The Albany Plastic Surgery Blog by Dr. William F. DeLuca




Correcting Tuberous Breasts with Surgery

Tubular Breast
Many women tend to be self-conscious about having tuberous breasts; however, an experienced surgeon can perform a dual plane breast augmentation with a periareolar lift to correct this condition.

Tuberous breasts is a condition where the breasts form into a tube-like shape because of constriction at the base of the breasts during development. The breasts also tend to develop farther apart and unevenly than a normal chest. The breasts are often characterized by enlarged areolas and sagging. Although this condition may prevent a woman from breast-feeding, it doesn’t lead to any other pregnancy or fertility related issues.

Women with tuberous breasts may range from type one, which is the mildest to type five, which is the most severe. With type one, only the lower inside of the breast is constricted. In the most severe cases, the entire breast is constricted and can be physically deforming.

While having this condition isn’t necessarily a physical concern for health related reasons, it can be psychologically troubling to women who suffer from this condition. Many women tend to be self-conscious about their breasts, and shy away from intimacy, or are embarrassed to get undressed in front of their partner.

There are also other issues to consider for someone with tuberous & tubular breasts. Many women tend to have trouble finding bras or other undergarments that fit properly. Some women have to specially order their bras in order to support their breasts correctly.

One option for women with this condition is breast augmentation with a lift surgery. For women who are self-conscious or frustrated about the shape of their breasts, a surgeon can correct the size and fill out the shape. The doctor can also debulk the area around the nipple in cases where the areola is large or puffy.

The surgery is particularly challenging; however, a good surgeon with plenty of experience can correct this condition with a dual plane breast augmentation with a lift. It’s important to discuss the surgery and your expectations with your doctor before heading into the operating room, if you are considering this type of surgery. In many cases, surgery can correct this condition restoring the breasts completely.

Rhinoplasty Recovery: What You See Right After Surgery is What You Get

Photo Of Doctor And Patient Discussing Plastic Surgery RecoveryI recently read a blog post by a plastic surgeon in Manhattan who specializes in rhinoplasty. The surgeon made a point that I have seen echoed by quite a few other plastic surgeons on RealSelf.com when answering questions from patients going through rhinoplasty recovery.

The question being posted across multiple online forums is: How different will the nose look 1 year after surgery as compared to 3 months, or 6 months? In other words, “If my nose looks great at 3 months, will it still look good a year from now? Or will it look overly defined and tight as more time passes?”

My opinion is this – there is no definitive answer. Each nose is different and no one can predict how your nose will change over time. However, one thing is glaringly clear to me about rhinoplasty recovery: If the nose doesn’t look good at 3 months, it isn’t going to look good in a year.
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Skin Tightening Q&A: Do “Non-Surgical” Lasers and Ultrasound Work?

Question - Can you offer some insight into all the non-surgical procedures that are inundating the market for skin tightening, for instance, lasers and soundwave technologies? Many are saying they were featured on shows like Dr. Oz to lend credibility to their claims…. I suspect it is just another “too good to be true” story, but your thoughts on the subject would be most welcome. – Debra


Answer - Excellent questions, Debra. Regarding the latest generation of “non-ablative” lasers for skin tightening and sound-wave technologies, the short answer is that, as with most things in life, “there are no shortcuts” and “if it’s too good to be true, it usually is” (for more on the high cost of smartly marketed, less invasive and/or expensive treatments and technologies, please see slides 14-17 from my ‘What to Look For in a Plastic Surgeon‘ presentation.

That said, if a new product, technique or technology is shown to be both safe and superior to the current treatment standard (through peer-reviewed, double blind studies by other plastic surgeons), my approach has always been to assimilate/incorporate it into my practice. Even then, however, I try to never be among the first wave of users. This helps ensure not only the safety of my patients, but also their satisfaction with the results as well.

Case in point, for years, laser liposuction companies and MDs claimed that the machines not only suctioned fat, but were also a method of non-surgical skin tightening. The technology was promoted featured on promoted featured on Oprah, GMA, The Today Show, People Magazine (‘The New Lipo: Has Fat Met Its Match?) and hundreds of other publications. But since its introduction, no studies have confirmed its superiority to traditional tumescent liposuction methods. What has been confirmed, though, is laser liposuction’s potential to burn skin. More on that here.

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Breast Q&A: To Breast Lift or Not to Breast Lift, With or Without Implants?

Perhaps the two most frequently asked questions I receive from women interested in breast enhancement surgery are:

  1. “Do I need a breast lift with or without implants?”
  2. “Can I get an ideal result with just breast implants?”

As with most operations, it’s always best to get things right the first time around. And when it comes to breasts, getting it right doesn’t typically mean looking great for only a few short years before the effects of gravity and time undue all the good work that was done.

So when I advise my mastopexy (breast lift) patients on what their options are for achieving the best and most youthful looking breast possible, I always make sure that they have a crystal clear understanding of what their surgery options are and how each option will look and feel over time (re: 1 year, 5 years, 10 years etc.) rather than just what they can expect to look like during the immediate post-operative period.

9 times out of 10, the best path forward is clear and the patient is in full agreement that the procedure’s pros outweigh any cons that may inherently be involved (e.g. a slightly longer incision in return for a stronger, more longer lasting lift).

Of course, not every breast fits perfectly into one of the the breast types described below, but most do, so hopefully readers will find the following example photos and procedure recommendations helpful and/or informative , especially if they are considering their options for a breast lift with or without implants/augmentation.
 

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Face Q&A: For Sunken Hollow Cheeks, Fillers, Fat Injections or Facelift?

Question – Below my cheekbone a hollow channel is inching towards the center of my face. I had a facelift two years ago and cannot figure out what is causing this. What can be done to correct this?

The facelift was two years ago. On one cheek, just below my cheekbone and along the path of the lift, a hollow channel has been inching toward the center of my face. The doctor has assured me that this was not a thread lift. The hollow is about 1.25″ in width. The skin above it is taut and looks lifeless. The hollow keeps lengthening and it looks awful. What could be happening? And can anything be done to stop it and/or correct it? – via RealSelf


Answer – Given that your facelift was two years ago, there are a couple possible reasons for why your cheeks now appear hollow/sunken based on the details you provided in your question: One possibility is that your surgeon did more ‘pulling’ & ‘tightening’ of your skin and not enough/any fat or tissue reposition. Another possibility is that you’ve experienced some fat re-absorption within the cheek area in the 2 years since your facelift as a result of weight loss, changes in diet, and/or BMI. The good new is that there are a few ways to replace the volume you’ve lost, which I’ll detail below.

 
How an overly tight facelift can cause hollow cheeks

Without before and after photos, it’s difficult/impossible for me to diagnosis what’s causing your cheeks to appear hollow after facelift surgery. That said, hollowing of the cheeks is most likely a result of how the skin was repositioned/draped during your previous facelift surgery. Not only does overly tightened/pulled skin create the ‘joker’ look so many over-done facelift patients have, but also, excessive hollowness in the mid-face region just below the cheek bone.

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Mommy Makeover Q&A: What Will My Mommy Makeover Recovery Time Be?

Question – How long is the down time during a mommy makeover recovery? How much pain will I be in after surgery?

What is recovery like with a mommy makeover? I have scheduled both a breast augmentation with lift and a tummy tuck and am pretty scared. I am worried that the pain will be unbearable.

I know medication will be provided but I do not want to be comatose. I have 2 small children and a wonderful husband that will be taking 100% care of all 3 of us but I also want to be coherent. Will I be alert and will I be in so much pain as to scare my children? I have had 2 c sections and the pain was completely bearable.


Answer – Both procedures, breast augmentation and tummy tuck, come with a certain degree of pain and discomfort; that said, every patient’s pain tolerance is different. Most patients feel “uncomfortable” for the first few days, but after about a week, begin to feel reasonably well. By the 2nd or 3rd week, you should be back to performing most of your normal, day-to-day activities.

Pain level and recovery time are two of the most commonly asked questions of my mommy makeover patients – it’s very important that you make the most of your early-recovery. Ample rest and low-to-no stress is key. Pain during recovery can also be a big part of that trepidation. The best place to start answering this question is to consider the surgical plans behind your personal transformation.

It’s important to know the details of each procedure in order to make the best decisions regarding your own mommy makeover. While each makeover is tailored to the individuals needs and goals of each and every patient, the surgery usually includes a breast enhancement and some body contouring procedures.

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Breast Q&A: What’s the Best Way to Correct Grade 1 Breast Ptosis (Sagging)? Implant, Lift or Both?

Question – What is the best way to correct breast ptosis, high or moderate profile implants, a breast lift or both?

Stage I Breast Ptosis

Breast sagging after pregnancy

I am 36 years old, breastfed 2 kids, and have lost volume in my breasts. I have some sagging but my nipple is still over the fold. I weigh 130 pounds and am very fit and toned.

I am 5″4″ and my breast size is a 34B. Before my kids I was a 34C cup. When I was breastfeeding I was a 34D cup. I would like to be a D cup and wonder what type of procedure would be best to correct my ptosis?


Answer – Since you have a small amount of glandular ptosis (pseudoptosis), you not only want to fill-OUT, but lift-UP a little as well. Therefore, my approach would be a dual plane breast augmentation, which would fill out the inferior/lower pole nicely, give you muscle coverage across the upper two thirds of the breast and a nice, slightly lifted appearance.

More specifically, given your body measurements and photo (which shows pseudoptosis with mild Grade 1 ptosis), I suspect that 450cc moderate plus profile implants are needed to give you both the breast size (D cup) and breast lift you desire.
 

How To Classify/Grade Breast Ptosis

Simply put, grade 1, 2 or 3 glandular ptosis, which refers to how far the areola is sagging below the inframammary fold beneath the breast, the lower attachment point of the breast to the chest wall.

  • Grade 1: Mild Ptosis – The nipple is at the level of the inframammary fold, but most of the breast tissue is below the nipple.
  • Grade 2: Moderate Ptosis – The nipple is located below the inframammary fold and below the majority of the bottom breast tissue.
  • Grade 3: Advanced Ptosis – The nipple is far below the inframammary fold and points towards the floor.
  • Pseudoptosis – The nipple lies above or at the level of the inframammary fold while the majority of the breast has descended below the level of the fold. This is not true ptosis, or sagging.

Diagram of breast ptosis (drooping/sagging) degrees/stages

The degrees/stages of breast ptosis (drooping/sagging)


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Botox Q&A: How Long Does Botox Last and What Makes the Effects Last Longer?

Question – How long does Botox last? What determines how long it will work for me?


Answer – In most patients, Botox lasts between 3-4 months. However, there’s quite a bit of anecdotal evidence suggesting that it’s possible for patients to achieve results that last up to 6, 9 or even 12 months after consistent, long-term and properly-administered use of the Botox product.

In other words, what determines how long the effects of Botox lasts is:

  1. the dosage (and whether or not it’s been properly diluted)
  2. the duration & consistency of use
  3. the skill/experience of the injector or surgeon who administers the injection

The x factor within the “consistent, long-term and properly-administered” conditional I included is, of course, “properly administered”. After all, consistent treatments over several years will matter very little if the wrong amount of Botox has been injected imprecisely/incorrectly. That’s why 2 of the 3 factors explored in this post address it (re: ‘dosage’ and ‘skill/experience of the Botox injector‘).
 

1. Dosage: Why injecting & diluting the proper amount of Botox = key

Botox injection units dosage

Recommended Botox dosage (in units) – American Society of Plastic Surgeons.

The first factor that impacts the longevity of Botox’s winkle-reducing effects is the dosage. Botox is diluted for safe use regardless of the injection site, so the impact it has on the surface is largely dependent upon the amount of injections. The site of injection will determine the amount of injections you receive.
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Guest Post: Microtia “Little Ear” Reconstruction Surgery – Key Concepts

DeLuca Plastic Surgery in Albany, New York welcomes guest blogger Dr. Mark Mitchell Jones, a plastic surgeon in Atlanta Georgia who specializes in microtia “ear” reconstruction.

Microtia is a common birth defect where the middle and outer ear do not develop normally. The literal meaning of Microtia, comes from the Latin words micro and otia, or “little ear”. In 90% of all cases only one ear is affected.

The standard rib graft technique is the preferred method of Microtia correction. This technique involves surgery in several stages and usually takes 9-12 months to complete. There are several advantages to this technique. The reconstructed ear is created out of living tissue and therefore of a natural skin tone. It reacts to heat and cold and will grow with the child. It is also more durable than a plastic ear and will not need to be replaced.

Over the course of my career I have personally pioneered several innovative techniques to use along with the standard rib graft reconstruction, including the Integrated Cartilage Graft, Wrap Around Earlobe, Juxtaposition Ear and Bespoke Ear. The differences between each are as follows:

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Breast Q&A: Will High Profile Breast Implants or Moderate Plus Give Me Natural Looking Breasts?

Question - Will High Profile breast implants give me natural looking breasts vs Moderate or Moderate Plus?

I am 5’4″ 125lbs, 31″ ribcage, 34C (wanting at least a DD) and my breast measures 13cm wide. I told my PS I wanted large, very nice looking (not high and ball-looking) breasts. He told me he will use a smooth, round, High Profile, 500cc silicone implant and it will look “very nice” with a “nice downward slope”. Everywhere on the internet says that high profiles don’t give a really nice natural look, and that moderate profiles do. Will high profile breast implants give me large, full, and natural-looking breasts with nice cleavage?


Answer - Although I use Moderate Plus or Moderate Profile prosthesis in the vast majority of cases, given your base width dimension of 13.0cm and your wanting a 500cc implant, a High Profile implant would be appropriate.

In answer to your question, it is not so much the size of the prosthesis that results in a ‘natural’ or ‘unnatural’ look but rather the surgical technique used in relationship to the pre-operative breast appearance.

If, on examination, your nipple to inframammary fold distance is 5.0cm – 6.0cm (meaning that the fold does not need to be lowered excessively), then a high profile implant can be placed in a position that provides adequate inferior/lower pole projection and avoids creating an overly round upper half of the breast (i.e. the “high, ball-looking” and ‘unnatural’ look you don’t like).

That said, there are many women who like the look of round, projecting breasts with upper pole fullness (high cleavage) – neither look is ‘right’ or ‘wrong’ so to speak, they’re just different. Every plastic surgeon has a certain aesthetic style they prefer (re: some aim for the most natural looking shape and size possible while other find the ‘high and round’ look more attractive), but at the end of the day, if the patient is clear about the way they want their breast to look after surgery, it’s my job as their surgeon to achieve it (within reason of course).

Breast implant profiles: high profile vs moderate vs moderate plus

Breast implant profiles: high vs moderate plus vs low

Before diving into a few specific recommendations given the measurements you provided, here are my general thoughts on each of the 3 Mentor breast implant profile types:

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