To answer your questions...

Question #1:

>I read your post on the internet and am writing to ask a question of you. I had a MRM in October of '95, and a revision of it in March of this year (due to the mutilation done by the first surgeon) I now have a lump of fat going from under my arm and under my breast, if it were it there. Can liposuction remove this excess fat? It was after the drain was removed from the second operation that this mass appeared.

An Answer:

I'd see your doctor (surgeon) to make sure this may not be a recurrence. It might also be an area of scar tissue. Neither of these items would be terribly amenable to liposuction. It could also be fluid from the surgery which could be drained via needle. This one has many possibilities, so you'll really need to see a doctor for an examination.
With all this said, there can be fat left in a conspicuous position following mastectomy. Often with the breast removed patients notice a ridge of fatty tissue running from the edge of what used to be breast to the arm pit. This can be treated by liposuction often with an improvement in the contour.
Finally, I would take into account that a Modified Radical Mastectomy (MRM) is a cancer operation. The surgeons performing this operation are trying to keep the cancer from taking your life. Cosmesis is a separate issue left to a plastic surgeon who may be called upon to help with reconstruction of the breast. In this light, the term "mutilation" that you had associated with one of your operations may be a bit harsh.
Thanks for the question,
John Di Saia, M.D.

Question #2:

>Hello, my name is Clarita, This is my first time on the internet and I would like to know more about Breast Implants. I am thinking of getting surgery and I am not sure whether I should go with Silicone or Saline Solution Implants.
>
>Also, I would like to know the web site addresses of different implant manufacturers and/or suppliers, as I have to order them according to my doctor's instruction.
>
>Of particular interest is a French company known as "Amoena" which is the brand my Doctor has recommended and I would like to know how reliable they are.
>
>I live in Medellin Colombia, the city of eternal spring.

An Answer:

Interesting. In the United States, predominantly saline breast implants have been available after the silicone version was removed from the market in 1990. Silicone gel was just re-approved for augmentation last year in the US with restrictions. The allegations for which gel implants were removed have not been well supported by research, but local reactions and an increased contracture rate would make me lean toward saline implants still. The silicone implants do give a more natural feeling result (assuming you don't get a firm contracture). With regards to brands, I am not aware of the brand of which you speak.

In the United States, the implants are not ordered by the patient. The surgeon supplies them in the operating room. Some breast implant manufacturers have web sites. The only ones I have seen are those of Mentor and Allergan (Inamed was bough recently by Allergan).

Thanks for your question and good luck,John Di Saia, M.D.

Question #3:

>If you have a few minutes, I was hoping you could help me. I'm 34 years old and I've had "saddle bags" ever since I was a teenager. I used to be really athletic and in pretty good shape (I'm not so athletic anymore, or in especially great shape, but I'm in OK shape). Anyway, I've ALWAYS had problem thighs and have thought about liposuction for many, many years. However, I've seen those shows that show the terrible side of what happens to some women who have the surgery performed. I have also seen recent news reports about a newer, safer liposuction that is being performed. Would liposuction really get rid of my problem thighs, and also, approximately what could the cost be?>Thank you for your time. I look forward to hearing from you.

An Answer:

It is really impossible for me to answer your patient-specific question without seeing you. I would suggest you seek a consultation with a Plastic Surgeon to look at your problem areas and perhaps render an opinion. I don't know what "newer, safer" form of liposuction you are talking about. Take into account that what the television news programs consider "new" may not be new to surgeons. The producers of these shows often attempt to make what surgeons consider mundane into something "new and exciting" for the lay public....unfortunate but true.
Thanks for the question,
John Di Saia, M.D.

Question #4:

>Dr. :
Is there any procedure or treatment for dark circles under your eyes. I have had this problem all my life. Please advise.
>Thank you

An Answer:

You may want to try a bleaching cream and use sun screens to keep the problem in check. I know of no reliable surgical solutions to this problem.
Thanks for the question,
John Di Saia, M.D.

Question #5:

>Hi,>I am interested in breast augmentation as I have breast fed three children and have lost all breast fat. I have gone from a happy B to a very unhappy A. I am looking to enhance what I have to a large B. Would this seem feasible without looking like the skin has been stretched too far? (I really wouldn't want that "bubble" look on my chest) A question that hasn't been approached in your column.

An Answer:

Regarding "bubble chest," the good news is that after a few children, your chest skin has probably become more lax. It would be less likely for you to take on the appearance of tension that you describe. In fact, depending upon exactly how lax the skin has become, the question of the need for mastopexy or "Breast lift" comes into play. Make sure you discuss these items with your surgeon fully.
Thanks for the question,
John Di Saia, M.D.

Question #6:

>Could you please tell me how long it takes for the skin to heal after having liposuction under the chin? Also why does the tissue seem so hard where the lipo was preformed 10 days after the operation. In this instance it does not seem any smaller right now.
>
>Thanks in advance

An Answer:

This is a difficult question as it really depends upon how much work was done and your own healing tendency. Often with post-operative swelling, the change cannot be seen for a few weeks. The tissue may be firm due to swelling. You should be followed carefully by your doctor to be assured that things are as expected for your particular case.
Thanks for the question,
John Di Saia, M.D.

Question #7:

>I have read most everything on the web about this "uplifting" procedure. I have two questions: 1) I heard once about a lift procedure that was developed somewhere in Europe which involved incisions in the armpit, rather than on the breast itself. Have you heard of it? Do you have any information?

>(2) How do I know if I'm a candidate for the modified version which is just reducing the areola and surrounding area? >>Thank you for your help.

An Answer:

Mastopexy is literally re-positioning of the nipple-areolar complex with some re-development of the skin envelope of the breast. As such it seems quite logical that incisions upon the breast would be necessary. To answer your first question, I do not know of a method involving incisions in the armpit. The modified version using a circumareolar incision can be used when only mild preoperative breast ptosis (droop) is present. The patient should be advised however that this form of mastopexy results in a less than attractive wrinkling around the areola although this does fade with time. Of course, the traditional mastopexy involves several incisions and the potential for more severe scarring. Another method of mastopexy for very mild ptosis in patients seeking augmentation is to use a larger breast implant. There is naturally a limit here and a potential for a recurrence of the ptosis. Without seeing you, it is not possible for me to tell you where you lie along this series of options. A consultation with a qualified plastic surgeon would help.
Thanks for the question,
John Di Saia, M.D.

Question #8:

>Good Morning Doctor!!
>
>I would like to find out what risks, if any, are involved with receiving Breast Implants and having diabetes??? Would this cause my diabetes to become out of control, or would it be a safe thing.
>
>Please advise at your earliest convenience...
An Answer:

Relative to your diabetes, I am unaware of any specific risks. The risk that does come to mind is infection. Diabetics are more prone to infections than other people. With this said however, I know of no study that clinically showed this in the case of breast implants. We do not change our approach or keep such a patient on long term antibiotics, as no one has shown this to be necessary or efficacious.
With regards to specifically your diabetes, you may wish to ask your internist or endocrinologist if he or she knows any different.Thanks for the question,
John Di Saia, M.D.

Question #9:

>I just have one question and I would appreciate it if you could give me your best possible answer.
>How defined could liposuction of the chest and abdominals get. Is it at all possible for the doctor to get the specific spot defined enough so that the muscles show through the skin. Right now I am about 16% bodyfat.
>Thank you!

An Answer:

Liposuction is aimed at the deep layer of fat. There are superficial and deep layers in the abdomen more than the chest. A complication seen when suctioning too superficially is the formation of stretch marks. In addition, suctioning to excess can cause necrosis (death) of the overlying skin. Liposuction is designed to change contour. Radical changes tend to look obvious and lead to increased complications. With this said, it really depends upon exactly where the area of concern is and it's size. Often improvements can be made.
Thanks for the question,
John Di Saia, M.D.

Question #10:

>Please let me know how I can research a particular plastic surgeon.
>
>Robert

An Answer:

Surgeon credentialing is somewhat complicated. I have more adequately addressed this issue here.

Thanks for the question,John Di Saia, M.D.

Please note that this information (as well as that on all my pages) is offered freely to individuals considering cosmetic surgery. No rights are granted and it is not to be reprinted or copied without the author's prior written consent. Beware that although efforts have been made to assure accuracy, many of the issues discussed here are a matter of professional opinion. Consultation with a qualified Plastic Surgeon should be obtained to answer more detailed and potentially personal questions.