So, you’re thinking of having breast surgery…augmentation, reduction, lift, or perhaps implant exchange. What do you ask your plastic surgeon and how do you know she is qualified? Most importantly, how can you be sure she will take care of you and keep you are safe?

First, you want to make sure your plastic surgeon is Board Certified and a Member of the Aesthetic Society if you are considering any kind cosmetic procedure.

Second, do your research. Insist upon seeing photographs of your plastic surgeons previous patients and ask to speak with them regarding their experience. Check out your surgeon’s website. Does their philosophy and approach resonate with you?

Third, during your consultation, ask yourself if you feel comfortable with your surgeon. Do you trust her? Do you click with her? Do you like her? These impressions are imperative when choosing your surgeon, because your relationship is just as important as the results with which she will provide you. This bond will not only make you feel safer but also provide your doctor with the insight to give you exactly what you want.

Last, ask your friends who they’ve seen. Were they happy with their results? Would they go back? This will help you make an informed decision.

Good luck with your search!!

So you’ve had a few kids and now you’re 20-40 lbs heavier with breasts that are deflated, stretch marks all over your tummy, belly button & breasts. You have skin that hangs over your pubic area that prevent you from being able to tuck in any shirt or find clothes that fit nicely.

You try to eat well, exercise, and be healthy but all you see are your flat saggy breasts and hanging tummy skin. You get discouraged and depressed and you eat that extra piece of cheesecake because … what’s the use, nothing makes any difference!

Let me tell you, break the vicious cycle and take charge of your life. It is true, you will not be able to make the skin shrink or lift your breasts with diet and exercise but it will make you mentally feel better until you can get a MOMMY MAKEOVER!!

What is a MOMMY MAKEOVER? It can consist of a breast augmentation with a breast lift, tummy tuck with liposuction, and/or brachioplasty to reduce the skin of the arms. You can have all of these surgeries done at one time with one recovery depending on how much excess skin and fat will be taken off.

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If you are a prisoner of your heavy saggy breasts that cause rashes from the breast sweat, sick of the neck and shoulder pain, and the extra pounds you continue to carry because you can’t even walk much less exercise, you need to explore the possibility of a BREAST REDUCTION AND BREAST LIFT which is most of the time covered by insurance to relieve all of the above symtoms. (more…)

After a long history in breast implants and removal of the silicone breast
implant in 1992, the FDA on November 17, 2006 approved Allergan and Mentor
to again market their silicone breasts implants for primary breast
augmentation in the US. These breast implants differ from the older silicone
breast implants due to the more “cohesive” nature of the silicone, their
outer shell, as well as the styles (shapes) of implants available. Long term
studies were performed on the silicone implants to ensure their safety
leading to their reemergence on the market and ongoing studies currently are
required of the implant manufacturers to ensure the continued long term
safety of the implants.

The newest trends emerging on breast implants center on the development of
cohesive, highly cohesive and form stable gel silicone implants that have
been affectionately termed “gummy bear” implants. These are not widely yet
available in the US, but have been available in Europe since 1994 and in
Canada since 2000 through a special trial program and have been approved for
wide spread use since October 2006. Trials on these implants were also
conducted in the United States and the data are currently being accessed.

Personally, the biggest news on breast implants is the reemergence of
silicone breast implants since November of 2006. They are extremely safe,
more reliable, and in my opinion age better than the saline implants that
there is less “rippling” and palpability in the long term.

You should understand that once you undergo your first breast augmentation surgery
which IS extremely safe, you will be obligated to a few more surgeries of
implant exchange at 10-25 years from the time of breast enhancement. This of
course depends on if the patient becomes pregnant, gains or loses weight and
on the natural aging process of the breast. More importantly, the general
public should understand that the majority of woman who undergo breast
augmentation do not merely desire big breasts, but are inherently
dissatisfied with the shape and perhaps the asymmetry of their breasts and
they desire a more proportionate, shapelier, AND also a slightly larger
volume breast.

Did you know that breast reductions are normally covered by your insurance plan and is one of the best things you will ever do for yourself. You will lift your breasts and stop that awful skin on skin sweating which results from your breasts touching your abdominal skin.

My favorite quote from one of my patients that comes to mind describing the results: “I just went from National Geographic to Playboy.”

That truly is how you will feel way better than nature.

The heavy pulling weight on your shoulders and neck will be relieved with the reduction in size of your breasts. DR KOO guides you as to the size you will be reduced to which will still be proportionate to body but so much lighter and perkier.

Even your tension headaches from the pull of your heavy breasts will be relieved. You will be able to exercise and be much more active helping you lose weight and feel and look even better.

Dr Koo’s office will work with you to make everything very easy and do all the paper work for you. Her office works with patients from all over the United States and especially college students coming home for the summer and the holidays who have limited time to have the surgery and to do all the paper work.

The BREAST REDUCTION is very safe and DR MICHELE KOO is a Board Certified Plastic Surgeon with extensive experience in the surgery and will make sure that everything goes very safely and smoothly for you. She understands what a woman wants her breasts to look like. She will lift your breasts and reshape and resize them to make you feel so much more comfortable.

Most women retain their nipple sensation and are still able to go on to breast feed after a breast reduction surgery. The relief and change in self esteem is profound. This is especially true for the young adult woman or even teenage who are mercilessly teased about their big breasts.

The surgery is not painful with a quick recovery and can most often be performed as an outpatient.

If you’re tired of saggy, heavy breasts that cause you shoulder, neck and back pain, with skin rashes, you need to explore the possibility of a breast reduction, breast lift with DR MICHELE KOO, MD, FACS, ST LOUIS, MISSOURI, 314-984-8331.

DR KOO truly believes that a BREAST REDUCTION is a very safe procedure that will change your life. Your breasts will be lifted, lighter and reshaped. You will feel that your breasts are shapelier and that you are able to do so much more physically than you ever have before. Your friends will keep asking you if you’ve lost weight and you’ll look and feel so much better.

It is difficult for you to exercise and get healthier due to the size and heaviness of your breasts. You are in a negative spiral downward with your large heavy breasts making you more inactive. The more inactive you are the more weight you gain and the more weight you gain the heavier yours breasts become.

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If you are sick and tired of being trapped by your saggy, lifeless, flat breasts and hanging skin with stretch marks after pregnancy and breast feeding there is something you can do about it.

Plastic surgery to remove all that excess skin and fat and lift your breasts to their original position with fullness on top can be achieved safely.

If you are looking for a MOMMY MAKEOVER, you have found the right person in Dr Michele Koo, MD, FACS, St Louis, MO, who is a Board Certified Plastic Surgeon. She will listen to exactly what you want and be able to get rid of that frustrating hanging large belly that has made you depressed for years with liposuction and a tummy tuck (abdominoplasty). At the same time you can address your breasts which may have lost most of the nice sexy full volume and is now hanging on your abdomen. She will examine you and determine if you need a breast lift alone or a breast lift along with a breast implant (breast augmentation) to achieve that full, firm, sexy and lifted breast that you used to have.

MOMMY MAKEOVERS addressing the breasts and tummy in one operation is very safe and Dr Koo will let you know how much can be done at one time safely, and whether you can achieve what you are looking for with only a breast augmentation and liposuction or if you need more contouring by removing skin with a breast lift and tummy tuck.

One of the most important aspects in the success of any surgical procedure is the physical condition of the patient at the time of surgery. Even though liposuction, breast augmentation and a tummy tuck are elective procedures, Dr Koo assesses you using the same standards as those used for anyone who is undergoing any type of surgery. This is very important for your safety and well being. Dr Koo emphasizes your safety above all and ensures that you will have an excellent outcome safely.

Dr Koo specializes in contouring the body after pregnancy and weight loss. She obtains a thorough medical history from all patients who are to undergo a MOMMY MAKEOVER and a diligent physical examination is performed. Surgical history, including previous procedures is obtained for the YOUR safety.

Patients with comorbid conditions such as tobacco use, hypertension, coronary artery disease, chronic obstructive pulmonary disease, diabetes mellitus, hepatitis C, and human immunodeficiency virus are screened carefully. Patients with a history of pulmonary embolism, deep vein thrombosis, or blood clotting disorders require added precautions, such as chemoprophylaxis and sequential compression devices.

Dr Koo uses sequential compression devices in the majority of liposuction, tummy tuck, and breast lift and breast augmentation procedures. Conditions that may increase the risk for deep venous thrombosis include chronic venous insufficiency, family history of thrombotic syndromes, obesity, trauma, severe infection, polycythemia, central nervous system disease, malignancy, homocystinemia, a history of pelvic or lower extremity radiation therapy, and use of birth control pills or hormone replacement therapy.

Medications that the patient may be taking is reviewed, as many common prescribed and over-the-counter medications may affect wound healing and blood clotting. Medications such as aspirin, nonsteroidal antiinflammatory agents, birth control pills, vitamin E, and herbal preparations such as St. John’s wort are recognized to interfere with the coagulation mechanism. Dr Koo recommends avoidance of such agents before surgery. Some medications may also interact with medications used during surgery.

MOMMY MAKEOVER BLOG continues on next Blog

BEFORE BREAST AUGMENTATION 34A

AFTER BREAST AUGMENTATION 34D

DR.  MICHELE KOO, MD, FACS MISSOURI, ILLINOIS, KANSAS, 314-984-8331

Dr Koo feels that there are certain facts that you should know about breast augmentation and breast implants and she wants you to be well informed. The better informed you are, the better your results will be as she will be able to communicate with you as to what your possibilities are. Her time is your time and she wants your surgery to be as perfect as it can be and that the size, shape, and look of your breasts will be exactly what you picture in your mind.

The following is an article in the Plastic and Reconstructive Journal that Dr Koo wants you to have access to by Dr William Adams of University of Texas Southwestern Medical University, December 2008. Dr Koo has her own techniques that are variants what is mentioned in the article but wants you to understand the preparation and techniques that go into determining your ultimate choice of implants, size, position, shape, and look of your breasts.

A process is defined as a group of practices that are completed successively to reach a goal. For 45 years, breast augmentation has been thought of as an isolated surgical procedure; however, well-documented elevated reoperation rates of 15 to 24 percent over 6 years in successive premarket approval studies have resulted in a critical analysis of this procedure. Factors that impact outcomes have been identified and practice recommendations have been established.

Background: Breast augmentation has been an integral part of plastic surgeons’ practices for over 40 years. Although devices have evolved, patient outcomes are still not ideal, as documented in multiple premarket approval clinical trials. Unlike many other areas of surgery, the practice of breast augmentation has suffered from the lack of a defined process for patient management. The purpose of this study was to clinically define and evaluate the process of breast augmentation and analyze patient outcomes using these practices compared with existing premarket approval trial data.

Methods: Three hundred consecutive primary breast augmentations from 2001 to 2005 were followed prospectively. Each patient underwent a defined process of breast augmentation including structured patient education and informed consent; tissue-based preoperative planning consultation; refined surgical technique; and structured postoperative instructions, management, and follow-up.

Results: The mean follow-up was 2.1 years. The most common complications were rippling and palpability, soft-tissue stretch, and hypersensitivity. The overall reoperation rate was 3.7 percent for the entire group and 4.7 percent and 2.9 percent for saline and form-stable cohesive gel implants, respectively.

Conclusions: Optimizing patient outcomes in breast augmentation requires defining the overall process to allow for enhanced patient outcomes. This is the first report that defines and integrates the entire process comprehensively that is validated by outcomes data. This process is transferable to other surgeons and, using this algorithm, patient outcomes in this study were superior to premarket approval clinical trial data. In summary, approaching this procedure with a global process produces superior patient outcomes in breast augmentation.

Dr Michele Koo, MD, Board Certified Plastic Surgeon, St Louis, Missouri, 314-984-8331.

Breast augmentation is an extremely popular and safe surgical procedure that 100’s of thousands of woman have undergone without any complications. The majority of these woman are extremely happy and would choose to have to surgery again if given the choice to do over again. In 2007, the FDA again allowed the use of silicone gel implants for elective breast augmentation for cosmetic reasons.

However, with time and aging of the implant, the breasts may change and the implant become encapsulated (scar formation around the implant). The breasts may become hard and misshapened and painful. The breasts may become too saggy and heavy and extremely uncomfortable for the woman.

Breast implant removal and replacement along with a breast lift is very safe and often a normal sequelae to breast augmentation that is over 15-20 years old. The recommended life of a saline or silicone implant is approximately 15-20 years. Whether a breasts starts to show the changes of encapsulation (hardening) and pain depends on where the original breast implants were placed, the original type of implant, and, of course, the patient herself.

The surgery that needs to be performed to change the breast implants is largely dependent on what was done at the time of the original surgery, whether the implant was placed under the breast or under the muscle, what type of implant was used, and what the breasts look and feel like in its current condition.

A breast implant exchange or a complete breast implant removal without an implant replacement can be performed. If the breasts have become saggy and have fallen so that they are too low on the chest, a breast lift may have to be performed at the same time as the breast implant replacement or removal. All of the above procedures can be performed very safely in one procedure by DR MICHELE KOO, MD of St Louis, MISSOURI, 314-984-8331.

There are a few points that Dr Koo wants you to understand about breast implants and breast augmentation according to an article by John B Tebbets in the Journal of Plastic and Reconstructive Surgery.

Factors That Affect Responses to a Breast Implant

Every medical device implanted into the human body is placed in an environment where certain factors cannot be predicted or controlled by the surgeon or the patient, especially factors related to a patient’s individual wound-healing characteristics and the genetic characteristics of each individual patient’s tissues.

A breast implant has a range of effects when placed into the body, effects that continue for the entire time the device is implanted. Short- and long-term effects of a breast implant in the body depend on three different sets of factors: device-related factors, surgery-related factors, and factors related to the patient’s wound-healing and genetic tissue characteristics. Surgeons and patients have some level of control over device-related and surgery-related factors, including implant type and size, maximal soft-tissue coverage over the implant, and optimal surgical techniques to minimize tissue trauma and bleeding. Neither surgeons nor patients, however, can predict or control patient wound-healing and genetic tissue characteristics.

Factors That No Surgeon or Patient Can Predict or Control

No surgeon or patient can predict or control a patient’s wound-healing characteristics or a patient’s genetic tissue characteristics, factors that can affect outcomes following breast augmentation. Each patient has unique, individual wound-healing and genetic tissue characteristics that influence the interaction between a breast implant and the surrounding tissues. Individual wound-healing characteristics influence the characteristics of the capsule or lining that forms around every breast implant and affect the degree to which that capsule tightens or contracts, which in turn determines whether capsular contracture will cause excessive firmness of the breast or other deformities. A patient’s wound-healing characteristics may also affect the quality of incision scars, the risks of infection or fluid production around an implant, and other factors that can affect the aesthetic result. Genetic and hormonal effects of pregnancy and nursing vary from patient to patient and can affect aesthetic results and outcomes.

A patient’s genetically determined tissue characteristics can affect the response of the patient’s tissue to the implant, including how much the skin will stretch and thin in response to a specific size implant and how the breast tissue overlying the implant will respond. Surgeons and patients can avoid selecting excessively large implants, but even an appropriate-size implant for a patient’s visible tissue characteristics may cause excessive stretch of the breast skin envelope in patients whose tissues do not adequately support the weight. Unfortunately, surgeons have no tests available to predict a patient’s wound-healing or tissue responses to a breast implant. As a result, no surgeon can predict or control the occurrence or severity of capsular contracture, infection, tissue stretch deformities, or other conditions relating to patient wound-healing and tissue characteristics.

Reoperations: The Risks, the Tradeoffs, and the Logic

Every additional reoperation that is required following placement of breast implants imposes additional risks, costs, and tradeoffs to the patient. Some reoperations are medically necessary, but others are not. Severe capsular contracture, infection, and fluid accumulation around an implant are medical reasons to perform an additional operation. A patient’s request for a size change to a larger or smaller implant, though desirable to the patient, is not medically necessary and imposes risks and costs that may not be logical medically. For example, although the risk of infection with implant exchange is small, it is not zero, and for the patient who experiences such a complication, the incidence is 100 percent and may require implant removal without replacement or may produce an uncorrectable deformity.

Every reoperation causes additional surgical trauma and bleeding, and healing after each additional surgery produces more scar tissue, the effects of which are uncontrollable. Seemingly simple operations such as a minor revision for implant malposition or excessive stretch, though usually safe, invoke healing mechanisms that are uncontrollable and can result in exchanging one deformity for another. Logically, reoperations should not be performed for reasons that have no medical necessity or to address relatively mild aesthetic conditions where the risks and effects of the surgery might possibly produce a change that is worse or different compared with the existing condition.

Implant Removal without Replacement: The Logic

Breast implants are not medically necessary devices. Regardless of the efforts and costs to place breast implants, if certain conditions or complications occur, continuing to attempt to salvage the implants or leaving implants in place can cause permanent damage to a patient’s tissues, producing deformities that are uncorrectable.

Once a patient has breast implants, virtually every surgeon and patient wants to keep the implants in place. The positive effects of implants make some patients unwilling to even consider removal without replacement under any circumstances. Removal without replacement must be a joint decision of the patient and surgeon, both of whom must recognize and acknowledge that the aesthetic consequences of removing implants may be far more preferable to possible permanent, uncorrectable deformities and additional reoperations with additional costs and risks if the implants are left in place. Surgeons and patients should define criteria for removal without replacement before the patient has a breast augmentation, and the patient should understand and document her acceptance of these conditions in informed consent documents. A surgeon’s willingness to adhere to stringent criteria for reoperations directly influences reoperation rates, risks, tradeoffs, and costs to the patient.

Unilateral versus Bilateral Implant Removal

When a condition requiring implant removal occurs unilaterally, removal of one implant creates a deformity (asymmetry) that virtually guarantees at least one reoperation to replace the implant. Unilateral implant removal encourages patients and surgeons to prioritize implant replacement, often sooner than is medically optimal. Unilateral implant removal can compromise future decisions and the timing of those decisions. When removal is indicated, bilateral implant removal totally avoids these compromises and eliminates a demand for reoperation based on asymmetry.

Implant Removal without Replacement: The Criteria

Every surgeon must define personal criteria for implant removal without replacement, based on clinical experience, medical indications, and logic. On the basis of more than two decades of experience, I recommend breast implant removal without replacement for the following clinical conditions or situations, and I require that every patient accept and acknowledge these criteria in informed consent documents before the primary augmentation

* Recurrence of capsular contracture after having performed a complete capsulectomy and implant replacement with a new (textured saline if the primary was silicone gel filled) implant for a first capsular contracture of grade III or IV (limits total reoperations for capsular contracture to two).

* Recurrence of stretch deformity (bottoming, lateral malposition) after having performed a previous capsulorrhaphy, partial capsulectomy (if indicated), and exchange to a smaller implant (limits total reoperations for stretch to two).

* Traction rippling or visible implant edges medially when there is no additional tissue coverage available locally (e.g., conversion of submammary to subpectoral), or when pectoralis coverage has been previously compromised by division of medial pectoralis origins.

* Culture-documented contamination or infection of the periprosthetic pocket, regardless of implant type or pocket location (any occurrence of documented infection). This approach optimizes rapid resolution and minimizes inflammatory effects on tissues that occur with prolonged salvage efforts, effects that may produce significant and sometimes uncorrectable tissue deformities over time. Further, this approach minimizes the risks and costs of future reoperations attempting reimplantation, and it eliminates reoperations for recurrent infection or capsular contracture that can occur after attempted reimplantation.

* Recurrent seroma, regardless of negative cultures, after treatment of an initial seroma with exploration, capsulectomy (if indicated), and prolonged drainage.

* Inadequate soft-tissue coverage, when pinch thickness of tissues covering any area of the implant is less than 0.5 cm (except when coverage deficit is medial or superior and can be improved by dual plane or retropectoral implant placement).

* In any situation where two previous reoperations have been performed, for any reason (limits reoperations to three, including removal without replacement).

Criteria to Limit Reoperations

The following criteria have evolved over more than two decades to limit reoperations with their inevitable risks, tradeoffs, and costs:

* No reoperations for implant size exchange if not medically necessary (e.g., a slightly larger implant after performing a capsulectomy, provided adequate soft-tissue coverage is available).

* No reoperations for grade II capsular contracture.

* No reoperations for minor stretch deformities [<3 cm of additional widening of the intermammary distance due to lateral envelope stretch, <2 cm of elongation of nipple-to-inframammary fold distance (bottoming) 6 months or more postoperatively regardless of emptying of upper breast or slight excess volume in lower breast].

* No reoperations to adjust nipple-areola position if sternal notch-to-nipple distances are within 1.5 cm bilaterally (for either primary or secondary procedures).

* No implant replacement if patient has previously required bilateral implant removal for any condition or suspected condition, including replacement of saline-filled implants following removal of silicone gel-filled implants to address concerns of connective tissue disease or other undefined symptom complexes or psychological conditions.

* No reoperations if patient is unwilling to sign detailed informed consent documents acknowledging that she understands and accepts that every reoperation involves additional risks, tradeoffs, and costs, that correction of any condition by reoperation is not guaranteed, and that with any reoperation, we may exchange one set of problems or compromises for a different and not necessarily better set of conditions.

Results

The above-described criteria, combined with implant selection based on quantifiable tissue characteristics and more detailed patient education and informed consent were applied in 1662 reported cases using textured, saline-filled breast implants with up to 7 years of follow-up. The resulting overall reoperation rate was 3 percent. Acknowledging the limitations of comparing the studies, this 3 percent overall reoperation rate at up to 7 years compares favorably to the overall reoperation rates of 13 and 21 percent at 3 years in the saline premarket approval studies of Mentor and McGhan and to the 20 percent reoperation rate at 2 years in the most recent silicone gel premarket approval submission by Inamed Corporation.

Discussion

Factors such as the surgeon’s experience, the surgeon’s technical skill, the reasons for reoperations (device-related versus surgery-related), and other factors preclude direct, scientifically valid comparisons between our reoperation rates and those of the premarket approval studies. Nevertheless, the large clinical experience with long-term follow-up reported in our studies includes every reoperation for any reason, similar to the premarket approval study results. In the premarket approval study, capsular contracture was categorized as a device-related reason for reoperation when in fact surgical tissue trauma and bleeding are significant if not major stimuli for capsular contracture. A reoperation is a reoperation, regardless of whether the patient requests it for size change or an improvement in aesthetics. Selective categorizing and analysis to shade interpretation of results and causes is largely nonproductive, if reducing reoperation rates is a goal. By defining and implementing out points and decision and management algorithms, we have dramatically reduced reoperation rates in our practice over the past two decades.

Conclusion

To reduce the rate of reoperations, with their inevitable risks, tradeoffs, and costs to patients, and to reduce the incidence of tissue-compromising deformities resulting from multiple reoperations, surgeons must define strict criteria for reoperations following breast augmentation and for bilateral implant removal without replacement. The criteria described in this article resulted in overall reoperation rates that are substantially lower compared with overall reoperation rates in recent large premarket approval submissions to the Food and Drug Administration. Each surgeon must define criteria according to his or her individual surgical experience and practice characteristics, but current Food and Drug Administration rulings and guidance suggest that continued availability of breast implant devices for patients demands that patients experience lower reoperation rates.

Dr Michele Koo feels very strongly that her patients can benefit from primary breast augmentation for elective cosmetic reasons as well as from breast implant revisions should the need arise. However, as the article above emphasizes, re-operation for breast implants have certain risks and complications that are out of the control of the surgeon and the patient. Dr Koo wants the best outcome for her patients and she feels that the better informed one is when going into the initial surgery, the easier it will be for all subsequent surgeries.

Dr Koo wants her patients to understand that no matter how pleased you may be with the original breast augmentation or revision surgery that once a breast implant is used, that will then obligate you to subsequent surgeries whether it is for an implant replacement after many years, or whether it is due to your breasts changing shape and size after children or weight gain and loss.