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Scareless Breast Augmentation

A Johannesburg prominent plastic surgeon explains…

Contemporary media, including cinematography and glossy magazines have promoted large breasts as a symbol of beauty and sexuality; notice the image of Barbie with her small hips, waist and disproportionate large breasts.  Breast augmentation is therefore one of the more popular operations requested from plastic surgeons in the last decade. The trade-off of breast augmentation surgery, like any other surgical intervention, is a scar.  Scar on the breast inevitably produces a blemish however, in most instances it is a justifiable trade-off for the improved shape and volume.

Inserting breast implants through a small incision under the armpit can be regarded as scarless…

In the plastic surgeon’s continuous quest to minimize or eliminate scars as much as possible, the axillary approach to breast augmentation was developed. This approach leaves the inevitable scar in the armpit, an area aesthetically dissociated from the breast aesthetic unit. The small incision (approx.5cm long) is horizontally placed in the skin crease of the armpit and when it matures it usually blends and becomes inconspicuous. The arm pit approach leads easily into a sub muscular pocket which the favorable position is elected by most plastic surgeons for insertion the implants.

One of the trade-offs of the under-arm approach is that the scar is only exposed when you elevate your arm. This is only evident in the immediate period after the operation, for some six to twelve months.  This period requires restrain of arm movement, to keep the scar concealed until it matures fully.

This approach has the distinct advantage of avoiding any surgery on the breasts.  In addition to avoiding scars, this technique avoids alterations to the architecture of the breast, ensuring breast feeding after the surgery. It also has a cosmetic advantage over the sub mammary incision (incision at the junction of the breast and the chest wall) which is exposed whenever the breast moves up, usually in the most inappropriate social circumstance.

What are the risks involved?

On rare occasions numbness of the inner arm is experienced, which usually settles within a few weeks. On the rare occasion hypertrophic scar or keloid may occur under the armpit.


Sweat and Tears

Summer is finally here… the glorious season of long sunny days and hot lazy nights. It’s the time for skimpy bikinis, short skirts and tiny tops. Which all sound fabulous -unless of course you’re one of the many people who suffer from excessive sweating and body odor. This is a disorder that is fairly common and can cause the individual discomfort and great embarrassment. So how can this be treated? ASM reports…

Hyperhidrosis is a disorder characterised by excessive uncontrollable sweating in excess of the amount required to regulate body temperature. The cause of hyperhidrosis is not known. In some people the excessive sweating is associated with chronic offensive under arm odor. The reason for the offensive odor is attributed to sweat gland secretions (short-chained fatty acids and ammonia) reacting with bacteria on the skin surface. Another explanation to the odor could be a change in the chemical composition of the sweat.

Under-arm over sweating often begins at puberty and has a significant negative impact on social, professional, and emotional aspects of peoples’ lives.

A 2004 study of 150,000 households in the United States showed that the incidence of hyperhidrosis is approximately 2.8% of the population. It is estimated that hyperhidrosis effects over 8.5 million individuals in the U.S alone. Approximately 51% of these individuals suffer from under-arm hyperhidrosis of various degrees of severity.

Problem? No sweat…

Methods of treatment can be classified into non-surgical or surgical.

Non-surgical methods consist of injections of botulinum toxin type A (i.e. Botox)

Surgical treatments range from minimally invasive to full excision to nerve-severing surgery.

Botox requires 2-3 session of injections per year and is considered effective.

Liposuction of the sweat glands; curettage type of minimally invasive surgery is considered to be the state of art in the surgical treatment of under-arm Hyperhidrosis. This approach involves minimally invasive surgery associated with a minimal complication rate. The procedure is usually performed under local anaesthesia with deep sedation. Ambulatory (day basis) set up is adequate for the procedure. The liposuction cannula is employed to remove some of the sweat glands and reduce the remaining glands. Substantial improvement is the usual outcome. Recurrence rate of 2-20% has been reported.


Arms and Inner Thigh Elevation (after massive weight loss)

The upper inner thigh and the arms often depict loss of skin elasticity as an early sign of aging. Both areas are often involved in the process of weight gain/loss. The skin in these regions usually responds to weight loss by hanging rater then shrinking, hence the reason for cosmetic surgical elevation.

About the procedure

Young men and women with elastic skin will benefit from liposculpture of the inner thighs and arms but older individuals who underwent massive weight loss require excess skin excision. An attempt to conceal the scar in the arm pit or in the skin crease of the groin is made in the suitable candidates. This scar requires a year or more to settle completely.

About the Anesthesia

The operation can be performed on a day basis or may require an overnight stay in hospital. Local Anaesthetic is often performed under conscious sedation or light general anesthesia.

Tightening Up

Loosing a substantial amount of weight is a positive step for one’s health and  appearance.  However, the downside of this is that it can result in loose and sagging skin.  This also often occurs after pregnancy.  If a woman has carried a number of children, more often than not she will find the skin in certain parts of her body is no longer as tight as it once was.  It is therefore not surprising that an increasing number of women are undergoing cosmetic procedures to improve the appearance.

The areas of the body that are most frequently subject to loose skin are the inner thighs, the arms and the abdomen.  In the past, anyone who wanted to correct these problem areas usually faced complex surgery.

In recent times, surgeons have started using non-invasive rejuvenation techniques on these three problem areas on the body.  Over a period of around three months, the patient is treated with different modalities tailored to what their circumstances are   e.g.  when patients come to see the surgeon, she may present with a combination of little extra fat as well as loose skin and stretch marks. In this case the practitioner would concentrate on reducing the fat volume and would then try to tighten and shrink the skin. This is done by stimulating the formation of certain components within the skin such as collagen and elastine that will cause a process of contraction and retraction.  A number of key treatments are being used when putting together an individual program including mesotherapy and Laser therapy and because each program varies so greatly, results will differ.  In some cases, liposculpture is also performed.  The treatment program usually takes around three months, however some patients may find the result only final after six months.  If there is only a little bit of loose skin to start with, the patient will usually see a big improvement early on. If there is a lot of loose skin, they can still achieve a very good result but it will be more difficult to achieve and will take more time.  

That is why it is so important to diagnose the problem properly and concentrate on administering the right series of treatments for each individual patient.  Patients are encouraged to make general life style changes usually related to diet and exercise to achieve optimal results.  A maintenance treatment is usually required every six months to a year.  With practitioners reporting up to 80% improvement in skin tightness after a 3-month program it is no wonder that an increasing number of patients are turning to non surgical techniques to return elasticity of the skin of their body to what it once was.


My Tummy Tuck & Liposuction took 10 years off me (the story)

Post pregnancy... Mini tummy tuck or a complete Tummy tuck? Most women expect their stomachs to zip back into shape after their baby is born. Unfortunately, this rarely happens on its own - no matter what top models and Hollywood stars say! Invariably your skin will remain a bit stretched and slack. On one end of the spectrum, exercise will help a lot to tone your abdominal muscles and if all else fails, there's always the option of a mini tummy tuck for that stubborn slack, flabby skin.


Before                After

Surgery, specifically a tummy tuck (abdominoplasty) will invariably remove stretch marks below your navel and along the sides of your stomach. However, that tummy tuck surgery is specifically aimed at removing flabby skin that will not respond to exercise and diet, points out Johannesburg plastic surgery, Vive Clinic. The removal of stretch marks is more of an added benefit than a reason to undergo abdominoplasty in the first place.

Depending on the extent of the excess skin and fat to be removed, your surgeon may opt for either a “complete abdominoplasty” or a “mini abdominoplasty”.

The complete tummy tuck

The complete tummy tuck (abdominoplasty) is designed to tighten the abdominal muscles and remove excess skin and fat.

Complete abdominoplasty will require general anaesthetic and you will need to stay over night in hospital after the surgery. With a complete abdominoplasty, you'll probably be back at work within seven to 10 days, although you'll need to avoid anything too strenuous for at least four to six weeks and a tummy tuck means you won't be able to pick your baby up for a while.


Before                 After

It’s also not painless...expect to be sore and bruised for a while after the op.

It is possible to perform an abdominoplasty at the same time as another intra-abdominal procedure, such as a tubal ligation (induce women's infertility) says Vive Clinic, although he prefers not to. He also advises against combining an abdominoplasty with a Caesarean-section.

A mini abdominoplasty (skin tightening only) can be performed under a local anaesthetic and once you're fully awake you'll usually be able to go home, although you will probably need to return to the hospital the following morning for a check-up.

The mini tummy tuck requires a shorter recovery time and is most suitable for women who are back to their goal weight, who suffer from lax skin only, while their muscles are still toned and firm.


Top tips for sculpted tumies and thighs

Overall body fat contributes to how lean your thighs are.

The body’s fat compartment is one system. Doing leg exercises actually burns five times more body fat than doing sit-ups. Exercising the whole body is the way to burn fat

off your thighs and working the thigh muscles twice a week is plenty. Muscles become stronger and firmer through the process of adaptation. When you stress the muscle, it will need time to recover, but will emerge stronger.

If all else fails, opt for liposculpture!

Despite following a sensible diet and exercise program, many people still feel selfconscious about parts of their body where certain fatty areas simply refuse to shift. Both men and women within their healthy height-to-weight ratio fit into this category, but whose problem is that they have bulges of fat that are disproportionate to their figure, which they find unattractive. Liposculpture is all about shape, so a precision sculpture technique is required, where the emphasis is on creating slender contours in generally attractive physiques. Liposculpture in these cases highlights the athletic, shapely nature of the figure.

Often people don’t realise how dangerous it is for your posture to carry excess weight.

Obese people tend to change their posture in order to adjust to their over shifting body balance. They tend to curve their back,

sometimes creating a dangerous body imbalance. Excess weight creates more pressure on the spine and the feet, which in

turn causes changes in body posture. This in turn could eventually cause permanent damage to the skeleton. A significant amount of weight loss has to take place prior to liposuction in the case of extremely overweight candidates.

Slim down as much as you can prior to opting for liposuction

“I’ve gone from a size 20 to a size 16 before my liposuction surgery” says Elena*. “I planned to have liposuction at the end of the year and decided to lose as much as I could until the surgery.” Losing weight prior to liposuction surgery is crucial. Not only do you prove to yourself and your surgeon that you are committed to changing your body shape, but it also puts you in the right frame of mind before and after the surgery. In fact, losing even a small amount of weight could be crucial for your safety during liposuction surgery. A responsible surgeon will not agree to perform liposuction on extremely overweight patients.

People with realistic expectations of liposuction surgery are usually very pleased with the results and often they not only look better in their clothes but also feel more confident and at ease with their bodies.


Breast Implants - FAQ - Answered by prominent Johannesburg plastic surgeons


What is the recovery time after breast augmentation?


The operation can be done on a day basis or overnight stay. Discomfort is related to the ositioning of the implant. Position under the muscle is more likely to be associated with

more discomfort in the early post-operative period. Most women can resume light activities within two to four days, driving within the first week, light sporting activities in the second week and full activities within three to four weeks.


Can one lose nipple sensation?


There can be changes in nipple sensation after breast implant surgery. Sensation in the nipple and the breast can increase or decrease. The range of changes varies from no sensation to intense sensation and this is temporary in most cases.


Is breast feeding possible after breast augmentation?


Breast augmentation is usually not associated with ability to breast feed. The axillary approach (inserting the implants under the armpit) and the under-the-breast approach do not violate the breast at all and therefore the risk of not being able to breast feed is minimal.


Can silicone breast implants affect the quality of milk while breast feeding?


No evidence has been found for any connection between having silicone implants and interference with milk quality.


Can you sleep on your side after having implants?


Immediately after the procedure, while sleeping on the side, the new implants can rotate and become slightly distorted. Your doctor will probably encourage you to sleep on the back for at least six weeks until the breast implants settle in their correct place.


Can implants drop after a few years?


In the immediate period after surgery, the muscles are tight and they press on the implants, sometimes causing them to feel firm. It generally takes a month to six weeks for the swelling to subside and three to six months for the muscles to relax and stretch out, allowing the implants to come forward and drop into place. Thereafter, the natural process of breast sagging occurs, same as for any woman


How do breast implants affect mammography?


Breast implants may make mammography and detection of breast cancer more difficult. It is possible however, to obtain additional views during mammography so that detection of breast cancer may be facilitated. Any woman who has breast implants should notify the mammography technologist that she has implants, before the procedure.

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