Breast reconstruction can be a very rewarding aspect of a plastic and reconstructive surgeons practice. It can also be one of the most challenging aspects of the practice. In a mastectomy, the blood supply to the skin and the blood supply to the nipple areola complex are removed. Then, the breast is reconstructed with a foreign silicone object, which is…
There are several occasions where patients come to our practice and they have previously undergone a mastectomy reconstruction, but would like to improve the appearance of their reconstruction. Common reasons for wanting to improve the appearance of their reconstruction is thin skin, with waviness and rippling of the implant, asymmetry of the reconstructed breast volume or position, and capsular contracture.…
When patients choose to undergo lumpectomy and when the cancer resides outside of the standard Wise mastopexy pattern, the pattern is sometimes adjusted to remove the skin above the tumor. This will help the oncologic surgeon remove the skin above the tumor and help to clear the anterior margin. When the incisions are sutured closed the final suture placed is…
Nasal airway obstruction is a common problem affecting many people including many athletes. When inspired air rates are maximal during sports airway obstruction can become a challenging and cumbersome problem for the patient. The nasal septum when it is deviated inferiorly can cause obstruction of the external nasal valve. Often on rapid inspiration the decreased airway causes collapse of the…
There are many times after trauma to the nose or after rhinoplasty procedures when the nasal cartilage framework loses support. When the loss of cartilage support occurs in the lower lateral cartilage, then the external nasal valve does not have adequate support on nasal inspiration. When the patient inspires forcefully or rapidly, the lower lateral cartilage collapses toward the septum…
Secondary breast augmentation procedures are common. A secondary breast augmentation procedure commonly occurs when patients have had there breast implants in place for greater than 10 years. Both saline and silicone gel implants are surrounded by a silicone elastomer shell. Over time, with repeated folding, the shell can break. If a patient has saline implants, a break in the shell…
Breast reconstruction is a common procedure in the United States and more specifically in Newport Beach, California. Often patients may have undergone a bilateral mastectomy with implant reconstruction. At the time of the mastectomy, the nipple areola complex may have been removed and the breast reconstructed with tissue expanders and then subsequently the placement of bilateral mammary prosthesis. When the…
Tissue expander and implant reconstruction can be accomplished at a later stage following mastectomy surgery. When the mastectomy reconstruction is performed at a later time, the term used is a “delayed reconstruction”. During a delayed reconstruction, the mastectomy defect is re-created and often a tissue expander is placed beneath the skin and or pectoralis major muscle. The skin is then…
DIEP flaps are excellent options for breast reconstruction in patients who have undergone radiation therapy. Often the skin above the tumor needs to be resected during a mastectomy and an oncoplastic mastectomy is completed to facilitate clearing an anterior margin. When tissue expanders are placed and then radiated, the tissue expander can be affected by capsular contracture forces around the…
Patients who have breast cancer may be a candidate for lumpectomy and intra-operative radiation therapy. The intra-operative radiation therapy is completed at the time of the lumpectomy and the lumpectomy defect is closed. The aesthetic outcome following this type of oncologic resection and reconstruction can have a great outcome.
