December 13, 2011 by Dr. Leo Keeganby Dr. Leo Keegan
Why is there a trend toward older women undergoing plastic surgery procedures?Women of all ages have always enjoyed the benefits of plastic surgery. What is different is that women between the ages of 45 and 65 are starting to look at their surgical options differently. As women over the years have become more health conscious, they have also become more youthful and active. When people are feeling good and living longer, it’s only natural that they want to have that feeling of vitality represented on the outside. This has led to an expansion of the surgical options offered to these active women.
What are some of the surgeries you are seeing older women undergo?We are seeing a lot of older women undergo surgery for their breasts and abdomen, which they may have decided to do since having children. Breast reductions, breasts lifts and tummy tucks are becoming increasingly common Another interesting thing we are seeing is breast reduction surgery for women who had their breasts augmented 10–20 years ago. Today, their bodies may be in better shape leaving their breasts disproportionate in size to their body.
Why are older women starting to have these types of surgeries?Because older women are exercising more, taking care of themselves better, eating more healthily and, more importantly, not smoking, they are better surgical candidates. Improvements in anesthesia provide greater degrees of safety and allow many patients to feel good afterwords and even go home within a few hours of surgery.
Are these surgeries limited to women with excess weight from childbirth or unwanted breast implants?No. Thin women can also have a significant amount of skin laxity, commonly referred to as loose skin, which can result from weight-loss or from skin stretching during pregnancy. Though these women may be quite fit, the loose and hanging skin can only be removed through surgery. It's a variation of a tummy tuck. At times this skin removal can be combined with a breast lift or breast reduction.
Are you seeing an increase in non-invasive surgeries?Yes. Traditionally, women in their 50s and 60s would be candidates for a face-lift. Now, women are finding other non-surgical procedures that are less invasive, such as fillers, Botox and laser resurfacing that helps maintain a youthful appearance without surgery. In addition,Non invasive body contour procedures such as Coolsculpting now allow patients to improve their appearance with essentially no down time or recovery.
Is there any reason why you would recommend an older woman having surgery other than for cosmetic purposes?In addition to cosmetic surgery, there are a variety of other reasons why older women have opened themselves up to the possibility of undergoing surgery. Many women will notice an insidious post menopausal weight gain while others develop progressive breast enlargement and drooping. These developments can make it difficult for an older woman to exercise or pursue certain physical activities that they would normally enjoy. Additionally, breast enlargement can also lead to back, neck and shoulder pain, symptoms which may be significantly relieved by breast reduction surgery.
October 14, 2011 by Dr. Leo KeeganBy Dr. Leo Keegan
Questions About Pain and Pain Management After a Tummy Tuck
Every patient who is considering a tummy tuck in NY will naturally be concerned with the amount of pain they will experience during the postoperative period. Often, they will have received misinformation from a variety of sources and their concern will be unnecessarily heightened. Although all patients will experience some degree of pain in the days following surgery, it is quite manageable with tapering amounts of pain-relieving medication.
For those patients who have had c-sections in the past, I explain that they can expect their pain and recovery time to be significantly less following a tummy tuck than after their c-section. With this frame of reference, the expected pain can be placed in better perspective.
One method I use to reduce a patient’s pain is the placement of a “pain buster” pump: a small catheter placed to deliver local anesthetic to the surgical site. The local anesthetic flows continuously and requires no intervention from the patient. The placement of this pump makes the patient more comfortable and generally reduces their need for pain-relieving narcotics, allowing for an early return to ambulation.
So, although pain is always on the patient’s mind, it is generally not as bad as they expect. However, all patients require pain-relief, though how long for differs between individuals: some only need pain-relieving medication for one day, while for others it could be one week. In fact, most patients are pleasantly surprised that they feel comfortable enough to be out of bed and on their feet the first night after surgery. For all patients, post-operative pain quickly and gradually diminishes, and recovery is much quicker than they often expect.
Concerns About Scarring After a Tummy Tuck
As a plastic surgeon, scarring is the biggest potential concern because it is permanent and something which is not completely within my control. Most patients will heal well and develop a normal scar, however sometimes a patient’s scar will be thicker or wider than they would like. If a patient has had previous surgery I am able to get a good idea of the quality of scar the patient will make.
Although scarring is a real concern for both me and my patients, most patients understand and accept that it is the trade-off for achieving an improved body contour. From a geometric point of view, the more skin that is removed in a vertical dimension, the longer the scar will be.
Ideally, I like to place the scar in a low transverse line that begins above the pubis and moves out towards each hip. Excess skin and fat, stretch marks, and other scars can reliably be removed, significantly improving the abdominal contour. Despite the presence of a scar, the final appearance of the abdomen should be quite pleasing.
Questions Regarding Recovery Time After a Tummy Tuck
Patients also want to know about the recovery time. Many tummy tuck patients are young and have young children at home. Our lives are all so busy these days, so ensuring minimal disruption to household and childcare responsibilities is very important to many of my patients. All patients will need to consider their individual family and life circumstances when they consider the timing of surgery. Nevertheless, living in this busy world there is never a completely perfect time for surgery.
Recovery time after a tummy tuck, like pain, will differ from person to person. Patients often want to know when they will be able to lift their children, when they can drive, etc. Most patients will achieve these milestones gradually over the course of the first 10 days, becoming more physically active as they feel stronger.
I tell them that if they have a 2 year old, for example, they’re not going to be able to reach over the crib and lift the toddler out, but they will be able to cuddle their child if they’re sitting next to one another or if someone else puts the child on their lap. Usually by 10 days they can resume driving as long as they’re not taking any pain medicine. Within 3 weeks, patients can expect to feel about 85% to 90% normal; at this point most patients are feeling surprisingly well and need to be careful not to overdo things. Abdominal exercising should be avoided for approximately 8 weeks after the surgery date to allow complete healing and to maintain their contour.
For more on tummy tucks, contact our New York Plastic Surgery Office
December 9, 2010 by greenhood
DIEP Flap Breast Reconstruction: IntroductionThin women with moderate to large breasts present a clinical challenge for post-mastectomy breast reconstructions. Autologous reconstructions that use a patient’s own body tissue, such as DIEP flap and TRAM flap surgeries, offer the most natural reconstructed breasts. However, many thin patients, particularly those undergoing a double mastectomy, often have insufficient abdominal tissue for a purely DIEP flap or TRAM flap reconstruction.
Traditionally, this subset of thin, large-breasted women have selected an LD flap surgery, which uses a patient’s latissimus dorsi (upper back) muscle to reconstruct the breast flap. In a later surgery, an implant is placed inside the new breast flap to add the desired volume. Unfortunately, many young, healthy, active women are ultimately disappointed with both the scarring and loss of muscle function associated with LD flap surgeries.
In contrast, DIEP flap surgeries, which utilize fatty abdominal tissue to reconstruct the breast area, do not generally result in extensive scarring. DIEP flap incisions can generally be hidden inside the bikini line, and the procedure can also result in improved post-operative abdominal contour. In the past, however, slender women with inadequate abdominal tissue have not generally been offered the opportunity to undergo DIEP flap reconstruction.In recent years, we have developed a successful hybrid surgery that combines a DIEP flap procedure with the immediate insertion of a breast implant. We believe that this hybrid DIEP flap surgery is a viable and superior reconstructive option for thin patients who prefer autologous reconstructions. This paper presents the first documented case studies of six patients who underwent hybrid breast reconstructions, combining DIEP flap surgery with the immediate placement of silicone gel implants.
DIEP Flap: Patients and MethodsOur study included six patients who received implants plus DIEP flap reconstructions in NYC's Mount Sinai Hospital between 2007 and 2009. Five of the six patients received bilateral reconstructions.
Patients were initially evaluated in the private offices of top plastic surgeons in NYC Doctors Leo Keegan and Dr. Carlin Vickery, and all options for post-mastectomy breast reconstruction were discussed in detail. All of the patients selected for the procedure were initially considered to be good candidates for a DIEP flap surgery, but ultimately had insufficient abdominal tissue for a purely autologous surgery. All six patients were classified as thin or normal weight based on Body Mass Index (BMI) calculations. The patients’ BMI ranged from 18.0 to 23.5, with an average BMI of 21.8. (A BMI of 25 is considered the top of the normal weight range.) The patients ranged from 37 to 60 years old, with an average age of 47. All patients were nonsmokers at the time of surgery, though three patients were ex-smokers who had quit at least nine months prior to the date of the surgery.
Three of the six patients requested augmentation relative to their pre-mastectomy breast size, and were considered ideal candidates for DIEP flap surgery with an implant for added volume. Two additional patients had loose abdominal skin, making them reasonable candidates for autologous reconstruction, but they simply had insufficient abdominal tissue to achieve an acceptable post-operative breast mound. One patient had previously undergone bilateral breast reconstruction with implants, and she developed complications in one of her reconstructed breasts. She chose DIEP flap surgery as a “salvage” procedure, but an implant was necessary to achieve symmetry with the other reconstructed breast.In all six patients, the DIEP flap procedure and insertion of the implant occurred immediately after the mastectomy. In all patients, smooth round gel implants were used, and all six patients continue to receive regular post-operative consultations in the offices of plastic surgery New York Doctors Keegan and Dr. Vickery. When this article was written, patients had been monitored for 6 to 34 months after their surgeries.
DIEP Flap: Results and DiscussionAll patients were satisfied with their post-operative breast reconstructions and abdominal contour at the time of their latest follow-up consultations. There were no cases of implant infection requiring antibiotic treatment, implant removal, or implant exchange. The average length of postoperative hospital stay was 5 days, and all patients remained in the hospital for 4-6 days after their surgery.
These results suggest that hybrid DIEP flap surgeries with implants provide a safe, viable solution for thin women who prefer a natural look to their reconstructed breasts. Because of the natural tissue provided by the DIEP flap procedure, implants have a minimal impact on the overall shape of the reconstructed breast. If performed by a skilled team of surgeons, a DIEP flap reconstruction with implants can be tailored to replicate the appearance and feel of a natural breast. The DIEP flap procedure creates a comfortable skin envelope for the implant, and patients can expect to enjoy long-lasting results, with a relatively low risk of complications.Ideal candidates for hybrid DIEP flap surgery with implants are likely to be thin women who prefer the natural look and feel of autologous breasts, but lack sufficient abdominal tissue for a purely DIEP flap surgery. This procedure might also be appropriate for women who wish to avoid the loss of muscle function associated with LD (latissimus dorsi) flap surgeries. Finally, women who seek an augmentation of their breast size relative to their pre-mastectomy size may benefit from hybrid DIEP flap surgery.
DIEP Flap: ConclusionThis study, though small, demonstrates that hybrid DIEP flap surgeries with implants can be performed safely. Hybrid DIEP flap reconstruction can be used successfully in thin women who request augmentation relative to their pre-mastectomy breast size, but have insufficient tissue for purely autologous reconstruction. Women with these characteristics have traditionally been offered LD or TRAM flap reconstructions with implants, and we believe that the hybrid DIEP flap procedure offers an outstanding alternative with a low incidence of complications.
About the Plastic SurgeonsDr. Leo Keegan and Dr. Carlin Vickery are New York’s longest-tenured surgical team specializing in breast reconstruction surgery. In addition to their groundbreaking work with hybrid DIEP flap reconstructions, NYC Doctors Keegan and Dr. Vickery perform a full spectrum of breast reconstruction surgeries, including LD flap, TRAM flap, SIEA flap, and implant-based reconstructions. Dr. Keegan and Dr. Vickery are among a select group of doctors who are board-certified in both general surgery and plastic surgery, and both doctors have decades of experience using microsurgical techniques. Data for this article was compiled by Dr. Daniel Maman and Dr. George Xipoleas, both of whom also participated in the surgical process.
By Dr. Leo Keegan and Dr. Carlin Vickery
What is a Mommy Makeover?
Although motherhood can bring tremendous joy to a woman’s life, pregnancy can wreak havoc on a new mother’s body. The process of childbirth can cause permanent changes to a woman’s body, including loss of breast volume, damage to the abdominal muscles, and increased skin laxity in the midsection. Many of these physical changes can only be remedied by surgical procedures. A Mommy Makeover is a combination of body contouring surgeries designed to restore a woman’s figure to its pre-pregnancy state.
Pregnancy and childbirth can cause abdominal muscles to separate, with the center connecting fascia splayed like taffy between the muscles. A tummy tuck (abdominoplasty) can be performed to reposition these muscles and restore the architecture of the abdomen. In most cases, a Mommy Makeover consists of a tummy tuck combined with a breast lift, breast augmentation, or breast reduction surgery.
Are you a candidate for a Mommy Makeover?
Before surgery is considered, it is recommended that a woman perform core strengthening exercises, modify her diet and return to her pre-pregnancy weight. In some cases, however, diet and exercise simply do not achieve the desired results. This frequently happens after two or three pregnancies, when the architecture of the abdomen has been permanently altered. In these cases, surgery may be the only viable option.
Ideal candidates for a Mommy Makeover typically suffer from separated abdominal muscles and loss of breast shape and volume. A woman who has bulging pockets of abdominal fat that do not respond to diet and exercise may wish to consider a Mommy Makeover to regain her pre-pregnancy figure. Patients who undergo a Mommy Makeover at our Manhattan office can expect to enjoy the return of uplifted, tight breasts and a flat, bikini-ready abdomen.
Most women who undergo a Mommy Makeover are in their thirties, but many women in their twenties or forties are also great candidates. A Mommy Makeover is often performed on women who are accustomed to having lean, tight bodies. Young, healthy women who are in good shape generally recover quickly from a Mommy Makeover and face minimal risk of complications.
Preparing for your Mommy Makeover
Like any other surgery, a NYC Mommy Makeover requires careful preparation before the procedure. To avoid complications and unnecessary discomfort, the following steps are recommended:
- Avoid taking medications, such as aspirin, that can increase bleeding.
- Maintain a light diet for 24 to 48 hours before the surgery.
- For patients who require substantial abdominal surgery, bowel preparation to empty the colon may be needed to prevent discomfort.
- Because flying increases the risk of blood clot formation in the legs, patients should avoid flying for several days before the surgery. In the days leading up to the surgery, patients should remain active to ensure adequate blood circulation.
Recovering from a Mommy Makeover
Within three weeks after a Mommy Makeover, patients are usually 85-95% recovered from the surgery. To ensure a quick and healthy recovery, patients should become mobile as soon as possible. All of our Manhattan patients receive one-on-one overnight care from our outstanding staff of registered nurses, all of whom have extensive experience in helping patients optimize their recovery from plastic surgery. A pain pump, which delivers targeted doses of pain medication to a specific area of the body, can help patients to maintain mobility soon after the surgery. In most cases, patients are up and walking within a few hours after a Mommy Makeover.
Our modern, peaceful overnight Manhattan facility is designed to maximize the comfort of our patients during the recovery process. Our well-appointed, private recovery room is equipped with cable TV, and each patient receives the undivided attention of our overnight nursing staff. Friends and loved ones are welcome to visit the patient during recovery at the facility, but are not allowed to stay overnight. We encourage family members to reserve their energies for after the patient returns home from NYC for their Mommy Makeover, when they may need to take a more active role in the patients recovery process.
Within one week of the surgery, most patients still have sensitivity in their abdominal area, and patients may experience swelling for several weeks after the surgery. Patients are highly mobile within a week of the procedure, but are advised to be conservative with their movements to prevent damage to the sutures. Patients should avoid picking up their children during their recovery from a Mommy Makeover, but driving is allowed within 7 to 10 days after the surgery.
At least 2 to 4 weeks should pass before a patient flies on an airplane. If a patient must fly within a few weeks of a Mommy Makeover, she is strongly encouraged to walk around during the flight to maintain blood circulation. Within three weeks after a Mommy Makeover, patients can resume most of their normal activities.
What are the long-term effects of a Mommy Makeover? Is there scarring?
A post-surgical scar is inevitable, but a skilled surgeon can help to minimize the visibility of the scar. The tummy tuck scar usually extends from one hip to another, but the scar tends to fade over time, and is generally unobtrusive after 12 to 18 months. By letting the patient bring in her preferred swimwear before the surgery, we can tailor the location of the incision to minimize the visibility of the scar.
Most patients enjoy a high degree of satisfaction following a NY Mommy Makeover. Patients benefit from stronger abdominal walls, allowing core muscle strength to return to its pre-pregnancy levels. Overall, our patients look and feel much better as a result of their surgeries, and can return to their busy lives with energy and confidence.
December 3rd, 2010
By: Dr. Carlin Vickery and Dr. Leo Keegan
Competently provide access to high standards in content rather than fully researched processes. Quickly integrate extensible vortals whereas team building "outside the box" thinking. Distinctively monetize sticky metrics rather than user friendly relationships. Rapidiously impact functional experiences rather than one-to-one mindshare. (more…)