FAQ’s

Breast Cosmetic Surgery

Q: What is Breast Reconstruction Surgery?

A: Breast Reconstruction Surgery deals with replacement of lost tissues (reconstruction of Breast) after Cancer Surgery.

Q: Who needs Breast Enhancement?

A: Underdevelopment breast- Breast not developed at the age of 16-18 years. Post Location – loose Breasts after feeding of baby.For improvement of body image –Enlargement of breast.

Q: How it is Done?

A:Breast Enhancement is done by placing an implant below the breast by small skin incision. The incision for cosmetic insertion most commonly is made along the lower edge of the areola, in the axilla or in the infra mammary fold.

Q: How safe are implants?

A: In 2006, the FDA approved the sale of silicone breast implant. Numerous studies conducted during the 14years moratorium found no real connection between silicone implant and disease. The implant were deemed safe and effective.

Q: Any Other Method of Enhancement?

A: Yes, by Fat taken from patient own body.

Breast Reduction

Q: Who needs Breast Reduction?

A:1. Young girls suffering from excessive enlargement of breast (Virginal hypertrophy of breast) 2. In adult females with abnormally enlarged breast leading to physical disability like pain in shoulder, heavy weight on chest & poor hygiene under the breast & social embarrassment.

Q: How the procedure is done?

A: Excessive tissue is taken out surgically, keeping in mind the shape and symmetry of the breast.

Q: Does it have any adverse effort on lactation/ Baby feeding?

A: Yes, there is possibility of difficulty in lactating after breast reduction surgery. But now with newer techniques like superomedial pedicle the incidence of lactation related problems has decreased.

Q: Does Liposuction help in breast reduction?

A: Yes, it can be helpful in patient with moderate enlargement of breasts.

Gynecomastia

Q: What is Gynecomastia?

A: Gynecomastia is a condition in which there is abnormal enlargement of breasts in males.

Q: Why there is abnormal enlargement in young adolescent males (Gynecomastia)?

A: Gynecomastia is usually due to imbalance of hormones at the time of development of male sexual characters (puberty). Many times it can be without any reason also (Idiopathic).

Q: Is there any medical Treatment for its correction?

A: Once the patient has completed 16-18 years the chances of cure by medicine are negligible. Patient requires surgery for its correction.

Q: What is right time to operate?

A: Usually after 16 Years of age.

Q: How it is done?

A: It is done by a very small incision kept around the nipple complex which is hardly visible after the surgery. Most of the tissue is removed by liposuction & sometimes if gland is large it needs excision.

BREAST RECONSTRUCTIVE SURGERY

Q: What is Breast Reconstruction Surgery?

A: Breast Reconstruction Surgery deals with replacement of lost tissues (reconstruction of Breast) after Cancer Surgery.

Q: Is it possible to recreate natural looking breast after Cancer Surgery?

A: Yes, it is possible to recreate reasonably normal looking after Cancer Surgery.

Q: How the breast is recreated?

A: The breast is recreated from tissue taken from back or lower abdomen. Tissue expenders or breast implant are also used in some cases.

PLASTIC AND COSMETIC SURGERY

Q: How is plastic surgery different from other surgeries?

A: General surgery deals with the operations of various diseases and disorders in the body. Plastic surgery is a surgical super-specialty that deals with the healing and restoration of patients with injury, disfigurement or scarring resulting from trauma, disease or congenital defects. A plastic surgeon has the imaginative power to sense the problem and draw the outcome of a surgery and plan accordingly.

Q: Are any plastic materials used in plastic surgery?

A: Plastic is not used in plastic surgery. The word plastic comes from a Greek word “plastikos” meaning “to mould”. However some plastic surgeries involve use of implants made of silicone and titanium and polyethylene that are accepted by the human body.

Q: There is a general impression that plastic surgery leaves no scars after surgery. Is it true?

A: Scarring is a natural consequence of healing. Plastic surgeon understands the nature of healing and involves incisions in the lines of the skin and suturing the wounds meticulously in layers using small stitches and threads. Hence there is only a small line of scar left which eventually becomes inconspicuous.

Q: How come film actors and actresses who undergo plastic surgery have no scars?

A: Cosmetic surgeries of the nose are done by making incisions inside the nose hence there is no scar outside. Also surgeries like “liposuction” are done making very small scars which slowly become less visible.

Q: How effective are scar removal creams in treatment of scars?

A: Some creams can lighten scars but cannot remove them completely. Only time is the factor which decides when a scar would fade. Plastic surgery can reduce the scar size and make it less visible.

Q: Is there any emergency in plastic surgery?

A: Almost 50% of the plastic surgeries are emergencies. Most surgeries like trauma and injuries of various parts of the body and injuries of the vessels and nerves, cases of “replant” (replacing the cut body parts-fingers or hands etc), avulsed scalp are emergency procedures and need to be done as early as possible for good results.

Q: Is plastic surgery expensive?

A: Most of the plastic surgeries are comparable to any surgeries in the question of expense. Some cosmetic procedures and procedures which involve use of implants may be a bit expensive. Plastic surgeries like “replant” which involve long hours (up to 8 hrs) and the use of microscope may be expensive depending on the kind of injury and work required.

Q: What are the uncertainties and risks in plastic surgery?

A:There are always risks associated with surgery and specific complications associated with all procedures. Post-operative complications such as infection and blood clots are rare, but can occur. Infection can be treated with drainage and antibiotics, but will prolong the hospital stay. You can minimize the risk of blood clots by moving around as soon after the surgery as possible. Poor healing, which results in conspicuous scars, may necessitate a second operation. Smokers should be advised to stop, as smoking may increase the risk of complications and delay healing. One can reduce your risk of complications by closely following the surgeon’s instructions before and after the surgery.

Q: Does plastic surgeon treat common skin swellings like cysts and lipoma?

A: Plastic surgery can be done as it involves use of incisions in skin lines and layered suturing for minimal scar formation. Some small swellings like lipoma (local fat deposition) may be sucked out by small incisions.

Q: What comes under plastic surgery?

A: Plastic surgery includes the following-

  • Birth defects of the face, including splits of the lip and palate,nasal deformities and deformities like asymmetry of theface, small ears, non developed ears and other ear defects.
  • Injuries of the face like wound and cuts and severe facial injuries and fractures of the bones of the face and jaws.
  • Surgeries of the hands and legs like crush injuries and fractures due to road traffic accidents and factory machines and home accidents, birth defects of hands and legs and surgeries on the vessels and nerves.
  • Nail surgeries and repair of damages nails.
  • Any type of burns like fire, hot liquid, electricity and chemicals and its skin cover problems and contractures.
  • Any wounds after infections and their cover.
  • Replantation (replacing back the cut body part like fingers and hands) and reconstruction of body parts.
  • All types of reconstruction following removal of tumours and cancer resulting in disfigurement of any part of the body including the face, breasts, and trunk.
  • Aesthetic (cosmetic) surgeries like rhinoplasty (nose surgery), breast augmentation and reduction (breast surgery), face lift sand blepharoplasty (face rejuvenations), hair transplants (baldness surgeries), liposuction (fat removal) and scar removal and other surgeries.

Q: What are the uncertainties and risks in plastic surgery?

A: There are always risks associated with surgery and specific complications associated with all procedures.

Post-operative complications such as infection and blood clots are rare, but can occur. Infection can be treated with drainage and antibiotics, but will prolong the hospital stay. You can minimize the risk of blood clots by moving around as soon after the surgery as possible.

Poor healing, which results in conspicuous scars, may necessitate a second operation. Smokers should be advised to stop, as smoking may increase the risk of complications and delay healing. One can reduce your risk of complications by closely following the surgeon’s instructions before and after the surgery.

Q: What should one know before selecting a plastic surgeon?

A:Patients should check the following-

  1. Patients should seek out a doctor who is both trained and experienced.
  2. They must make sure that the doctor is board-certified.
  3. They must see multiple before and after pictures of patients on whom similar procedures have been performed.
  4. These days plastic surgeons specialize in particular areas like hand surgery, micro surgery, facial surgery and aesthetic surgery so one must choose the specialist that does the surgery one wants to have.
  5. Don’t base your decision solely on price.

Q: What is smile train program? How is it done at Sir Ganga Ram Hospital?

A: Smile Train is a non-profit organization based in New York City with the mission of providing free plastic surgery for children with cleft lip and palate in about 80 developing countries including India.

At Sir Ganga Ram hospital smile train program is conducted as a free OPD every Friday and admitting the children on the same day with specialized paediatric care and with free operations being done every Saturday. This includes primary (first time) as well as secondary (after surgery) defects of the lip and palate correction. There is also provision for speech therapy after the surgery for these children. A record of photographs taken before and after surgery is maintained and the children are followed up accordingly.

Q: What are common birth defects treated by plastic surgeons? What age do they require operations?

A: Common birth defects under plastic surgery are-

Defects Age of surgery
Head and neck defects(Cranio-facial defects) Before skull bones fuse ( before the age of 13yrs)
Other syndromes Depending upon the defect
Ear defects (Microtia) 8 years of age
Other ear defects Depending upon the defect
Coloured swellings (vascular malformations) Depending upon the defect
Cleft lip By 3 months
Cleft palate By 9 months
Genito-urinary defects (Hypospadias, epispadias) 1 1/2 to 2 yrs of age
Indeterminate sex After DNA test and the decision of the child.
Hand and finger defects (Polydactyly, syndactyly) 9 to 10 months

Q: Does plastic surgeon treat common skin swellings like cysts and lipoma?

A: Plastic surgery can be done as it involves use of incisions in skin lines and layered suturing for minimal scar formation. Some small swellings like lipoma (local fat deposition) may be sucked out by small incisions.

Q: What is a keloid? Is there any permanent cure for keloid?

A: Keloids are the excess growth of scar tissue at the site of a healed skin injury. It usually has a smooth top and a pink or purple color. Keloids are irregularly shaped and tend to enlarge progressively.Unlike scars, keloids do not subside over time. They are more common in people ages 10 to 20, and in African Americans, Asians, and Hispanics. In some cases, the tendency to form keloids seems to run in families.

The best treatment is prevention in patients with a known predisposition. This includes preventing unnecessary trauma or 8 surgery (including ear piercing, elective mole removal), whenever possible Treatment methods are intra-lesional corticosteroids, silicone gel sheeting, cryosurgery, radiation therapy, interferon alpha, Pulsed dye laser. Excision of a keloid is usually not done because it may cause formation of larger keloids.

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Q: Can plastic surgeon treat vitiligo patches?

A: Vitiligo is a condition that causes depigmentation of patches ofskin. The cause of vitiligo is unknown, but research suggests that it may arise from autoimmune, genetic, or viral causes. There is no cure for vitiligo. But the patches can be treated by removing them and skin grafting the areas.

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Q: If any part of hand is cut, is it possible to re-attach it?

A: It is possible to re-attach some parts like fingers, wrist and forearm. This is called “replant” this involves long hours (up to 8 hrs) and the use of microscope for suturing of small vessels, nerves and muscles depending on the kind of injury. Such surgeries should be done immediately because the success rates go down with delay in presentation of the patients.

Q: Section Is transplant possible from another donor?

A: Transplant is possible from another donor. In some life threatening cases parts can be used from the dead or living, but they would require use of steroids and other strong drugs like immunesuppressors life long.

Q: What is the role of plastic surgeons in home accidents?

A: Home accidents managed by plastic surgeons include-

  1. Scalds and burns
  2. Chemical burns like acid.
  3. Falls
  4. Crush injuries
  5. Wounds and cuts

Q: What should one do in case of burns?

A: The first response in a burn situation is

  • Stop the heat source or break contact between the heat source and the skin.
  • You can cool the burn with water.
  • If blisters form, they should not be broken because they protect the burn from infection.

For heat or thermal burns

  • Rinse the burn (without scrubbing) or immerse the affected area in cool water until the pain is gone.

For accidents involving drenching by a hot liquid

  • Place clothed victim in water bath or shower.
  • Never peal stuck clothing from a burn.

In cases of electrical burns

  • Turn off the electric power at the source.
  • Do not touch the victim until all wires are clear.
  • Make sure the victim’s breathing and heartbeat are regular.
  • Check places where the electricity entered and exited the victim’s body
  • Make sure they get medical attention
  • Treat minor burns with cool water and have the victim seek medical attention.

With chemical burns

  • Locate the chemical container and follow the label directions for emergencies.
  • Remove any contaminated clothing.
  • If the eyes have been affected, flush them for 30 minutes. For acid chemicals, immediately flush the affected area for 15-20 minutes.
  • For dry chemicals, brush the chemical off the skin then flush the area for 15-20 minutes.
  • Make sure the victim seeks medical attention.
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Q: What is skin grafting?

A: Skin grafts are often employed after serious injuries, wounds and burns when some of the body's skin is damaged. Surgical removal (excision or debridement) of the damaged skin is followed by skin grafting. The grafting serves two purposes: reduce the course of treatment needed (and time in the hospital), and improve the function and appearance of the area of the body which receives the skin graft.

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Q: Is there any colour difference in the skin grafted area from the surrounding skin?

A: Initially, after grafting, the skin is darker in colour for a few weeks, but eventually it gains the same colour and looks very much normal. In some this takes longer and the graft may never be exactly the same colour as the rest of the skin.

Q: Is skin grafting necessary for treatment of burns? What happens if skin grafting is not done?

A:Skin grafting is necessary for treating burns. A skin graft will:

  • Help to heal the affected area quicker.
  • Help to reduce any pain and discomfort when dressings are changed.
  • Help to reduce the risk of infection and scarring.
  • Help to stop limited movement (contracture) if the burn is on a joint.
  • Cover an area that has lost skin. If grafting is not done, there is a risk of infection, scarring contracture and prolonged morbidity.

Q: What is the difference between skin graft and flap?

A: A skin graft is a piece of healthy skin, which is taken from one area of the body and placed over the affected area. The area where the skin is taken from is called a donor site.

A flap is a piece of tissue that is still attached to the body by a major artery and vein or at its base. This piece of tissue with its attached blood supply is used in reconstructive surgery by being set into a recipient site (injured area onto which a flap or graft is placed).

Q: What are free flaps?

A: "Free flap" implies that the tissue, along with its blood supply, is detached from the original location ("donor site") and then transferred to a new location ("recipient site"). This is in contrast to a "pedicled" flap in which tissue is left attached to the donor site.

Q: What are tissue expanders?

A: These are ballon like devices which are used to expand the skin. Keeping living tissues under tension causes new cells to form and the amount of tissue to increase. This may be accomplished by the implantating expanders beneath the skin and periodically, over weeks or months, injecting a saline solution to slowly stretch the overlaying skin. This extra tissue is used for reconstruction of wounds or for inserting implants.

Q: What are implants? What are various types of implants in use?

A:An implant is a medical device manufactured to replace a missing biological structure. The surface of implants that contact the body might be made of a biomedical material such as titanium, silicone or apatite depending on what is the most functional. In some cases implants contain electronics e.g. artificial pacemaker and cochlea implants. Some implants are bioactive, such as subcutaneous drug delivery devices in the form of implantable pills or drug-eluting stents.

Q: How is silicon used in plastic surgery?

A:Silicone is a chemical polymer derived through a heating and refining process from the element silicon-- the sand on the beach is made from a combination of silicon and oxygen called silica. In plastic and reconstructive surgery, silicone is the material of choice for many types of solid implants used to enhance or reconstruct the cheeks, chin, and jaw. Semi-solid (cohesive) silicone implants are also used for the augmentation of the breasts, male chest (called pectoral implants), calves, biceps, and even sometimes the buttocks.

Q: Is breast implant safe for un-married women? Is lactation possible after it?

A: Silicone gel-filled breast implants have a reasonable safety and effectiveness when used as labeled. Once the baby is delivered, patient may have exaggerated breast engorgement with pain. There should be no problem in breast feeding after the implants. If the breasts were augmented because of underdeveloped (hypoplastic) breasts, then the patient may have trouble producing enough milk.

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Q: Why do male breasts enlarge? What is the treatment? Male

A:Male breast enlargement that arises in puberty often resolves on its own, within a matter of months, as hormone levels normalize. When the condition arises in adulthood, it tends to persist. As men age, they tend to lose testosterone and gain weight. The former contributes to gynecomastia (which is actually defined as enlargement of glandular tissue within the breasts), the latter to a related condition known as pseudogynecomastia, in which enlargement is caused by deposits of fatty tissue under the breasts,

The surgery of choice is liposuction to remove fat and scalpel surgery to remove glandular tissue, both done by a plastic surgeon.

Q: Can baldness be treated? Does hair transplant come under plastic surgery?

A: Baldness can be treated, but not cured.

Hair transplant is done by a plastic surgeon. This involves using small grafts of naturally-occurring units of one to four hairs, called follicular units, to move hair-producing follicles to balding areas of the hair restoration patient's scalp. A strip of skin containing many follicular units is extracted from the patient and then dissected under a stereoscopic dissecting microscope. Once dissected, they are implanted into the recipient sites of the patient's scalp.

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Q: Does hand surgery come under plastic surgery?

A:The field of hand surgery deals with both surgical and non-surgical treatment of conditions and problems that may take place in the hand which can be dealt by plastic surgeons.

The following conditions can be indications for hand surgery:

  • Hand injuries
  • Carpal tunnel syndrome
  • Carpometacarpal bossing
  • Rheumatoid arthritis
  • Dupuytren's contracture
  • Congenital defects
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Q: Can damaged nails be repaired?

A: Damaged nails like cut or avulsed nails can be repaired by plastic surgery. The procedure is called nail bed repair.

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Q: What is the role of plastic surgery in skin cancers?

A: Treatment of skin cancer may require surgery to remove cancerous growths. Plastic surgeon can surgically remove cancerous and other skin lesions using specialized techniques to preserve your health and your appearance. Although no surgery is without scars, the plastic surgeon will make every effort to treat the cancer without dramatically changing your appearance. For some people, reconstruction may require more than one procedure to achieve the best results.

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Q: What is the role of plastic surgery in oral cancers?

A: The cancer surgeon and plastic surgeon will be working together to reconstruct the cancer defect after surgery. Surgery for oral cancers can involve removing a part of the tongue, the floor of the mouth, and even a part of the jaw in more advanced cases. The role of a plastics or reconstructive surgeon is to help repair these areas once the surgery to remove the cancer is completed. Reconstructive surgery can involve moving tissue from one part of the body to another. This type of surgery may involve “free flap” and cover.

Q: Do plastic surgeons treat facial injuries?

A: Facial trauma can involve soft tissue injuries such as burns,lacerations and bruises, or fractures of the facial bones such as nasal fractures and fractures of the jaw. Facial injuries have the potential to cause disfigurement and loss of function.

Plastic surgeons are surgical specialists trained in thev comprehensive management of trauma to the lower, middle and upper face and facial injuries.

Q: Do plastic surgeons treat eye problems?

A: Problems related to the interior of the eye are dealt by ophthalmologists but procedures like eye lid reconstruction and repair are done by plastic surgery.

Q: Can plastic surgeons treat ear and nose problems?

A:Plastic surgery can treat defects of the external ear like traumatic cuts and wounds and defects like microtia (small or undeveloped auricle) and defects of the nose like crooked nose. Cosmetic procedures on nose and ear are also done. The rest of the diseases are operated on by the ENT specialists.

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Q: What is breast reconstruction? What are the methods for breast reconstruction?

A: Breast reconstruction is the rebuilding of a breast, Often this includes the reformation of a natural-looking areola and nipple. This procedure involves the use of implants or relocated flaps of the patient's own tissue.

There are many methods for breast reconstruction. The two most common are:

  • Tissue Expander - Breast implants
  • Flap reconstruction- This procedure may be performed by leaving the donor tissue connected to the original site to retain its blood supply. Ex-The latissimus dorsi muscle flap and abdominal flaps (DIEP flap and free-TRAM flap)

Q: How soon can breast reconstruction be done?

A: The primary part of the procedure can often be carried outimmediately following the mastectomy. Surgeons may choose to perform delayed reconstruction to decrease this risk of infection.

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Q: What are lasers? Where are they used?

A: The term "laser" originated as an acronym for Light Amplification by Stimulated Emission of Radiation. They are used in the following surgeries

  • Fine Lines and Wrinkles
  • Skin Tightening
  • Pigmented Lesions
  • Precancerous Lesions
  • Vascular Lesions
  • Tattoos
  • Hair Removal
  • Acne and Acne Scars

Q: What is VAC?

A: Vacuum assisted closure (VAC) or Negative pressure wound therapy (NPWT), also known as topical negative pressure or subatmospheric pressure dressings, is a therapeutic technique used to promote healing in acute or chronic wounds and enhance healing of first and second degree burns. A wound is sealed to promote wound healing using sub-atmospheric pressure applied through a specialized dressing.

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Q: What are fillers?

A: Facial fillers are injections which fill out wrinkled or uneven areas of the face. They include Restylane, Collagen, Perlane, Sculptra and even your own tissues taken from another part of your body. The filler is injected into the skin itself to plump up the depressed line in the skin.

Q: What is BOTOX?

A: BOTOX is a drug that uses Botulinum Toxin Type A to treat wrinkles. It is used for the temporary improvement in the appearance of moderate to severe facial lines (frown lines and cheek lines).

Q: What is fat injection?

A: Fat grafting is a procedure that uses the patient`s own fat tissue to increase the volume of fat in the subcutaneous area of the body. Fat is taken out by a method called liposuction and then transferred to the desired area. It is also used to fill wrinkled, creased faces and naso-labial lines (cheek lines).

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Q: What is liposuction? How is it done?

A: Liposuction removes pockets of fat from troublesome areas such as the thighs, abdomen, and upper arms.The basic procedure involves a few steps:

  • Local or IV sedation or GA will be used, depending on the type and number of procedures undergone
  • A few tiny incisions are made near the area to be treated
  • Tumescent fluid (fluid that decreases pain and bleeding) is injected.
  • A small, tube-like instrument called a cannula is inserted through the incisions in order to reach the fat deposits
  • The cannula then breaks up and vacuums away unwanted fat
  • The procedure is finished with the incisions usually being sutured or allowed to heal.

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Q: Does liposuction help in weight reduction?

A: Liposuction is more of body contouring procedure and weight loss by surgery as such can only be achieved by bariatric surgery. However large volume liposuction (removal of more than 5 L of total volume from the patient) can help to some extent for reduction of weight.

Q: How does plastic surgery help in re-shaping body after massive weight loss?

A: Liposuction in an obese patient, after massive weight loss by bariatric surgery or exercise,is reasonable when the goal is to improve a troublesome body contour area. It can be combined with abdominoplasty. It is not reasonable to use liposuction as a surgical technique for weight loss.

Q: What are collagen dressings? When are they used?

A: A collagen dressing is made with a form of collagen to aid in the body's healing processes. Collagen is a category of structural proteins that are naturally present in the human body and are especially common in connective tissue. Types of wounds that benefit from collagen dressing include chronic or stalled wounds and wounds with large surface areas. Pressure ulcers, or bed sores, and similar ulcers caused by complications of diabetes, wound from burns also benefit from collagen dressings.

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Q: What is micro surgery? What comes under it?

A: Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves (typically 1 mm in diameter) which have allowed transfer of tissue from one part of the body to another and re-attachment of severed parts.It is useful in cases like Free tissue transfer, replantation and transplantation.

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Q: What is the role of plastic surgery in nerve surgeries?

A: Nerve compressions and nerve injuries can be treated by plastic surgery by end- to end suturing or nerve transfer and grafting.

Surgeries of the brachial plexus, sciatic nerve, nerves of hands, legs and feet come under plastic surgery.

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