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Board Certified Plastic Surgeon
Board Certified Plastic Surgeon
Board Certified Plastic Surgeon
Your dilemma is one of the most common complaints for patients who are lean and athletic with a little glandular settling but not ptosis. This time your doctor provided you with advice and recommendations that I would agree with. What he probably did not provide was an explanation why he recommended putting implant in the subglandular pocket. I believe that in your case and based on the pictures shown, you do not need a breast lift as your nipple position is not low enough to satisfy breast lifting with added scarring. The subglandular implantation will fill your breast tissue in front of the muscle and create a more cosmetically balanced appearance because you do have glandular settling and the implant will anchor the tissue in a better position but only if placed in front of the muscle. The disadvantage of subglandular positioning is that the implant is placed one layer deep instead of two layers. You seem to be torn between one and two layers of covering your implant. The advantage of putting it behind the muscle is that your doctor will place it two layers deep. However, your breast tissue has settled and to put the implant underneath the muscle, your nipple will be in a very low position due to glandular settling showing in the picture. The main disadvantage of putting it two layers deep under the muscle is that it has less of a lifting effect on the breast tissue and over the years, 5-10 years from now, your breasts will continue to slide off the position of the implant which stays in place due to submuscular positioning. The 5-10 year period may be shortened or lengthened depending on the type of skin you have, future pregnancies, if any, significant weight changes and existing tone and presence or absence of stretch marks in your skin of the breast. I feel for your dilemma and ultimately you have to make a compromise decision between subglandular and submuscular positioning of the implant. While you are considering your options, let's not forget that you do have very aesthetically pleasing chest shown in the picture provided. The implantation will enhance the aesthetic outcome but no implant surgery is perfect on all counts. I hope this helps and best of luck.
Board Certified Plastic Surgeon
Your question if you are a good candidate for skin removal is a very common one. The significant weight loss undergone is the most difficult thing to achieve and you have accomplished that already. After losing over 280lb the excess skin will certainly require removal, redraping and reconstruction and the best time to have surgery is when you are closest to your ideal body weight. It is difficult to tell your height from the pictures so you have to calculate your body mass index to see if you have closed in on it. Have in mind that many people who lose weight cannot achieve that ideal number so don't be discouraged. If you are planning on losing more than additional 20lbs, try to bring yourself to that level before proceeding with surgical planning. However, based on the pictures you may have already achieved the maximum required to get the best possible outcome with your existing state. There are many factors to consider and this is just a generalized outline for your consideration.
Board Certified Plastic Surgeon
The pictures submitted are not adequate to define the base of the breast and where it is attached to the anterior chest wall. That is the point which determines whether you need a skin lift to your breasts or only more volume to fill your existing skin on the chest. The position of your breast on the chest determines if you need a skin lift or not. The most critical relationship is the position of the nipple compared to the base of the breast where it meets the anterior chest wall. Mild degrees of ptosis may benefit from a skin lift but it is not always required. A 400cc volume implant will allow elevation of the breast by filling the skin of the breast and will simulate a lift providing the nipple is in a good position at this stage. I would suggest you return to your surgeon to discuss this further and have him explain it to you in a satisfactory manner. Breast surgery is very private and personal and if you are not satisfied with the explanation of the recommended treatment, you should definitely seek another opinion until that is achieved.
Board Certified Plastic Surgeon
From the pictures submitted, your tuberosity of the breasts is mild. The confusion usually arises with other body types that do not apply to your particular situation. Depending on the size of the implant you choose, the plane of insertion of the implant should be determined. Your treating surgeon should offer you all different options with their relative advantages so you can make an intelligent decision after consideration. If there was only one perfect way to do a procedure, all surgeons would perform it in that way. Most of the confusion arises when one body type patient requests a procedure to be performed as was done on someone that has a different type of tuberous breasts. If you consider tuberosity of the breast as a constriction ring that is internally present, putting the implant in front of the muscle underneath the breast will allow expansion of the breast against the constricting tuberosity. When you have a deep placement underneath the muscle, the implant will not be able to expand at the tuberosity in the breast due to the muscle layers separating them. A "D" or "DD" cup that you desire will only be satisfied with a moderately large implant insertion. An excessively large implant underneath the muscle would cause separation of the muscle from most of its rib and bony attachments which defeats the purpose of putting it in a deeper plane. It is important for you to understand the differences and for your physician to explain these differencies to your satisfaction.
Board Certified Plastic Surgeon
The advantages of working out on a regular basis are significantly more than the minimal risk related to soreness in the muscle from excessive workout before breast surgery. Only if you perform an excessively strenuous workout on your muscle together with putting the implants underneath the muscle would you have any negative effects of exercise before a breast augmentation. Even then, the excessive workout has to be performed less than 24 hours before surgery to have any negative effect. In short, enjoy your workouts and enjoy your breast augmentation results.
Board Certified Plastic Surgeon
The difference of 0.2cm is less than 1/10 of an inch. This would probably be difficult to even measure with a measuring device. More important is that you have to communicate with your surgeon at a level that alleviates your worries. It is important to understand that not all surgeons that perform breast implantation are trained to be board-certified plastic surgeons. Most implant surgeries yield very satisfactory results, however some implanting surgeons are not well trained in the specialty. Do your homework regarding the credentials of your treating physician and you will have no worries about the outcome.
Board Certified Plastic Surgeon
You should be congratulated for taking care of your physique after 3 childbirths. Pregnancy and childbirth are the number one cause for cosmetic imperfection of the body and breasts, whether you nursed your children or not. You need to be aware that 90% of women have asymmetries in their breasts due to differences in location, nipple-areola size, rotation, projection and positioning. The asymmetry seen in the pictures is relatively slight and would be even less visible with breast augmentation. The pictures are not adequate to go in depth regarding your areolar size and contraction, as you can see in the frontal view that left areola was more contracted compared to the right one when the picture was taken. Based on this limited information, I would say your expectations are not unrealistic and you should expect better than average result. I hope you find this helpful but you definitely have to interact with your treating physician to assure that all your questions are answered and then your expectations will be truly realistic.
Board Certified Plastic Surgeon
Amazing results after juvederm injection. I had multiple injections by other doctors but Dr.Khattab is the best by far. I am so pleased with the result and the staff are really amazing. It was very easy to make appointment. They used numbing cream so the injection was very much painless. I saw immediate result.
Best experience ever! I would highly recommend this doctor to any mom that's a little nervous to get her body back, just do it, best decision of my life!!!! I had a tummy tuck, hip, & waistline lipo, as well as breast augmentation. Completely painless, best anesthesiologist, and nursing team. Very, nice staff, and state of the art facility! Friends and family already having their mommy-makeovers too! Updated on 19 Dec 2015: Super happy with these amazing results!!! Updated on 19 Dec 2015:
I have always been on the heavy side. I hit 200lb in sixth grade! By the time I was finishing eighth grade I had weighed over 300 pounds. I was never one of those self conscious fat people. Like most I was the funny fat guy, the guy who walked with his head held high with so much confidence. I never watched my weight and would avoid doctors appointments so I didn't have to go through the dreaded height and weight check that always left both the doctor and nurses shaking their heads. From early on I was always told that I wouldn't be able to lose weight without weight loss surgery. I was even told that I could lose 50lbs and no one would be able to tell because I was so heavy! I always just brushed it off and felt that as long as I could walk and breath without any complications, I was fine. It wasn't till about the end of 11th grade year when I decided I wanted to be one of those people who came back to school after summer vacation and awed people. Starting the first day of summer I stepped on the scale and it read 399. My mind and my heart started racing since I hadn't imagined it got that bad. I'm not going to blame anything for my weight gain. I was a conscious water and knew I wasn't being healthy. I love food. After the initial shock wore off I developed a game plan. I started off small and got rid of soda. It is true about soda being just sugar. I looooved Dr. Pepper, I couldn't get enough. Sometimes I would drink a whole 2 liter and not even bat an eyelash. Giving up soda was hard but I did it. After a month of no soda I was down 50LBS! And no one could tell the difference; I guess my doctor didn't just talk to hear himself speak. As soon as I saw I lost the fifty pounds I ran into the living room and the only response I heard was "are you sure?" The fifty pound loss and no notice was utterly defeating. I wanted to just give it all up and forget the whole deal, but then I had a change of heart after listening to my mom speak about my Abuela in Mexico having a hard time with her diabetes. As big as I got and as much as I ate and drank, I never got diabetes. I'm first generation American and so my families are in their countries still, and I don't know much about them, let alone their medical history. I started asking and found out some scary facts. Diabetes is prevalent on my Mexican side, and heart disease was a scary trait from my Sicilian side. I looked at myself and told myself that I didn't want to be a 20 something year old diabetic with a heart condition. From there I started making healthier choices. Walking more, eating a little less, and eating healthy were the three biggest factors of my extreme weight loss. By the time I got back to school I was 90 pounds lighter, and boy did they notice then! By the end of my senior year I was 140 pounds lighter than I was when junior year ended. I was 259 pounds and I looked and felt amazing. After graduation I started going to the gym because I finally felt comfortable enough to go. By my freshman year in college I was down 200lb. I stated lifting weights and focusing on tightening and toning and did all that I could. Talking to my my new adult doctor and explaining everything to him really awed him. At this point I was living with and apron of excess skin that no amount of cardio/weight training was going to fix. He referred me to a plastic surgeon but my insurance company denied my consultation. Another setback on my way to a better healthier me (trust me there were a lot) I was in a funk and it took me almost a month to fight my insurance company on this. After some hoop jumping I was finally approved for my consultation. I was approved for a mini tuck that was covered by my insurance with only a $200 deductible. I scheduled my mini tuck one week after my last day of school and June 15th was my big day. Updated on 11 Oct 2015: Recovery was a lot less scary than I had anticipated. The procedure itself was rather fast. I was in at 6:00 am and was home by 10:30am. It was a same day procedure so literally fifteen minutes after waking up they sent me on my merry way. They put internal sutures as well as staples on the incision, which was hip to hip. They warned me about pain and how often to take the pain meds; "don't wait to take them every four hours, take them thirty minutes before so you don't have to experience pain waiting for them to kick in." That advice made me a little nervous but I always prided myself on my ability to endure pain (I was so clumsy growing up that they new my name in the emergency room). I decided to do my healing at my apartment rather than going to my mothers home. I personally think healing in a place comfortable to you trumps healing somewhere "convenient". I live on the third story with no elevator, and my mother lives in a home with no stairs. Ideally, my mothers home was perfect, except for the fact that she has three cats and two dogs, not to mention my sister and her newborn baby. Rest is a big part of recovery and I knew that there would be no rest found there. Much to the dismay of my family, I chose to treck those three flights (two small, and one that seemed to have no end in sight) leading to my apartment/sanctuary. When I got to the top of the stairs I felt triumphant, I felt proud, and I felt like I was going to pass out. This was the first time I've ever felt like I was going to faint. This was the first time in a long time that I felt so vulnerable. Ive always been so independent, always doing something, the realization hit me that I can't really do anything for the next couple of weeks without depending on someone. The second I got into my apartment my mother helped me to my next big obstacle; the bed! I had my bed made tall so that I can store things under, this was the first time I have ever cursed my bed. I'm about 6'1, 6'2, and with the added height of my mattress, my feet dangle ins don't touch the floor when I sit on it. My mother walked me to the side of my bed and did her best to get me on comfortably. Nothing about this situation was comfortable. After 10 minutes of stop and go I was finally ingrained in my mattress with my legs and neck propped up on some pillows. By this time I was exhausted and just wanted to sleep. I'm a light sleeper, so my mom popping her head in every five minutes was troublesome. After the fourth time, by the look on my face, she got the hint to leave me to rest; if looks could kill. Before my mom left me to rest she let me know that " I will just be in the living room watching tv if you need me, my phone's volume is turned all the way up, just ring and I'll be right in." My mother, bless her heart is more trouble than help sometimes; this was one of those times. I awoke an hour later with the need to pee. I picked up my phone and sent a text to my mom, five minutes go by and no response. I decide to call her phone and it goes through the motions and then reaches her voicemail. I call her again and there's no answer. So far I've been laying in bed with the urge to pee only getting stronger. I'm having flashbacks to my nurse warning me not to try and get up and do things without someone's help, "you can rip yourself open" she warned. So now I'm just laying in bed calling out to my mom, but the tv is too loud, she can't hear a thing. Another ten minutes go by and my grandmother facetime's me to check on me, so I explain to her the predicament I'm in. After hanging up with my grandmother and forgoing her advice to "pee yourself, rather than rip yourself open" I decide to bang on the wall while calling her cellphone again; no response. By now it's been an hour and I'm really wishing she would go back to her periodic check ups, but I guess I used all my luck getting up the stairs. I decide that it's now or never, so I slowly inch my body off the bed and use this large stick to hoist me up. I must have gotten up too fast because for a few seconds all I saw was white. I make it to my bedroom door and thankfully the bathroom is right next to my room. Once I open the door I yell for my mom because I felt a little woozy. She comes rushing over with wide eyes, and then asks me in a stern tone " why are you out of bed by yourself? Why didn't you call me to come help you?!"; if looks could kill. I have her lift the lid to the toilet and let her scold me some more while she waited on the other side of the door. I couldn't flush the toilet because my height makes it to where I have to bend to reach the handle and I wasn't bending anytime soon. Once I tell my mom to check her phone she then realized the fault was hers. Her excuse for not answering was she decided to tidey up my kitchen because she was bored. The rest of the day went off without a hitch. I was thankful for my mom being there to help me with my drains and with getting me things to drink or eat, but I was happy that there would be someone else to take care of me the next day. All in all the first day was not as scary as I was expecting it to be. The only pain I had wasn't even from the incision, it was from my lower back from laying in bed all day long.
In 2011 I was referred to Dr. Khattab, I fell in love with his staff and especially him, he is so awesome. They make you feel welcome and its just a warm feeling in the office. I told him what I wanted and he gave me just that, It is now 4 years later and I still love my breast as I did day 1. I would highly recommend him and now I'm ready for some more work, he is my first choice and I know I won't be disappointed. Updated on 20 Aug 2015: So here I am 8 days post op I'm super bloated
I've been thinking about a breast reduction for 15 years now. Seeing a picture of myself in a swim suit last month did it for me. After seeing a pain management specialist for the past 2 years and being prescribed Vicodin every month for the pain, I asked my primary care doctor if he would get a referral for the breast reduction. It took about 3 weeks and I had an appointment with the plastic surgeon. Yesterday I went to see the him and he said I was a perfect candidate and that he'd take good care of me. Waiting for the final approval from the insurance company, but have the surgery tentatively scheduled for September 4th, when I come back from 10 days with in the mountains with my husband. Updated on 13 Aug 2013: Am going to love saying good-bye to these! Updated on 15 Aug 2013: Does anyone have any advice on preparing for surgery. Should I be avoiding anything now to make my healing time faster? Updated on 16 Aug 2013: Surgery has been moved two weeks. Gives me more time to workout and diet. Trying to lose another 10 lbs and build muscle. I enjoy reading all your stories so much, thanks for sharing, it calms me down. Updated on 11 Sep 2013: Ok, so here we go, time to keep you updated on the progress of my surgery. Tomorrow is pre-op and I'm so looking forward to it. Updated on 13 Sep 2013: I had my pre-op yesterday morning and blood work done. Pretty darn simple and the office staff at Dr. Khattab's Beyond Beautiful Surgery Center are amazing women. They really took their time to discuss the procedure, what to expect and told me that Dr. Khattab would also spend time with me before the procedure to discuss everything. My prescriptions are filled (Keflex and Norco), my Marena surgical bras have arrived, I received the soap to shower with the morning of surgery, so I'm almost ready to go. Have to clean the house next week and do a little grocery shopping, but I think this is going to be a breeze on September 23rd. At least I feel prepared. I've been advised that I will stay in the hospital for 2 days, 1 night so I should enjoy having the nurses pamper me. Updated on 13 Sep 2013: http://www.breastreduction4you.com/surgery_preparation.htm Updated on 17 Sep 2013: Went to my primary yesterday for surgery clearance. Had EKG, mini physical and he reviewed my blood work. He said to make sure that whoever is helping me change bandages wears surgical gloves, said a lot of infections can be avoided. Updated on 23 Sep 2013: So, last night's sleep was about 6 hours without interruption and then the nerves kicked in. I've been up for two hours and now ready to hop in the shower and wash myself with the Hibiclens soap. I have to wash my hair and body with it, no conditioner, lotion or deodorant. I'll see you all on the other side in about 8 hours. Updated on 29 Sep 2013: Hi Ladies! I'm happy to report that I made it to the other side, barely. I had a very successful surgery, but in recovery, my heart decided to beat abnormally which kept me in recovery for 5 hours and then I had to be admitted to the telemetry unit ( a floor where you are monitored 24/7) all kinds of bells went off, every time my heart beat was abnormal. It was a very stressful time and I'm thankful I'm home now. The cardiologist put me on a beta blocker medication and my heart seems to functioning normally for now. My husband was just wonderful although very scared when they wouldn't let him see me after surgery. He took this week off work and has been attending to my every need. We just returned from grocery shopping where we stocked up on veggies, and healthy food for me. Other than the heart issues, the surgery was easy. Tomorrow, it will be one week and I have no pain. Also, the Dr. didn't use any external stitches or staples. He said without external stitches, the breasts will look pretty normal. I also had a drain, but only for the first night, he removed it the very next morning and I've no drainage at all. In fact, very little blood was on the dressings that we change daily. Here is the picture, hubby took when I arrived home. I'll post more later. Updated on 29 Sep 2013: Updated on 2 Oct 2013: Healing is going well. Saw my PS yesterday and he wants to leave the surgical tape on for another week. Also, told me to rest for another week, good thing I can work from home. I can take showers now also, which is good because while I adore my husband, I'd rather bath myself. Heart is doing great, no more episodes like in the recovery room, I think the meds are helping. If you are thinking of doing this procedure, go for it. I love my new boobs, I just can't wait to get the surgical tape off and sleep on my side. Updated on 8 Oct 2013: I went this morning with my husband to the two week post-op checkup. The old surgical tape was removed (original tape put on during surgery) and replaced by new surgical tape which I need to keep on for another two weeks. All of the incisions are healing, as you can see, some of the scabs haven't fallen off and Dr. didn't want to pull them off today. I was also released to drive today! I'm so ready to go shopping. I was really happy with this checkup! Ladies, even though you feel fine, don't lift anything, clean the house, laundry, etc. for a month. There is a lot of healing left to do, most of it on the inside, where we cannot see. When I started this journey, I was big, about a 38EE, now I'm a large 36C and Dr. said I'm still a little swollen. - Should be the perfect 36C in a couple of months, which is exactly what I asked for.
I am totally blown away! I haven't shown my stomach in years because the hernia was so bad and now I am wearing fitted tops and even a two piece at the beach! I have a very thin frame so I was not the typical tummy tuck candidate, but he did a fantastic job and I couldn't be more pleased.
I broke my nose at 14- I needed immediate surgery to realign my nose and sinus cavity. The plastic and reconstructive surgeon told me that it wasn't going to look pretty- I would likely have a hump on my nose and that I would need a second surgery once my nose had healed to correct the cosmetic and breathing aspects. At 16, I went ahead with an open rhinoplasty and I'm so happy I did. First of all, my nose was a MESS for the two years I waited for the second surgery. I didn't even look like myself prior to the accident- it was really depressing, especially since I had just started high school. Ugh. My surgery was much more intense than others who just go for purely cosmetic reasons since there were elements of reconstruction that were necessary. I think my surgery took a total of 4 hours and I wound up having to stay the night in the hospital. My eyes were swollen shut for about 3 days and I was completely bruised under both eyes for about a week. Despite all this, the outcome is fantastic. I can actually breathe through my nose and I look how I'm supposed to. It helped to restore my confidence and I honestly couldn't be happier. It's been about 10 years since I've had the surgery and my results are still fantstic. My nose has changed a little, since it naturally does for the rest of your life anyway, but it still looks great. So happy I went through with it.
I found Dr Khattab online on my quest to get a thinner waist, i am not a big woman, i'm 5'4, 145lbs but i have the abdominal pouch and some back fat, so i decided that it's time to get rid of them both. The appointment and consult was okay and so i paid and had the procedure done. On my one week post op, everything looked okay but at my six weeks appointment, i started noticing that i look the same, the things that made me decide to get the surgery were still there, i told the doctor that i wasn't pleased but he kept trying to convince me that i'm going to see changes soon, on my third post op visit i still did not see any changes, and told him but he still said the same thing. I feel like such a fool for givIng somebody my money who totally ripped me off, he never offered to fix it, its almost a year after my surgery and i look at my self at the mirror feeling very angry, i hope he's still enjoying the money, what a rip off.
I got my procedure done with a large applicator on my lower abdomen with the same impression as all people on this site - no down time, no side effects, etc. And have gone through the same pains many people have been feeling. Day 0, 1, and 2 I had numbness and no pain/issues whatsoever. Day 3 I started feeling the pins and needles sensation that would not go away. All day and night. The night part is what got me to call my MD on day 4 for medical assistance. I read people's reviews thinking, I will be able to tolerate this pain, I have a high tolerance for pain. These people aren't lying. The pain is real. I have had a kid with contractions starting in my back, have multiple piercings, and 20 tattoos. Yet this is a pain in its own class. I really think this is nerve pain. Here is what I have learned: 1) The pain is mentioned in a UK aftercare site, but no US sites... 2) The pain occurs when I even touch my abdomen. So clothing stimulated it as well. Thank God for my work schedule, because I have 5 days off till I go back to work. I have spent the last 2 days with my pants rolled to my hips and a sports bra on, which has helped considerably. This adds to my theory that it's a nerve pain. Also the mention of Neurontin prescribed by a physician to some other person on this site. My doc prescribed norco, and if nothing else, it has helped me sleep at night. This is a beast of a pain since motrin usually helps me and it has not here. Hence, my theory of it being a nerve pain. 3) Cold treatment helps when the pain gets unbearable. Ice packs for a few minutes to 'reset' the pain. 4) There was no real aftercare info on any US sites. But that UK site mentioned dry brushing - which is the use of a natural bristle brush to brush the skin. The strokes should all be directed towards the heart, and it is supposed to allow the lymph system to move the broken down fat to the circulatory system for excretion from the body. The site also said drink at least 2 liters of water a day. And also exercise at least 30 minutes a week. At this point, I can barely walk let alone run. So working out will be put on hold. I guess if you're super motivated you could do squats or upper body stuff. I am too doped up for that. 5) I feel huge right now. It is day 5 and I'm hoping it is inflammation from the treatment/post-treatment. I read that the removal of the dead fat cells causes an inflammatory reaction in the body. Scientifically it makes sense... but I feel huge and horrid. I have also gained some weight, even though nothing in my diet has changed. Time will tell how things will look in a few more weeks/months. I will continue to post updates. Hope this helps people. It sucks that the pain is not addressed by some physicians, and ignored by others. But like all medical treatments out there - they all have side effects. No pain no gain! (Or loss, in this situation!) Updated on 25 Jun 2015: So tomorrow it will be 2 weeks and the swelling has gone down significantly. It looks back to normal. I never had bruising but I had soreness. The pain was neurogenic in nature. I called the medical office again and was prescribed Neurontin and that was what finally helped! It took a few days (3-4) for it to completely kick in, but I can finally wear clothes! I actually had to leave work halfway through my shift because I couldn't take the sensation. It's still not 100% normal and I can tell after a long day I need to uncover my abdomen. But I was able to work out today!! Before I couldn't even walk fast because the slight jiggling would cause irritation when rubbed against my shirt. Don't see results yet but it's still early! I will try to post pics. I just can't find them on my computer.
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