Bolitho MD

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9834 Genesee Ave Ste 311 La Jolla San Diego, California
Phone: (858) 458-5100

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13Jan, 2017

Breast reduction recovery expectations

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Breast reduction recovery expectations

When women decide to undergo a breast reduction, more times than not, they have done their due diligence about the procedure. Even prior to their consultation with a board-certified plastic surgeon that specializes in breast surgery, they have put a great deal of consideration and thought into the procedure.

While this surgical decision is a personal one, women who choose to embark on this procedure do so for a variety of reasons. However, the one goal most agree upon is decreasing the size and weight of their naturally large size so they can achieve the following:

  • More balanced proportions
  • Lessen discomfort such as neck, shoulder, and back pain
  • Improve symmetry
  • Achieve aesthetic goals

A breast reduction surgery involves the removal of redundant skin, excess tissue, and fat. Also patient dependent is the repositioning of the nipple-areola complex to a more youthful position.

Typically done under general anesthesia, a breast reduction procedure is performed as an outpatient surgery. While most patients return home the very same day of their surgery, in some instances, it may be recommended for others to stay overnight at the hospital for extensive reductions or a medical condition that may need monitoring following surgery.

While patients will be mobile the same day of their surgery, it’s highly advised that they have assistance for the first 24 to 48 hours following their procedure. They may also need someone on hand to help them dress or assist them in caring for younger children for a few days.

Patients who have a desk job can expect to return to work in about a week whereas someone with more laborious responsibilities such as nursing may require a couple of weeks.

A breast reduction surgery is considered a common procedure, and patients are generally quite happy with their surgical outcome. It renews a person’s comfort level be it aesthetically or even physically.

Another postoperative guideline is to avoid heavy lifting which includes not taking on more than 10 pounds within the first couple of weeks. Aside from walking, most patients are required to wait four to six weeks before returning back to their normal exercise regimen. Between this time-frame, patients can gradually increase their activity levels. At six weeks following a breast reduction surgery, patients generally return back to their full and normal activities.

It’s important to stop a specific movement if there is any discomfort and relay this to your plastic surgeon. Following postoperative guidelines and having clear communication with a patient’s plastic surgeon is extremely advantageous.

While swelling generally decreases a couple weeks following surgery, it completely recedes in about two to three months. This is when a patient is able to visibly notice the final results of their procedure.

21Dec, 2016

Plastic surgeons recommend cessation of e-cigs prior to surgery

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Plastic surgeons recommend cessation of e-cigs prior to surgery

In a recent December publication of United Press International, Health Day News reported how two plastic surgeons stated in the Plastic and Reconstructive Surgery December issue how stopping the use of e-cigarettes prior to surgery was highly advised. The doctors highlighted in the piece included Dr. Alan Matarasso of Albert Einstein College of Medicine and Dr. Peter Taub of Mount Sinai Medical Center.

According to Health Day News, the doctors stated, “Based on our current best knowledge, it seems reasonable to advise plastic surgery candidates to cease e-cigarette use,” they said. The doctors continued, “Refraining from [e-cigarette] use four weeks before surgery is a prudent course of action, despite the fact that it has yet to be determined if the effects are similar to traditional cigarettes.”

While the health impacts of “nicotine vapor” continue to be researched, it appears the reason for this medical recommendation underscores patient care. The doctors referred to a study which revealed how stopping traditional smoking three to four weeks prior to a procedure could significantly decrease the risk of postoperative complications.

Blood flow and blood supply is essential following plastic surgery procedures, such as breast surgeries and abdominoplasties. Tissue healing following surgery requires this blood flow.

Erring on the side of caution, it’s believed that e-cigarette users should follow the same protocol as those who use traditional tobacco products. The reason behind this cautionary advice stems from the fact that the side effect of nicotine is best described as a vasoconstrictor.

According to the American College of Surgeons, traditional cigarette smoking does increase complications both during and following surgery. It’s their estimation that following the “no smoking rule” a few weeks prior and after surgery lessens the risk of wound healing by nearly half.

Many plastic surgeons also encompass the cessation of nicotine patches and gum in this medical protocol.

In addition to nicotine, carbon monoxide is also another concern.

While carbon monoxide withdraws oxygen away from the tissue area, as mentioned earlier, nicotine constricts blood vessels which deliver oxygen and nutrients to tissues. Again, this blood flow is vital to the healing process.

If the percentages in oxygen and nutrients drop during the recovery process, there is a risk factor following surgery in areas such as infection, increased chance of scarring, and additional complications.

While some plastic surgeons follow a smoking cessation of four weeks prior and after surgery, others have a more conservative approach of six weeks. A large gap of time is highly recommended and encouraged.

During a patient’s consultation with their plastic surgeon, it’s imperative to be candid regarding any smoking history. And this includes vaping. A surgeon’s top priority is the care of his/her patients and making certain, as a doctor-patient team moving forward, all can be done for an outstanding surgical outcome.

21Oct, 2016

Why a woman may seek a breast revision surgery

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Why a woman may seek a breast revision surgery

When a woman considers a breast augmentation surgery, it’s important that she is thoughtful about the decision. During her appointment with a board certified plastic surgeon, she can inquire about the procedure, the recovery and the outcome. Also at that time she can be candid in regards to why she wants this surgery and her expectations following it.

Excellent communication between plastic surgeons and their patients is imperative.

While a patient may have done their due diligence before undergoing their breast augmentation procedure, there are cases when she may very well consider a breast revision surgery based on either a desire or need. This can occur months or even years later.

These reasons may vary and include the following:

  • Challenges with breast asymmetry
  • Capsular contracture (scar tissue surrounding the implant has tightened)
  • Symmastia
  • Removing and replacing an implant(s) which has ruptured
  • Deciding on a new implant size
  • Implant rippling
  • Interchanging saline with silicone implants (or vice versa)

It’s entirely up to the patient as to whether or not they want to return to their original plastic surgeon for the revision or seek another. If the choice is the latter, it’s highly recommended to research only board certified plastic surgeons that specialize in breast surgery and ones who are adept in breast revision surgeries.  Once more, this is a personal decision. In addition to this, other surgeries they should excel in may consist of a breast lift, breast reduction, and breast reconstruction. Surgical aptitude in breast surgeries can help patients achieve a positive surgical outcome.

As mentioned earlier, there are various reasons as to why a woman may seek a revisionary breast surgery.  Some patients may discover over time that the original size implant they chose years ago no longer fits their lifestyle. For example, when a woman has completed having her family in her forties, she may come to the realization that the implant size she chose in her twenties may no longer be aesthetically appealing to her.

In the same breath, her skin tissue may have transformed over time due to weight gain, breastfeeding and weight loss.

Every patient is different as are their aesthetic needs.

For whatever reason a woman decides that she is interested in pursuing breast revision surgery, always remember that locating a board certified plastic surgeon should be at the top of the checklist.

And truly, this certification cannot be understated. A doctor certified in plastic surgery can help ensure a positive surgical outcome while keeping patient safety in the forefront.

13Jul, 2016

Online Consultations Garner Attention

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Online Consultations Garner Attention

A new online cosmetic consultation portal helps individuals connect with multiple plastic surgeons.

Plastic surgery is an evolving field of medicine affording patients with refined techniques, superior technology, and strides in science at every turn. While patients are benefiting from these numerous changes, pathways in learning more about procedures and board certified plastic surgeons are progressing, too.

A variety of internet platforms such as patient review sites have helped numerous individuals. However, there is a new site named Zwivel that has emerged addressing the needs of potential patients living in a fast-paced world. Described as an online cosmetic consultation portal, individuals can connect with multiple plastic surgeons learning about the procedures they are interested in, recovery information, surgery prices, and more.

Janet Morrissey of the New York Times wrote a comprehensive piece on Zwivel. While plastic surgery entails even nonsurgical treatments such as cosmetic injections, it’s an industry that is indeed becoming part of the American culture. And it’s available to everyone. 

Many who have used Zwivel are calling it the pre-step to a plastic surgery consultation. It’s a complimentary site for potential patients which can mean a cost and time savings of booking multiple consultations with plastic surgeons in the early stages of their research.

Founded by Dr. Gary Breslow and Dr. Craig Abramowitz, Zwivel was created to help make the introductory process with plastic surgeons and prospective patients more effective.

“Just as Match.com allows strangers to scroll through and evaluate potential dates, Zwivel allows patients and doctors to size up each other and ask questions before committing to surgery,” Morrissey reports. “The site allows patients to check out doctors’ credentials, send photos or videos of themselves to preferred doctors, and get those doctors to answer questions about cosmetic procedures and prices, all free.”

With a Zwivel connection, the same questions can be sent to multiple doctors allowing a person to decide which doctor is a better match.

According to Zwivel, numbers have swelled since 2015. Last year, 800 doctors were signed up and that has skyrocketed to 1,400. Patient numbers have jumped from 6,100 to over 28,000.

When interviewing co-founder Dr. Breslow, he conveyed to the New York Times that roughly 36 percent of individuals who book a consultation actually move forward in scheduling the surgery. Dr. Breslow believed that this ratio was a direct link to people having incorrect or insufficient facts prior to their appointment. 

“Patients who are severely overweight sometimes think liposuction is the answer, and I tell them, ‘You don’t need liposuction; you need to lose weight,’” Dr. Breslow told the New York Times in his article. “Or a patient may want $20,000 worth of surgery and thinks the whole thing is going to cost $200.”

For some, Zwivel is creating a window of opportunity to transform connections between individuals and doctors into formal consultations. It also affords people with the opportunity to be reminded of realistic expectations and to help do away with any misconceptions.

While Morrissey pointed out that not everyone is still convinced that a virtual consultation is their current way of doing things, it’s available. And at the end of the day, having options and being mindful is always a great thing when plastic surgery is up for consideration. 

 

26May, 2016

Considerations for revisionary breast surgery

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Considerations for revisionary breast surgery

Through many years of practice, revisionary breast surgery has evolved into a specialty.  Those who have undergone a breast enhancement procedure will sometimes want–or sometimes need–a revision surgery. Implants may be used in procedures such as a breast augmentation, breast lift, or breast reduction.

It’s important to note that not all patients who undergo a lift or reduction may require an implant – it’s a personal choice that can be discussed at a consultation with a board certified plastic surgeon.

While some patients may be displeased with the aesthetic outcome of their initial procedure, there may be other factors which lead them to seek a revision. These reasons, both personal and medical, may include the following:

  • Symmastia
  • Capsular contracture
  • Implant rupture
  • Bottoming out
  • Symmetry issues
  • Implant disappointment
  • Downsizing implants
  • Replacing implants

 

In some instances, women who are finished having their families may have chosen to have implants placed without undergoing a breast lift. While some patients are content with the results, others may be dissatisfied with the position and want to improve their appearance with a revision.

For mothers who had an enhancement prior to bearing children, undergoing a second augmentation after building their families is also another aesthetic scenario. The effects of bearing children, such as weight gain and breastfeeding, may alter the appearance of woman’s bust line. In some instances, a lift may be recommended to address skin redundancy

Another motive may be when a woman decides that the upper silhouette she wanted to achieve many years ago through implants is not a current aesthetic goal at this point in her life. In these instances, she may decide to downsize.

As one can imagine, revisionary breast surgeries are performed for a variety of reasons.

When electing to undergo a revision for aesthetic purposes, it’s generally advised to wait four to six months following the initial surgery to ensure all healing is complete–this includes any residual swelling. If a patient decides that she does not want to return to her original surgeon for a revision, it’s highly advised that she seeks a board certified plastic surgeon that specializes in breast revision surgery. Surgeons at this level have mastered their craft.

During a consultation with a new cosmetic surgeon, be candid with the doctor when it comes to the reason, or reasons, behind the revision. At this first appointment, clear communication is necessary. It’s important that the surgeon doing the revision surgery and the patient have an excellent rapport.

Following an exam, the doctor will convey their thoughts regarding a revision. The details of the surgery, the recovery process, and realistic expectations will also be discussed.

Before or during the consultation, make it a priority to review their patient gallery photos of women who have undergone a breast revision surgery. If possible, ask the doctor if they have any “before or after” images of patients who were in a similar circumstance(s). This will provide an excellent gauge as to whether or not the surgeon’s talents are aligned with a patient’s goals.

17Mar, 2016

Breast Revisionary Surgery Transforms and Corrects

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Breast Revisionary Surgery Transforms and Corrects

Breast surgery is a personal decision which should be made mindfully and thoughtfully. While moving forward with the best of intentions, sometimes a patient’s surgical outcome is not to her satisfaction. Be it a breast reduction, breast augmentation, or breast lift with augmentation, a situation may arise which triggers a patient to consider a revision.

There is an array of issues which may occur following the primary operation.

“There is one issue that we call symmastia in where the skin in between the breasts actually lifts off the sternum and can be challenging to correct,” said patient concierge Karen Martindale, who works alongside renowned plastic surgeon Dr. D. Glynn Bolitho. “And another issue a patient may experience is capsular contracture.”

Other matters patients experience may include symmetry challenges, downsizing or replacing breast implants, and more. Martindale explained that some patients after their childbearing years may have had implants to improve volume without a lift. Patients who want a revision in this case are generally not content with the descension.

Martindale explained that when a woman comes in for a consultation, it is most optimal if they have on hand their previous operative notes and what type of implants they currently have so the doctor can review the material.

“Following this, Dr. Bolitho will perform an examination and will be able to show patients a before-and-after gallery of those who underwent the same type of procedures with outstanding results.”

Martindale attributes Dr. Bolitho’s expertise from years of experience in performing breast reconstruction surgeries for women who had lost one or both breasts to cancer.

And each person is different in terms of how long they will wait until they seek a revision. In addition, they may undergo more than one revision.

“Some patients will travel long distances to find the right surgeon to help them with their issue. We’ve had patients in our practice who find Dr. Bolitho after undergoing several revisions,” she said.

According to Martindale, Dr. Bolitho has helped women achieve the aesthetic symmetry they desired, avoid another capsular contracture, and reverse a host of other issues.

“Many women we see in consultations are so close to taking out their implants completely due to the frustration levels,” she said. “I personally have a friend who had eight procedures before she came here to see Dr. Bolitho.”

Martindale shared how her friend was told by one surgeon that she had to have her implants removed because she was prone to capsular contracture. She would encapsulate weeks after surgery, and her implants would be hard again.

And then she went to Dr. Bolitho for a revision.

“My friend is so happy and there has been no evidence of a repeat capsular contracture,” she said.

Martindale’s friend is one of many patients who has sought Dr. Bolitho for help. Breast revisionary surgery can truly transform a woman’s desired aesthetics.

5Jan, 2016

Cosmetic surgery and treatments in 2016

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Cosmetic surgery and treatments in 2016
With a new year, many individuals may consider this as an opportunity to improve their aesthetics through diet, exercise and cosmetic procedures. Recently, the New York Daily News covered an industrywide survey from an online website named RealSelf. This website is considered a portal which offers patients the opportunity to learn more about plastic surgery and nonsurgical options. With the assistance of plastic surgeons, potential candidates can have their questions answered as well as those who are patients in the midst of a procedure recovery.

A regarded site, RealSelf generated a survey to those working in the field in hopes it could glean a better understanding on where the plastic surgery trends were directed in 2016. According to the responses, five items stood out among the rest which included the following:

• Buttock augmentation
• Decrease bustline
Lip enhancement
Neck rejuvenation
Chin enhancement

Looking into 2016, these procedures appeared to be paving the way to a new year.

Body Contouring Procedures

When diet and exercise are unable to correct areas of the body where lax skin or stubborn fat deposits remain, many turn to body contouring procedures as an option. There are many procedures which fall into this category which may include the following:

• Breast lift
• Upper arm surgery
• Body lift
• Liposuction
• Tummy tuck
• Buttock augmentation

And more….

Buttock Augmentation

Board certified plastic surgeons are noticing that the desire for a more voluptuous chest size is now being shifted toward buttock augmentation. Implants are utilized for this surgery to enhance the size and curvature of the posterior region. According to the RealSelf survey, women prefer a smaller bustline and want to increase the shapely curves in their hind end.

Lip Augmentation

On the nonsurgical front, lip augmentation with the use of fillers is gaining attention, and according to the survey will attract new patients.

As reported by Jacqueline Cutler of the New York Daily News, “Thirty percent of dermatologists and 43% of plastic surgeons report they received more requests about lips in 2015 than 2014, another trend expected to continue.”

Neck and Chin Surgeries For Selfies

During 2015, there were an array of articles discussing how selfies were indeed an impetus for so many individuals wanting to undergo a facial and neck rejuvenation. Selfies have redefined how people see themselves, and most importantly, how they want to improve themselves.

While some patients may be tolerant with their facial aging for a period of time, the improvements they currently seek are surgically geared toward a more youthful neck and redefinition of the chin.

“And 68% of the doctors say they expect to have patients requesting neck and chin work in 2016,” Cutler wrote.

Plastic Surgery Consultations

While surveys can give insight as to where plastic surgery trends are headed, it’s highly urged and recommended that potential patients have a consultation with a board certified plastic surgeon to discuss the procedure(s) they are interested in. While learning more about the procedure, they can understand the recovery process.

Plastic surgery is a personal decision and one that should be made with thoughtful consideration.

22Oct, 2015

How Some Women Experience Breast Pain In Sports

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How Some Women Experience Breast Pain In Sports

In the world of competition, women continue to break barriers and records in sports. For many, athletics is part of their lifestyle, and for others, their profession and livelihood. A recent article published by the Telegraph UK was an eye opener in terms of how many women involved in sports struggle with breast pain.

A portion of the article was dedicated to equestrians.

According to Radhika Sanghani of the Telegraph UK, a group of British Women admitted to having stopped participating in a particular sport due to breast pain.

“Last year a study from the University of Portsmouth’s Breast Health Research Group found that one in five women said breast pain was a barrier to exercise,” Sanghani wrote. She continued, “The same researchers are now working on a study about horse riding specifically, which will be launched in the next couple of months. Preliminary information from the study suggests that high numbers of riders struggle with breast pain – but Dr. Jenny Burbage, one of the researchers, tells me women participating in many sports tend to experience discomfort.”

Women who are naturally large chested may very well experience pain and find it awkward participating in sports. A client of mine, who was an equestrian and rode dressage for more than a decade, admitted the discomfort she experienced.

“It’s no surprise to me that this study in the United Kingdom revealed these numbers,” Ms. M said. “While I don’t ride anymore due to back issues, when I did it, there was discomfort. And despite whatever bra I wore, even one that was professionally fitted, there was never enough support for DDD.”

Ms. M admits she had never really thought about a breast reduction surgery at the time.

“Riding my horse was more of a hobby, but if I rode more, I would have definitely considered it,” she said. “I always felt that even my riding posture was off due to the weight I had to carry, too.”

In the article, it was also mentioned how some women may find how their athletic performance could be hindered due to breast pain, as well.

For women who live every day in discomfort because of this heavy weight, they not only complain about how challenging it is to take part in sports, but also in exercising. Additionally, finding fashionable garments which fit appropriately can be a quite a task.

Moreover, women who must carry this weight can suffer from the following:

  • Neck pain
  • Back pain
  • Headaches

And more….

The article also made an interesting point that many athletes may not admit to the discomfort they feel. Sadly, a stigma may be present. And hopefully, through educational articles this stigma can be eradicated.

From the riding arena to the tennis courts, the publication also made mention of Simona Halep, who is considered a tennis celebrity. In her late teens, reports indicate she decided to undergo a breast reduction surgery from a 34DD to 34C.

She candidly told the press, which was also highlighted in the Telegraph UK, that prior to her surgery her skill on the courts was compromised.

She added, “My ability to react quickly was worse and my breasts made me uncomfortable.”

Following breast reduction surgery and full recovery, her ranking at 57 leapt to 4 in Paris.

It’s only natural that when people hear about breast reduction surgery that they think of aesthetics. But truly, breast reduction surgery should also be viewed as providing relief to women who have endured so much discomfort and pain.

20Aug, 2015

Breast Reduction Surgery Brought Into The Spotlight

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Fashion Girl Relaxed With Her Legs Raised Up

Recently, Hollywood celebrity Ariel Winter of television sitcom Modern Family decided to publicly announce her reduction mammoplasty also referred to as breast reduction surgery. Winter was one of many women who suffer with the daily discomfort due to excess weight on their chests.

While most women undergo this surgery at 18 years of age and over, Winter, 17, had the surgery during the early part of summer. The surgery transformed her from a bra cup which was a size 32F to 34D.

She recently told a People magazine reporter, “I was 15 years old with [size] F [breasts]. How do you navigate that?”

Having a celebrity such as Winter convey what she did is helpful to so many women who experience the same troubles she did. They are able to relate to what she has encountered as well as empower themselves knowing that there is a solution and not to discount the benefits of breast reduction surgery.

Numerous women are affected with discomfort due to their breast size. In fact, it is estimated that more than one million American women are encountering this.

Moreover, most women do not impulsively decide on this surgery. They perform their due diligence by researching it, finding the best board certified plastic surgeons, perusing before and after galleries on surgeons’ websites, and visit helpful online resources where potential patients can ask doctors questions such as RealSelf.com.

Despite being fitted for the right bra and undergarments, there still remains a direct link to pain and discomfort due to the heaviness. As mentioned earlier, women seek this breast reduction surgery because of the excess weight on their chest which can cause the following issues:

*Back pain

*Neck pain

*Headaches

*Shoulder pain

*Shortness of breath

*Numbness and tingling in the arms

Headaches may be derived from the tightness in the shoulders and neck.

It is also important to point out that the more excess weight on the chest a woman carries, the more her shoulders tend to lean and roll forward. This may cause anatomical changes to her frame. Her posture may be compromised to compensate for the cumbersome pounds she must carry.

A group of doctors, including Bethannie Snodgrass, MD who authored, “When Less Is More: The Complete Guide for Women Considering Breast Reduction Surgery,” clearly points this out in her comprehensive book.

Snodgrass wanted her readers to know that this position could potentially cause a compression located in the thoracic spine. A culmination of pressure in the shoulder blades, ribs, nerves may theoretically cause this.

Another area of discomfort which cannot be overlooked is the shoulders. By the end of the day, bra straps are embedded so deeply into the shoulders of women leaving red and painful indentations.

Like all cosmetic and reconstructive surgical procedures, the decision to learn more about a breast reduction should be made thoughtfully. And teaming up with the right board certified plastic surgeon can help answer questions and navigate a patient in their decision making process.

8May, 2015

Breast Reduction Goes Beyond Cosmetics

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Life achievement - happy woman arms up in success. Back view of

When a woman lives a life in daily discomfort because the size of her natural breasts is too large, a breast reduction surgery is incredibly transformative. There are many ladies who endure pain and inconvenience because of their bust size.

The size of large breasts can take its toll. Yes, even with the best bras on the market, the neck and back are indeed stressed from the extra weight. Additionally, towards the end of the day, bra straps leave painful, red indentations upon each shoulder. Aside from placing extra material underneath the straps, not much else can be done.

And on hot days, skin irritation can occur.

While pain generally is the superseding reason why women undergo this procedure, another reason for consideration is how downright uncomfortable and cumbersome it can be to have large breasts.

Others may feel that a woman having natural large breasts is “fortunate,” but for a group of these ladies what they do feel is unfortunate.

For example, regular exercise may not be a regular routine. The idea of jogging, hiking, and weight training can be both painful and unbearable. And while swimming can be highly beneficial, those with very large breasts may be hard pressed to find a swimsuit which fits properly and may shy away from the sport if they must go to a public pool.

And the key to healthy living is the ability to exercise.

On a daily basis, finding the right clothing to wear is very challenging and options are limited. Some women find themselves wearing baggy tops in an effort to conceal their size.

While pain and discomfort are at the forefront, a lack of self-confidence may also loom.

For those ladies with large, natural breasts who have children, they may realize after their childbearing years that their size has increased substantially. There are instances where a leap in one or more bra cup sizes has occurred. In addition to heavier breasts, they may also have experienced a more extensive drop and loss in volume.

A breast reduction is a procedure which many women consider when they have a difficult time on a daily basis with aches and discomfort. A consultation with a board certified plastic surgeon is the first step in determining whether or not a patient is the right candidate.

During the consultation, a potential patient can ask a variety of important questions such as details about the surgery, scarring, recovery, risks, and side-effects. It’s also advisable to request to see before-and-after photos of patients who underwent the same surgical procedure.

Find a doctor in where there is a comfortable and professional rapport. This is important because plastic surgery is considered a journey, and because of this, having a good relationship with a surgeon is vital.

There are many patients who undergo this surgery and are thrilled with the results and their new outlook on life.

Still, a breast reduction surgery is a personal decision and should be made thoughtfully and pragmatically.

Once the choice is made on having a breast reduction, the next step is finding the right surgeon through meticulous research, patient reviews, and referrals.