A mother of 2 in her early 50’s whose children are grown and who is now ready to do something for herself. She has lost 20 lbs with diet and exercise but is still bothered by the appearance of her abdomen in clothing. She feels that her breasts are too full and droopy after children. Her case is interesting for a few reasons. She has a large scar in her right upper abdomen ( a right subcostal incision or sometimes called a “Kocher incision” ) from an open gallbladder removal in the past. This can make the abdominoplasty more challenging by potentially interfering with the blood supply to the abdominal skin during an abdominoplasty.
She also has ‘fat pockets” in her anterior axilla which bother her in an evening dress. They can be treated at the time of a reduction mastopexy with liposuction. I generally to not perform the abdominplasty and a breast reduction at the same time-it is too much surgery for most patients and difficult early in the recovery of an abdominoplasty when a patient needs to use her arms to get in and out of bed.
She is shown 2 years after her abdominoplasty, and 21 months after her reduction mastopexy and liposuction of the axilla. I like to place the abdominoplasty scars low, in a “thong line” position where they can be hidden by most clothing styles. Her scars are quite good, but are easily hidden by her two piece bathing suit. She reports that her abdomen feels much stronger now when she does Yoga, and she never thought she would feel comfortable wearing a bikini again!
A mother of 6 in her late 40’s who is bothered by fullness and asymmetry ( a difference in size and shape) of her breasts, as well as looseness and bulging of her abdomen. She is shown 13 months after bilateral breast reduction and 6 months after lipo-abdominoplasty. Although her weight has increased by 20 lbs, since her second surgery, she remains thrilled with her improvement.
A body builder and mother of 1 in her late 40’s who is bothered by a deflated appearance of her breasts, as well as wrinkling and looseness of the abdominal skin above the umbilicus. She gained and lost 70 lbs with her pregnancy, and recently lost another 30 lbs. She is 5’2” and 122 lbs. She is shown before and again, one year after bilateral dual plane breast augmentation with 300 cc round textured high profile silicone gel implants placed through an inframammary incision, combined with an abdominoplasty.
The decisions for her case are complex and deserving of discussion. Body builders are a unique population because they have very thin tissues. The implant can be places above the muscle so that no motion is seen as the pectoralis muscles are triggered, but the breasts do not age as well, and because her tissues are so thin might show rippling in the cleavage area. A “dual plane” placement allows the implant to be below the muscle in the upper breast where it has more padding and coverage, but above the muscle in the lower breast to that the implant can settle more with the breast an avoid a “waterfall” effect with the breast dropping off of the implant mound. In patients who have had significant weight loss, the breasts will tend to drop to the side more because of decreased elasticity. This can be even more of a problem with body builders who are constantly triggering the pectoral muscle. So texture of the implant can decrease the risk of this potential lateral shift and stretch. The three implant companies have different degrees of “aggressiveness” of the texture, and late seroma formation, and pseudocapsule formation may be more likely with the more aggressive textures. So we chose the company with the texture that is the least aggressive ( but has been shown to have the same “grip” known as the coefficient of friction). At one year her breasts remain stable and have not shifted to the side.
In her abdomen, she could consider a “reverse abdominoplasty” which would place a scar under the breasts and at the upper abdomen but has not been as successful in my hands in tightening the skin. “Floating” of the umbilicus would avoid a scar around the umbilicus and a vertical scar in the lower abdomen but would not tighten the upper abdomen, which is her problem area. After much discussion and viewing of photographs of other patients, she elected for a traditional abdominoplasty with a small vertical slit closure scar in the lower abdomen as being a worthy tradeoff for tightening of the overall abdomen. These scars will typically continue to fade and improve over the next year. She is thrilled with her result, and busy preparing for her next competition.
A mother of 2 in her late 30’s who is bothered by severe bulging of her abdomen in clothing and in a bathing suit. She “carried big” with her pregnancies. She is also bothered by the small size of her breasts. She was a Full C when pregnant and now is a 32 A. Although her tissues are thin and more likely to show wrinkles from an implant, she has chosen Saline implants after considering the options because she likes the benefit of more easily knowing when the implants leak and is willing to accept the tradeoffs of more palpable and visible wrinkles and ripples when compared to silicone. She is shown before and again, 6 weeks after surgery. Her scars are typically at the worst at 6 weeks and will now fade and improve over the next two years. There is also typically swelling in the lower abdomen that continues to resolve over the next 4 months. She is already quite thrilled with her results. She is 5’ 2 ¼” and 105 lbs and chose a 325 cc smooth round moderate profile saline implant placed through an inframammary incision and below the muscle.
A mother of 2 in her late 40’s. She is 5’3” and 152 lbs, having lost 20 lbs with diet and exercise. Her case is complicated by having a previous open gall bladder surgery. She also has an umbilical hernia. She is shown 8 months after abdominoplasty with umbilical hernia repair. She is also 4 months after bilateral breast reduction including liposuction of fatty deposits in her upper lateral breast (axillary lipodystrophy).
She is thrilled with her early improvement, and is now able to feel comfortable in a 2 piece bathing suit for the first time in many years.