DR. Salzhauer: Last week, for those of you who were listening last week, you know that we were joined by a guest who is back in the studio with us today who is about to undergo body surgery and breast reduction, and breast lift. Her name is Ariani and she is in the studio with us today, and she is going to talk with us about her motivations for the surgery. Without further ado, let's get on with our first guest, Ariani.

Jeannine: Good morning, Ariani.

Ariani: Good morning.

DR. Salzhauer: Good morning. Ariani is a doctor from the Dominican Republic and a soon to be patient of our practice here. She has large breasts, right?

Ariani: Yes, I do.

DR. Salzhauer: What cup size do you wear?

Ariani: I'm currently a 38 DD.

DR. Salzhauer: 38 DD.

Ariani: I think I'm in denial. Maybe I'm a triple D, but refuse to go up.

Jeannine: I think so.

DR. Salzhauer: Talk about these things. I see this every day in the practice, the things that bother you about having large breasts. I know I've examined you so I know you have shoulder grooving from the braw straps, a lot of them get back and neck pain. Tell me about that.

Ariani: It's been really hard. I grew my breasts — well, grew — when I was 13 years old. It's very difficult. I'm also having either a tummy tuck, or lipo. Or both. We haven't decided yet, with my breast surgery. I've lost weight, and no matter how much weight, I lose, I go up and down, they don't go down. So it's very, very difficult. I have problems. I can't wear button down shirts, they always pop in the front. I have difficulty finding nice bras. We all know how important a nice braw is, very much so. I always look top heavy, like I'm about to fall over. I have a lot of neck pain, I get head aches, back aches, it's just very difficult. And I don't like going out, I don't like being seen this way. And I want to look my best.

DR. Salzhauer: Right. And what about the beach and that sort of thing?

Ariani: I don't really frequent the beach. I've lived in Florida a year and a half and I have yet to go.

Jeannine: I didn't know that.

DR. Salzhauer: Well, God willing when the surgery's over you'll be at the beach every weekend.

Ariani: Yes, we will publish a photo of myself in a bathing suit at the beach on the web site.

Jeannine: All right!

DR. Salzhauer: You know, one of the things that's most gratifying for me as a surgeon is the breast reduction surgery. Because first of all, the results are immediate. I mean even in the recovery room patients feel better, their balance is changed, they feel like a weight is lifted off their chest and they can sit up properly. The procedure itself is really not that painful; mostly because we don't deal with any movement of bones or muscles around. We're just taking some of the fat tissue and skin and fat tissue off the breast. I know that some people don't undergo the procedure for fear of pain, but really in our practice breast reduction is one of the least painful procedures that we do. Certainly less painful than liposuction or tummy tucks, and the like. So put that fear out of your mind. It's not that painful a procedure.

Preoperatively speaking, you need to obviously be in good health, which you are, Ariani? Right?

Ariani: Yes.

DR. Salzhauer: And of course if you have any history of breast cancer in your family that needs to be checked out first with a mammogram just to make sure everything's okay, because if we are going to operate on your breasts, you want to make sure they're 100% healthy at the time of surgery. I'll give you some tips for good outcomes like medications to avoid. Aspirin is a big nono. Many people don't know that Excedrin for head aches also has aspirin in it. And that will lead to excessive bleeding during the surgery. So avoid that. Obviously you should have good nutrition, like always, and of course no smoking. Smoking is a big no no with plastic surgery. You need to quit at least a month before and a month after. Ariani, you're not a smoker, right?

Ariani: No, sir.

DR. Salzhauer: Okay. I don't expect that to be a problem at all.

Ariani: So pretty much stick to Tylenol and I have no problems.

DR. Salzhauer: Pretty much stick to Tylenol and you won't have a problem.

Ariani, you're a DR, right?

Ariani: Yes, I am. I graduated from medical school in the Dominican Republic.

DR. Salzhauer: And I know a little bit about your background. I know you worked in New York at a dermatologist's office, and I know you have plenty of opportunity to do this procedure in the past. Tell us why you waited?

Ariani: I was scared. I was scared for myself, I was scared about my scars, I was scared about my outcome. I know a lot of great doctors and most of the fears are irrational, just like most fears are.

DR. Salzhauer: Well, let me talk about the scars a little bit, because it is important for anybody who's considering a breast reduction to think about. The scars for most breast reduction go around the areola, that's the darker part of the nipple, and down the middle of the breast, shaped like a lollipop. That's most cases. Now some cases, with exceedingly large breasts –

Ariani: Like me.

DR. Salzhauer: … the nipple has fallen a lot, we have to take out more skin. And so the scar that we need to use goes around the areola, down, and then underneath the breast, shaped like an anchor. It's called an anchor scar, or an inverted T incision. And the scars generally fade with time. Now all scars get worst for the first 3 months after surgery or after any injury at all. They get more red, more raised and thick. And then at 3 months your body turns off that scarring process, and the scars begin to fade and flatten. By one year, most scars are very, very pale and very flat. The only exceptions to that are the patients who have *Keloids*. And we actually have an email question related to that that we got during the week, and we'll get to later. So Ariani, tell me about your tummy.

Ariani: My tummy is large. We're working to make it smaller. I am trying to also weight now for my breast surgery and also for the rest, to see what my options are. Maybe you will be able to only do lipo.

DR. Salzhauer: Well, you know, there's — let me just explain for our listeners. There's a difference between a tummy tuck and liposuction.

A tummy tuck involves an incision where we actually cut away the skin and fat in one block from the lower part of the abdominal tummy wall. Obviously the benefit of that is you get rid of any loose skin, any stretch marks from the lower abdominal area. And of course you get rid of a lot of fat. Now liposuction on the other hand uses tiny little incisions, to just remove the fat through metal canulas. A canula is like a tube with a hole on the end of it. And its hooked up to a vacuum suction machine that aspirates, or pulls out all the fat. Now in some cases the skin has enough elasticity, it's tight enough that after the fat's gone the skin contracts and everything looks great. In some cases — and usually the skin becomes less elastic after the age of 35 or so — you take out the fat with liposuction, and the skin remains a little bit flaccid and it hangs over and sometimes, liposuction can actually make a tummy look worse if the skin does not have enough elasticity to make it snap back. So depending on your needs, either liposuction or a tummy tuck might be right for you.

Now, liposuction is best reserved for those patients who are near their ideal weight. You've looked it up online and you've put in your height and your weight and you'll see how close you are to your ideal body weight. But they just have certain pockets of fat — like the lower belly usually in men, the love handles in men, the hips and thighs in women, love handles in women — those are areas that are resistant to diet and exercise. No matter how much you go to the gym, no matter how many diets you're on, those areas just don't seem to go away. Those are the best candidates for liposuction, small pockets that fine tune your body to the shape you want.

A tummy tuck is reserved for patients who have a larger amount of fat and a lot of loose skin. And typically that happens again in either older women, or women who have had babies. Again, another advantage to the tummy tuck is you can lift up the skin and tighten the muscles underneath to make the tummy as flat as possible. So basically those are the differences between a tummy tuck and liposuction, and Ariani, we'll go through those in the office again and figure out which is best for you.

You mentioned that you were starting to diet and exercise, etc, and I've found that a lot of my patients use a procedure such as a tummy tuck or liposuction to jumpstart their weight loss and exercise regimen. You know, it's a little bit depressing and you are overweight and you go to the gym, and especially those first 10 pounds, they don't seem to come off very easily. You're at the gym, you don't like to be seen at the gym to begin with, many times, you're on the tread mill, you're out of shape, and you don't see results quickly, and so after 3 or 4 weeks you just want to give up. So what I've seen in my practice is women come in, they have the tummy tuck or the liposuction, it doesn't get them into the perfect shape that they want, but it gets them into much, much better shape and good enough to go to the gym and feel confident, and to continue their diet and exercise program. So I anticipate that that's what itâs going to do for Ariani. So what do you feel about that?

Ariani: That that sounds like a plan.

Jeannine: I think she's going to do very well. Actually, I was very surprised when I first met Ariani because in clothes she didn't look as big as she really is, because she wears something almost to tie herself down. And I felt so bad when I saw it, because she really is going to have a good good result. Because she really does have much bigger breasts than she appears to have in clothes.

Ariani: That's a throwback from teenage years, when you minimize them and make them look as small as possible and try not to draw attention to yourself. Now that I'm a little older, I don't mind drawing attention to them. They look great in a bra –

Jeannine: That was exactly my point.

DR. Salzhauer: We're going to make them look great out of a bra. Another question that comes out of a breast reduction is: Is the sensation of the nipples going to change? And nipple sensation for a woman varies tremendously. Some women don't give a hoot about nipple sensation. In fact, some women don't even like to have their breasts touched at all.

Jeannine: Hey, I just want to look great.

DR. Salzhauer: Right. Other women, nipple sensation is a critical component of their sexual life. So in most cases, after breast reduction, you do preserve — the techniques that we use do preserve — the nerve supply to the nipple; usually by 6 months after surgery the sensation is about where it was before the surgery. In some cases, you can lose sensation. It's rare to lose sensation in both nipples, usually it's one or the other, and usually it's just a decrease in sensation and not a complete loss of the sensation of the nipples. And in other cases I've seen, there's an increase in sensation for some reason after the surgery. Either the nerves grow back stronger, or establish connections that weren't there beforehand. So nipple sensation is one of those things that it can be important for many women, and exactly how you're going to end up is hard to predict beforehand. It needs to be considered. You know, it's something patients need to know about beforehand. Ariani?

Ariani: Yes, Sir.

DR. Salzhauer: Listen. We are looking forward to your surgery, and I would love to have you back on the show with your permission after the surgery to talk about it. A few weeks ago we had Laura on the show who had her rhinoplasty, and her breast augmentation, and she came on the show two days after her surgery and did a great job for us. And she's going to be coming back in a couple of weeks to tell us how things are going. I know she looks fantastic and she'll be happy to share her thoughts and experiences with everybody.

Ariani: I'm very excited. As soon as I'm done, I'll jump from the rooftops and shout from the treetops.

Jeannine: Are you going to get an implant with that? The breast reduction?

Ariani: I don't know, Dr. Salzhauer. What do you recommend?

DR. Salzhauer: I don't think so. I think she's got enough of her own breast tissue to make a very nice, firmly shaped breast. And her breast tissue is not that soft, it's actually quite firm, so I think she's gonna be fine without an implant. Personally I don't like doing mastectomies — or breast reductions — and implants at the same time. I mean, think about it: you're doing two opposite things. You're making the breasts smaller and you're making them bigger at the same time in other areas. And those two things tend to conflict and tend to be somewhat unpredictable. And again, in her case, she has plenty of breast tissue and she's lived long enough with double or triple D breasts and could use a break on her back and shoulders.

Ariani: Double.

DR. Salzhauer: I definitely would not recommend [implants] in your particular case.

This entry was posted on Sunday, April 29th, 2007 at 11:00 am and is filed under Breast, Breast Reduction, Liposuction, Tummy Tuck. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.