Joys of smoking

Many times, when looking at the list of the things patients must do before plastic surgery, some smokers are dismayed to find they must give up the habit at least three to four weeks before the procedure and continuing on through some weeks after the procedure.

Plastic surgeons are not being politically correct. Our concern is about the substances in tobacco that conflict with good medical practice and plastic surgery outcomes.

For starters, nicotine injures the blood vessels and makes them constrict. That means less blood can flow to points in the body where it’s needed.

And one instance when a free flow of blood is most needed is right after surgery that requires longer incisions. Blood is very necessary for proper healing because blood carries vital nutrients and oxygen to the wound site.

Why? If the blood flow is limited, healing can be so delayed the tissue on both sides of an incision can actually die – this leads to very poor scars. Smokers are also at a much higher risk under anesthesia.

Other undesirable side effects include:

• Increased risk of infection
• Longer-lasting bruises
• Raised, red scars

On the other hand, I realize how addicting smoking is and that you may be in some discomfort. You can’t use Nicorette because it also contains nicotine but you can get a prescription for Chantix or Wellbutrin.

That’s why I applaud efforts of plastic surgeons around the nation who actually use carrots, and fewer sticks, to provide additional motivation to giving up the habit, at least long enough to allow for a good outcome to your surgery.

For instance, one board-certified New England plastic surgeon offers fee discounts for patients who give up smoking permanently and lose weight. And it’s all on the record – patients there must submit urine samples before surgery!

A California plastic surgeon, Darshan Shaw, M.D. was featured in our local newspaper, The New York Times, when he started offering non-smoking prescriptions to patients who could only have their surgery after permanently giving up the habit for good.

That creates more healthy patients and a better-than-average-shot at an excellent outcome to rejuvenation surgery.

Many times, it comes down to a question of how the patient wants to look after surgery:

• With a shirt on
• Without a shirt

In some cases, all that’s needed to produce a flatter chest is liposuction.

The exception is when actual, glandular breast tissue – yes, mammary gland tissue — sits under the nipple; that type of tissue does not easily yield to liposuction and must be excised away.

That can usually be done through the areola – the dark areas surrounding the nipples – so the surgical scar is well concealed at the edge of the areola.

Liposuction requires only small puncture wounds about one-eighth inch long. Those scars soon fade.

If a young person has very large breasts, removal of the excess underlying tissue will allow the skin to shrink spontaneously – much like letting air out of a balloon.  So rarely, if ever, is additional skin removal required.

If there is residual skin, six to eight months after the original operation, then a much smaller second procedure (with fewer scars) can be done to remove the excess skin.

If an older person has lots of excess skin as well as breast tissue, then he can elect to have everything removed and tucked at one time.

But that results in a trade-off of scars (which fade) for a trimmer contour.  Alternatively, he can elect a two-stage procedure, as described in the previous paragraph.

Before your first consult with a plastic surgeon, you can get a rough idea what’s needed by the position of your nipples. If they are in the center of the chest muscles, liposuction and breast tissue removal may be just the ticket. That leaves about a one-inch scar in the lower part of your areola. It’s not very noticeable.

Shirts off guys, take delight!

But if the nipples are pointing south, some skin will also probably have to be removed. That can result in a longer scar above, around or through the areola and nipples. After healing, you’ll have a flatter chest and look good in a T-shirt.

But for shirts off-guys, take heart. Those longer scars don’t last forever; they lighten and fade over time.

Depending on the person’s particular case and how much fat, breast tissue and scars must be removed, scars can be located:

• From side to side above and below the areola into the chest
• Under the areola into the chest area in a U-shape
• Under the areola but well hidden in the fold where the breast mound meets the chest

In some cases with a lot of sagging skin, the areola is repositioned higher on the chest.