Breast
Breast Augmentation
Breast augmentation also known as breast enhancement. Breast augmentation is typically done with implants, however in the future there may be more interest is doing this with fat grafting.
At this time the types of implants that are available are saline, silicone, anatomical shaped (gummy bear) and fat grafting.
Saline implants are a silastic shell filled with saline. They come in different profiles. If the implant breaks you know about it right away because it loses volume. People worry very little about the side effects of saline. They can be done in all ages even in women under 22 years of age. Disadvantages of saline is typically they are firmer because they are slightly overfilled to prevent waves and irregularities and wrinkling. They may have an unnatural feel and a shell fold feel at the bottom edge that can be felt and even occasionally even seen.
Silicone implants come in smooth and textured styles and a variety of sizes and profiles. Silicone implants can have a very natural feel, indistinguishable from breasts. Silicone implants are mostly used in the smooth form in the United States with a larger pocket in attempts to avoid capsular contracture or scar tissue.
Anatomic “gummy bear” implants are typically a firmer silicone that has less leakage if the implant ruptures, however they are firmer to touch, they are more expensive and only come in anatomic shaped implants. And because of their shape if the implants rotate they can cause significant distortion. This rotation may increase over time and is one of the major disadvantages of using anatomic implants.
FAQ:
- Is the implant typically placed above or below the muscle? Approximately 98% of implants in our practice are placed below the muscle. The reason for placing implants below the muscle is to create a more natural contour with the muscle smoothing the transition from the implant to the chest wall. The placement of the implant under the muscle has a much lower rate of capsular contracture in comparison to above the muscle. The disadvantages of placing the implant under the muscle is muscle movement with exercise, particularly weight training with tight clothes where the upper pole of the breast does flatten somewhat and cause some distortion.
- How long does it take to get back to work after breast augmentation? With a surgical procedure, there will be soreness involved. Most patients are off of work about an average of 4-6 days following the augmentation. Patients will also be restricted in some activities, and can expect to return to normal activity and exercise about 3-4 weeks following the procedure, barring any complications.
- Fat grafting the breast is in infancy nationwide. There is some concern of the safety of this. Legally if one fat grafts to the breasts one must have a very extensive specialized research laboratory license. Fat grafting typically is limited by the recipient site and therefore negative pressure therapy is introduced prior to fat grafting and a limited amount of fat can be placed at each time. The BRAVA system is not FDA approved, however it is being used for breast reconstruction with fat grafting around the country.
- For augmentation a limited amount of fat can be placed and typically to get the volumes needed for implants the process is many months long and 3-5 times more expensive in the end.
Types of implants:
Saline Implants are a silastic shell filled with saline. They come in different profiles. Saline implants can be placed in all ages, even in women under 22 years of age. People worry very little about the side effects of saline. And if a saline implant fails, the patient is aware of the failure because the implant loses volume. One disadvantage of using a saline implant is the unnatural feel and firmness, saline implants are slightly overfilled to prevent waves and irregularities and wrinkling. This is why the saline implant may have an unnatural feel and a shell fold feel at the bottom edge that can be felt and even occasionally even seen.
Silicone implants come in smooth or textured styles and a variety of sizes and profiles. Silicone implants can have a very natural feel, indistinguishable from breasts. Silicone implants are mostly used in the smooth form in the United States and with a larger pocket in attempts to avoid capsular contracture or scar tissue.
Anatomic or “gummy bear” implants are a type of silicone implant, made with a highly cohesive, form-stable silicone gel that typically has less leakage if the implant ruptures. Advantages of the gummy bear implant is that it can provide a more natural, anatomical look can be less prone to wrinkling, and can be firmer to touch. Some disadvantages of the gummy bear implant are that they are more expensive, require a larger incision to place and only come in anatomic shaped implants. Also, because of their shape if the implants rotate, they can cause significant distortion. This rotation may increase over time and is one of the major disadvantages of using anatomic implants.
Fat grafting in the breast is in infancy nationwide. It is the process of taking fat tissue from other parts of the body, usually by liposuction and then it is processed and injected in the breast. However, there is some concern of the safety of fat grafting. Legally, at this time, fat grafting can only be done with an extensive specialized research laboratory license. For augmentation purposes, only a limited amount of fat can be placed at a time, requiring multiple sessions to get the volumes needed for implants. This makes the process many months long and 3-5 times more expensive in the end. Also, The BRAVA system, an external tissue expander, is not FDA approved, however it is being used for breast reconstruction with fat grafting around the country.
For more information about breast augmentation, contact our office to schedule a consultation with Dr. Lamb.
Breast Reduction
Bilateral reduction mammoplasty, is a type of breast reduction done to remove excess fat, tissue and skin from the breasts. Patients that would benefit from a breast reduction are usually experiencing issues with neckaches, backaches, headaches, bra strap grooving and rashes in large breasted women, typically a DD breast cup size or greater with a few exceptions. The goal is to achieve a breast size more proportional to your body and reduce discomfort.
The operations that are done are basically named by the blood supply: superior medial pedicle, inferior pedicle, free nipple graft technique.
FAQ
- Is breast reduction covered by insurance?
Yes, the majority of breast reductions are covered by insurance. Most do not require a referral from a health care provider.
- Can this operation be done as an outpatient or does it require a hospital stay? A vast majority of breast reductions can be done as an outpatient. However, elderly patients with more medical issues are typically done in the hospital.
- What is the satisfaction rate of breast reduction? Nearly 100%. Most people only have one regret, they wish they would have it done it sooner.
- Typical comments from people who have had breast reductions: One patient’s initial comment was: Fabulous! Best thing I’ve ever done for myself!
To find out more about the options available for breast reduction, contact our office to schedule a consultation with Dr. Lamb.
Breast Reconstruction
The goal of breast reconstruction is to recreate one or both breasts to near normal symmetry and appearance following a mastectomy or other trauma. The process can involve several procedures or can be done in an immediate fashion at the time of skin sparing, nipple sparing or complete mastectomies.
Reconstruction in an immediate fashion can be done with a tissue expander, which requires as the name implies, tissue expansion with saline injections. After the expander filled to an adequate size, it may be left in place for a period of time before a permanent implant is placed.
When the permanent implant is placed, frequently in the upper pole of the breast (in the lateral aspects and where indicated), either excess skin is removed and fat grafting is smoothed around the edges to make the implant less visible. At the time of tissue expander or implant placement, it is common to use biological fabrics such as Alloderm or Strattice to provide support for the implant from the edge of the pectoralis major muscle down to the chest wall.
Delayed reconstruction can be done, either in one stage or in two stages, with a tissue expander depending on the needs of the situation. Nipple and areolar reconstruction can also be done with biological tissue or more popularly, tattooing the nipple and areolar complex with a 3-D tattoo.
For more information about breast reconstruction, contact our office to schedule a consultation with Dr. Lamb.
Mastopexy (Breast Lift)
Mastopexy, or breast lift, is a procedure to improve the look of sagging breasts, usually due to pregnancy, breastfeeding, weight changes and gravity. A breast lift removes excess skin and contours the breast. This can be done in conjunction with an augmentation procedure.
Circumareolar mastopexy: a donut of skin is taken out around the nipple and the nipple is altered a small amount either reducing the size of the areola or shifting the position of the nipple 1cm or so. With this type of lift, there is a tendency to stretch back out, so there’s a very specific indication for use.
Vertical mastopexy: an incision is made around the nipple and down to inframammary crease. This can be done for small adjustments in nipple position with minimal volume changes.
Full mastopexy: where volume can be adjusted, the breast can be reshaped and the skin can be tailored resulting in incisions similar to a breast reduction, however the control over the result is much greater.
To find out more about the options available for mastopexy, contact our office to schedule a consultation with Dr. Lamb.
Augmentation Mastopexy
Augmentation Mastopexy involves reshaping and contouring sagging breasts and can be done in combination with an increase in breast size, placing an implant at the same time. This procedure can be done for cosmetic or reconstructive purposes.
For the breast lift and augmentation, the breast tissue may be reshaped, the nipple position is shifted and breast firmness will be increased by tightening the skin envelope. This can be done with all types of mastopexy as well as placement of implants, typically in the submuscular plane. You will also have a choice between the type of implant which can be discussed during your initial consultation.
For more information about augmentation mastopexy, contact our office to schedule a consultation with Dr. Lamb.
Gynecomastia (Male Breast)
Gynecomastia is a swelling of breast tissue in boys or men, usually due to an imbalance of the testosterone and estrogen hormones. Gynecomastia can affect one or both breasts and can cause an uneven appearance. Some males experience pain in the breasts or embarrassment because of the condition. Most commonly, this condition affects boys between 11-14 years old. Sometimes the conditions will improve (or reduce in size) to some degree with puberty in males.
However, when the swelling of the breast tissue does not improve, it may require a combination of liposuction and direct excision.
Liposuction alone can be done on fatty breasts, however direct excision in general on younger breasts can be more effective.
At the same time of reducing the breast tissue, the nipple can be reduced in size and occasionally skin may need to be removed because of redundant skin.
To find out more about the options available for gynecomastia, contact our office to schedule a consultation with Dr. Lamb.
Face
Facelift
A facelift is a cosmetic procedure to reduce the signs of aging in the face and neck. Skin loses elasticity and volume as we age. Add in factors such as smoking, sun damage, heredity and weight fluctuations, and these can contribute to changes we see in the face over time. A facelift removes excess, sagging skin, smoothes folds and wrinkles and can lift and tighten muscles and facial tissue.
The most common type of facelift done today is the short scar facelift. This type of facelift preserves the hair bearing area of the sideburn, circles around the tragus, the small piece of cartilage in front of the central part of the ear, behind the earlobe and back. Short scar facelifts are typically done in combination with tightening the facial fascia or S.M.A.S. (superficial muscular aponeurotic system) The tightening of facial fascia significantly helps to eliminate jowls and tighten the lateral platysma and neck.
When doing a facelift, ancillary procedures can be done to include eyelid surgery, cheek or lip fat grafts, also, defatting the neck and tightening the bands of the neck in the center typically referred to as plication.
FAQ:
- How long does it take to get back to work after a facelift? With this surgical procedure, some bruising and swelling of the face is normal and expected. It should subside within about a week and be difficult to notice after about 2 weeks, so most patients are back to work 1-2 weeks following a facelift. Patients will also be restricted in some activities…expect to return to normal activity after about 2 weeks, and stenerous exercise after about 4 weeks following the procedure, barring any complications.
For more information about a facelift, contact our office to schedule a consultation with Dr. Lamb.
Reduction Otoplasty (Ear Surgery)
Ear surgery, or otoplasty, is a surgical procedure done to adjust the shape, symmetry or position of the ears. It may also be referred to as pinning the ears back. Prominent ears are fairly common in young children and typical candidates for this surgery are children older than 5 years, teens and adults. Having this surgery as a child or teen has the increased benefit of more pliable cartilage which allows for ease of reshaping. But in children, this operation is rarely done before the age of 5 years old. The ear is almost fully grown at about 5 years of age, about 85% of the height of an adult ear and the procedure can be safely done without causing major growth disturbances.
Reduction otoplasty can be done either under local anesthesia or IV sedation or general anesthesia with local supplementation.
Shaping the ear with permanent sutures to help avoid a recurrence is important. This can be done either unilaterally or bilaterally depending on the needs of the situation.
To find our more information about reduction otoplasty, contact our office to schedule a consultation with Dr. Lamb.
Blepharoplasty (Eyelid Surgery)
Blepharoplasty or eyelid surgery is a surgical procedure done on the eyelids to refine their appearance. This procedure will remove excess sagging skin on the eyelids interfering with vision and can add or remove fat from the eyelid. It can be performed on the upper eyelids, the lower eyelids or both. This operation can done under local anesthesia. The upper eyelid may need excess skin and fat removed to help reshape the eye and improve the field of vision. But sometimes fat grafting can be done to help contour deficiencies in certain areas…in the medial upper eyelid hollow. The lower eyelid may need excess baggy skin removed and sometimes the overall contour will be improved by adding or removing fat.
For more information about blepharoplasty, contact our office to schedule a consultation with Dr. Lamb.
Rhinoplasty (Nose Surgery)
Rhinoplasty is the alteration of the nose by reshaping, removing and in some cases adding cartilage to redefine the nasal contours. Cartilage is frequently obtained from the nasal septum at which time typically a septoplasty is done for obtaining graft material and straightening a deviated septum.
Rhinoplasty can be done in a closed or open fashion. Open rhinoplasty is done through a small incision over the columella, up around the cartilages into the nostril thus exposing the entirety of the nasal cartilages and nasal bones directly. Many find that their control is greater, however the disadvantage is external scarring.
Closed rhinoplasty alteration without an incision across the clumella is done intranasally. The dorsum can be taken down and reshaped and the cartilage altered. Septoplasty can also be performed without the risk of devascularization of the nose, post operative swelling and avoidance of an external scar.
Additionally, surgery on the nose may be required to improve impaired breathing or discomfort caused by an abnormal structure or a deviated septum. Septoplasty is the alteration of the nasal septum with or without turbinate reduction and can be done in cases where breathing symptoms indicate need. Septoplasty is also done for obtaining graft material at the time of rhinoplasty. Rhinoplasty preoperative planning and execution is very important, as well as very precise management of patient’s expectations.
For more information about rhinoplasty, contact our office to schedule a consultation with Dr. Lamb.
Reconstructive
Breast Reconstruction
The goal of breast reconstruction is to recreate one or both breasts to near normal symmetry and appearance following a mastectomy or other trauma. The process can involve several procedures or can be done in an immediate fashion at the time of skin sparing, nipple sparing or complete mastectomies.
Reconstruction in an immediate fashion can be done with a tissue expander, which requires as the name implies, tissue expansion with saline injections. After the expander filled to an adequate size, it may be left in place for a period of time before a permanent implant is placed.
When the permanent implant is placed, frequently in the upper pole of the breast (in the lateral aspects and where indicated), either excess skin is removed and fat grafting is smoothed around the edges to make the implant less visible. At the time of tissue expander or implant placement, it is common to use biological fabrics such as Alloderm or Strattice to provide support for the implant from the edge of the pectoralis major muscle down to the chest wall.
Delayed reconstruction can be done, either in one stage or in two stages, with a tissue expander depending on the needs of the situation. Nipple and areolar reconstruction can also be done with biological tissue or more popularly, tattooing the nipple and areolar complex with a 3-D tattoo.
For more information about breast reconstruction, contact our office to schedule a consultation with Dr. Lamb.
Cleft Lip and Palate Surgery
Cleft lip and cleft palate are birth defects that can occur independently or together, and happen when the lip or mouth doesn’t form properly during pregnancy. It is one of the most common birth defects and happens in the natural population somewhere around 1 in 500-700 live births. While the cause is not always known, a cleft lip or palate can be genetic in origin. Children with this condition may experience difficulty with feeding, speech, hearing and dental problems.
A cleft lip repair is usually done at about 3 months of age. The procedure is done in the hospital with an overnight stay. Prior to cleft lip repair, special steri strips with an elastic area in between, tapes the lip partially together to reshape the lip to make the tension on the repair less, therefore getting more consistent results.
A cleft palate repair is typically done at 8-9 months of age, the earlier the repair can be done is somewhat better, if safe, for speech development. This procedure requires one night stay in the hospital and can be a bit harder for the child to recover from.
If a lip revision is necessary, this is not done until the child is about 4-5 years old. Palate revisions are typically for either poor speech in which a second operation can be done to improve this or in the case of palatal fistulas.
FAQ:
- Are there special bottles available with children with cleft lip and palate to make feeding easier? Yes, pigeon nipples, Dr. Brown nipples and Haberman nipples have all been used very successfully as well other internal valved nipples. Also a normal nipple could be used if the opening is enlarged to facilitate flow of milk. However, be careful to not overload the infant’s ability to swallow with too much fluid at one time.
- Will my child requires more surgeries besides the repairs to the lip and/or palate?
As your child ages and their facial structure changes, they may need follow up procedures to improve breathing, speech, hearing and for dental or orthodontic reasons. One procedure, Alveolar ridge bone grafting, is done somewhere between 9-11 years old with the maturity of the canine tooth, as seen on x-ray, as it descends into place. This procedure helps to stabilize the permanent teeth. - Most patients are involved in the Cleft Lip and Palate Clinics in either Grand Forks or Fargo and the clinics are also located in Bismarck and Minot. The clinic can help coordinate care, such as organize speech therapy, follow hearing and other medical concerns.
To find our more information about a cleft lip or palate, contact our office to schedule a consultation with Dr. Lamb.
Body
Abdominoplasty (Tummy Tuck)
Abdominoplasty, or tummy tuck, is a procedure done to remove excess skin and fat around the abdomen and can include the repair of separated abdominal muscles. Liposuction can also be done in conjunction with a tummy tuck to remove excess fat that collects around the abdomen and waist. There are different abdominoplasty surgical procedures offered that depend on the results desired by the patient.
Mini abdominoplasty: a small amount of skin is taken out typically with no alteration in the position of the umbilicus. This procedure is frequently combined with liposuction.
Full abdominoplasty: the umbilicus is incised, skin flap advanced and the umbilicus is reset. At the same time of full abdominoplasty, liposuction is frequently done in the upper flap, lateral flanks and the muscle is tightened when indicated to restore normal function, such as in the case of diastasis recti.
Diastasis recti: when the rectus abdominus muscles split apart…this condition is usually a complication of pregnancy and can require surgical intervention to repair the muscles.
Extended abdominoplasty/circumferential abdominoplasty (body lift): an operation that is done in two parts, where the posterior aspect is marked carefully, excised, closed, patient is flipped over in the supine position from prone and then the abdominoplasty is done to complete the operation. The recovery for this lift can be quite extensive frequently requiring nursing care in a hospital setting.
FAQ:
- How long does it take to get back to work after a tummy tuck? With an abdominoplasty, you can expect to be limited in your activity for period of time following surgery. Most patients are back to work within 4 weeks after a tummy tuck procedure. Patients can expect to return to normal activity after about 6-8 weeks following the procedure, barring any complications.
For more information about abdominoplasty, contact our office to schedule a consultation with Dr. Lamb.
Liposuction
Liposuction (suction assisted lipectomy) utilizes suction to remove fat through various sized stainless steel cannulas, improving body shape and proportion.
The procedure is done with a fair amount of fluid injected prior to liposuction as well as either external ultrasound or occasionally internal ultrasound.
External ultrasound breaks own fat and allows liposuction to be done in stubborn areas more effectively.
Internal ultrasonic liposuction has been used in the past and largely is abandoned secondary to skin irregularities, entrance site burns and contour issues.
Recently, laser liposuction in has gained popularity for it’s ability to somewhat shrink the skin at the time of liposuction, however precise temperature control is necessary to avoid skin breakdown.
All methods of liposuction are similar to traditional liposuction for the removal of fat. How the skin is prepped and managed with external heat or laser can effect the outcome, but in the end, the removal of fat still happens in all techniques. However, traditional liposuction in experienced hands can be highly effective.
Cool sculpting/I-Lipo is an FDA cleared procedure showing it is reasonably safe. Cool Sculpting can show modest improvement…showing some promise in small treatment areas. But it is still not a replacement for traditional liposuction in larger areas. Plus, the treatment is not without side effects. The side effect most commonly reported for Cool Sculpting is significant pain, sometimes lasting for an extended period of time.
FAQ:
- How long does it take to get back to work following lipsuction? You can expect some bruising and swelling in the treatment area for about 7-10 days. You may have to wear compression garments or elastic bandages/wrap in the area that was treated for a few weeks following the procedure to help reduce swelling. Most patients are back to work within a few days. Patients can expect to normal activities within several days to a few weeks following the procedure, barring any complications.
To learn more about liposuction, contact our office to schedule a consultation with Dr. Lamb.
