Monthly Archives: August 2015

Is a Tummy Tuck Scar Covered by a Bikini and Underwear?

iStock_000000177225Small It goes without saying that any woman considering a tummy tuck in Tampa is concerned about the resultant scar. Dr. Traci Temmen’s patients routinely ask, “how long will my tummy tuck scar be,” and “how low will my tummy tuck scar be?” But in reality, what most patients really want to know is, “will my tummy tuck scar be covered by a bikini and normal underwear?”

While it is impossible to speak for all plastic surgeons, or all patients for that matter, leading plastic surgeon in Tampa, Dr. Temmen, describes here a normal postoperative tummy tuck scar in her practice at Temmen Plastic Surgery.

Question: How long is a typical tummy tuck scar?

Dr. Temmen: For a normal-sized patient, with a BMI less than 30, my tummy tuck scars are usually ten to twelve inches long. For most patients, this tummy tuck scar is approximately one inch longer, on either side, than a C-section scar. By many standards, a tummy tuck scar of this length, similar to the length of a C-section scar, is the same length as a mini tummy tuck scar. I rarely extend a tummy tuck beyond the points of the hipbones and never extend a tummy tuck scar around the sides or back of a patient.

Question: How low is a typical tummy tuck scar?

Dr. Temmen: I generally place my tummy tuck scars five to seven centimeters, or two to three inches, above the top of the vaginal lips in the midline. Laterally, the C-section scar extends slightly superiorly, but almost never extends above the level of the hipbones. If a patient has had a previous C-section, I am usually able to place their tummy tuck scar at or slightly below their old C-section scar and then remove the C-section scar during the tummy tuck surgery.

Question: Is a tummy tuck scar covered by a bikini or underwear?

Dr. Temmen: For most patients, the resultant tummy tuck scar will be covered by bikini bottoms and/or normal underwear. Very thin patients, with relatively little excess abdominal skin, may have a tummy tuck scar that is slightly higher than normal and may be at least partially visible, particularly in the midline, in a standard bikini bottom or underwear. I can usually predict which patients will have a higher or longer tummy tuck scar than usual and forewarn these patients ahead of time.

Question: How long does it take a tummy tuck scar to heal?

Dr. Temmen: In general, it takes two to three months before a tummy tuck scar will be 80-90% as strong as the surrounding skin. The healing and appearance of a tummy tuck scar proceeds in a cyclical fashion. Initially, the scar will appear as a fine, fresh line. After several weeks, the scar becomes red, hard, and raised. Then after six months to one year, a tummy tuck scar will become softer, flatter, and will appear as a fine, white line. Because it takes so long to see the final appearance of a tummy tuck scar, most plastic surgeons recommend waiting at least six months to one year before considering any type of tummy tuck scar revision.

Question: What can I do to prevent or minimize my tummy tuck scar?

Dr. Temmen: Unfortunately, anytime a patient undergoes cosmetic surgery, there will be a scar. As a plastic surgeon, I try to make each tummy tuck scar as short, thin, and hidden as possible. To try to minimize the appearance of a tummy tuck scar, I recommend that my patients avoid sun exposure to their scar for one year. Sun exposure can cause scars to become darker and more noticeable.

Question: Are there any creams or ointments that can help my tummy tuck scar heal better?

Dr. Temmen: There isn’t one magic cream or “potion” that has been proven to make scars heal better or faster. If there were, everyone would use it. With that said, for patients that want to try a topical treatment for their tummy tuck scar, I usually recommend a silicone-based ointment. Topical silicone agents have been shown to decrease the appearance and soften all types of scars, not just tummy tuck scars. To learn more about all of the cosmetic surgery procedures Dr. Traci Temmen, a Board Certified Plastic Surgeon performs we encourage you to visit her website or contact her today: 813-771-6393

How Long Should You Wait to Have a Tummy Tuck After Pregnancy?

Babies are wonderful and beautiful…but stretch marks and loose, saggy abdominal skin are not! Whether they admit it or not, every new (and not so new) mother is anxious about getting her “pre-baby body” back. This concern over recovering from pregnancy and the birth of a child has many women asking Dr. Traci Temmen, “How long should I wait to have a tummy tuck after pregnancy?”

Mom with Child

Abdominal Wall Changes During Pregnancy:

Everyone knows that abdominal skin stretches during pregnancy. However, in actuality, all layers of the uterus, abdominal wall, and skin stretch during pregnancy to accommodate the growing baby. The uterus, which is usually the size of closed fist, increases to the size of a large watermelon at the time of a term pregnancy. The abdominal wall muscles, particularly the rectus abdominis muscles (a.k.a. the “six-pack” muscles) and the connective tissue between the two muscles, stretch in a vertical as well as horizontal direction making them thinner, longer, farther apart, and weaker at the time of delivery. Finally, the abdominal wall skin (and occasionally the skin of the back, flanks, buttocks, and thighs) stretches rapidly and circumferentially, which sometimes results in stretch marks and/or a loss of skin elasticity.

Abdominal Wall Recovery After Pregnancy and Delivery:

Immediately after delivery of a baby, many women are disappointed to discover that they still look six months pregnant. This is due to many factors. It takes at least six to twelve weeks for the uterus to shrink to its original size after the birth of a child. An enlarged uterus is a major contributor to the immediate post-baby belly “pooch.” It takes even longer, between six and twelve months, for the abdominal muscles to strengthen, tighten, and return to their original position. Unfortunately, while the rectus abdominis muscles generally strengthen over time, it is not uncommon for the thick, dense fascia between the lower rectus abdominis muscle to stay thinned and separated. Abdominal fascia lacks the ability to recoil the same way as muscle after significant stretching and trauma. This area of weakened rectus muscle fascia, usually below the belly button, is called a rectus diasthesis if greater than two fingerbreadths can be felt separating the two rectus muscles after the birth of a baby. Rectus diasthesis is a major contributor to a long-term “mommy tummy” and one of the most common indications for a tummy tuck in post-partum women. Finally, similar to the rectus muscles, the abdominal skin also needs between six and twelve months to contract. Unfortunately, while stretch marks will not disappear, they do fade and lighten over time. Stretch marks that are initially wide, deep, and bright red or purple, will become light, thin, and shallow within several months to two years.

When to Have a Tummy Tuck After Pregnancy:

Because it takes at least six to twelve months for all the soft tissues of the pelvis and abdominal wall to contract and recoil as much as possible, Dr. Traci Temmen tells all her patients at the Plastic Surgery Center of Tampa to wait at least six months after the birth of a child before proceeding with tummy tuck surgery. This six to twelve month time period also allows time to lose the “baby weight,” ensuring the flattest, tightest post-operative belly possible. If a tummy tuck is performed before the soft tissues and skin of the abdomen have had time to contract and recover from pregnancy, the abdominal skin will be loose and patients may have a lower abdominal bulge once contraction is complete. This, obviously, is not the ideal result and defeats the purpose of performing a tummy tuck in the first place!

Tummy Tuck Immediately After A C-Section:

Not only does it not result in an effective tightening of the abdominal skin and soft tissues (as described above), but performing a tummy tuck immediately following a Cesarean-section is dangerous and potentially life threatening. In the initial postpartum period, women are at an increased risk for blood clots in the legs and/or lungs. Any type of surgery, particularly an intra-abdominal surgery like a Section-section or a tummy tuck, significantly increases this risk of blood clots and/or death. For this reason, Dr. Temmen (and most other reputable plastic surgeons) would never perform a tummy tuck surgery immediately following a C-section or vaginal delivery of a baby.

For more information on the prevention and treatment of stretch marks, please see Dr. Traci Temmen’s blog from April 2015 titled: Here’s the Skinny on Pregnancy Stretch Marks.

For more information on scheduling a tummy tuck surgery after the birth of a child, or to schedule a free tummy tuck or mommy makeover consultation, please call Dr. Temmen today at 813-771-6393.

How Long Do Breast Implants Last?

Many people considering breast augmentation in Tampa have heard that they have to get their breast implants replaced every ten years — but is this really true? Is there really an expiration date for breast implants? We check in with a doctor who is considered by many to be the best breast augmentation surgeon in Tampa: Dr. Traci Temmen.

Breast Implant Warranty:

Regardless of the manufacturer, most implant companies warranty their breast implants from mechanical failure for ten years. This means that if the breast implant ruptures or leaks, or has any other type of mechanical failure, within ten years of placement, the manufacturer will cover the replacement cost of the implant, and occasionally, help pay for other fees typically associated with the surgery such as the surgeon fee, facility, and anesthesia fees associated with replacement. Some newer breast implant manufacturers also warranty their breast implants from capsular contracture for a specific number of years, often two to three years, after placement. Capsular contracture is the formation of excessive, thick scar tissue around one or both breast implants that can lead to pain, implant malposition, and/or breast hardness.

Fortunately, it is easy to tell if a saline breast implant has ruptured. If a saline breast implant has ruptured, the breast will visibly decrease in size over a period of several days to weeks as the saline leaks out of the implant and is absorbed by the body. However, it is not so easy to tell if a silicone breast implant has ruptured. If a silicone breast implant ruptures, silicone does not leak from the implant and get absorbed by the body, as it does a saline implant. Rather, the silicone remains in the breast capsule and often remains inside the breast implant shell. The patient may not have any idea their silicone breast implant has ruptured or they may experience a change in breast shape or firmness. Thus, MRI imaging is necessary to diagnose a silicone breast implant rupture.

It is because of this ten-year warranty that many patients believe they must get their breast implants replaced after ten years. However, Dr. Traci Temmen of Temmen Plastic Surgery, tells her patients that if after ten years they are still happy and not experiencing any trouble with their breast implants to “leave well enough alone!” There is no medical, surgical, or health reason to replace breast implants ten years after a breast augmentation unless the patient has experienced a rupture, is unhappy with her appearance, or wishes to exchange her breast implants for a specific reason.

Breast Implant Rupture Rate:

Like anything, breast implants do “age” with time. After approximately ten years, the rupture rate for a breast implant is 1% per year. This means that if a breast implant is 15 years old, there is a 15% chance that it will rupture or leak during that year. If a breast implant is 25 years old, there is a 25% chance that it will rupture or leak during that year. Because of this additive risk of rupture, many patients considering a breast lift or other revisionary surgery, will choose to replace their breast implants (even if they are experiencing no trouble with the breast implant itself) at the same time if their breast implants are at least seven to eight years old. While it is not mandatory to replace breast implants during a revisionary surgery, it is recommended if the breast implants are several years old in order to avoid an additional revisionary surgery if the breast implant were to rupture in the future. Fortunately, there is no difference in the rupture rate between saline and silicone breast implants
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When Should You Replace Your Breast Implants?

Still, many patients wonder when they should replace their breast implants. Below are Dr. Temmen’s basic guidelines on when to replace breast implants after an initial breast augmentation surgery:

1. If you have a diagnosed breast implant rupture (and wish to maintain breast volume rather than simply remove the ruptured implant).

2. If you are considering a revisionary breast surgery, such as a breast lift or change in implant position, and your implants are seven or more years old.

3. If you are unhappy with your size and wish to have larger or smaller breast implants.

Other than the reasons above, there is no need to replace breast implants after a certain number of years. If a patient is happy with her breast implants and is experiencing no trouble, there is no need to replace them, regardless of the time from the initial breast augmentation surgery. There are plenty of women with twenty or even thirty-year old breast implants, that have never undergone a revision or replacement, and are perfectly happy with their appearance!

If you have additional questions about replacing your breast implants, or wish to schedule a free consultation with Dr. Traci Temmen, please call the office today at 813-771-6393.

Saline vs. Silicone Breast Implants

One of the most important questions for patients considering breast augmentation surgery is whether or not to choose saline or silicone breast implants. Fortunately, for most patients, either type of breast implant is safe and will give a pleasing, long-lasting result.

Saline and silicone breast implants have essentially the same rupture rate, meaning a silicone breast implant has the same chance of leaking per year as a saline breast implant. Both types of breast implants are safe to use, and neither silicone nor saline breast implants have been linked to health problems or illnesses.

shutterstock_278020784 Saline Breast Implants:

Pros-

1. In general, saline breast implants are much less expensive than silicone breast implants. At Temmen Plastic Surgery, a pair of saline breast implants costs approximately $1,000 less than a pair of silicone breast implants. Patients who are trying to keep the cost of their breast augmentation surgery as low as possible often choose saline breast implants simply because of the lower price.

2. If placed on top of the pectoralis muscle, most studies show that saline breast implants have a lower capsular contracture rate than silicone breast implants. However, as most breast implants, particularly saline breast implants, are placed under the pectoralis muscle, this is rarely an area of concern.

3. Rupture of a saline breast implant is easy to diagnose. If a saline breast implant ruptures, or leaks, the leaking fluid will be absorbed by the body over a period of days to a couple weeks, and the breast size will visibly decrease. Thus, expensive diagnostic tests are not necessary to diagnose rupture of a saline breast implant.

Cons-

1. For very thin patients, rippling of a saline breast implant is much more visible and palpable than with a silicone breast implant. For this reason, Dr. Traci Temmen advises thin patients considering saline breast implants to place the implant below the pectoralis major muscle. The additional coverage offered by the pectoralis muscle makes saline implant rippling much less noticeable.

2. Most patients and plastic surgeons agree that silicone breast implants look and feel more natural than saline breast implants. Saline implants tend to feel a little firmer and have more projection than a silicone breast implant.

Silicone Breast Implants:

Pros-

1. Silicone breast implants generally look and feel more natural than saline breast implants, particularly for thin patients with little overlying soft tissue coverage. Since their approval by the FDA in 2005, the vast majority of patients at Temmen Plastic Surgery choose silicone breast implants for their breast augmentation surgeries.

2. If necessary, silicone breast implants are available in round as well as shaped (a.k.a. anatomic) varieties.

Cons-

1. Silicone breast implants are only approved by the FDA for use in patients 22-years old and older. Patients younger than 22-years can choose to have their cosmetic breast augmentation with silicone breast implants, however, this will void the manufacturer’s warranty and is considered “off-label use” by the FDA.

2. Because rupture of a silicone breast implant is difficult to identify by physical examination, the FDA recommends that patients undergo an MRI three years after their breast augmentation surgery, then every two years thereafter. While many patients choose not to undergo routine MRI scanning, this is the only reliable way to diagnose leaking, or rupture, of a silicone breast implant.

For additional questions on breast augmentation with either saline or silicone breast implants, or for a free breast augmentation consultation, call Dr. Traci Temmen at Temmen Plastic Surgery today at 813-771-6393.