Below are some of the most frequently asked questions patients have about plastic surgery issues. If you have any other questions, or would like to schedule an appointment, we would love to hear from you.
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During your consultation we will discuss your desired changes and expectations, review your medical history and current health, and make an assessment on whether the procedure(s) in question are right for you. This is a good time to ask specific questions about the procedure so that you are fully prepared, mentally and emotionally, for surgery. We will discuss the results that can be achieved, with the aid of photos and/or computer imaging. When a final decision is made, you will need to sign an informed consent stating that you are fully aware and understand what is entailed by your pending operation, including the potential complications and secondary effects.
Insurance providers generally cover costs for reconstructive surgery but not for cosmetic surgery. For example, insurance providers will often pay for breast augmentation to reconstruct a breast following a mastectomy; breast reduction to remedy back pain caused by heavy breasts; eyelid surgery to remove sagging skin that blocks vision; nose surgery to allow for a patient to breathe better; or tummy tucks to remedy the vertical separation of abdomen muscles known as diastasis.
In 1998, the Federal Breast Reconstruction Law was passed requiring insurance providers to cover breast reconstruction surgery and any cosmetic operations necessary to create symmetry in either breast. If your surgery is covered by insurance, pre-certification is required. We will be happy to assist you with the process.
If you do not have a surgeon in your area who performs the type of reconstruction you are seeking, your insurance provider will often pay for surgery in another city or state. Please call our office at Beth Israel Deaconess Medical Center, so that we can help with the arrangements necessary for out of town patients.
Autologous reconstruction uses the body's own tissue to recreate the breast. Once the blood supply has been established, it remains with you for life. The skin and fat transferred is very similar in consistency to breast tissue and feels like a normal breast. The newly created breast changes through life with normal weight fluctuations and age.
Implant reconstruction often requires multiple operations in order to achieve a final result. In many patients revision and reoperation is necessary every 10 years. This is usually for capsular contracture or scar tissue formation that tightens around the implant. This may cause the breast to feels artificial and unnatural. In patients where radiation therapy is used for treatment of the breast cancer, there is a risk of capsular contracture as high as 40%.
A transverse rectus abdominus myocutaneous (TRAM) flap uses the skin, fat, and underlying rectus muscle to reconstruct the breast. For a bilateral mastectomy and reconstruction both muscles are removed. Patients who undergo a TRAM flap experience abdominal weakness from the muscle loss. They also have a risk of developing abdominal hernias or bulging of the lower abdomen. Because the muscle is divided this can lengthen recovery.
This is in contrast to the DIEP flap where the rectus muscle is preserved and functions after surgery. There is minimal abdominal weakness, a very low risk of hernias, and patients return to normal activity and exercise much faster.
Generally we advise patients to wait for 3 to 6 months after chemotherapy prior to reconstruction. This allows the body to fully recover from chemotherapy. Radiation therapy can be problematic because of the skin changes and scar tissue formation associated. We recommend waiting for 6 months or more after radiation therapy prior to proceeding with reconstruction.
Occasionally, a tissue expander can be placed at the time of mastectomy to hold prevent scar formation and hold the skin envelope prior to radiation. Autologous reconstruction is then performed 6 months after the radiation therapy has been completed and replaces the tissue expander at that time.
The issue of breast implant safety has been a hot topic throughout the last few decades. As a result, more stringent standards have emerged in order to protect patients. Current breast implant procedures primarily use silicone shell implants filled with a saline solution. Occasionally, silicone-gel filler is used; but this is highly regulated by the FDA, and generally only acceptable in reconstructive surgery procedures. Rarely, an implant will rupture or leak. With saline implants, the saline is safely absorbed into the body. The effect of silicone-gel leaking into the body is still being researched. If rupture or leaking is detected early, the implant can be easily replaced. Other possible complications from breast implant surgery may include blood clotting or pooling, overly sensitive breasts or loss of sensation in the breasts, and capsular contracture (a hardening of the tissues surrounding the implant). Our expert team is dedicated to making your operation a smooth one. We take every precaution necessary to reduce the possibility of any complications.
Generally, post-operative instructions call for rest and limited movement in order to speed up the healing process and recovery time. The length of recovery varies with each procedure and is different for each individual. Bruises usually disappear within a few days, and most swelling is gone in a matter of weeks. If you follow our post-operative instructions carefully, you will be able to enjoy your normal activities within no time. Your scars will fade over time but are permanent. We take care to conceal any scars so that they are barely visible, if at all. The image-enhancing effects of plastic surgery become more evident over time with certain procedures taking up to a year for your body to fully adjust and settle into its new look. When you come in for your consultation we can discuss your expected recovery period and any post-operative instructions in detail.
It is a relatively common practice for a plastic surgeon to perform multiple procedures during one operation. This allows the surgeon to better “sculpt” your final appearance. In addition, having several procedures done simultaneously saves you the expense of paying the operating room and anesthesia costs more than once. However, having too much done at one time can lead to complications. The decision to have multiple procedures done depends on which procedures are being done, the extent of surgery, the operating time, and your age/health. Ultimately, the surgeon decides whether or not it is appropriate to include more than one procedure in your operation.
There several important factors that come into play when deciding whether plastic surgery is the right option for you. One of the most important factors is your health. Being in good health greatly reduces the risk of complications occurring during surgery and leads to a speedy recovery. Next, you need to ask yourself what your motivations are. People who have plastic surgery generally find that the surgery enhances their overall appearance and self-esteem. Thirdly, you should have realistic expectations. Plastic surgery is both a science and an art, neither of which are perfect. Set reasonable goals as to the result you wish to achieve and be prepared to thoroughly discuss these goals during your initial consultation.
Due to the variety of procedures available in plastic surgery, there can be no blanket rule on age although age will be taken into consideration when planning your operation. For example, there are many different types of breast reconstruction ranging from simple to complicated. It is important to understand what is involved with each option. What is a good procedure for one person may not be an appropriate procedure for another. We are committed to making your experience a successful one.
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