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Board Certified Plastic Surgeon
It is tough to say which is a "better" reconstruction as there is no such qualitative measure as to which one is a "better" one as I assume your main goal is the final aesthetic outcome of the breast reconstruction. What is better for you may not be for someone else as everybody has different skin qualities, breast shapes, volume, size (even differences - more the norm than the exception) as no two breasts are exactly the mirror image or in perfect symmetry. The advantage of a single stage breast reconstruction however, is that it is one surgery for both the mastectomy and the breast reconstruction. Whether you qualify for that technique however is a decision made between you, your surgeons (oncologic and plastic) and your medical team, that is whether your breast skin and nipple areolar complex is safe to preserve given the stage of the cancer, the size of it, how far away is it from the nipple and other "personality" characteristics of the cancer that is biopsied that can be different in each individual as are the breasts. It is important to remember, that in either scenario, breast reconstruction at time of mastectomy whether implants are used as single stage or staged with tissue expanders or with your own tissue as from they tummy or back, all of these may require revisions in the future. There is always room for aesthetic perfection and improvement of results as the years go by and our bodies age and elasticity changes, weight gain / loss etc.... The short answer, is yes it is less times in the operating room and down-time from personal and professional life when same time implants are placed at time of mastectomy (again not every woman may qualify for this as it depends on the stage and other things mentioned above). The best candidates for same time implant single stage breast reconstruction are as in the case of Ms. Angelina Jolie, where she did not have active cancer, but had tested positive for the BRCA1 mutation therefore, she tremendously lowered her risk by deciding to remove both breasts and reconstruct at same time, but in her case her surgeon had decided to stage it with tissue expander first as some surgeons feel they can better control the final aesthetic outcome. Alternatively, some women may want slightly larger breast volume post reconstruction than their original breast size, and therefore, tissue expanders may be temporarily used for a short time to stretch the muscle and skin to minimize the risks of vascular problems to the skin envelope if a larger implant was used in the first stage, to protect the skin and the final aesthetic reconstruciton. Therefore, it is an individual choice, multifactorial in nature, but remember that you will be living with the reconstruction and that needs to be in the best possible aesthetic result and it is not always the best in one stage. Even with staged reconstruction, revisions are the rule than the exception, the trusted rapport that you have and the aesthetic sensibility and skill that your plastic surgeon has is key in making your reconstructive journey a satisfactory and rewarding experience for all involved. I hope this helped in answering some of your questions :-)
Board Certified Plastic Surgeon
AlloDerm, AlloMax, FlexHD and others are Acellular Human Dermal Matrix products that help support the internal skin envelope during implant based breast reconstruction. In previous decade, when patients were deemed candidates for tissue expander / implant two stage breast reconstruction, the initial expander was inserted deep to the pectoralis major, serratus anterior and upper insertion fibers of the rectus abdominus muscles such that a "full" muscle coverage was done over the expander and later exchanged with permanent implants once adequate fill volume and stretch was reached. In the advent of this cadaveric donated dermal matrix and its FDA approval for breast reconstruction, the matrix is used instead of the serratus anterior / rectus muscles, which are left non disturbed on the chest wall and instead, the matrix is attached to the rib cage tissues along the mammary fold. This matrix then acts like a "hammock" and supports the lower half of the expander / implant such that the weight of the implant is not solely carried by the skin, but by this internal brasserie, the matrix, minimizing the chances of skin stretch and other deformities. The use of this matrix is key in same time mastectomy and implant reconstruction as a single stage as the skin envelope of the breast is preserved in this setting and the matrix is used to support the lower half of the implant and the upper half still always covered by the elevated pectoralis major muscle.
Board Certified Plastic Surgeon
I would have waited longer than 5 days to address the "clumping" if it was injected properly, it would most likely have flattened with time. Unless it looked grotesque, I would have waited for at least two weeks before using hyaluronidase to melt it away which inadvertently also melted some of your own fibroblast produced hyaluronic acid. So for now, I would recommend for you to be patient and allow your body to recover before addressing the area with some other "product" that could potentially worsen the appearance. You could have gently massaged it and most likely it would have gone down in profile. I recommend that you wait and follow up with the doctor who injected it given that you trust his expertise and have good rapport and you do believe that he/she has your best interest at heart. Sometimes less is more when there is a perceived problem and patience is key and your trusted rapport with your plastic surgeon is maintained.
Board Certified Plastic Surgeon
Juvederm or Restylane - both Hyaluronic acid based fillers do stay longer than expected sometimes up to three years especially at the nasal or lower eyelids/upper cheek areas to fill in "indents" dark grooves as these are areas that do not move as often (theoretically) and therefore are not subjected to "stresses" of constant shear stress and stretch stress as other areas on the face that are more animated. I do not suggest ever using any "permanent" filler to any area as none of the permanent fillers, and some have been around since the 50s as liquid silicone - as they have never been approved as safe for injections in the face or body as liquid forms - by the FDA. Whereas the hyaluronic acid based fillers may be used safely to these areas as off-label use, they will last longer than expected with good results and easily removed or dissolved by hyaluronidase if necessary. So keep with your original plan with your doctor and follow up.
Board Certified Plastic Surgeon
Dear LidiaAnna: There is no real substitute for an autologous fat transfer or "Brazilian Butt Lift." That said, I have on occasion used SCULPTRA for subtle buttock augmentation with great results. Sculptra, as you may know, is a man-made product that is FDA approved for facial volume loss. It is not a permanent filler, however, and after it is injected it is eventually turned into collagen by your own tissues. The use of SCULPTRA for buttock augmentation is an off-label use but a viable option if you do not have adequate fat to transfer. The outcome is not as dramatic as a buttock implant but may meet your expectations. The success of the procedure certainly depends on the technique of the plastic surgeon. A more definitive answer that applies directly to your case would require an in-office consult.
Board Certified Plastic Surgeon
I don't even know where to begin to express my gratitude and appreciation for Dr. Salibian and William at this office. My experience with getting a breast reduction was nothing short of amazing and I could never convey how thankful I am. I literally called on a random Wednesday and was scheduled the following day for a consultation. I was a nervous wreck but Dr. Salibian was patient and listened to what I wanted and walked me through the process of what exactly could be done. I was unsure of how long the process would take due to having to deal with insurance but William walked me hand and hand through the process and we got it completed in 3 weeks! William was alway in contact with me and whenever I needed assistance completing part of the process he assisted with it. Like I previously stated I was a nervous wreck and I was also working full time and being a parent so I was STRESSED; throughout William reassured me it will get done and not to worry. He was right, three weeks later I was approved and on the operating table! The day of surgery we discussed what I wanted again and was reassured I would not have pancakes for breast! I have never had a small breast before so I was prepared to feel distraught and like I had made a mistake. He delivered nice full breasts and I think it is one of the best decisions I have ever made in my life. The office is beautiful, the people and the experience are beautiful as well. I cannot wait to do the rest of procedures here!
Dr. Salibian's practice provides the level of care that if I could give higher than 5 stars, I would. From the minute I called to make an appointment with William, who went out to his way to accommodate my schedule, to the immaculate office space, to Dr. Salibian himself - the kindest, most compassionate doctor who took all his time to listen to my concerns. The symmetry with which Dr. Salibian injected was nothing less than perfect. His light, gentle touch made me feel comfortable and at ease. There is also no hard sells - Dr. Salibian was so honest and discussed with me what I needed - instead of trying just to sell me a product or service. I waited for a while to find the right practice, and I have. Thank you for this incredible experience and results!
Im not sure exactly what the date was, but I met Dr. Salibian about 10 years ago, and had a breast augmentation and lift on one side, my daughters did a real number on me while breastfeeding! He did an amazing job, his bedside manner is so kind and comforting. He is honest and authentic and just an amazing doctor. I consider myself blessed to be his patient, he has helped me “gracefully” grow older with botox and filler as well. I completely trust him because he keeps me natural and not over done. I can’t recommend him enough!
I found Dr. salibian through a good friend and called several times throughout the years working up the courage to finally have that reduction that I've needed since I developed boobs. It's a very scary decision to make but Dr salibian's calm demeanor and collaborative nature eased my anxiety and fear. The surgery went smoothly and my healing has gone just as expected. I remember saying at one of my post op visits "I never knew I could look this way" and almost teared up a bit. Dr salibian is an artist for sure and meticulous about his work. I barely have any scars and am loving the results! This is a very big decision that requires a doc that's not only knowledgeable and skilled, but cares about you and how you feel. Dr. Salibian is the doc that fits this description. To add, Dr salibians prices are reasonable and fair. Call him! You will not regret it!
I strongly recommend Dr. Salibian for his expert surgical ability. I was referred to him through my insurance company and he is one of the best doctors I've worked with. I needed to have reconstructive/revision surgery due to previous mastectomies and reconstruction (2005, 2009) with 2 different methods and 3 different surgeons; I had been living with awful results which affected my confidence and outlook on life. I feel so much better now. In November of 2022, Dr. Salibian was able to revise both "breasts" for a much more symmetrical, natural, and visually balanced result. He had to fix a number of issues and I am so pleased with the major improvements he was able to make. Plus, Dr. Salibian is a kind person with a calm demeanor which helps the overall process. His assistant William is attentive, conscientious, and a pleasure to communicate with.
If you're lucky enough to be one of Dr. Salibian's patients - congratulations! If not, then immediately stop what you're doing and call his office to schedule your appointment ASAP. I waited YEARS to make that call and that's the only thing I regret about the whole process. Don't make the same mistake I did. After not one but TWO unsuccessful ear surgeries with another plastic surgeon (many years ago) I promised myself to never go under the knife again. But I hated my ears and the mirror was my biggest enemy. Until now. It's been a month since my surgery and I can't stop looking in the mirror! It's like a completely different person. Just look at the images!! Everything about this surgery and the whole process was exactly what I had hoped for. Dr. Salibian's attention to detail, his insanely reasonable prices, his attitude, all his knowledge... did I mention his attention to detail?? You just can't go wrong with Dr. Salibian. Thanks for everything, Mossi!!
I want to express my deep gratitude to Dr.Salibian for his excellent work. He did liposuction and Brest lifting to me and I am very pleased with the results. I felt great the day after the operation and also the next day. I am full of strength and energy, I have no severe edema, no big bruises. I love how my Brest and body looks like now. He is a super professional surgeon and very nice and kind person. They called me from the office next day after the surgery to know how I feel. I truly recommend Dr.Salibian to everyone . Rest assured that with this doctor you are in good hands and the results will exceed all your expectations.
Dr. Salibian is the most patient, caring, and honest doctor and human being I have met. I met Dr.Salibian when I had just been diagnosed with breast cancer. Those were not my best days, but he made them so much better. He has done an amazing reconstruction on my breasts. I am beyond pleased and happy with how they turned out. Furthermore, in the midst of all this, I needed a scalp flap rotation (due to another previous surgery complication on my skull) and without a doubt, he was the surgeon for me. I only wish I had met him sooner. He takes the time to listen to your needs and concerns, and explains his process in a way you will understand. Not to mention, his staff is always so helpful! I would recommend Dr. Salibian for all your plastic, reconstructive, and beauty needs!
I can't say enough good things about Dr Salibian and his staff. I had 15 year old saline implants that needed replacement. Dr Salibian patiently explained all of my options and I decided upon silicone implants. The process was incredibly smooth and the surgery was successful! I'm so happy that I found Dr Salibian and his wonderful staff.
I had transconjunctival lower blepharoplasty 1 month ago with Dr. Salibian and couldn't be happier with the results. It's made me look like 'myself' again. I also had upper lid blepharoplasty with him about 10 years ago and those results still look great. He has a great eye, and gives very thoughtful suggestions about what would (or wouldn't) improve a situation. I highly recommend him and would certainly turn to him for any procedures I consider in the future!
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