breast enlargement

Breast enlargement, or augmentation mammoplasty, enhances the body contour of a woman who is unhappy with her small breast size. Other purposes of this procedure include: To correct reduction in breast volume after pregnancy. To balance a difference in breast size. As a reconstructive technique following breast surgery.

Breast lift

Breast lift surgery, or mastopexy, restores a more youthful appearance to a woman’s breasts. Over the years breasts can lose their shape and firmness due to pregnancy, nursing and loss of skin elasticity, causing them to sag. Mastopexy will raise and reshape breasts—slowing the effects of aging and gravity.

BREAST RECONSTRUCTION

Breast reconstruction offers much hope for a woman losing her breast to cancer. Reconstruction can often be performed immediately after the mastectomy, so the woman does not have to live with one breast.

Breast Reduction

If you have large breasts that limit your physical activity and cause pain, breast reduction may be right for you. Breast reduction surgery removes excess breast fat, glandular tissue and skin to achive a breast size in proportion with a woman´s body and to alleviate the discomfort associated with overly large breast.

hiperhidrosis

The clinic condition known as HYPERHIDROSIS is when the release of sweat exceeds the thermo regulating needs of the organism. For the patients, this clinic condition represents discomfort and unpleasantness that may interfere with their daily activities, social and professional relations. The areas most commonly affected area the armpits, the hands palm and the feet sole. The first symptoms generally appear during the adolescence.

liposucTIOn

Liposuction is a very common, popular procedure. It is designed for the permanent removal of fatty tissue, commonly referred to as "cellulite." It is an elective procedure that allows the plastic surgeon to remove undesirable, subcutaneous fat in isolated areas that do not respond to diet and exercise.

AbdominoplastY

Abdominoplasty, or a "tummy tuck," is designed to correct a protruding abdomen resulting from weak abdominal muscles, weight gain or pregnancy. Obesity causes the skin to lose its elasticity.

MINI AbdominoplastY

This operation is designed to patients who are seeking aesthetic correction of the abdomen, and their problems are largely limited to the lower abdominal area and have only mild to moderate excess of skin and fat.

GLUTEAL AUGMENTATION

These procedures are for the patient who desires more roundness in the buttock area. The buttocks are augmented with the use of implants or with your own fat.

THIGH LIFT

The Thigh Lift is a surgical procedure that is used to eliminate excess skin and fat from the outer or inner thigh.

CALF AUGMENTATION

The calf implants are available in different sizes to suit your individual needs. The implant is made primarily of silicone. They are still soft, but firm and have the feel of a well exercised and developed calf muscle.

breast enlargement

levantamiento de busto

Breast lift surgery, or "Mastopexy", gives a youthful appearance to a woman’s breasts. Over the years breasts can lose their shape and firmness due to pregnancy, breast feeding, and loss of skin elasticity, causing them to sag. Mastopexy will raise and reshape breasts—slowing the effects of aging and gravity. This procedure can reduce the size of the areola, the darker skin surrounding the nipple.

Mastopexy is commonly performed along with breast augmentation (implants) to increase breast firmness and size. This may appeal to women who have lost breast volume after pregnancy. Pregnancy and nursing often result in stretched skin and therefore decrease in volume. If you are planning a future pregnancy, it is advisable to postpone your breast lift as pregnancy will likely cause further stretching.

As with all plastic surgery, realistic expectations and emotional stability are important. Though breasts of any size can be lifted, women with smaller breasts enjoy longer lasting results.

The Procedure

Though not a simple operation, mastopexy is normally safe when performed by a qualified plastic surgeon. Mastopexy is occasionally performed in a hospital, but more often is done in an outpatient facility. Breast lifts are usually performed under general anesthesia. Local anesthesia may be used with a sedative if the incision is small; you’ll be awake but relaxed, and will feel minimal discomfort.

The surgery may take between 1 1/2 to 3 1/2 hours. A more common approach involves an incision along the natural contour of the breast where excess skin will be removed. The nipple and areola are then repositioned. The skin surrounding the areola is brought together to reshape the breast with stitches around the areola and the lower breast area.

Possible Complications

As with any surgery, there are possible complications. A patient may suffer an adverse reaction to the anesthesia (rare), or experience bleeding and infection following a breast lift, causing scars to widen. Poor healing and wider scars are more common with patients who smoke.

Because milk ducts are left intact, mastopexy will not affect your ability to breast-feed.

For best results, follow your physician’s advice both before and after surgery.

After Surgery: What to Expect

After surgery, your stitches will be covered with gauze and an elastic bandage or a surgical bra will hold the breasts in place. Your breasts will be bruised, swollen, and you may experience some mild discomfort for a couple of days. Your doctor may prescribe pain medication. A soft support bra replaces the bandages or surgical bra after a few days. In the recovery stage, it is important to wear the bra at all times.

After a week or two, the stitches will be removed. Some noticeable, permanent scarring is normal, but easily covered by your bra or bathing suit. The scars may be red and lumpy for a few months, eventually fading and becoming less obvious. The procedure can also leave you with unevenly positioned nipples, or a permanent loss of feeling in your nipples or breasts.

To ensure proper healing, plan to stay at home for at least a week before returning to work. You will need to avoid lifting anything over your head for 3-4 weeks and avoid strenuous sports for a month.

breast reduction

 

Breast reduction or “mammooplasty”is a procedure which is done in patients that want to improve both physical appereance and physical problems due to the excess weight in breasts. The goal is to give women a more attractive look and contour to the waist, as well as a proportional breast size to the rest of the body. Women will benefit from their appereance, self steem, and security as well as the medical problems that involve a large breast.

Medical problems associated to this condition are: neck and back pain, skin irritation, bone deformities, and respiratory problems. Large and heavy breasts also affects standing posture that can interfere in normal activities such as exercise. The excessive size in breast may also affect in a woman’s self confidence or may feel less attractive.

The Procedure

Breast reduction can be done with local anestesia with sedation or general anestesia depending on the patient’s condition. During the procedure, body fat, glandular tissue, and breast skin are removed making the breast look smaller, be lighter, and firmer. The areola may also be reduced in diameter(the darker skin surrounding the nipple).

The insisions are made around the areola-nipple complex and may be vertically extended below the submammary furrow, leaving an anchor type scarring.

Nowadays it is possible, depending on each particular case, to make smaller insisions to obtain the reasult. The areola-nipple complex is moved upwards until is placed in the desired position.

After the operation, a bandage is placed in the breasts to mantain symmetry on both of them during the initial period of healing.

Post-operative pain is minimal and they can be controlled with oral medicamentation. Scars may vanish in between 6 and 18 months after the surgery.

This surgery may reduce the ability to breast feed, but it is not common.

Recovery: What to Expect?

When the operation is done by a certified plastic surgeon is a very safe procedure; nonetheless as any other surgery there is a list of complications that include: bleeding, infection, adverse reaction to anesthesia. After the operations, some pacients develop irritations around the nipples, this can be trated with topical antibiotics.

Risks involved can be reduced if you follow the pre and post-operative intructions that will be given by your surgeon.

Swealing and bruising vanish during the first 2 weeks after the surgery. In the beggining the breasts might look different from one another or that they are placed on an undesired position. The final result will take place in between 6 and 12 months, this depends from hormonal variation, weight changes, and pregnancy.

Even tough your surgeon can make scarring as invisible as possible, a permanent scar is inevitable. Smokers have more chances of having a bad and/or bolder scarring during the healing process. At the beggining scars will appear redish and bulky, as time goes by they will become more discreet. The good news are the this scars will be hidden underneath your underwear and bathing suit. Most of the time this won’t keep you from wearing small clothes.

Breast Feeding

With the actual technique it is possible to leave a breast capable of breast feed your baby after pregnancy, nonetheless, due to the large amount of breast tissue that is body fat, this ability can be reduced.

Some patients may experience a loss of sensitivity in the nipples. Rarely, during the operation, nerve sensitivity may be lost.

Final Result

Breast reduction is one of the most dramatic results in cosmetic surgery. The surgery takes away any discomfort of having large and heavy breasts and leaves a more proportional body figure which gives the patient the chance of look better wearing smaller clothes. Your new image will be easily accepted and you can enjoy the benefits of the operation in a short term after it.

Breast reconstruction

Breast reconstruction offers much hope for a woman losing her breast to cancer. Reconstruction can often be performed immediately after the mastectomy, so the woman does not have to live with one breast. Depending on health conditions, however, a mastectomy patient may have to wait before undergoing reconstructive surgery. In either case, reconstructive surgery holds much promise that the post-operative breast can match the natural breast again.

The Surgery

When reconstructive surgery is performed immediately following mastectomy, a breast mound is created in place of the breast that has been removed. This is done in the hospital under general anesthesia.Dr. Salcedo and Dr. Ramirez will work with your oncologist to ensure the best possible conditions for reconstruction.

Breast reconstruction usually involves more than one operation, and follow up procedures may be performed on an outpatient basis. Follow-up procedures may only require local anesthesia, and often involve a skin expander with a breast implant, and reconstruction of the nipple and areola. Sometimes surgery is the performed on the natural breast to match the reconstructed breast; however, this creates additional scars.

Once the breast mound is in place, your plastic surgeon may follow up with a skin expander and breast implant or flap reconstruction.

Skin Expander with Breast Implant

This is the simplest of breast reconstructions. Blood transfusions are not required, and there is minimal pain and a short recovery time. In this procedure, a tissue expander is placed under the skin. Once sutures are removed, saline is added weekly to the expander. This stretches the skin as it expands.

When the skin has been sufficiently stretched, the tissue expander is removed replaced by a permanent breast implant in a two-stage procedure. Nipple reconstruction, if desired, is a separate procedure.

Advantages: Simplest surgery and shortest recovery from surgery. This is the favored procedure for persons who have heath problems or contraindications to extensive surgery.

Disadvantages: Multiple trips to the office over several weeks or months to undergo expansion. Capsule formation or poor cosmesis due to thin skin.

Possible Complications:

• Loss of breast skin requiring removal of implant. If you have undergone radiation this procedure is not advisable as you are at increased risk for skin loss.
• Noticeable outlines of the implant due to capsule formation.
• Hard texture due to capsule formation.
• Thin breast skin.

Latissimus Dorsi Myocutaneous Flap

This surgery involves moving the latissimus dorsi muscle and overlying skin from the back to the chest to create a new breast mound. The incision is usually made along the bra line so the scar will be concealed.

Blood transfusions are not usually required. A breast implant can be placed under the flap if necessary to balance a difference in size. Nipple reconstruction is done later.

Advantages: This is a very reliable procedure, which provides a good environment for an implant. The chances of capsule formation around the implant are reduced.

Disadvantages: Scar across the back. There may be decreased strength in the back due to muscle loss. Capsule formation may occur and result in the need for additional surgery.

Possible Complications:

• Circulation problems with the flap.
• Formation of capsule around the implant.
• Symptoms from loss of shoulder muscle, such as decreased strength.
• Loss of back skin requiring skin grafting.
• Collection of fluid (seroma) under incision requiring needle aspiration.

Rectus Abdominus Myocutaneous Flap.

This is the most complicated and the longest reconstructive procedure, involving about 4-5 hours of surgery. One of the rectus abdominus muscles is tunneled along with the overlying skin up to the chest. The breast mound is created to match the opposite site. A blood transfusion may be required. You may donate your own blood prior to surgery to be re-infused during the surgery.

Breast implants are not usually required. The tissue is generally adequate to match the size of the opposing breast. If the opposite breast is large or pendulous it can be decreased in size by a simultaneous breast reduction. Patients wishing to have this procedure must stop smoking six weeks prior to and six weeks following surgery. Failure to comply may result in death of the flap. A synthetic mesh is placed over the area where the muscle is moved. This strengthens the abdominal wall and minimizes the chance of herniation of the bowel. Nipple reconstruction is done as a second procedure. Some contouring of the new breast mound may be necessary at the same time.

Advantages: This provides the most natural looking breast reconstruction with the added benefit of a "tummy tuck". No implant is needed so capsule formation is not a risk. The scar is easily hidden with clothing.

Disadvantages: There is a risk of herniation of the bowel resulting from moving the rectus abdominus muscle. Abdominal strength is diminished. This is the longest procedure and has the greatest risk for requiring a blood transfusion.

Possible Complications:

• Inadequate tissue requiring the use of a breast implant
• Poor circulation to the flap resulting in tissue loss.
• Weakness or herniation of the abdominal wall.
• Placement of the umbilicus off center.
• Collection of fluid (seroma) under the skin requiring needle aspiration.
• Infection, in particular of the mesh requiring surgery for removal.

Nipple Reconstruction.

The reconstruction of a nipple adds a very pleasing final touch to the breast. This is a simple outpatient procedure that may be done with local anesthesia. An average time for this is about 1-2 hours. The goal of the surgery is to create a nipple that has the appearance of the nipple of the opposite breast. Skin is taken from the inner part of the upper thigh or from behind the ear. These areas tend to have a darker pigment, which will provide a better contrast to the breast tissue. As a second procedure the healed nipple can be tattooed to improve the color match of the opposite breast.

Possible complications:

• Excessive scarring.
• Shrinkage of the projecting part of the nipple.
• Infection of the donor site or the newly created nipple.
• Blood clot under the nipple, which may result in loss of all or part of the new nipple.
  
  

Reconstruction of the breast following mastectomy is a very rewarding procedure to both the patient and the surgeon. Many women describe a feeling of once again being whole. There are many materials available regarding breast reconstruction. There are support groups available where one can meet women who have gone through these procedures. Ask us for references, books and support groups in your area. Take advantage of these invaluable resources.

Hyperhidrosis

Sweating is the most effective way to regulate the body temperature in human beings.

The clinic condition known as HYPERHIDROSIS is when the release of sweat exceeds the thermo regulating needs of the organism. For patients, this clinic condition represents discomfort and unpleasantness that may interfere with their daily activities, social, and professional relations.

The areas most commonly affected are: the armpits, the hands palm and the feet sole. The first symptoms generally appear during the adolescence.

BOTOX in the treatment of HYPERHIDROSIS.

The sweat glands are responsible for the release of sweat. For the sweating process to take place, this gland needs to be stimulated by means of a substance know as ACETYLCHOLINE.

BOTOX acts preventing the temporary release of ACETYLCHOLINE and therefore, the excessive production of sweat.

What we notice is a decrease of sweat that may vary from 4 to 10 months, with a therapeutic effect in 6 months as an average, depending on the individual response and the treatment dosage of each pacient. It is considered a fast, safe, and effective procedure.

BOTOX VS. other treatments.

The current local treatments for HYPERHIDROSIS are frequently insufficient, produce short term effects and are not well tolerated.

The surgical treatment provides relief for longer periods, but it is associated to risk of surgery and anesthesia or to side effects such as compensatory HYPERHIDROSIS, which have been described in 54% to 90% of the cases treated.

LIPOSUCtion

Liposuction is a very common, popular procedure. It is designed for the permanent removal of fat tissue, deposited in certain areas that not respond to diet and exercise. It is an elective procedure that allows the plastic surgeon to remove undesirable, subcutaneous fat in isolated areas that do not respond to diet and exercise. These areas include the hips, thighs, abdomen, knees, ankles, face, and neck.

Liposuction is most successful in people with good skin tone who have fatty deposits. It is not a treatment for obesity. If weight gain occurs following liposuction, the fat will be deposited in areas that have not been treated. The procedure can be repeated, if necessary. To maintain the safety on the procedure, there is a limit on how much can be done at one time.

A variety of factors can affect the results: Physical condition, genetic, diet, exercise, smoking, alcohol intake, and skin elasticity.

Body contours made irregular by fat can be improved by this procedure; it cannot correct contours that are irregular for other reasons, such as muscle weakness or hernia. However, combined with other procedures, liposuction can correct these other deformities with good results.

The Procedure

Liposuction is done under regional anesthesia on an outpatient basis in a hospital or surgical center. The surgeon makes small (less than 1/2 inch), discreet incisions in the areas to be treated. A cannula is inserted in a small incision and attached to a suction machine. The procedure may take an hour or more, depending on how many areas are involved.

Recovery

Recovery from liposuction depends on the amount of fat removed and the areas treated . Expect a fair amount of swelling and bruising in the following two weeks. You will wear special garments provided to apply pressure, minimize swelling, and provide support while healing. These garments also assist in retraction of the skin. Stitches will be removed in a week to 10 days.

Results are recognizable almost immediately and will continue to improve as swelling subsides. The day after surgery you should be up on your feet and walking around. Increase your activity daily until full activity is resumed at 2-4 weeks. You will be ready to return to office work in 3-5 days and more active employment at 10-14 days. Avoid the sun until all bruising has subsided. A sunscreen should be used routinely; it is easy to get sunburned during recovery because of decreased sensation.

The results of liposuction are permanent. If you were to gain a large amount of weight you might note rippling in the treated areas, depending on skin elasticity.

Possible Complications: As with any surgical procedure, complications can occur. Cosmetic complications include contour irregularities, skin discoloration, asymmetry, scar tissue, tape burns, accumulation of blood or fluid under the skin. Uncommon complications include loss of sensation, skin breakdown, fat embolism, serious infection or shock. Bleeding does occur during liposuction. There is a limit to the amount of fat that can be safely removed in a given procedure.

Following liposuction, the scar will go through a maturation process—during the first 8-12 weeks they may be red and possibly raised. The scars will mature over 6-12 months and become pale, flat and soft. You may experience numbness, burning, and tingling around the incision site. These symptoms are almost always temporary.

Please let us know if you are prone to keloid scars.

Abdominoplasty "Tummy Tuck"

Abdominoplasty, or a "tummy tuck," is designed to correct a protruding abdomen resulting from weak abdominal muscles, weight gain, or pregnancy. Obesity causes the skin to lose its elasticity. These conditions may not respond well to diet or exercise if the skin and underlying muscles have been stretched.

With abdominoplasty, the abdominal wall muscles are tightened and excess fat tissue and skin are removed to improve the body contour. The goal is a more narrow, flatter abdomen. Realistic expectations are important. Abdominoplasty is not a substitute for weight loss.

Dr. Salcedo and Dr. Ramirez consider age, obesity, and smoking habits when evaluating a candidate for this procedure.

Before Surgery

We will take a complete medical history and conduct a careful examination to evaluate your general, overall health. Ideally, the patient has no health problems and wishes only to remove an excess deposit of fat or loose abdominal skin. Patients on a weight-loss plan should be close to their target weight before having the operation. Women planning future pregnancies should delay abdominoplasty, as pregnancy may promote further abdominal stretching.

Photographs will be taken before and after surgery

Antibiotics will be prescribed prior to surgery to prevent infection. To minimize the possibility of excess bleeding, you will need to avoid taking drugs containing aspirin. You will also be advised to bathe with antiseptic soap for several days prior to surgery.

The Procedure

Abdominoplasty is performed using regional anesthesia. You may be given medication beforehand so you will feel relaxed. The surgery may take 2-5 hours, depending on the patient's overall condition. You may be released after a few hours or may also require a couple days of hospitalization.

The procedure is most commonly performed by making a U-shaped incision below one hipbone, across the pubic area and under the other hipbone. A second incision is made around the navel. The skin is then separated from the abdominal wall and lifted up to the hipbone, exposing loose tissue covering the abdominal muscle.

Loose, stretched out muscles are tightened with sutures and excess skin and fat are removed. The skin is lowered over the abdomen and the navel is reconstructed. The incisions are then sutured together. Drains are often inserted to eliminate fluid buildup and firm elastic bandages are applied to the area.

Recovery: What to Expect

You may experience some discomfort immediately following surgery that can be controlled with pain pills. Some swelling is normal. You will be given special instructions for showering and changing your clothing until the surface stitches are removed in 5-7 days. You may also be required to wear a support garment.

The speed of recovery depends on your physical condition prior to surgery; those with stronger abdominal muscles usually recover faster. Allow at least 2-4 weeks of healing before returning to work.

Some scarring is also normal. It often takes 9-12 months before the scars begin to fade.

Though the recovery period is longer than that of other cosmetic procedures, the rewards are great for a patient previously distressed by a protruding abdomen. Those who follow a proper exercise routine and healthy diet will benefit from abdominoplasty at its most.

Mini-Adominoplasty

This operation is designed to patients who are seeking aesthetic correction of the abdomen whose problems are mostly limited to the lower abdominal area and have only mild to moderate excess skin and fat. Compared with the abdominoplasty, this procedure needs a smaller incision, less dissection, less resection of tissue, less job done to the abdominal muscles and, of course less scar. The aesthetic result is excellent and the morbidity is reduced.

The Procedure

The operation can be made under regional anesthesia (epidural), and most of the time as an outpatient basis. The incision is placed at the pubis, if there is a previous scar for C operation, we can use the same one. It is from 6 to 8 inches long, depending the skin we need to resect, but the idea is to make a scar that can be covered by the bikini. We tighten the abdominal muscles from the umbilicus to the pubis and sometimes we place a drainage that remains for 3 days to one week. Very often we do liposuction to the flanks and upper abdomen.

Recovery: What to Expect

Patients are sent home following surgery and after recovering from the effects of the anesthesia, the same day of the operation. As this is a more limited procedure than abdominoplasty, the symptoms and recovery time should take less time and less in intensity, and the patient must be able to full exercise and return to normal duties at six weeks postoperatively tops.

Gluteal Augmentation

These procedures are for the patient who desires more roundness in the buttock area. The buttocks are augmented with the use of implants or with your own fat. Buttock implants are sometimes requested to enlarge underdeveloped gluteal muscles to give more balance to the patient's look in contrast to the body`s features. The other technique used is the use of liposuction and re-inject body fat in the buttock area. Sometimes these patients request calf implants as well.

The Implant

The implants are either made from solid silicone, a felixible yet firm material or a softer form of cohesivve silicone (encased in a silicone bag). With cohesivve silicone, a more natural feel is at hand and if there is a rupture of the bag, this cohesivve silicone is reported not to leak. The solid silicone implant is more resistant than a gel filled implant. You are measured at your pre-operative visit for the size and shape that adapts to your needs.

Fat Grafting

You must have plenty of existing body fat in the back, thighs, abdomen, arm, etc., to harvest for use in augmentation. With this procedure there is little fat necrosis/absorption.

The Procedures

In the gluteal implant procedure, the implant is placed between the muscle and the fascia which is the thick, white connective tissue, covering the muscle. The implants are placed above the "sitting area" so you never actually sit on them.

The incisions are made in the sacral area, between the gluteus and is not seen even with a short bikini.

In the fat grafting procedure, the fat is gently removed using liposuction with a special cannula that is very thin and less-damaging. The fat particles are then purified and inserted into the layers of the buttocks through a single 1/8" incision. The tiny bundles of fat are implanted near tiny vessels so that an adequate blood supply is given to the newly placed fat cells to increase their chances for survival.

thigh lift

The Thigh Lift is a surgical procedure that is used to eliminate excess skin and fat from the outer or inner thigh. The ideal candidates for thigh lift are women and men who have exces skin and won`t respond to exercise or diet.

The Thigh Lift incisions may run around the hip or on the inside of the leg. Special care is taken to avoid disturbing deeper layers of fat in order to protect the nerves, glands, and veins of the leg. Liposuction can be used to remove excess fat is other regions to enhance the effect. While there is a permanent scar on the legs, it is typically well hidden.

CALF AUGMENTATION

Calf implants are designed to be soft, yet solid. The implant is made primarily of silicone. They are soft in felling, but firm in consisntence and have the appereance and feeling of a well exercised and developed calf muscle. The calf implants are available in different sizes to suit your individual needs. It is not a "one size fits all" type of implant - each patient seeks different results.

For cosmetic enlargement, 2 implants are usually used in each calf (a total of 4 implants per patient) and are placed under the large muscle that forms the bulk of the calf. Using a single implant will result in an artificial look. Single implants are used frequently in reconstructive procedures, which generally require only one side to be augmented. The procedure is the same in both genders, men or women. Calf implants are placed within the muscle compartments but on top of the actual muscle. The implants are not placed underneath the muscle to avoid damage on inervation and irrigation that is located in that general area. Usually the implant length is determined by the length of the patient's own muscle.