The Question
One of the most frequently asked question types we get concerns revisions to previous cosmetic procedures. As an example, consider the focus of this week’s Ask Dr. Pane segment, presented by Atlantic Coast Aesthetics. The patient, from Orlando, writes, “I am 26 years old and had a baby four years ago. I exercise regularly but still have unsightly stretch marks and excess skin in my stomach area. I also wanted to know if I should have my breast augmentation revision since I think they’re too far apart. I am also not interested in having any more children.”
The patient provided photographs of the abdominal area, but not the breasts. Therefore, Dr. Pane’s considerations of the breast area are based on experience and speculation. For this case, an in-person clinical evaluation will be necessary to properly determine the optimal course of action. However, Dr. Pane is far more confident regarding the abdominal area, although again, photographs are a poor replacement for actual, in-person evaluation.
The Answer
Dr. Pane says this case really needs to be broken into two parts, so he’s going to consider each area individually.
Concerning the tummy tuck, Dr. Pane says the abdominal area actually looks very good based on the pictures. There is a bit of loose skin and some evidence of stretch marks, but this is really quite minimal by comparison with the “average” abdominoplasty patient. While the patient may derive some benefit from a tummy tuck procedure, in this case she will want to weigh the perceived benefit against the scarring the surgery will inevitably produce.
This brings us to the question of the breast augmentation revision.
In most cases, if the implants are performed properly, the breasts will fall a bit to the sides when the patient is lying on her back. This is normal for female anatomy, especially when larger breasts are concerned, either naturally or through augmentation through fat transfer or implants. Many people erroneously believe the breasts should remain in a more or less static position regardless of posture after augmentation, but if the augmentation was performed properly, this typically should not happen.
Over time, if the augmentation was based on implants, there is a possibility that the internal pocket may stretch out, especially if large implants were used. This is not unusual as the body adapts to the implants and works to accommodate them. Depending on the reason why the breasts are assuming their current attitude, adjusting and tightening the implant pocket may correct the issue. On the other side of the coin, if the breasts are resting in a more or less natural attitude, a breast lift or adjustment downward in implant size may be a better option.
One thing to remember about cosmetic surgery is that although the results are long-lasting, they may not always be permanent. Additionally, the objective in the hands of an experienced surgeon is always to produce the most natural-looking and -feeling result possible. This is going to vary somewhat depending upon the patient’s build, height, weight, BMI and other factors. Because of this, the patient’s expectations may not align perfectly with the final outcome. It is crucial that patients understand while it is possible to give a ballpark projection and prognosis, it is not always feasible to accurately predict everything the body may do as it ages and changes due to gravity, environmental and habitual factors and simple time progression.
Another factor to keep in mind is that it is difficult to evaluate patients’ conditions and concerns from photographs. While these can be useful diagnostic tools for forming first impressions, they are not and should never be used as a substitute for hands-on evaluation in a clinical setting. This is because photographs are necessarily limited in the angles they show, what they conceal and do not offer the ability to actually touch or move the areas of concern. Therefore, any diagnosis or prognosis set from photographs is under ideal circumstances an educated guess, nothing more. The patient should consider arranging a clinical evaluation for a more accurate and personalized opinion.
If you have a question, concern or interest regarding any facet of cosmetic surgery, we at ACA welcome the opportunity to speak with you. Simply call us at (561) 422-4116; follow us on Instagram, Twitter and Facebook; or contact us through our website at https://acplasticsurg.com/contact. Your question may even be the topic of an upcoming Ask Dr. Pane segment, helping us educate and inform others while addressing your points of interest. Remember, at ACA we believe the only bad question is the one you don’t ask!