Schneider Centre for Plastic Surgery

The tummy tuck, otherwise known as an abdominoplasty, is a surgical technique used to improve the appearance of the abdomen or belly. Most abdominoplasties involve tightening the muscle wall to help flatten the abdomen and liposuction to contour the flanks and hips.

Aging, pregnancy, weight loss or weight gain, and environmental effects such as smoking will change the elasticity and laxity of the abdomen’s skin. The skin can loosen either in just the lower abdomen, it may loosen only in the upper abdomen, or it can loosen throughout the abdomen. Where the skin has become lax and the quantity of laxity, determines our surgical approach. Abdominoplasty incisions for skin laxity vary significantly.  In fact, we perform 5 differently located incisions based on the problem.

The endoscopic abdominoplasty uses the smallest incision, slightly shorter than a c-section scar and located in the same place.  The procedure is only used in patients who have no skin laxity. Through this incision, liposuction and muscle plication is performed.

The mini-abdominoplasty procedure uses an incision a little bit longer than a c-section scar and enables us to remove small amounts of laxity of the lower abdomen.

A full abdominoplasty scar also lies low in the torso’s natural skin creases but extends to the hips. It allows the surgeon to remove the skin from where a c-section scar would be located to above the umbilicus (belly button). This produces tightening of both the lower and upper abdominal skin.

A reverse abdominoplasty incision is located under the breasts. There are some patients who only have skin laxity in the upper portion of the abdomen. This incision is ideal for this patient.

Finally the last incision occasionally used is the vertical midline incision.  It may be used in patients who have had an extreme amount of weight loss and have significant laxity or in the rare patient who only has significant stretch marks located centrally around the umbilicus but these extend both above and below the belly button.

A variety of options exist depending upon the patients desires and how their abdomen has changed with time.

When patients come in for breast augmentation, one of the key things we try and learn from them is what shape they desire for their breasts. We like to categorize this as a breast that appears very natural, or a breast that appears very round.

Here is what we mean.  If you were to look straight on at the breast and draw it as a line drawing, you would draw a shape that looks like the letter U. Breasts of course vary in their shape and the U can be drawn as large U’s, small U’s, wide U’s and short U’s and long U’s. However the basic shape is a U.  The top open part of the U we call the upper pole of the breast and the curved bottom of part of the U we call the lower poll. The upper pole of the breast may have some fullness or it may be flat with the chest wall.  The bottom part of the U is where the breast is most full. 

When you look at the breast from the side a line can be drawn from the upper pole to the lower pole. This line is called the breast slope.  In a natural appearing breast, the slope is either straight or it might be concave with a curve like a ski slope.  In general, when a breast implant is placed, the plastic surgeon can either maintain a natural straight slope, though at a different angle, or a rounder projecting curve can be created in the upper pole of the slope. What the surgeon does to create the pocket for the implant and what type of implant is inserted, will determine this shape.

Breast implants have a flat base and a curved outer surface.  When the implants are laying on a flat surface, the amount of height that the outer curved surface has is called the implants projection. Round implants come in four basic types of projection or profile: low, moderate, high, and very high.  The different implant companies give their profiles different names, but for simplicities sake, we describe them as low profile, moderate profile, high profile or very high profile.

When the patient and implant are upright, the volume of the implant flows to the bottom of the implant. This makes the implant have a more teardrop appearance.  This varies somewhat with the different profiles.  Low profile implants tend to produce the most natural teardrop appearance.  Moderate profile implants can also produce a natural appearance with more projection to the breast.  High profile and very high profile implants produce less of a teardropped shape and more of a round shape with more fullness in the upper pole of the breast.

There are a few other considerations in determining breast shape. The first is implant position, and the second is “overfill”, a term used when using saline implants. When an implant is properly positioned, the greatest amount of projection (P’) in the implant should be centered behind the nipple.  If P’ is not centered behind the nipple, it can adversely affect the shape of the breast.  For example, if P’ is located above the nipple, it can actually create the appearance of the nipple pointing downwards.  If P’ is located too far towards the cleavage, it can make the nipple appear that it is pointing too far to the side.  It is very important that the implant and P’ be appropriately positioned in each breast or significant differences in the appearance of the breasts will result.

Each implant has advantages and disadvantages. First lets consider breakage. Patients are commonly under the impression that they need to change their implants every ten years. This is not true. If the implant is not broken, and the patient is happy with her breasts, there is no need to change the implant.

All implants, just like all mechanical devices known to man, will break. It is generally stated that saline implants have an average life span of ten-fifteen years. This means that some implants will last shorter than 10 years, some much longer than 10 years, and many will need to be replaced somewhere in that 10-15 year range.  When a saline implant breaks, either the valve malfunctions, or the shell tears, and the saline leaks out. The body safely absorbs the saline and the breast deflates. Silicone implants also break. The latest studies show a breakage rate of 8% at 10 years. Because the new cohesive gel silicone does not migrate like the old oil implants, a patient may not be aware that the shell has torn. Therefore, it is recommended that a patient have an MRI intermittently to check for implant rupture.

Now lets consider the most important aspect differentiating saline and silicone implants: performance. Implant performance is determined by look and feel. Some implants may have visible ripples. These become more prominent in patients with little breast tissue and in patients who are very thin. Silicone implants tend to have significantly less visible rippling than saline implants. Implants also come in several different profiles, meaning how much they project for a given base diameter. Different profiles produce different looks ranging from very natural to very round. Saline implants allow the surgeon to tailor the look slightly more than silicone implants because the surgeon can overfill the implant to a certain extent. This may be useful for a patient looking for a very round look.

Finally, the patient should consider feel. Silicone implants tend to feel much more natural than saline implants. Yet some patients actually want a firmer feel to their breasts so the advantage really lies in a patient’s desire.

Choosing the implant type is important prior to having your augmentation. Know what you are choosing and why.

Your consultation is the first step in making your decision to undergo a cosmetic procedure.   After you have done your initial research, be it online, through friends, etc., it is important to prepare a list of questions as well as expectations that you have for your  procedure to discuss with the Surgeon .
During the consultation, the Surgeon will go over your medical history,  possible risks associated with any given procedure, as well as answer any and all questions you may have.  He will also give you his opinion on what he feels is the most appropriate procedure(s) to reach your goals.

Next  you will  speak with the Cosmetic Surgery Coordinator who will go over financial details, scheduling requirements and show you some of the Surgeons before and after photographs. 

Your consultation is key because it gives you a chance to have your questions answered and the process for proceeding is explained .  It is imperative that you  feel safe, comfortable and have complete confidence in the Surgeon you choose.   Our goal is for you to have  the best possible results!

Please feel free to take your first step, by calling 239-277-9999 to schedule a COMPLIMENTARY consultation with Dr. Schneider!

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