical scar. Most patients don't require this or want this. There's no question that and abdominoplasty or tummy tuck will make a huge difference in your appearance and probably how you feel about your yourself!  I recommend you seek counsel with a board-certified plastic surgeon in your area. Best Wishes!Joel A. Williams, M.D., FACS

Thanks Gforce for your questions and photos.  Correcting asymmetries on the breast can be challenging because there are often other asymmetries of the underlying chest skeleton that play a role. One major factor that you did not specifically mention -what size breast you would prefer. The base width on the smaller left side will dictate the implant volume if you seek a natural result. A reduction on the right with a similar sized implant could work well. It's all about controlling variables in your case and similar sized implants eliminates one of the variables. You often times end up trading one asymmetry for another when you place a larger implant in the smaller skin envelope side. You also might consider the lollipop scar type lift instead. I agree that surgeon experience is definitely the key to a good result in your case. Get several opinions until you are confident and comfortable with your surgeon. Also, get the revision policy nailed down in advance as a touch up would be more common in cases such as yours. Best Wishes!Joel A. Williams, M.D., FACS

Hi jade5233 and thanks for your questions. First, I think that you will be happy with either implant mentioned. The HP implants tend to give slightly more projection for a given base width, but they put additional pressure on your natural breast tissue if your breast is small and the skin tight. If there is some looseness to the skin or "deflation" that has occurred with your natural breast, the HP will usually work fine. Given the minimal difference in base diameter of the two implants mentioned, there should not be a "GAP" provided the lateral pocket is dissected conservatively. As a further note, the natural central "gap" between your breasts is a function of your specific anatomy and will be largely unchanged after augmentation. If you have a wide space, perhaps a wider, shorter implant would not accentuate that space. Only the surgeon examining all aspects of your chest and breasts can make sound recommendations. There are always trade offs with every decision and those should be discussed in detail with your surgeon. Try not to stress. There is no "perfect" implant. Best Wishes,Joel A. Williams, M.D., FACS

 Hello and thank you for your question. It appears that you have lost a significant amount of weight and for that you are to be congratulated. At this point extra skin seems to be your biggest problem. To address that issue would require a tummy tuck or body lift type procedure. I agree with the recommendation to seek several opinions until you're you are comfortable with the plan moving forward.good luck and best wishes,Joel A. Williams, M.D., FACS

Hi and thanks for your question. There are a couple of things to consider at this point. Although pricing does vary by region and even within a region, the lowest price may not be the "best option", just like the cheapest shoe isn't the best shoe, and you can take a shoe off if you don't like it! Although it may be tempting to seek out the cheapest price, Be particular and selective about who you let do things to your body. The cost to correct problems, if they can be corrected at all, is always much more expensive than any money saved on the front end. The next consideration is how you would pay for any complications or revisions that could come up. Although breast augmentation has a very low complication rate, it is not zero. You would hate to stress out your finances further by having no reserve. No elective surgery is worth that kind of stress. All that said, financing options abound, but nothing beats the satisfaction of waiting and saving up for something you really want. Best Wishes,Joel A. Williams, M.D., FACS

Hi and thanks for your photos. The result of a breast augmentation is generally going to be your breast only bigger. So....if you like your breast shape and want it bigger, that's what you will get with an implant alone. If you are hoping for a lifted, less sagging breast, a lift will be required. If you are worried about a "botched job", you haven't fiund confidence in the surgeons you have seen so far. Get more opinions until you are comfortable with the plan and the risks involved. You can have confidence in the fact that there are great board certified PLASTIC surgeons all over the country that are honest, caring, and take great pride in their results. Remember "botched" is a sensationalist TV program that capitalizes on people's misfortunes and results of poor decision making. It does not reflect the norm.Best Wishes for an outstanding result!Joel A. Williams, M. D., FACS

   Hi and sorry to hear about your problem. Regarding the open incision, I would notify your surgeon immediately. Not only do you need some direction on what to do next, I'm sure he would like to know. It will take time for your implant to stretch your skin and settle on the right. You have to remember the larger implant was probably placed into s smaller skin envelope. Many times you end up trading one asymmetry for another. Close follow up with your surgeon is always recommended.best wishes,Joel A. Williams, M.D., FACS