Robert T. Buchanan, M.D.
I have mildly tuberous (more noticeable when I am thin) and moderately fibrous breast tissue. My dad's mom had a double mastectomy due to breast cancer and I have been told that I am more at risk because of the fibrous tissue and family history. What are the pros and cons of having breast augmentation surgery and placing implants to break up the fibrous tissue and correct the tuberous appearance? I don't have a lot of extra money but I have good insurance and my breasts are causing me pain.
There are several parts to your question. First, a breast augmentation will correct tuberous breasts and enlarge the breasts. If this is your goal, then proceed with the breast augmentation. It will not, however, break up the fibrous tissue other than that causing the tuberous breasts. You are at an increased risk of developing breast cancer because of your family history. However, the "fibrous tissue" has no bearing whatsoever on your risk. The only way to determine if you have any greater risk than your family history is with a biopsy of any unusual area, if you have such. Most of the things you could find do not increase your risk. A breast augmentation will not lower your risk, but it will not raise it either. It also does not change your ability to detect a breast cancer as long as you have diagnostic (not screening) mammograms after the breast augmentation. Breast augmentation will also not reduce your breast pain. In fact, it may make it worse. There are some ways to treat this, including a no caffeine diet and some medications. If the diet does not help, you could talk to your doctor about other options.
I am worried that the recommended amount of tissue to be removed during a reduction by my insurance company is too much.
I am worried that the amount of breast tissue to be removed recommended by my insurance company might be too much. They want 450 grams removed from each breast. I am a size DD now and that would put me to a size B cup (my breast tissue is more fibrous than fatty). How can I know that a B cup will look good on me? Will my breasts still look attractive once this is done? I am worried about scarring and about changing the structure of my breasts. It's not that they are unattractive but just too large. If I lose weight after the surgery (I have about 15 pounds to lose) will my breasts get even smaller?
Your insurance company does not recommend the amount of tissue that you should have removed in a Breast Reduction. They only say how much you need removed for them to pay for it. If you do not need or want as much removed as the insurance company requires, then the reduction is cosmetic. You can still have it to get to the size you desire, but you are responsible for the costs. Most of the Breast Reductions I now do fall into this category. You also have another problem, however, - that is the timing of your reduction. If you are going to lose more weight, you should wait on the breast reduction until you have lost the weight. A recent study done on breast reduction found that, although those women who had the breast reduction done before weight loss were generally happy with the result, most had concerns about the breasts after the weight loss. Those who waited until after weight loss were the happiest.
Is it OK to have twilight anesthesia instead of general anesthesia for a facelift and eyelid surgery?
Will twilight anesthesia be OK for a 4+ hour facelift, along with upper and lower eyelid surgery?
Twilight anesthesia does work for facelift and blepharoplasty. In fact, I used to do all mine this way. I have, however, found that general anesthesia works much better both for me and, especially, for the patient. I believe it is also much safer. If you are going to have twilight anesthesia, make sure the person doing it is a board certified anesthesiologist and that the procedure is done in a facility where general anesthesia is possible. Otherwise the person caring for you may not be able to care for an emergency and the facility may not be equipped to handle one.
R. T. Buchanan, MD
I am presently strongly considering having a breast lift without implants. I have no plans of being pregnant in the next few years, but do believe that in the next ten years I will have children. Is it possible and safe to have a breast lift redone after pregnancy, and is it likely that this would be necessary?
Since you are not considering pregnancy for a number of years, it is very reasonable to have a breast lift now. No one can say whether you will need it redone after pregnancy or not. If you do need breast lift revision after pregnancy, it is a safe and reasonable procedure when done properly with the knowledge of how the previous procedure was done. Therefore, go ahead and enjoy a new look now, but make sure you have the operative report afterwards in case you need it in the future.
Can facial abrasion scars be surgically treated and redone to produce a more positive healing outcome?
Our 16 year old daughter was involved in an ATV accident on 7/3/2011 whereby she received several facial abrasions from landing on the road. Her wounds have healed. However, the new skin healed over the dirt, tar, etc. which apparently was never cleaned out properly in the emergency room. She in the meanwhile has been covering these 'tattoos' with makeup. Can these facial abrasion scars be surgically treated to produce a positive healing effect and outcome? Where would I find a surgeon to undertake this surgery?
Traumatic tattoos can be treated several ways. The only way to know what is possible is by examination. Consult a Board Certified Plastic Surgeon who has experience in this type of procedure.