Plastic Surgery FAQ

Since 1986, Charleston plastic surgeon Dr. Terranova has given patients the answers they need to make informed decisions concerning plastic surgery. Here are some of the most frequently asked questions and the doctor’s responses.

Abdominoplasty

What is an abdominoplasty?

An abdominoplasty (commonly called a tummy tuck) removes excess skin and fat, as well as restores weakened or separated muscles in the abdomen – common characteristics following pregnancy or significant weight loss. Sometimes liposuction is used to refine the result or to address problems that coexist in the flank areas.

Where are the scars?

The incision runs along the top of the mons pubis and angles up to the hip points. We try to design it so that it will be covered by panties and bathing suit bottoms. It is a long incision but the length is necessary because of the large amount of redundant skin that is usually removed with this procedure.

How long does the operation take?

An abdominoplasty usually takes 2 1/2 to 3 1/2 hours depending upon the size of the patient. More time will be needed if liposuction of the flanks is being performed. That will usually add another 1 1/2 to 2 hours.

If I become pregnant following abdominoplasty what will happen?

The pregnancy will proceed normally. However, in all likelihood, all of the aesthetic improvements will be undone.

How much swelling will there be and how long before it resolves?

There is significant swelling after surgery. This is particularly true of the area immediately above the incision line. Swelling is usually maximal after about 48 hours. It will resolve slowly, but most will be gone in a couple of months. The area immediately above the incision line may not reach its final level of flatness for some 6-9 months.

How much pain will I be in after abdominoplasty?

The tightening of the muscles does cause discomfort. Patients are unable to walk fully erect or lie flat for some days following surgery. Discomfort is greater when moving around, so sitting or reclining quietly, lessens pain. Oral narcotics and muscle relaxers will make the pain tolerable. All that said, I have never had a patient tell me she would not do it again.

How long will I be out of work?

That depends on the work. Sedentary occupations usually require a week or two of recovery. More demanding occupations will require longer.

How long before I can tan?

It is recommended that you avoid sun exposure while any bruising remains. It is also recommended that the scar be protected from any sun exposure while it still remains red or pink (usually 6-9 months).

When can I shower?

We usually recommend waiting for the first shower until the second postoperative day. Sooner than that and we find that it is simply too uncomfortable, which risks dizziness and fainting.

I have read that abdominal tissue can be used to reconstruct the breast after mastectomy. If I were to get breast cancer and require a mastectomy, would I still be able to use abdominal tissue for reconstruction?

The blood supply to the abdominal wall skin and fat is altered following abdominoplasty such that this tissue can no longer be used in breast reconstruction. Fortunately, there are many other options available, including other areas of your own body tissues which can be used.

What kind of anesthesia will I have?

Our anesthesiologist will give you medication through an IV. Once you are asleep, we will inject local anesthesia into the surgical areas. There is no breathing tube or ventilator and you will not feel or hear anything during the procedure.

Where will the operation be performed?

The surgery is performed in our office operating suite. It is fully accredited by the American Association for Accreditation of Ambulatory Surgery Facilities.

Please read our page Questions about Tummy Tuck for more information on this subject.

Breast Enhancement

How long do I have to wear a sports bra after surgery?

Usually 1-2 weeks. Longer if the incision is in the crease as an underwire bra will be painful for a few weeks.

How long do I have to wait after breast-feeding to have surgery?

We recommend 4-6 weeks.

Do I have to replace my implants every 10 years as reported on the Internet?

No. Implants with no problems need not be replaced.

Where will the operation be performed?

The surgery is performed in our office operating suite. It is fully accredited by the American Association for Accreditation of Ambulatory Surgery Facilities.

Do implants cause problems with mammograms and the detection of breast cancer?

First, implants do not cause breast cancer. Breast cancer can be detected in women with breast implants in the same way and at similar stages as in women without breast implants. However, special views must be obtained. Mammogram technicians will do this routinely when told that the patient has implants.

Are all breast implants put under the muscle?

I place the vast majority of breast implants under the muscle. I feel that such placement gives you the highest likelihood of obtaining a natural-appearing result. Also sub-muscular placement is better for mammograms. However, there are some preoperative problems (e.g. severe tuberous deformity) and some patient occupations (e.g. bodybuilding, masseuse, etc.) which are better dealt with by sub-glandular placement.

What is the approximate cost of breast augmentation?

Approximately $4,200-5,000. The silicone implant is more expensive than the saline implant. This includes the surgeon’s fee, the anesthesia fee, and the operating room fee.

What incision sites are available?

There are four sites available (peri-areolar, inframammary crease, axillary, and umbilical). In our practice we use the peri-areolar (around the edges of the areola) or inframammary crease (underneath the breast) approaches exclusively.

Do you recommend postoperative massage?

It is not clear whether massage is necessary to keep the implants soft when the implants are placed under the muscle. However, it certainly does not hurt and therefore we recommend it. We start at the first postoperative visit (making allowances for pain and tenderness, of course) and we recommend continuing it for one year.

Does breast implant surgery affect nipple sensation?

Nipple sensation can be affected by placement of the implant. This has nothing to do with the location of the incision. It has to do with the fact that the nerves that provide sensation to the nipple are necessarily stretched in creation of the implant pocket. In most cases there is no long-lasting effect. However, in a few cases there can be some permanent loss of sensation.

How much work will I miss?

Most of our patients are feeling reasonably well on the second or third postoperative day and are back to work (assuming that this work does not require heavy use of the arms) in 5-6 days.

How long does breast augmentation surgery take?

Usually about one hour.

Can I tan after surgery?

Sun exposure while there is still bruising is definitely not recommended as it can lead to permanent pigment changes in the skin. The same is true of the scar from the incision site. As long as the scar remains red or pink (usually 3-6 months), sun exposure is not recommended for the same reasons. However, the use of sunblock on the scar will allow you to go to the beach.

What kind of anesthesia will I have?

Our anesthesiologist will give you medication through an IV. Once you are asleep, we will inject local anesthesia into the surgical areas. There is no breathing tube or ventilator and you will not feel or hear anything during the procedure.

When can I shower following surgery?

We recommend that you wait until the second postoperative day for your first shower.

When can I drive following surgery?

Most patients will no longer require prescription pain medication during the daytime by the second or third postoperative day and usually feel strong enough to drive by the third or fourth postoperative day.

How much pain will I have after surgery?

During surgery, we will inject both short-acting and long-acting local anesthetic after you are asleep. This helps to limit the amount of medication that the anesthesiologist is required to use. It also provides a 3-4 hour window postoperatively where pain is minimal. When that local anesthesia does wear off, there will be a fair amount of discomfort related both to the surgical procedure itself and to muscle spasms if the implant is placed below the muscle. However, by that time, you will have taken one or two pain pills and the muscle relaxer, which will help significantly. Most of our patients feel reasonably well by the second or third day postoperatively taking Motrin or Aleve for daytime pain relief and require prescription medication only at night to help with sleep. Most of our patients are driving and back to work by the fifth or sixth day postoperatively.

What postoperative medications will I require?

We will prescribe a medication for pain relief, a muscle relaxer to help with muscle spasm, an antibiotic, medication to help with nausea if it occurs, and a medication to help reduce swelling and bruising.

How much swelling and bruising will I have?

There is swelling and bruising after any surgical procedure. How much, of course, varies with the individual patient. Swelling and bruising are usually maximal at about 48 hours after surgery. Bruising is usually gone in a week or so. The majority of the swelling is gone in 4-6 weeks.

What is the difference between saline and silicone implants?

Both are good implants in their own way. The saline implant comes deflated and can be placed through a relatively small incision. However, because it is filled with a fluid (saltwater) it can look and feel like a baggie full of water. The visual issues are particular problems in very thin women or women with very small breasts. The palpability issue is present in almost everyone. The new-style silicone implant is also a very good implant. Multiple scientific studies have been done which show that there is no link between silicone and any disease process. There are very few problems with visual rippling and the silicone implant, because it is filled with a gel, feels close to normal breast tissue. The silicone implant, however, comes pre-filled and therefore requires a somewhat larger incision for placement. The silicone implant is also twice as expensive as the saline implant. The surgical fee is the same for either implant.

Do you have a specific recommendation as to the choice of incision site?

I prefer the peri-areolar approach. From my perspective, there are three shortcomings of the inframammary crease incision. Firstly, the entire weight of the implant is directly on the inframammary crease incision. This leads to scar widening; so, the scar in the inframammary crease is more noticeable than a peri-areolar scar. It is my experience that the peri-areolar scars are often quite inconspicuous.
The second problem is in the creation of the inferior sweep of the implant pocket. If not done correctly, the inferior aspect of the breast can look either blunted on one side or the implant can actually sit too low (we call this “bottoming out”) making the nipple appear to be too high. It is easier to get this correct from the peri-areolar approach. Finally, I like the fact that the implant is a lot further away from the outside with the peri-areolar approach than the inframammary crease approach.

How do you know what size implant to use?

I will ask you how large you wish to be. Someone who wishes to be a medium B-cup has a very different picture in their head than someone who wants to be a small D-cup. Then we will perform a physical exam to determine whether or not your anatomy and specific tissue characteristics will allow for placement of the size implant that you desire. Not all patients can be as large as they would like. And, some patients actually are better off being a little larger than they initially desire in order to correct other underlying problems (such as excess skin and breast sagging following pregnancy). Finally we will ask you to try on various sized implants in a non-padded bra (which we will supply) so that you can tell us what is indeed optimal for you. This will give us a starting point. In the operating room, after we create an implant pocket, we will place a temporary implant into the pocket which we call a sizer. This sizer can be rapidly adjusted with air and we can quickly judge whether our starting point is perfect or something a little smaller or a little larger is perfect. We have all sizes of implants on hand, so we never have to worry about not having the appropriate size available.

If you have additional questions related to Breast Augmentation, please visit our page dedicated to Questions About Breast Augmentation.
For more information on Breast Implants, please visit our page on “When Should I Replace My Old Breast Implants?
What is Capulsar Contracture?

Breast Reduction

What is breast reduction surgery?

Breast reduction (reduction mammaplasty) is an operation that reduces the size of the breast and re-positions the breast higher on the chest wall. It is done to alleviate symptoms caused by overly large breasts (macromastia). Typically these symptoms are neck, shoulder, and upper back pain. Headaches are sometimes seen as well. The operation is performed under general anesthesia, usually takes 3-4 hours, and is done on an outpatient basis.

Will this surgery relieve my symptoms?

Women with overly large breasts (macromastia) often have a particular set of symptoms including neck, shoulder, and upper back pain. Sometimes headaches are also part of the picture. If no other causes of these symptoms exist (for example, there is no shoulder bursitis or cervical disc problem), then breast reduction surgery will significantly relieve the symptoms in almost all cases. Lower back pain can be caused by (or worsened by) macromastia, but the linkage is much less certain and breast reduction surgery may not alleviate the pain.

Where are the scars and what will they look like?

The incisions run around the areola, straight down from the bottom of the areola to the inframammary crease, with a horizontal incision of variable length in the crease itself. This is the typical “anchor” incision that is often talked about. Because the skin must be closed tightly in order to shape and support the breast properly, the scars are almost always initially quite noticeable. However, they will fade considerably with time. I have seen many breast reductions years later where the scars are quite acceptable.

Will my insurance cover this surgery?

Most insurance plans will cover breast reduction surgery if surgery is documented as medically necessary. However, most insurance plans have numerous and very specific criteria that have to be met in order for medical necessity to be shown. We review these criteria with every patient to determine the likelihood of insurance coverage.

Facelift

Where are the scars in a facelift?

Generally, the facelift incision runs along the margin of the temporal hairline (sideburn), in front of the ear, and around and behind the ear lobe. Depending upon the amount of excess skin in the neck, the incision may extend behind the ear and along the posterior hairline. Sometimes we add a short incision under the chin to tighten and smooth neck muscles.

What kind of anesthesia will I have?

Our anesthesiologist will give you medication through an IV. Once you are asleep, we will inject local anesthesia into the surgical areas. There is no breathing tube or ventilator and you will not feel or hear anything during the procedure.

Where will the operation be performed?

The surgery is performed in our office operating suite. It is fully accredited by the American Association for Accreditation of Ambulatory Surgery Facilities.

How long before I can go out in public?

Much of the swelling and bruising is resolved in about a week. Stitches are removed at that time and makeup can be used, allowing many patients to run errands and even return to work.

How painful is facelift surgery?

A facelift is not very painful. There is discomfort and most patients will take pain medication the first evening, but after that Tylenol or Motrin are generally sufficient.

Liposuction

Is liposuction used to treat obesity?

Liposuction is a contouring operation, not a solution for obesity. Liposuction removes fat from under the skin in selected areas. If enough areas are addressed, it may indeed appear as if the patient has lost weight, but in reality only a few pounds are removed.

Does liposuction improve cellulite?

No. Research has shown that when significant cellulite is present, liposuction either changes the problem very little or makes it slightly worse. Also, none of the technologies on the market which claim to cure or improve cellulite actually work.

Is liposuction permanent?

The result is permanent as long as the patient does not gain weight. Liposuction does not cause fat to go to the treated area in preference to other areas or to other areas in preference to the treated area. Basically, any area treated by liposuction will behave just as if nothing had been done.

What about swelling and bruising?

As with any surgical procedure, there is postoperative swelling and bruising. The amount of bruising varies from patient to patient. It is largely gone within 1-2 weeks. The amount of swelling varies with the aggressiveness of the procedure. The more fat removed, the more swelling one will see. In addition, there will be areas of lumpiness that will appear as the swelling starts to subside. These hard lumps will eventually disappear. It is usually a matter of 2-3 months before the ultimate result can be seen.

Can liposuction be performed under local anesthesia?

Small areas like the neck can sometimes be successfully performed using only local anesthesia. However, it is very difficult, and sometimes impossible, to get a proper result treating larger areas using only local anesthesia.

When can I expect to be fully active again?

Unless liposuction is very extensive, patients should be up and active within 1-2 days. Most of our patients miss little, if any, work.

How long does the procedure take?

It varies. Liposuction of the neck usually takes 30-45 minutes, liposuction of the trunk can take 4-5 hours depending upon the size of the patient.

Where are the incisions and how big are they?

We use the minimal number of incisions required to get the best result. Each incision is 4-5 mm long (less than one quarter of an inch) and when healed almost always looks simply like a small blemish. Therefore, it makes no sense to skimp on the incisions if that means an inferior contour. We try to hide the incisions in inconspicuous areas like the belly button or in the inguinal crease, but sometimes they must be exposed. An example would be the flanks.

What is tumescent liposuction?

Tumescent liposuction is the gold standard of liposuction techniques where the fat layer between the skin and the underlying muscle layers is infiltrated with saline containing lidocaine and epinephrine. The lidocaine allows the procedure to be done with less general anesthesia. The epinephrine is the most important part and allows the procedure to be done with minimal bleeding. This technique has enabled extensive liposuction to be done safely.

What is Smartlipo?

Smartlipo is a technique whereby liposuction is performed using the tumescent technique in standard fashion followed by use of a laser wand to heat the tissues. This is done in the hope of enhancing overlying skin retraction, particularly in older individuals whose skin has lost elasticity. However, numerous studies have shown no significant difference between standard tumescent technique and laser-assisted liposuction techniques when performed side-by-side in the same patient. As is usually the case, the result depends on the surgeon and not his tools!

What kind of anesthesia will I have?

Our anesthesiologist will give you medication through an IV. Once you are asleep, we will inject local anesthesia into the surgical areas. There is no breathing tube or ventilator and you will not feel or hear anything during the procedure.

Where will the operation be performed?

The surgery is performed in our office operating suite. It is fully accredited by the American Association for Accreditation of Ambulatory Surgery Facilities.

What areas of the body can be treated with Liposuction?

Mastopexy (Breast Lift)

What is a breast lift?

A breast lift is a procedure designed to correct sagging of the breasts. This is done by tightening the skin around the breast, thus tightening the breast shape and elevating the breast. Basically, the breast becomes more “perky”.

Will my insurance pay for a breast lift?

Correction of breast sag is considered an aesthetic issue and is not covered by insurance.

How painful is this surgery?

This surgery is not particularly painful. But you can expect some postsurgical pain in the first day or two. However, that rapidly changes to just soreness and most of our patients are back to work in a few days.

Will I need a breast implant?

That depends on a couple of issues. Some patients not only want the breast to be more perky, but want it to be larger as well. A mastopexy will actually make the breast a little smaller because the skin that is removed does contribute a small amount to the overall volume. So, if a patient desires a noticeably larger breast, an implant will be required. Secondly, although the breast will be much more perky following mastopexy, the upper pole may still not have enough fullness to satisfy some patients, requiring an implant.

Can an implant be placed (augmentation) at the same time as the mastopexy?

In most cases, yes.

How long will the improvements last?

That depends on a number of factors. The most important ones are the overall condition of the skin envelope and the weight of the breast itself. If the skin is youthful and has excellent elasticity and the remaining weight of the breast is light, the result will last much longer than if the opposite is true.

Can anything be done to prolong the result?

In some cases, it is helpful to make changes to the breast tissue itself. In women who are large to begin with and who do not mind being somewhat smaller, we can perform a small reduction of breast volume, in addition to the lift itself. If the breast volume is not significantly large, we can fixate the breast tissue to the chest wall with sutures. In patients who insist on remaining large, we can offer a two-stage approach whereby volume is significantly reduced at the first stage and then an implant (which will not sag over time) is placed at the second stage.
We will work very hard to preview for you the result that you can expect both immediately after surgery as well as months later.

Where are the scars?

The extent of the scarring depends on the severity of the sagging and the amount of skin that needs to be removed. At minimum, there is a circular incision around the areola. Then, if necessary, a vertical incision is added that extends either part way or all the way to the crease. Finally in breasts with significant sagging and excess skin, an additional horizontal incision must be added underneath. This last is the “anchor” incision that is so often talked about.

What will the scars look like?

At first the scars are likely to spread some because the skin must be closed tightly. And very often the scars become hypertrophic, meaning the scar is raised and often darker than the surrounding skin. Very noticeable initially, over time the scar will flatten and lose the extra pigment.

Will mastopexy interfere with cancer screening?

No. If anything, cancer screening may be improved. The more compact shape of the lifted breast may be more amenable to both mammography and self-examination.

What kind of anesthesia will I have?

Our anesthesiologist will give you medication through an IV. Once you are asleep, we will inject local anesthesia into the surgical areas. There is no breathing tube or ventilator and you will not feel or hear anything during the procedure.

Where will the operation be performed?

The surgery is performed in our office operating suite. It is fully accredited by the American Association for Accreditation of Ambulatory Surgery Facilities.