Abdominal wall reconstruction can be rewarding surgery for both the physician and the patient. Previous or multiple abdominal surgeries as well as radiation can effect wound healing on the abdominal wall following repair. Larger hernias can allow a significant portion of the small intestines and possibly the large intestine to herniate through the abdominal wall and into the underlying skin.…
Larger hernias of the abdominal wall require that the muscles of the abdominal wall be put back into their normal anatomic position. The muscles often affected by previous complex abdominal operations are the rectus abdominis, the external oblique, the internal oblique, and the transversus abdominis. These muscles can be affected by previous incisions such as subcostal incisions for hepatic, pancreatic,…
Hernias can occur commonly after major abdominal surgery. Following abdominal surgery such as liver resections, pancreatic resections, and resection of intestines patients may be protein malnourished and have difficulty healing wounds. Patients with large hernias often dislike the abdominal bulge and experience a feelin of fullness in their lower abdomen. Restoring the abdominal wall musculature back to its normal position…
Lower blepharoplasty procedures are common among young people. As we age, the orbicularis occuli muscle may become weak or deposits of fat accumulate in the compartment around the eye. As this happens the appearance of bags or fullness of the lower eyelids occur. Typically these patients benefit from removal of fat from the lower eyelid and/or tightening of the lower…
There are several common reasons that patients undergo rhinoplasty. Common reasons tend to be the creation of a nasal bridge, rotation of the nasal tip downward to hide the appearance of the nostrils, and definition of the nasal tip. The placement of either a temporalis fascia graft with diced cartilage or a silicone graft along the nasal dorsum can build…
Rhinoplasty is one of the more commonly performed procedures at our Newport Beach location. Two popular reasons people have for changing the shape of their nose is 1) to improve the tip definition and 2) to decrease the nasal projection. Together these changes can be additive so that two small changes to the nose can significantly improve the appearance of…
Patients who undergo lumpectomy may require radiation in addition to their surgical treatment. Some patients are candidates for radiation therapy at the time of lumpectomy. This is called intra-operative radiation therapy and can be conducted at the time of lumpectomy. On some occasions patients may have breast cancer or pre-cancer in both breasts and can undergo bilateral lumpectomy and oncoplastic…
Mastectomy reconstruction with implants is a viable option in the non-radiated patient. The outcomes are variable and often depend on implant selection, implant size, and quality of the skin post mastectomy. We are seeing an increase in the number of patients who wish to remain the same size following their mastectomy or to go slightly smaller. I learn from my…
There are several inherited genetic mutations that may make a person more susceptible to breast cancer. Commonly encountered genetic mutations such as BRCA1, BRCA2, PALB2, and CHEK2 are identified in patient with breast cancer and those with DCIS. Frequently, these patients may wish to undergo contralateral prophylactic mastectomy. Prophylactic mastectomy is the removal of a normal breast to prevent the…
Abdominal wall reconstruction procedures are common. Abdominal wall hernias can occur after abdominal procedures. The components of the abdominal wall can be separated and biologic mesh can be used as a load sharing principle to repair the hernia. Protein intake is important before surgery and after surgery to prevent seroma formation post-surgery. We instruct many of our patients to eat…
Oncoplastic reconstruction is the combination of oncologic surgery and plastic surgery. The same techniques that are used to improve the appearance of the breast can be used to allow access to remove tumors from the breast while improving the overall shape and appearance. The tumors of the breast can be localized with either…
There are several oncoplastic techniques that are used to reconstruct the breast following lumpectomy for breast cancer. These oncoplastic techniques can be utilized in conjunction with DIEP flap reconstruction for mastectomy in sequence. Patients can undergo lumpectomy for breast cancer with oncoplastic reconstruction. The staging of the lumpectomy and oncoplastic reconstruction can place a ptotic nipple areola complex in a…
