Vanity Cosmetic Clinic

Hi,

I am Dr. Santosh Bhatia. So, today we are going to talk about a common procedure called as breast reduction. We often see women who suffer from a condition known as giganto mastia which is invariably speaking hormonal, sometimes you see it running in families this is nothing else but massive gigantic breast. Often it is seen in younger individuals also. I have recently operated on a 21 year old young female also for the same condition. Commonly, what a person suffers from in such conditions are besides the cosmetic appearance of large breasts, unable to buy relevant clothes, bras and things like that. They also have pain in the neck, shoulder, back, arms. They often complain of itching in the underside of breast because of lack of being able to clean that area well and constant rubbing of the breast against the abdominal wall or chest wall causing a lot of skin inflammatory reactions to that area. So, they often come finally extremely frustrated and tired of the size of the breasts to the extent where sometimes I have had patients who are so unimaginably speaking so frustrated with it that they sometimes they just remove my breast out.

Obviously we don't do that. We kind of counsel them and make them understand how we can reduce the size of the breast to make it more pleasant and more acceptable to themselves and to people around them. So, what is the procedure entail? Again, the most common procedure that we do is known as a breast reduction surgery. This can be done in different methodologies. Very rarely we may use liposuction or we may use liposuction as an adjunct to the conventional breast reduction surgery. Now in breast reduction surgery once obviously the patient comes in, I examine them, I understand what are their goals, what size they are looking at, I try to explain to them what can be achieved and definitely what cannot be achieved. I also try to assess them in terms of whether they have asymmetry in the breast, any nipple sensation problem they are suffering from and things like that. Now, again many women ask me questions like how will I be able to feed my child post surgery, will I have nipple sensation post surgery and various questions like that. Now commonly we see that nipple sensation is invariably speaking our goal is to maintain the nipple sensation, our goal is to maintain post surgical lactation or breast feeding. Very rarely it may happen that you may have decreased in nipple sensation, sometimes you may have difficulty in feeding your child but again it is a rare occurrence and not the normal.

In terms of the breast reduction surgery prior to surgery as any other surgery we call you in for clinical examination, certain blood tests and X-RAY are done. We sometimes do a mammogram if there is a suspicion of any kind of a lump in the breast and once we have your anaesthesia fitness, we go ahead with the surgery. The common types of surgery as I have explained to you earlier is we do a breast reduction with a circum vertical scar at the end of it so that the scar will be around the nipple areola complex and there'll be a vertical scar at six o'clock position down to us something known as the inframammary crease. Sometimes we take an anchor-shaped incision if the breast is very large, then we need to do that and in cases where it is possible, we may just make an incision around the nipple areola complex so that that scar is practically invisible. In terms of what are the results that we achieved so we normally typically depending again on the patient profile, on law of averages about 200-300 grams of breast tissue sometimes even 800 grams of breast tissue we have removed in patients who have extremely large breasts. After we do the surgery, there will be some tapes and bandages which is there on your breast for about 10-15 days. I commonly call you on day 3 wherein you come in and we do your dressing after which you come on day 10 to day 12 to remove the stitches.

During this period for the first three weeks you have to wear a sports bra that possibly has to be worn as much as possible without wearing any underwire bra or without wearing any bra with lot of designs and things on it. After your 15 days, then I call you on 1 month, 3 months, 6 months and after that a yearly follow-up is generally done. This procedure is fairly straightforward. You have to stay in the hospital for one night post the procedure just to keep a watch on you and sometimes in some patients if there is a very large amount of breast reduction we may put a drain inside the breast. This drain is nothing else but to remove any kind of fluid which is in building up into the breast and commonly again it is kept for 2 to 3 days after which we generally remove it. If patients often ask me what are the most common things or complications that we may see in such a surgery, you may get some amount of bruising, some amount of swelling which is common. It's just a sequel of your surgery. I don't call it a complication. It is there for about 15-20 days after which it all resolves. Thank you. For any further information, you can contact me on lybrate.com.

Thank you.

Hi!

I am Dr. Santosh Bhatia and today I shall be talking to you about a procedure called Vaser liposuction. What is liposuction? Liposuction is a procedure wherein we remove unwanted fat from certain areas of the body which in spite of diet and exercise does not reduce. Who is a good candidate for liposuction? A patient who has stubborn fat from certain areas in the body, patients who go to the gym, have a good diet, exercise regimen and in spite of all that cannot reduce their fat; are the ideal candidates for liposuction. Sometimes we get patients who do not like going to gym, who do not like exercising and have stubborn areas of fat, in those patients also liposuction may bring moderate results. Who are not good candidates for liposuction? Generally, women who have a history of multiple pregnancies, with losing abdominal skin, with stretch marks, with losing muscle are not ideal candidates for liposuction. Such patients require a procedure called tummy tuck with or without liposuction. Now, what are the types of liposuction? There is an old school fashioned liposuction which is called as suction liposuction or suction-assisted liposuction. There are other methodologies which are water liposuction, power-assisted liposuction and the most advanced being ultrasonic liposuction or vaser liposuction.

I generally do ultrasonic liposuction or vaser liposuction. What is the advantage of this procedure? Since this procedure emits a very high energy ultrasound energy, the fat gets melted like we are melting butter in microwave and the fat is removed very gently and delicately. So, the chance of bruising and swelling is minimized, the amount of skin contraction that we get because with the help of this ultrasonic energy is also another big advantage that we have seen and we can do high definition liposuctions also that is creating or etching a 6-pack or in women etching a nice abdominal muscle tone. In terms of the other advantage of ultrasonic liposuction, in addition, is that it is known that the amount of bleeding as such doesn't occur but the amount of bleeding is also very very minimal in comparison to any other type of liposuction. My basic technique of doing this is invariably speaking I do something known as 4-D liposuction or high definition liposuction. The many people ask me a question like what is the kind of incisions, what are the kind of cuts, what are the kind of scars that you get in such procedures. Generally the scars are the size of the cannula which is about 3mm and is seen in my hand over here and the scars are so small and inconspicuous and we very smartly try to locate the scars in areas of the body which are hidden in nature, primarily if you have a pre-existing scar we use that scar, in the naval if there is if that's a good location to put that particular scar, if you have stretch marks then I may try to use the stretch mark to use a scar.

So, you try to hide the scar as much as possible and they are hardly 3mm in size in any case. In terms of the post-op care of liposuction generally patients, they come in the morning for surgery and they leave in the evening and I generally do 5 litres of liposuction at any given point of time. In terms of the other post-op care, there is a pressure garment that the patient has to wear which is nothing else but a corset. This corset you have to wear for 24 hours every day for 3 weeks and after 3 weeks optionally speaking it is meant to be worn at least 12 hours a day. This further reduces the chance of swelling and improves and and accelerates the result that we get. In the sense of the liposuction procedure itself, on the morning of surgery, you come nil by mouth or not eating anything 12 hours prior to the surgery and you go home in the evening with 3 medications primarily 1 antibiotic, 1 anti-inflammatory and 1 antacid. So, this is a typical daycare procedure that is done and typically most patients I call them at on day 10 to remove their stitches, I call them on the day on 1 month to evaluate them once, 3 months and six months for your final photograph and that is when we compare our final results.

Now patients also ask me what are the disadvantages of this procedure. The disadvantage primarily being that if you have loose skin, lose muscle then this is this only is not procedure for you; you may have some swelling, you may have some bruising, you may have some irregularity which is most often temporary, you may have asymmetry. Now I often try to point out to patients about their existing asymmetry pre-surgery because everyone is slightly asymmetrical and even post-surgery there is a chance that you may be slightly asymmetrical. In addition to that the risk related to anesthesia is also there. However, we have a very good anaesthetic team; hence we are less worried about such kind of complication. Which are the areas that we can commonly do liposuction? So, liposuction is done in areas like the abdomen, the flank, the back, upper back, lower back, the chest area for men most often, sometimes in women also, the arms, the thighs and the calf.

So technically wherever we have fat, we can liposuc it. So, what the procedure intakes? First, the patient under general anaesthesia is under local anaesthesia after which a small stag incision is made, tumicin fluid which is a cocktail of different fluids are placed inside or underneath the skin. Once we have tumeced the area, I vaser the area with the help of vasering device which melts the fat after which a suction cannula is attached and the fat is aspirated or sucked out. And finally, one must understand that this procedure is not a weight loss procedure, it is a body contouring or body sculpting procedure wherein we may lose a couple of inches however we may not lose a lot of weight.

Thanks

Hi!

I am Dr. Santosh Bhatia. And today we are gonna discuss something related to breast augmentation surgery. So, there's often a misnomer regarding breast augmentation surgery and people always get confused what exactly whether they require, if they don't require it, do they desire it, they don't desire it so there are various thought processes regarding the same. So hopefully I will be able to clear some concepts regarding the same. So, breast augmentation surgery is fairly safe surgery. Most often it is a day-care surgery. You come in the morning, we offer it to you and we send you home in the evening. Breast augmentation surgery is there two various types of surgery broadly speaking. One is with the help of an implant and the other one is with the help of a fat injection. I'll try to demystify both of them for you also. So, breast augmentation with the help of implants is done with two different methods.

One we can put a saline implant, second, we can put silicone implants. Silicon is the most common one that is being used since the shape is well retained. Nowadays you get highly cohesive breast implants hence you get a good shape in the breast and it's maintained for a very prolonged period of time. In breast augmentation with the help of an implant in that also there are two types: one round implant and the second one is an anatomical implant. In the plane that we place it, there again there are different planes that we can place it: one is behind the gland, one is behind the muscle and one is behind the fascia. Now all these are very confusing to a layman and I don't expect you to understand it until we come and explain everything to you with the help of diagrams and to understand what you require, what are your goals, what are your needs based on that I'll tell you which is the aptest one for you. In the incision or where the incision is made again, there is one below the infra-mammary crease or below the breast that is at the inframammary crease, the second one is around the nipple areolar complex and the third one is in the axillar.

These are various methods that we can use. Again, each individual is different, each individual's requirements are different hence, based on the requirement we decide what has to be done. In terms of implants, there are different when you come in the first time to meet me, I obviously assess what you have, what you want, what are your desires, what are your goals. Is it because you are doing it because there is a loss of the breast which has taken place because of pregnancy, lactation because of those reasons or just then you have something on those hypomastia or small breasts or you just desire cosmetic improvement. You know everyone it's different. Sometimes people come because of an asymmetry in the breasts or once they have one side bigger one size smaller. We try to match it to the level best that we can. So now when you come in for the first time when you come for consultation obviously, I need to see your entire history, whether what is your past medical record, whether are you fit enough for the surgery or you are not fit enough for the surgery. We do a few blood investigations.

Many times I need to do a mammogram. Why is a mammogram done is to just so that we have a record before the surgery about your breasts and about the breast condition? So, as I as I said that when you come in for the surgery or the day of consultation, your medical history is taken, the records are seen, whether you have any pre-medical past medical condition. I do a mammogram. Once the mammogram is done then we get an understanding of your breast parenchyma or the current breast tissue. There are after that its I kind of determine to try to determine what is the size that you're looking for. Now, based on the size that you're looking for, there are different types of breast sizes as I've shown over here. So, there is from 100cc to 400cc of breast sizes which are available. So, I kind of make you wear them, try to see so that you see yourself in the mirror, you take photographs, you get an understanding, you ask your partner, your husband or maybe your some close family person that who would you who you like to talk about, you can decide based on a variety of these features.

Once we decide that, yes this is a particular size that is required, then the based on many of different types of markings that I do, many different types of measurements that I do, I decide exactly which size and which shape will be most apt for you based on that. So, I let you go and let you decide to a large extent as to what size you're looking at and then based on that based on my scientific and medical experience, I decide finally what is the final size that you require. Besides that, in terms of what most people ask me, they ask me many different various questions that does it cause cancer, can I breastfeed after the surgery, how fast can I exercise? So, in short, there is a study which is done where it is shown it is fairly safe. There is a new study which is being done regarding ALCL, that again when you come and I'll discuss that with you in detail in regards to what you can do after the surgery.

You definitely can you can do everything and anything but you can't do upper body weight exercises, you can't swim for a period of three weeks. Besides that, everything else is fine, you can go to you can go for a walk, you can go for a jog after 3 or 4 days. You'll have you'll be wearing a sports bra which is there. This sports bra has to be worn for a period of three weeks. No underwire bra and things are that are not allowed to be worn at that particular moment of time. In terms of how fast will you be able to join back work, I believe that most patients from various range of from one day to 3 days is when most people join back work. Yes, you do feel little heaviness, you may feel a little soreness, you may have a little sensory problem around the nipple for the first three weeks but this is all a part and sequelae of the surgery. After which so I come most commonly call you back on day three to do a dressing.

I call you on day 10 to remove the stitches and then I call you at one month, 3 months and 6 months just to take photographs so we analyze your entire recovery period of sorts. Regarding fat injection, on the other hand, it's a fairly new thing. It's very good. Some people do not want any implant they don't want to have something in their body as per what they say. Fair enough. Again, we can do fat injection even though it's not a gold standard, the shape of the breast is not as great as with an implant but yes, we can achieve a large change in your breasts.

So how do we do that procedure? We basically take a and a liposuction cannula, we do some liposuction. Again, most people are happy that they are getting some liposuction also done because of that. So, we do some liposuction, we remove the fat from say the flanks, the abdomen, the thighs wherever there's enough and adequate fat, we remove fat from that,  we kind of process the fat in a particular manner and we place the fat or we inject the fat into the breast. The recovery period of fat injection also fairly similar to that of the breast implant. For regarding any more information, I would always suggest please connect with me on Lybrate, so that I can give you more information as you desire.

Thank you!