Archive for the ‘Plastic Surgery’ Category

Breast augmentation using your own tissues (no implants) December 17th, 2008

Dr.Jugenburg

Breast augmentation is one of the most common cosmetic surgery procedures. There are many different ways of performing breast augmentation. Probably 99% are performed using implants. These could be silicone or saline (salt water), they can be round or tear drop shaped (anatomic) and they can be placed above or below the muscle. Finally, the implant can be inserted through an incision under the breast, through the nipple, or through the armpit. Sometimes an incision in the belly button can be used.

Aside from implants, there are very few surgeons who do fat injections instead of implants. This is associated with many potential problems. First, it is a very tedious procedure. There is a limit to how much can be done (you cannot expect a large increase in breast size with this technique). You may require multiple session. Finally, it is currently controversial whether or not it is a good idea to do fat injections into breasts because this can lead to small lumps that although completely harmless, can create a tremendous amount of anxiety in women who may be concerned about breast cancer. It is also unclear how much more complicated it is to screen these women for breast cancer. Studies are still ongoing, but at this time the American Society of Plastic Surgeons does not recommend breast fat injections for breast enlargement.

Another form of breast augmentation without implants is to transplant fat from another part of your body. This is a technique that has developed out of breast reconstruction techniques. In breast reconstruction after mastectomy, microsurgeons (a subspecialty of plastic surgery) are able to transplant fat from another body area (usually abdomen) to recreate a breast shape. In healthy women who have not had a mastectomy, this technique can be used for breast enlargement. The downside of this surgery is that it is very complicated. There are very few people in the world who can perform this procedure and because of it’s complicated nature, there is a risk of failure.

Finally, in a very select group of patients with droopy breasts, the breast tissue can be rearranged to create the effect of a breast augmentation. In effect, the patient has a breast augmentation without an implant. Unlike the previous two non-implant procedures, this procedure is very safe, has minimal risks, and the risk of failure is also minimal.

For more information about implant-free breast augmentation, please contact Dr. Jugenburg at The Plastic Surgery Clinic (http://www.theplasticsurgeryclinic.com) (http://www.plastica.ca)

Martin Jugenburg,MD, FRCSC
Toronto, ON

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Breast augmentation – chosing the right size November 13th, 2008

Dr.Jugenburg

Breast augmentation is one of the most common Plastic Surgery procedures. Despite it being so common and accepted by the general population, I find it surprising how little patients know about it. In this article I’d like to address one specific topic — the size. I would guesstimate that over 90% of my patients come in wanting me to recommend what is the right size for them. My answer is always the same. It doesn’t matter what I think. The only thing that matters is what size they like when the place a sizer into their bra and look in the mirror. Of course I’ll voice my opinion if I feel the size is too big for their chest, but otherwise it’s totally up to the patient. What do I mean by “too big”? As implants get bigger, they get bigger in their width, height, and projection. If an implant is too wide and too tall, it just won’t look good. It doesn’t look good when the implants are so wide that they are touching in the middle or are falling off the chest on the sides (or go under the armpits). It is very rare that my patients request such huge implants, but it does happen. Some women do wish to have huge breasts.

Martin Jugenburg,MD, FRCSC
Toronto, ON

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Correcting prominent ears in adults October 27th, 2008

Dr.Jugenburg

The difficulty in achieving natural looking ears after corrective surgery (setback otoplasty) is reflected by the great variety of surgical procedure that have been developed to address this problem. These procedures fall into two categories. “Cutting” and “Folding” procedures, referring to what is done with the cartilage which has to be shaped to correct the ear shape. In “Cutting” procedures the deformed cartilage is cut and re-arranged to give the proper shape. In “Folding” procedures the cartilage is folded into the proper shape without cutting it. The proponents of the “Cutting” techniques argue that once the cartilage is cut and re-arranged, it will never be deformed again. They feel and “Folding” procedures have a risk of the cartilage unfolding and deforming again. However, the main argument against “Cutting” is that in these procedures the cut edges of the cartilage leave behind sharp, un-natural folds. For this reason, majority of surgeons today perform “Folding” type of a procedures. Mustarde otoplasty is the most widely used technique where sutures are used to hold a folded cartilage in place. It is believed to give the most natural looking result and have the lowest risk of returning back to the deformed shape. A recent article by Burt Brent, MD, one of the most prominent ear reconstructive surgeons, describes an exciting new technical adjustment to the “Mustarde” technique. In it he injects a small amount of fluid just under the skin to hydrodissect the cartilage prior to the insertion of “Mustarde” sutures. Hydrodissection is a technique that I have extensive experience with when dissecting microscopic blood vessels and nerve, and I believe inclusion of this technique in “Mustarde” otoplasty will lead to longer lasting and better looking results.

Martin Jugenburg,MD, FRCSC
Toronto, ON

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