Marie E. Montag, MD

Losing weight is a major goal for people, especially around this time of year. Who hasn’t made a new year’s resolution to get back to the gym or to shed a few pounds? If you are successful, that is fabulous! But, unfortunately sometimes the weight comes off of areas you didn’t want to get smaller…specifically, the breasts! The breast is made up of a combination of fatty tissue and glandular tissue and with weight loss the fatty component shrinks making the skin loose. Depending on the elasticity of your skin and the amount of shrinkage of tissue that happens, a simple implant may reverse the damage. But, if the skin is loose and the nipple is in too low of a position, then a lift may be necessary. It does not work to just put a larger implant in when the skin is lax…the heavier implant will make the breast sag even worse! Every situation is a little different, but as a rule of thumb, if the nipple is at or above the fold or the breast an implant may be all you need. If the nipple is below the fold or the distance from the nipple to the fold of the breast is greater than 5cm, then it is much more likely you need a lift. The best advice is to be evaluated by a board certified plastic surgeon who is experienced in breast augmentation and lifts, who can guide you to the right treatment to meet your aesthetic goals.  

When contemplating multiple surgeries at the same time, the length of the anesthetics is felt to be a rate limiting factor for safety. Generally it is understood that if an anesthetic is longer than 5 hours that the complication rates escalate. Wound infections are more common, blood clots are more likely to form, and respiratory, fluid and electrolyte issues become a problem. At that point the benefits of the surgery are outweighed by the potential risks. In order to make the surgery safer, we need to find ways to cut back the length of time spent in surgery. This can be done by limiting the number of things done with your procedure, speeding up the time each portion takes, or doing different parts of the surgery simultaneously (at the same time). Most plastic surgeons would agree that addressing two major areas (such as the tummy tuck for the abdomen and augmentation, lift, or both for breasts) and one minor issue (like liposuction to hips, thighs and/or back) at the same time can be done safely and in a reasonable time frame. It will be up to your surgeon to tell you what he/she can reasonably do in 5 hours. This may partly depend on how complex your particular case is, but also has to do with how efficiently the operating room runs and the speed of the surgeon. At our facility, we have trained our scrub technicians to sew (up to our standards) and that cuts away a lot of time from the overall length of the case. Out practice also has multiple board-certified plastic surgeons, and in these types of cases we work together on the same patient so we can do that tummy and breasts at the same time. Typically a mommy makeover with tummy tuck, breast augmentation and lift and liposuction takes us about 3 to 3.5 hours. That is well within the safe window for anesthetic length. This ability to work simultaneously is not available in all practices or cities. Be sure to ask your plastic surgeon what he/she is able to do to control the added risk associated with extended anesthetic for combination procedures. The goal is always to keep you, the patient, as safe as possible, but also let you enjoy the benefits these surgeries can provide.

You hear amazing stories everyday about how normal people achieve fantastic success with weight loss through hard work and determination. The side of the story that you don’t hear about often is what happens long-term to those people. Obviously a good percentage of them maintain their healthy lifestyle and their body shape transformation and live happily ever after, but this is the real world…it’s easy to slide back into old, unhealthy habits, especially when life’s stresses get ahead of  you. Bad relationships, injuries or health issues are only a few of the things that can really upset your routine. For those who do eventually regain the weight, their bodies go through the same unfortunate changes they did the first time, and the amount of relapse depends on the amount of weight regained. Skin that was previously overstretched does not ever get back its elasticity and will only stretch thinner and have worse tone. Also, muscles that were sewn back together from a tummy tuck can separate again. If the weight is then lost again the sagging will come back (especially from the weight gain involved with a pregnancy and all of the stretching pressure that puts on the tummy). The good news is that we can go back and remove skin and tighten muscles again to get you back to a better figure. The best situation would be to avoid wide weight swings and yo-yo dieting, but at least there are procedures we can do to tailor your shape when you get back to a weight you are happy with.

Everyone today wants to combine as many surgeries together as they can to achieve their aesthetic goals, save money and have only one recovery. We as surgeons are happy to combine procedures as long as it can be done safely and if doing one part of the surgery does not worsen the results of another part. One combination that causes problems when trying to do almost anything with it would be the Brazilian butt lift. The main reason is that for the Brazilian butt lift you have to avoid pressure on the areas we transfer fat into. Patients are instructed to sleep on their abdomen and not on their back or sides. The pressure of your own weight on the fat can cause it not to take (to grow in) or to die. If the transferred fat cells die, you do not get your enhancement. Procedures like breast augmentations and tummy tucks require you to sleep on your back to avoid pressure on the implants and the tummy stitches. If you would sleep on your tummy after these procedures you could push the implants out of position or pop stitches and result in healing problems or bad scars. It would be a waste of time and money to do these together and risk ruining your final result. When considering a Brazilian butt lift and mommy makeover, I would recommend starting with the Brazilian butt lift (so we can use all of the fat on your tummy) to enhance your back side, and then when we go ahead later with the tummy tuck or the mommy makeover where we can remove the extra skin. Timing is everything when designing the schedule for your surgeries. I would recommend starting with a visit to a board-certified plastic surgeon so you can start planning the safest and most efficient way to reach your body contouring goals!

When contemplating multiple surgeries at the same time, the length of the anesthetics is felt to be a rate limiting factor for safety. Generally it is understood that if an anesthetic is longer than 5 hours that the complication rates escalate. Wound infections are more common, blood clots are more likely to form, and respiratory, fluid and electrolyte issues become a problem. At that point the benefits of the surgery are outweighed by the potential risks. In order to make the surgery safer, we need to find ways to cut back the length of time spent in surgery. This can be done by limiting the number of things done with your procedure, speeding up the time each portion takes, or doing different parts of the surgery simultaneously (at the same time). Most plastic surgeons would agree that addressing two major areas (such as the tummy tuck for the abdomen and augmentation, lift, or both for breasts) and one minor issue (like liposuction to hips, thighs and/or back) at the same time can be done safely and in a reasonable time frame. It will be up to your surgeon to tell you what he/she can reasonably do in 5 hours. This may partly depend on how complex your particular case is, but also has to do with how efficiently the operating room runs and the speed of the surgeon. At our facility, we have trained our scrub technicians to sew (up to our standards) and that cuts away a lot of time from the overall length of the case. Out practice also has multiple board-certified plastic surgeons, and in these types of cases we work together on the same patient so we can do that tummy and breasts at the same time. Typically a mommy makeover with tummy tuck, breast augmentation and lift and liposuction takes us about 3 to 3.5 hours. That is well within the safe window for anesthetic length. This ability to work simultaneously is not available in all practices or cities. Be sure to ask your plastic surgeon what he/she is able to do to control the added risk associated with extended anesthetic for combination procedures. The goal is always to keep you, the patient, as safe as possible, but also let you enjoy the benefits these surgeries can provide.