Breast augmentation implant surgery requires careful consideration, so partner with an experienced surgeon like Dr. Makhlouf for trusted results.  Contact us today for more information.

Researching Your Surgeon: Key to Safety

The popularity of plastic surgery is soaring—and more and more doctors are trying to meet the demand. Any licensed physician can claim to be a plastic surgeon, so the importance of making sure your doctor is properly trained and certified is paramount.

“With ever increasing numbers of providers offering plastic surgery, it can be easy for the public to become confused about a doctor’s qualifications, and the impact it can have on their safety” said Dr. Makhlouf, MD, an ASPS Member Surgeon based here in Chicago. “Plastic surgery is serious and, like any operation, it carries risks.”

Dr. Makhlouf is a member of the American Society of Plastic Surgeons (ASPS), the foremost authority on cosmetic and reconstructive plastic surgery and the specialty’s leader in patient safety initiatives.

To help consumers have the safest plastic surgery possible, Dr. Makhlouf has put together a checklist to guide patients through the process of planning for plastic surgery:

• Evaluate Yourself: Prior to researching a doctor, you need to be comfortable and confident with your decision to have plastic surgery. Ask yourself questions like “Why—and for whom—am I looking to have this surgery performed?” Patients should be internally motivated to have a procedure. “What kind of results am I expecting?” Having realistic expectations is an important facet of the process. “Is this a good time for me to have surgery?” All surgery requires recovery time, both physical and mental. Patients should allow for adequate time for adjustment.
• Check Your Doctor’s Board Certification: Determine if your physician is certified by The American Board of Plastic Surgery for plastic surgery of the face and all areas of the body. This certification ensures that the surgeon has graduated from an accredited medical school and completed at least five years of surgical residency—usually three years of general surgery and two years of plastic surgery. ASPS Member Surgeons meet these and other strict standards of education and experience.
• Ensure that Medical Facilities are Safe: Everyone who chooses plastic surgery has the right to a safe procedure. Procedures should be administered in a setting with the necessary equipment and qualified medical personnel to observe patients and manage potential complications, and should be accredited by a national or state recognized accrediting agency/organization such as the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), Accreditation Association for Ambulatory Health Care (AAAHC), or Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
• Obtain a Medical Evaluation: Your general health can affect the results—and safety—of the plastic surgery procedure you choose. When considering plastic surgery, consult with your surgeon for an evaluation and a full medical history to determine what is most appropriate and advisable for you.
• Be Informed: Talk about the procedure with trusted friends and family as well as your physician. When a treatment decision is made cooperatively between the physician and patient, the physician should explain the risks, benefits, alternatives, and reasoning for the proposed treatment, after which an informed consent document should be signed by the patient.

After you have thoroughly researched your doctor and consulted with your physician regarding your health, Dr. Makhlouf encourages you to ask your plastic surgeon tough questions during your consultation:

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Important Safety Tips for Patients Considering Overseas Plastic Surgery

If you are considering having plastic surgery, you have many choices. The variety and popularity of cosmetic procedures is growing, and there are more providers and facilities than ever before to choose from. A new trend finds some even offering low-cost “medical tourism” packages in exotic locales like Mexico, India, or Thailand. But are they safe?

The first thing to keep in mind is that plastic surgery is real surgery. You need to find out as much as possible about your doctor, the facility they operate in and how you will manage post-operative issues. Take your time. Do your research.

Vincent Makhlouf, MD, of The American Society of Plastic Surgeons (ASPS) based here in Chicago is dedicated to making sure consumers have the safest plastic surgery possible, and offers you the following Questions to Consider When Debating Having Surgery Abroad:

1) Is the physician qualified? Are the medical facility and equipment safe? Although there are many qualified physicians practicing all over the world in excellent facilities, many countries have no credible process for verifying physician training, or the standards of medical facilities and equipment. Patients can significantly decrease the dangers of plastic surgery by thoroughly researching both doctor and facility, or simply staying in the United States and selecting an ASPS Member Surgeon. All ASPS Member Surgeons are certified by the American Board of Plastic Surgery and put patient safety first.

2) How will my post-operative care and any complications be handled? Patients should consider that even routine post-op care (such as changing dressings and monitoring healing) can be necessary for several weeks—long after your “vacation” is over. And patients should also determine if they have insurance for complications resulting from cosmetic procedures abroad.

3) Are travel and vacation activities compatible with surgery?Although enticing, most vacation activities should be avoided after surgery, and a long return flight increases the risk of developing a pulmonary embolism and blood clots. Your surgeon should discuss what you can expect during recovery, and what you can do to minimize risk.

Dr. Makhlouf is an ASPS Member Surgeon. ASPS is the largest organization of board-certified plastic surgeons in the world. Representing more than 6,700 physician members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

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Learn about this unique plastic surgery procedure.

Today Plastic Surgery offers many options to address body contouring. I believe that as knowledge, technology and new pharmaceuticals continue to improve we will see many more avenues available to address these issues. A qualified surgeon must be able to offer a variety of modalities to address patients’ concerns: from liposuction to skin and muscle tightening to lipodissolve. He should be diversified and have more than one tool (a hammer) in his toolbox so that not all problems will be a “nail”.

Lipodissolve: a specific protocol for using a mixture of chemical in a specific pattern in a specific concentration and amount in order to achieve a lipolysis.

Lipolysis injection:  the injection of a chemical in the area where fat is present in order to induce the destruction of the fat cell and resorption of the fat layer.

Lipostabil: the brand name a German company uses for the chemical (Phosphatidylcholine) most frequently used in order to achieve lipolysis.

Phosphatidylcholine: the most common chemical used for destruction of fat cell and it is the one used in lipodissolve.

Deoxycholate: the chemical that is used to render phosphatidylcholine soluble.

Mesotherapy: this”therapy” is a technique to introduce various chemicals into the subcutaneous tissue. It lends itself to a variety of pharmacologic agents, not all with the purpose of dissolving fat.

Let us now concentrate on lipodissolve.

 Let us identify the chemicals.  The chemicals are phosphatidylcholine, deoxycholate, a vasodilator, vitamin B complex, and sodium chloride.

Is this procedure new?

As of 2006 over 50,000 treatments have been recorded in the United States and even larger numbers have been recorded in the rest of the World.

Are there complications?

There are very few complications.  Most of them are mild and benign in nature.  The more significant complication has been pain for two weeks after the procedure.

There are immediate sequelae to the procedure that we consider an inherent tradeoff.  These are bruising, redness, swelling and discomfort.

Side effects have included hematoma at the site of injection, nausea, malaise, dizziness, lightheadedness, diarrhea, and pain that lasted up to two weeks.  The most significant complication has been pain for two weeks after the procedure.

How does it work?

The fat cell wall is digested by phosphatidylcholine.  The fat leaks and is absorbed through an inflammatory process.  Hence some pain and induration will occur, and we will have to wait for the resolution of the inflammatory process.  That takes eight weeks.  By four to six weeks post injection, most patients will able to see an improvement.

How is the procedure done?

The procedure is done under topical anesthesia.  Multiple injections will be required in order to deliver the product to the various areas of the skin.  It is important for us to make certain that everybody understands that this is a procedure, which in order to deliver the expected result, will need to have an impact on the skin.

The postoperative care is straightforward and simple. Two days of rest and no social activity for one week are needed.

Lipodissolve is an exciting procedure for small amounts of fat deposit. Its place and role in our armamentarium is growing, not as much in replacing other procedures, but in treating areas of the body or specific problems other techniques did not address well or provided a less dramatic result.

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Learn about the various breast procedures in Chicago.

Patients interested in breast enhancement are frequently confused about the choices and options available to them regarding the type and size of implant, location of implant placement ( under or over the muscle) and the type of incision.  There are many reasons for the confusion, one of which is because questions cannot be answered independently of one another and therefore various decisions need to be made simultaneously.  The other reason for confusion is that much information is biased and opinionated and does not allow for a rational decision.

 I am going to start with the most difficult issues regarding the type of implant to use, saline versus silicone and its placement, above or below the muscle.

Let’s provide some factual information:

1. Saline implants require a smaller incision.

2. Saline implants provide flexibility in scar location.

3. For a given final volume, the envelope in a saline implant is smaller than that of a silicone implant resulting in a firmer implant as it lies outside the body.

4. Saline implants placed under the muscle tend to feel softer than above the muscle.

5. The firmness of the breasts is directly related to the scar tissue formed around the implant, inversely proportionate to the amount of breast and muscle tissue in front of the implant and the inherent firmness of the implant.

6. When an implant is placed underneath the muscle only the upper inner part of the implant is covered with muscle. The outer and lower part of the implant is covered by whatever breast tissue, fat, or skin is available.

7. Silicone implants are much more amenable to placement above the muscle.

8. Silicone implants are more expensive than saline implants.

9.  Silicone implants are felt to be longer lasting than saline implants, but the present type of implants have been on the market only since 2006 and have been implanted in trial since 1992.

10. Implants placed subpectorally have three drawbacks:

a. They are more painful in the immediate postoperative period.

b. They can occasionally result in distortion of the breasts with muscle contracture.

c. If the patient has some breast tissue and the breasts themselves are soft or become softer over time, the breast will tend to drop down while the implant stays in its initial higher position under the muscle. However, an implant placed underneath the breast tissue will tend to migrate down with the breast tissue, maintaining the aesthetic result longer.

11. Cleavage issues: the implant must be centered underneath the nipple; therefore, the cleavage is directly related to the distance between the sternum in the midline and the nipple itself, and the size of the implant to be placed in that space.  As the implant gets larger its radius becomes larger and if the center of the circle is at the nipple, then the larger radius will allow for more fullness medially and, therefore, more cleavage.

12. In order to have a satisfactory result with implant placement above the muscle, 2 cm of breast tissue in the upper pole are needed.  With silicone implants, we are not as strictly restricted as with saline implant by this law.

13. Mammography: The sensitivity of a mammography decreases with any type of implant in any position. Generally, radiologists prefer implants placed subpectorally.

MRIs are very valuable if implants are present and are required for patients who have silicone implants.

14. Incision site: there are four types of incisions available.

The inframammary incision is the most common incision and is felt to be the safest.  The next common incision is a periareolar incision. The way I perform the enhancement, is by making the incision in the lower part of the areola elevating the skin off the lower part of the breast and then going down underneath the breasts with a similar dissection as an inframammary incision. The axillary incision is performed less commonly. Its drawback is the inability to always properly dissect the lateral pocket to provide a natural result. If bleeding were to occur, it will occur farthest away from the entry site and may require a separate inframammary incision for control. Sometimes curvature of the chest prevents the surgeon from visualizing well the medial and inferior aspects of the pocket. Therefore, I personally reserve it to a situation where small implants are going to be placed.  The last incision is from the umbilicus.  This does not allow for silicone implant placement and voids the warranty that the manufacturer provides. I do not offer it to my patients.

Implant size: the way we manage size is a combination of the patient’s desires, the result of sizers tried in the office at least two times and the measurements we obtained during the examination. All that combined with my surgical experience dating back to 1987 is used to help the patient chose an implant they are happy with.

Breast Enhancement Photo Gallery

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