What is Abdominoplasty?

Many people have problems keeping their tummy area in shape. Some have tried dieting and exercise yet still do not get the results they want to have. Abdominoplasty might just be the solution for such concerns.

Commonly known as a Tummy Tuck, Abdominoplasty involves the surgery of the abdomen in which excess fatty tissue and skin are removed, resulting to a firm and smooth abdomen. The procedure entails the removal of excess abdominal skin, reduction of fat below the skin, and if necessary, tightening of the muscles of the abdominal wall.

Most people who undergo this treatment are those who have gone through pregnancies. Sometimes the old unsightly scars from a C-section, appendectomy, and stretch marks can be removed as well. A Tummy Tuck results to a more youthful, firmer, and flatter abdominal contour.

However, do take note that Abdominoplasty is not a substitute for weight loss. We highly recommend weight management programs for patients to maintain their weight and keep the body in its new shape.

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IGAP Flap – Inferior Gluteal Artery Perforator Flap

The IGAP flap, or the Inferior Gluteal Artery Perforator Flap is a variation of the SGAP flap. The procedure is virtually identical aside from the use of the inferior gluteal artery versus the superior gluteal artery. The physical difference to the patient is a donor scar lower on the buttock versus higher on the buttock. Which of these two procedures is most appropriate usually is determined by each patients individual anatomy.

Restoration of the nipple and areola follow. Scars fade substantially with time.

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SGAP Flap - Superior Gluteal Artery Perforator Flap

The SGAP Flap, or the Superior Gluteal Artery Perforator flap (buttocks), is ideal for those who do not have an adequate amount of excess abdominal tissue. The breast may be reconstructed with the skin, fat and the tiny blood vessels taken from the gluteal area.

Most women have enough excess tissue in this area to achieve a B or C cup breast size. The SGAP flap procedure is performed by using the tissue from the top part of the buttock without injury to the underlying gluteal muscles. A slight buttock lift results in the donor area with a fine line incision easily hidden within the panty line. The tissue is then transplanted to the breast and a microscope is used to connect the blood vessels supplying this tissue to those at the mastectomy site. The tissue is then sculpted into the new breast mound.

Restoration of the nipple and areola follow. Scars fade substantially with time.

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Endoscopic Latissimus Dorsi Flap

The Endoscopic Latissimus Dorsi Flap is similar to the traditional Latissimus Dorsi flap with several exceptions. The Endoscopice Latissimus Dorsi flap technique allows for the harvests the muscle without overlying skin or fat, and can be performed through a small incision in the underarm area. This procedure is suitably for patients who may have had radiation therapy and adequate skin, but are not candidates for tissues expansions or permanent implants alone.

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Breastlift (Mastopexy)

Over the years, factors such as pregnancy, nursing, and the force of gravity take their toll on a woman's breasts. As the skin loses its elasticity, the breasts often lose their shape and firmness and begin to sag. Breast lift, or mastopexy, is a surgical procedure to raise and reshape sagging breasts--at least, for a time. (No surgery can permanently delay the effects of gravity.) Mastopexy can also reduce the size of the areola, the darker skin surrounding the nipple. If your breasts are small or have lost volume--for example, after pregnancy--breast implants inserted in conjunction with mastopexy can increase both their firmness and their size. If you're considering a breast lift, this brochure will give you a basic understanding of the procedure--when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't understand.

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Breast augmentation

Breast augmentation can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you're physically healthy and realistic in your expectations, you may be a good candidate.

Types of Implants
The choice of implant filler, implant size, shape and other features will be determined based on your breast anatomy, body type and your desired increase in size. Your lifestyle, goals and personal preferences, as well your plastic surgeon's recommendations and sound surgical judgment are also determining factors. Implant manufacturers occasionally introduce new styles and types of implants, and therefore there may be additional options available to you.

Breast implants are medical devices with a solid silicone, rubber shell. The implant shell may be filled with either saline solution (sterile salt water) or elastic silicone gel. Both saline and silicone gel breast implants are approved by the U.S. Food and Drug Administration (FDA). Approval means that an implant has been rigorously researched and tested, and reviewed by an independent panel of physicians for safety.

The size of a breast implant is measured in cubic centimetres (ccs) based on the volume of the saline or silicone filler. Breast implants vary both by filler and in size, but there are additional features to consider:

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Breast Reconstruction

Tissue expansion is a procedure that enables the body to “grow” extra skin by stretching adjacent tissue. A balloon-like device called an expander is inserted under the skin where the breast was moved, and then gradually filled with salt water over time, causing the skin to stretch and grow. The time involved in tissue expansion depends on the individual case and the size of the area to be repaired. The advantages of tissue expansion are many-it offers a near-perfect match of skin color, sensation, and texture; the risk of tissue loss is decreased because the skin remains connected to its original blood and nerve supply; and scars are often less apparent than those in flaps or grafts. The expander temporarily creates what can be an unsightly bulge, making this option undesirable for some patients. Previous or future radiation therapy to the site of disease is a relative contraindication to tissue expansion and permanent implant placement. The majority of patients who undergo this type of breast reconstruction who also receive radiation therapy have an undesirable outcome, frequently resulting in removal of the implant. Restoration of the nipple and areola follow. Scars fade substantially with time. The reconstructed breast will likely differ in contour and feel to the natural breast.

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Formulated in a cream base this eye contour product helps replenish elastin and build collagen to reduce wrinkles and crepey skin around the eyes

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You will use this unique formula to lighten dark areas in the skin such as freckles, age and liver spots. This cream was designed for blending purposes. Your doctor will prescribe tretinoin (Complex A) and provide instructions for application, with Nu-Derm Blender.

Skin Health Restoration

Obagi is the pioneer in introducing the concept of Skin Health Restoration through correcting skin functions. While traditional methods of skin care address the surface only - with limited benefits, Obagi products address the skin in its totality. This Total Approach in treating and reversing skin aging remains unique in improving even the most difficult skin problems. Best of all, it can show you how to maintain healthy skin indefinitely.

I had mastectomy and tissue expander put in 4 years ago, then had infection 3 months later and had the implant removed, then had a Becker implant put

The DIEP flap method of breast reconstruction can only be performed a single time, whether it is one breast or both. Therefore, if a single breast is reconstructed with a DIEP flap and the other breast needs to be reconstructed in the future, a different type of reconstruction will have to be utilized. There are other flaps that can be used such as the TUG flap or SGAP, as well as the Latissimus flap with an implant. The other option, which has become increasingly popular, is to have a prophylactic mastectomy on the other side in order to have both breasts reconstructed simultaneously with the DIEP flap.

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What are some questions a woman should ask a plastic surgeon, before deciding on this reconstruction procedure?

What are the alternatives to the DIEP flap? (Including alternative microsurgical and non-microsurgical techniques.) Whether DIEP flaps are a significant part of the surgeons practice? (Since success rates are directly related to a surgeons experience.) What happens if the flap fails? (The national reported flap failure rate ranges from 3%-1dependingding on the type of flap performed.) How many additional surgeries will be necessary in addition to the DIEP flap? (At least one or more surgeries will be necessary in order to fine tune the appearance, as well as reconstruct the nipples in the final stage.)

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A DIEP flap is called a "free" flap breast microsurgery procedure. What is a "free" flap and how does microsurgery facilitate the success of a DIEP fl

The term "free flap" refers to the technique that utilizes the transposition of tissues a significant anatomical distance requiring the complete separation of the tissues from the donor site in order to move them to the recipient site. Microsurgery refers to the re-connection of tiny blood vessels by hand sewing them together or using a coupler device under a microscope. Free Flap Microsurgery is vital in the success of the DIEP flap since the muscle is not used (such as in the TRAM flap), the tissue is based on tiny vessels and must be moved a significant distance.

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What would some of the drawbacks (or risks) of a DIEP be?

The DIEP flap is a significant surgery, in that it can be a lengthy procedure averaging 4-8 hours, depending on size of the breast, size of the patient, unilateral or bilateral reconstruction, and unforeseeable anatomical variations that can increase the technical difficulty of the surgery. The hospital stay is a minimum of 3 days and the recovery can be relatively difficult, taking 4-6 weeks to get back to normal. There is also a small but real chance that a blood transfusion will be necessary. Patients can donate their own blood in advance if time permits. There is also a sizable scar left on the abdomen, although similar to that left by a tummy tuck.

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Candidates of DIEP surgery

One out of nine women has the possibility to have breast cancer. Every year, tons of women suffer and undergo the same situation-- fighting the same disease. Consequently, women suffering from breast cancer can choose to have breast reconstruction at the time of mastectomy, otherwise they may opt to go through reconstructive surgery at a later date.

Practically, every woman can prefer for a DIEP flap procedure, with only one exception. Women lacking sufficient abdominal tissue to create or reconstruct a breast can’t undergo such operation. Younger women who are exceptionally muscular or into sports, may fall in this category, and may select substitute reconstructive solutions.

In addition, women who are medically not capable to endure a lengthy surgery (six hours or more), should talk about further options with their oncologists. If they won’t be able to carry on the extensive procedure brought about by DIEP flap, they can opt for other short- timed operations—that has almost the same reconstructive measures.

Radiotherapy

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After mastectomy, radiotherapy is given to patients who are considered to be at risk of recurrence. Radiotherapy kills cells that are growing and has greater effects on cancer than on surrounding tissue.

After a few days of radiotherapy, the patient's skin may look red and feel a bit sore. Towards the end of treatment, there may also be some blistering of the skin.

Chemotherapy

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Chemotherapy involves being given a combination of anti-cancer medicines, often up to three at a time. It may be preferable for more advanced cancer that is not hormone responsive and for aggressive disease, particularly if the cancer has spread to other sites, such as the liver. It is sometimes administered prior to surgery in order to shrink a tumor.

Surgery

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Surgery can be an excision of the tumor with surrounding normal breast tissue (breast conservation) or removal of the whole breast (mastectomy). Clinical trials comparing mastectomy and breast conservation have shown that the two produce identical results.

If the lump is relatively small it is usually possible for the surgeon to remove it along with a small amount of surrounding normal tissue. This is called lumpectomy, wide local excision or breast-conserving surgery.

With a larger lump, this breast-conserving operation may not be possible because so much of the breast tissue would have been taken away that it would badly distort the breast.

Once the lump and surrounding tissue is removed it needs to be examined under the microscope. In some women, the surrounding tissue is abnormal and a further operation is necessary.

Risk Factors

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Some risk factors, such as age, sex and family history, can't be changed, whereas others, including weight, smoking and a poor diet, are under your control.

But having one or even several risk factors doesn't necessarily mean you'll develop cancer — most women with breast cancer have no known risk factors other than simply being women. In fact, being female is the single greatest risk factor for breast cancer. Although men can develop the disease, it's far more common in women.

Other factors that may make you more susceptible to breast cancer include:

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Age
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A personal history of breast cancer
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Genetic predisposition
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Radiation exposure
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Excess weight in upper part of body
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Late menopause
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First pregnancy at older age
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Birth control pills
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Mammographic breast density
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Precancerous breast changes (atypical hyperplasia, lobular carcinoma)

DIEP Flap Breast Reconstruction in Beverly Hills, California

DIEP breast reconstruction is an advanced technique in autologous (own tissue) transfer.

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Diep Breast Reconstruction

Over five hundred thousand breast cancer cases are diagnosed every year all over the world. One in nine women develops such kind of disease. When mastectomy, a surgical removal of all or part of the breast and sometimes associated lymph nodes and muscles, is a component of a patient’s medication, women may likewise reflect on having in need of attention, breast reconstruction.
As a woman, losing a breast is painful, physically and emotionally. It somewhat degrades her fundamental nature as a female, self- worth and sexuality, causing some trauma in her corporeal aspects also her sentiments. But with the transformation of the technological devices used by plastic micro-surgeons, rebuilding a lost breast of a patient’s recuperation, reinstating a wholeness experienced by many women, is possible.

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Diep Flap TUG Breast Reconstruction

Diep Breast Reconstruction @ Yahoo! Video

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Nipple Reconstruction

Nipple Reconstruction
During a mastectomy, the nipple and areola (i.e. the pigmented area surrounding the nipple) are customarily removed. Therefore, nipple and areola reconstruction represents the final stage of a complete breast reconstruction. It should be noted that these procedures are completely optional. Some women may want only the shape of the breast to fill a bra and look natural in clothes.
Nipple and areola reconstruction is performed at a time when the surgeon and patient are both happy with the final shape and size of the reconstructed breast. Depending on the type of nipple and areola reconstruction performed, this may be done either in the operating room or as a "day surgery" procedure in the surgeon's office or minor procedures room. This procedure may be performed under local or general anaesthesia.
How is the procedure performed?
The nipple may be reconstructed by using a flap or a graft. Flaps are pieces of tissue that are moved from one location to another with their own blood supply intact. Grafts are pieces of tissue that are completely removed from their own blood supply and rely on the in-growth of a new blood supply at the new site.
Flap reconstructions have an advantage over graft reconstructions in that the bulk and projection of the nipple are generally more reliable. The main disadvantage of flap reconstructions is that new scars are left on the breast surrounding the new nipple location. Transplants, on the other hand, leave scars at distant locations.
In modern approaches to nipple reconstruction, the nipple mound is created from skin taken as a local flap on the reconstructed breast. Various local flaps have been described, including the Skate flap, the C-V flap and the Star flap. Regardless of which approach your surgeon chooses, the outcome will be a nipple mound. The areola can then be either tattooed, or it can be reconstructed with a skin graft taken from elsewhere on the body. Common donor sites for the graft include the abdominal scar from a flap reconstruction, the inner thigh, or the buttock crease.

"You would never know that I had a bilateral mastectomy or missing both my latissimus muscles unless I told you. I owe my life to Dr. Leif Rogers for

1. Will insurance cover the reconstruction?

All health insurance plans will cover breast reconstruction after breast cancer, however coverage offered by the various insurance companies and plans can vary greatly, depending on the specific plan and frequently, whether your doctor participates in the plan.

2. A DIEP flap is called a "free" flap breast microsurgery procedure. What is a "free" flap and how does microsurgery facilitate the success of a DIEP flap reconstruction?

A “free” flap denotes a specific technical aspect of the procedure, describing the complete disconnection of the tissue from the donor site and reattachment to the recipient site by reestablishing the blood supply to this tissue. Free flaps require the utilization of microsurgical techniques in order to reestablish the blood supply; the blood vessels in the flap are hand sewn to recipient vessels in the area being reconstructed.

3. How long after my Breast Reconstruction can I have Nipple Reconstruction done?

Nipple reconstruction is typically the final stage of breast reconstruction. This can happen as early as three months after the initial surgery, but frequently will not be performed for six months or more. The reconstructed breast must be fully healed, without residual swelling in order to accurately place the new nipple and areola with predictability.

4. Will my reconstructed nipple have feeling after the surgery?

The reconstructed nipple will not have normal sensation, and may be entirely insensate (numb). It is not an actual nipple, but simply an mound of skin created surgically to simulate the appearance of a nipple. Some patients do report some protective sensation months to years after the reconstruction of the nipple, but this is not typical.

5. What do I do if the color of my new nipple does not match the color of the other nipple?

Tattooing can be performed approximately a year after the nipple reconstruction. The color can change over the first year as healing continues. It is not wise to perform tattooing prior to stablization of the skin pigmentation.

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Plastic Surgery for Men

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Leif Liu Rogers

FACS - American College of Surgeons
The American College of Surgeons is a scientific and educational association of surgeons that was founded in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice.
Membership

Members of the American College of Surgeons are referred to as "Fellows." The letters FACS (Fellow, American College of Surgeons) after a surgeon's name mean that the surgeon's education and training, professional qualifications, surgical competence, and ethical conduct have passed a rigorous evaluation, and have been found to be consistent with the high standards established and demanded by the College.

There is also another category of membership known as "Associate Fellow." This category was established to provide an opportunity for surgeons who are beginning surgical practice and who meet specific requirements to assume an active role in the College at an early stage in their careers.

The College currently has over 70,000 members, including more than 4,000 Fellows in other countries, making it the largest organization of surgeons in the world. There are presently more than 2,600 Associate Fellows.

Diep Breast Reconstruction

Over five hundred thousand breast cancer cases are diagnosed every year all over the world. One in nine women develops such kind of disease. When mastectomy, a surgical removal of all or part of the breast and sometimes associated lymph nodes and muscles, is a component of a patient’s medication, women may likewise reflect on having in need of attention, breast reconstruction.
As a woman, losing a breast is painful, physically and emotionally. It somewhat degrades her fundamental nature as a female, self- worth and sexuality, causing some trauma in her corporeal aspects also her sentiments. But with the transformation of the technological devices used by plastic micro-surgeons, rebuilding a lost breast of a patient’s recuperation, reinstating a wholeness experienced by many women, is possible.

Diep-BreastReconstruction.com

The Diep-breastreconstruction.com portal online. Within you will find recent and past patient testimonials, as well as different breast reconstruction procedure updates and contact information. Read more about Dr. Leif Liu Rogers, M.D., F.A.C.S.! Find out more about Breast Cancer and involvements. Take a look at Case Examples and Videos and Related Procedures. If you wish to contact us, take a look at the e-mail form.
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