There is perhaps no plastic surgery procedure more personal or that holds more promise for enhancing a woman's self-image than breast surgery, which offers not only cosmetic benefits, but health benefits as well. There are a number of options available to help women achieve their desired results: breast augmentation, breast lift and breast reduction.

• Known as augmentation mammaplasty, breast augmentation allows women who are dissatisfied with their breast size to achieve a more personally pleasing dimension and shape. The procedure is ideal for patients who want to restore breast size and fullness after pregnancy, breast feeding or weight loss.
  
  
  
• This is consistently one of the most common plastic surgery procedures performed nationally and is also one of the most common procedures performed by Dr. Garramone. Patients having this procedure are consistently some of the most satisfied patients in his practice.
  
  
• One of the primary decisions to make prior to this procedure is the type of implant and size of the implant. Both saline and silicone gel implants are used. Silicone gel implants were approved by the FDA in late 2006 for use in patients desiring a breast augmentation. Prior to that, their use was limited to reconstructive procedures only in the United States. The advantage of these implants is that they feel more natural than saline. We are now using silicone gel implants in the majority of our breast augmentation patients.
  
  
• The shape and size of a woman's breasts prior to breast enhancement surgery will influence both the recommended treatment and the final results. During the procedure, a small incision may be made either under the breast, around a portion of the areola or in the armpit. The implant is inserted either under the breast tissue, but above the underlying pectoralis muscle - or under both the breast tissue and the muscle. The incision is discreetly closed with tiny sutures designed to be inconspicuous. The best surgical approach for the insertion of implants is determined during the patient's consultation and depends on your preferences, your anatomy and Dr. Garramone's recommendation.
  
  
• Depending on which procedure is utilized, breast enhancement is performed most often under sedation and local anesthesia on an outpatient basis. Regardless of the procedure, most people return to their usual activities including work within one week of the procedure. Strenuous activities should be avoided for three to four weeks. Breast augmentation surgery can be combined with other procedures most often body contouring procedures on the abdomen like a tummy tuck.
  
  
• Known as mastopexy, a breast lift reshapes the breast are raises the position of the nipple by reducing or eliminating sagging, which may be caused by pregnancy, breast feeding, or simply gravity and age. This is a reshaping procedure and does imply and change in volume. In some cases, a patient may want a volume increase as well as a shape change and a breast implant may be used to accomplish the desired aesthetic result. With this combined procedure an implant may be used not necessarily to increase size alone, but to provide shape, projection and mostly fullness in the upper part of the breast where fullness is usually lacking. Typically, an incision is made to allow the removal of excess skin, while leaving as much breast tissue as possible. The nipple and areola are then repositioned to a more aesthetically appealing position on the breast to form an uplifted contour.
  
  
  
• A breast reduction is related to a breast lift but the focus of the procedure is different. The main objective of the breast reduction is to reduce the size or volume of the breast and reduce the amount of skin covering the breast. The scars left behind may be quite similar after these two different procedures. The procedures may blend together in the patient who desires a breastlift but would like to be a little smaller as well.
  
  
  
• Breast reduction, or reduction mammaplasty, can reduce a number of health-related complications that result from very large and heavy breasts, such as back and neck pain as well as restricted lifestyles. A breast reduction may also be performed not for health issues but to create more aesthetically pleasing breasts more in balance with the patient's body. The key is the removal of excessive fatty tissue, breast tissue and skin, which reduces the size of the breasts and makes them lighter and more youthful because the position of the nipple and areola are lifted as well.
  
  
• A breast lift or breast reduction is normally performed as an outpatient procedure under sedation or, in some cases, under general anesthesia. Most patients usually return to their usual activities about a week or two after surgery, but should avoid strenuous sports and other activities for approximately three to four weeks.
  
  

Liposuction enhances the body's overall shape by permanently removing fat deposits. Liposuction procedures are consistently among the top 5 aesthetic cosmetic plastic surgery procedures performed in the United States.

• Liposuction can be performed to achieve a relatively small volume reduction or in some cases a large volume reduction. In some cases, with smaller areas or with smaller volumes in delicate areas the operation requires a bit more care and planning and finesse and "liposculpture" is sometimes used to describe this procedure. It remains, however, a variation of liposuction.
  
  
• Liposuction can be performed alone or in conjunction with other procedures, it is effective on all areas of the body, including the face, neck, abdomen, back, buttocks, thighs, lower legs and arms. The result is an aesthetically pleasing physique that helps patients achieve their goals.
  
  
• Liposuction is commonly performed on both men and women. It may be the most common procedure performed on men. Men will tend to seek correction of the chest, abdomen and especially the flank areas. Women will tend to seek correction of the abdomen, flanks, thighs and arms. Less often, liposuction is performed on the leg below the knee to treat the calves and knees.
  
  
• Liposuction is performed through small incisions placed inconspicuously in natural skin creases using a high-vacuum instrument called a cannula, which is a tube inserted through the incisions into the treatment area. Prior to this however the areas to be recontoured are infiltrated with a solution containing saline, local anesthetic and epinephrine. This is referred to as tumescent anesthesia and it accomplishes several things. It produces bleeding and therefore bruising after the procedure. It results in less discomfort after the procedure and it makes the liposuction procedure itself more efficient.
  
  
• A vacuum pump removes fat by suction as the cannula is moved under the skin. The cannulas are of various dimensions and diameters depending upon the area of the body to be treated. The amount of fat removed will vary depending on the patient and the area of the body to be treated. Typically fat is removed along with a portion of the tumescent solution and this combination is referred to as the "aspirate" once it is removed.
  
  
• There are limits as to how much fat can be removed during an outpatient surgical procedure in order to maintain a margin of safety. After the procedure, the access incisions are closed with small stitches. A compression garment is placed on the patient and it is recommended that this be worn for at least 2-3 weeks after the procedure, however in most cases it is worn for 6 weeks. Most activities are resumed within 14-21 days depending on the extent of the procedure and the number of areas treated.
  
  
• Liposuction is not a substitute for a healthy diet, nor is it useful for generalized weight reduction - it selectively removes fat only from specific areas. The goal of the operation is always contouring of the treated body areas.
  
  
• When only one or two small areas are treated, local anesthesia may be used. When multiple or large areas are treated, IV sedation or general anesthesia is usually administered.
  
  
• During liposuction, fat can be taken from one area of the body and repositioned in another area to improve contour in that second area. This is referred to as fat injection or grafting. Fat is typically transferred to areas of volume loss such as the lower face and to the lips. In some cases areas where folds or creases develop are filled with fat from another area.

Commonly known as a "tummy tuck", an abdominoplasty removes excess skin and fat from the abdominal area to correct the changes that occur after pregnancy and also after weight loss.

• Patients who undergo tummy tuck surgery are able to look better in clothing and bathing suits and are typically more comfortable engaging in physical activities. They have an increased level of comfort and confidence.
  
  
• The underlying muscles and tissue of the abdominal wall are tightened, resulting in a trimmer, more youthful physique. Additionally, scars of the lower and mid abdomen can be improved, or in some cases eliminated. The results can, in many cases, be dramatic.
  
  
• The abdominoplasty or tummy tuck can considerably reduce the look of a protruding belly that is out of proportion with the rest of the body. The abdominoplasty is most appropriate for patients who are in good shape but have fat and loose skin around the abdomen that will not respond to dieting or exercise This procedure is most often used to treat women after having a pregnancy, which may have caused the abdominal skin and muscles to become weak and loose.
  
  
• Significant weight gain followed by weight loss, in men or women, can also leave a loose or sagging layer of skin and fat, which can also be treated with an abdominoplasty. Both pregnancy and weight gain cause skin expansion, which causes the deeper elastic structures of the skin to tear, resulting in stretch marks.
  
  
• Proper diet and exercise may help up to a point after weight loss or pregnancy, but exercise will not take away loose skin and excessive folds. An abdominoplasty is not a procedure to treat obesity nor is it a substitute for proper diet and exercise. Ideally, patients should wait to have a tummy tuck until after planned pregnancies and when weight loss goals are reached.
  
  
• Complete abdominoplasty allows maximum results. A tummy tuck achieves this by removing the extra skin which usually contains most if not all of the stretch marks, and tightening the abdominal muscles to enhance your shape and figure. The excess fat is usually contoured with liposuction. Alternatively, a limited procedure, or "mini-abdominoplasty", may be performed in select patients. In this procedure, the main lower abdominal incision is shorter. A shorter scar allows less skin to be removed. Which approach is best for each patient is decided during the patient's initial consultation. Scars from previous abdominal surgery may be used for a tummy tuck or removed during the tummy tuck. This is often the case for women who have Cesarean section scars. These scars are usually replaced with a new tummy scar.
  
  
• An abdominoplasty may be combined with other procedures performed on other parts of the body. For example, liposuction is commonly performed in conjunction with abdominoplasty. In some cases breast surgery is also combined with an abdominoplasty.
  
  
• A complete abdominoplasty is performed under general anesthesia or deep sedation. Most people return to their usual activities approximately two weeks after surgery. Strenuous activities should be avoided for approximately 4 -6 weeks. Giving yourself the proper time to heal and recover is very important.

This surgical procedure firms and sculpts the upper arm by removing excess skin and fat. By tightening the drooping skin of the arm and eliminating wrinkles, this procedure can result in a firmer, more appealing physique in both men and women.

• Sometimes, liposuction alone may be used to remove excess fat through small incisions, allowing the skin to tighten. It is possible that this will create enough of a correction, and no additional skin will need to be removed. In other cases, however, the skin will not have the necessary elasticity to sufficiently tighten around the arm. In these situations, the excess skin will be removed.
  
  
• The scar left behind after this procedure will depend on how much excess skin is present. Larger amounts of skin will require longer scars. The most dramatic results are obtained when all of the excess is removed and typically this results in a scar extending from the armpit to the elbow along the inner aspect of the upper arm. When the arm is at your side the scar is not visible. In some cases less skin can re removed through an incision confined to the armpit. This approach does not allow as much skin to be removed and is reserved for milder cases.
  
  
• Typically, an arm lift requires general anesthesia or deep sedation. Most people return to their normal routines approximately one to two weeks after surgery. Strenuous activities should not be performed for about four to six weeks.
  
  
• In some cases Thermage may be used in place of surgery to accomplish tightening of the skin. This will not produce results like a surgical correction but no anesthesia is necessary and this technique does not result in any scarring.