Michael L. Kreidstein, M.D.
Eight days ago I had saline implants removed, replaced with silicone under the muscle, and a breast lift. After the saline implant surgery I developed a hardening in my left breast. The doctor removed all scar tissue in the breast, but it is still very swollen. He said there is a blood clot in that breast. He told me I could either have it surgically removed or take Singulair for a few months and it will dissolve by itself. What is your opinion?
Singulair has been used to prevent capsular contracture (excessive scarring around breast implants. A small surgical hematoma can be allowed to dissolve and be absorbed, but if it is large, it must be removed to prevent healing problems. The hematoma may predispose you to capsular contracture, and as you already have a history of capsular contracture the use of Singulair is consistent with the goal of preventing a recurrence of the capsular contracture.
Should I reschedule Liposuction and Tummy Tuck surgery scheduled for next week as I've regained 20 pounds of the 105 lost?
I'm to have liposuction and tummy tuck surgery at the same time next week. I had lost a total of 105 pounds; however, since seeing my surgeon three months ago I have gained 20 pounds which makes me now 30 pounds from my idea weight. Should I reschedule the surgery and lose the weight again or doesn't it make a difference because both procedures are going to be done?
The issue of weight variation and surgery comes up often. Weight loss before surgery (more than 10% of your body weight a month) can be a problem, as you may be malnourished and thus prone to surgical complications. Excisional surgery (e.g. tummy tuck) is best done when you are at a stable weight that is at the low end of your range. It would be a problem if you lost substantial weight after a tummy tuck as this may result in you re-developing loose skin, but as you are fairly close to your ideal body weight this is unlikely. Liposuction can be done at any weight and is generally more accurate at a higher weight (bigger target tissue!). That said, the decision to have liposuction is best made when you are at your ideal weight. Your plastic surgeon will consider your personal circumstances and health to help you confirm that surgery next week is appropriate. Good luck!
Should surgeons interfere when a patient goes too far with cosmetic surgery?
This question is more complex than it appears. Obviously, a surgeon should decline to offer surgery if it won't help the patient. Interfere suggests a more active role for the surgeon, and it is an unfortunate fact that the patient I turn down can go down the street and potentially book with another surgeon, and it is not my right or responsibility to interfere in this process. The definition of too far is not always obvious, with a wide spectrum of opinions - some would consider any cosmetic surgery too far!
M. L. Kreidstein, MD