RESTORATIVE BREAST RECONSTRUCTION…Flap Methods


The reasons women choose to have restorative breast procedures are well stated in these quotes …

I need to feel whole again,” –  “You have given me back what cancer took away,” – “The reconstruction of my breasts made me feel restored…not reconstructed,”  –  “I want to look as good as I feel,”  –  “I want to look and feel sexy again…and want my husband to see me as sexy.” 

These are but a few of many thousands of thoughts from women who wanted to fully recover from their breast cancer…with a whole body.

Today, I review Flap Procedures (Stage II Breast Reconstruction/Restoration).  There are a variety of Flap Procedures used to restore breasts…not every type is right for every woman, but we determine this after careful and thorough evaluation of your needs and goals.  I tailor each flap procedure to achieve beautiful natural looking breasts. There are four muscle flap techniques as follows:


1) Latissimus Dorsi Flap 
uses a flap of skin and muscle from the back on the same side as the operated breast.  This is transferred forward to form a breast mound that will look and feel natural since it is your own living tissue.

2) TRAM Flap is the most common form of living tissue  breast restorative techniques used today.  It creates a natural looking, soft, warm breast.  TRAM Flap involves either free flap or pedicled flap techniques.  Pedicled flap means the tissue remains attached to its blood supply.  TRAM Flap procedures employ skin, fat and muscle removed from the lower abdomen and transferred to the chest.

3) DIEP Flap reconstruction employs excess skin and fat from the lower abdominal area, through an incision similar to that used for Tummy Tucks. This is a “perforator flap” technique that is muscle sparing…meaning no muscle function is sacrificed, but warm living tissue is used instead.

4) Gracilis Flap harvests excess skin and fat from the inner thigh to restore natural looking, soft, warm breasts.  This may be a TUT Flap (without muscle) which is referred to as a Transverse Upper Thigh Flap. When a small amount of muscle is required…a TUG Flap is employed.  Either flap can be harvested so the donor scar is discretely hidden inside the upper thigh.

This is a brief overview of the 4 Flap techniques used for restorative breast reconstructions.  Each of them has it’s own virtues… and all offer beautiful, natural looking and feeling breasts.  I have guided many women through making the right choices so as to ensure optimum results.

GOALS of RESTORATIVE BREAST PROCEDURES

Goals are critical to good outcomes.  You must have yours…here are mine: “all cosmetic surgery should be functional & all reconstructive surgery should be aesthetic & look as natural as possible.”  

ADVICE TO MY PATIENTS

Always ask me questions; ask to see pictures of my patients, gather information and consults with trusted mentors, make your decision.   There are NO wrong decisions. Choose a qualified, Board Certified surgeon with specialized training and expertise in reconstructive surgeries.

Next blog will cover Implant Breast Restoration.

Dr. Steven Davison

At DAVinci…we combine the supreme elements of art & surgical science.”


VECTRA 3 D IMAGING…see now what real results look like!


VECTRA 3D COMPUTER IMAGING

Well, I am proud  to offer the benefits of this revolutionary break through technology.  Since, more and more men and women of all ages and stages in life are coming in for anti aging procedures, it became clear that a more effective way of conveying information…and showing them their likely results… was essential.

The Vectra 3D computer imaging system can determine the correct breast implant size and shape, design the nose of your dreams, or take years off your face…before you’ve even committed to any procedure.  Clearly…these pictures are worth thousands of words.

VECTRA 3 D IMAGING…BRIEF OVERVIEW:

•Vectra 3D computer imaging has increased patient confidence

•You participate in creating your personal treatment plan

•3D Imaging by Vectra establishes a clear treatment plan

•Vectra’s 3D system offers unparalleled accuracy & flexibility

•Dr. Davison is able to convey more information…more clearly

•Allows you to see simulations of actual outcomes

•Vectra 3D demos procedures so you envision your likely results

•AND…here’s what some patients are now saying:

•  Unbelievable!  It was like seeing my new body in a 3D movie.

•  You can make all the changes you want…until you find the look that’s right for you.

•  The Breast simulation showed me how much better I would look with a lift and implants.

•  It’s impressive to realize how close the simulations are to the actual results.

•  It helped me make a crystal clear decision about breast augmentation and the right implants for me… based upon science.

Here’s how it Works:

Vectra’s 3D system employs three dimensional photos of your body.  Once captured and uploaded, you can view the images and procedure simulations on a large screen.  The simulations can be rotated and viewed from many different angles allowing you to actually see the full effect of your procedure.  Breast augmentation is a great example of this process.  The 3D system even selects various breast implant sizes and shapes, simulated over your own anatomy to help you choose the right one. And Rhinoplasty or  “nose job” outcomes are much easier to understand. For example: A nose with a hump, whether wide or crooked, should be viewed from several angles to more accurately see what needs to be done.  The 3D system makes this happen. It has erased frustration and concern for so many patients.

Have you been putting off a procedure due to being fearful about the outcomes?  Come in…let’s talk and then simulate them for you.  You will see it all clearly….and love it.

Dr. Steven Davison

“DAVinci…Where we combine the supreme elements of art and surgical science.” 

Breast Augmentation – 4 important decisions to make!


Breast Augmentation requires four important decisions for the surgical plan. Answering the key questions clearly improves communication and helps meet patient expectation.

1 – Size of the Augmentation.

This is key to the patient’s satisfaction. It is a little like Goldilocks this one’s too big, this one’s too small and this one’s just right. Using cup size as a starting point is fine but as everyone’s perception of cup size is different, fraut with pitfalls. A better estimate is to use cc increase. As there are physical parameters such as base width of the breast and skin envelope size, a starting range should be suggested by your surgeon. Trying on sizes in a trial and error session or using state-of-the-art 3D imaging are current ways to establish size. 3D imaging now allows patients to see their own chest with and without clothes after augmentation; it is just short of amazing.

2 – Type of Implant

Silicone versus saline is the question. If you’re under 22 years of age, saline is the only option, yet any older and it’s the patient’s desire. The safety concerns stirred up in the media have had no medical science support. So now it comes down to the pros and cons. Silicone implants are softer, lighter and more natural. Saline implants are more prone to rippling unless overfilled which leads to firmness yet can be placed through smaller incisions. This advantage has been negated by the success of an implantation tool called the Keller Funnel. Type of implant is irrelevant to size unless really large implants are chosen which need a larger access incision.

 3- Placement of Margin

The location of incision is either inframammary (in the fold under the breast), periareolar or around the nipple area, transaxillary via the axilla crease or through the bellybutton.  The axilla and bellybutton offer smaller, more hidden incisions where an inflatable saline device is inserted. This benefit is not so great now that more silicone devices are used. The inframammary incision gives the surgeon the most control, yet can ride up the breast with maturity. Ideally, the periareolar incision can be almost imperceptible when it heals but a poor scar or decreased nipple sensation are potential risks. A larger silicone access incision in the axilla can be cosmetically sensitive to the women doing moderate to high intensity exercise in which the arms are raised. An experienced surgeon should consider anatomy, the size and patient desires before pitching the incision. Beware the surgeon who just uses his or her incision only.

 4 – Position of Implant

The last issue is a subglandular device which is under the breast versus the device which is partially under the muscle. The advantage of under the breast or subglandular implant is more effective in size particularly to address some mild breast ptosis. The disadvantage is the implant may show through the skin. A subglandular device is not for thin-skinned individuals or those without at least 2 cm of breast coverage in the upper pole. The partial subpectoral placement means the upper 2/3 of the implant is under the pectoralis muscle. This has the advantage  to reduce the round edge of devices being obvious. The lower third of the device is still covered by the gland alone. Muscle force and function is not affected. In conclusion, the subglandular position is ideal for a larger breasted patient who wants more fullness to correct mild ptosis. The partial subpectoral device is better for most other patients.

FAT…A KEY TO YOUTHFULNESS


Fat can be your "Friend"...

Fat in the wrong places can be your worst enemy, but when it comes to facial aging, fat is key.  With aging and dieting, we often lose fat in the wrong places.  Places it needs to be in order to retain a youthful look.  Here’s how it goes:

  • At Birth the face is round with enough evenly distributed fat.
  • Mid to late 20’s facial fat starts to degrade (not visible yet).
  • Early 30’s and more fat loss – a more heart or oval shaped face emerges with fuller cheeks and a narrow chin area.
  • The 40’s ushers in more fat loss in the cheeks causing mid face droop and jowls.
  • By age 50 extreme fat loss shows as the face takes on a square or inverted triangle shape.

One “key” to restoring a youthful facial contour and shape is more fat volume in the face. Fat grafting is a wonderful procedure that produces natural, long lasting results – using your own excess body fat. We simply take excess fat from an area of abundance and “transplant it” to the desired area.  There is no risk of rejection or allergic reaction since it comes from your body. Downtime is minimal and the results well worth the effort.

I know it can be so confusing to know which is the right procedure – there are many good choices.  I try to keep you up on the best of the best.  I know what works, what looks and feels natural, and what is lasting.  I’m sold on Fat grafting (Fat injections, etc).  By the way, we use it to rejuvenate many areas of the body like the back of the hands etc.

Bottom line is…we’ve learned from Hollywood celebs that starting in your 30’s or 40’s and doing small anti aging procedures, keeps you looking younger…always.

Fat Grafting – keep it in mind.  You may want to use it sometime soon. Yours for Natural Beauty,

Dr. Davison

Look Younger in Minutes Without Surgery!


Cosmetic Injectables are a used for a "quick" lift

Since aging never pauses, we have to anti age everyday. I keep recommending injectable fillers because they really work to help defy aging. A Liquid Facelift is a great way to rejuvenate the face instantly and look years younger.  I treat these areas most often:

Temples, Tear Troughs, Above the ear, Jawline, Cheeks, Eye area, Mouth & lips, Nasolabial folds. Injections are done in my office and take only a few minutes. There’s little or no downtime. We use different fillers for different reasons, since each has its own merits. For example, hyaluronic acid fillers such as Juvederm® give an immediate lift, smooth away moderate to severe wrinkles and restore youthful contour. It’s versatile and lasts up to 18 months.

There are several great injectable formulas available, and we’ll educate you about them and help you make the best choice.  Often, we use a combination, like Juvederm® and BOTOX®, to get the best results. I never recommend or use anything that is not tried and true. I want you to get the most nautral looking results possible!

One other critical factor in getting great results from injectables is the “injector.”  Special training and understanding of the complex facial anatomy along with knowing how to do the injections is critical. I am an expert injector, not bragging, just a fact that’s very important. Next time I’m going to talk about the Vampire Facelift.  You’ll be amazed.  Until then: Keep putting your best face forward. For more information on Juvederm and Botox visit our website.

Dr. Davison

 

Summer Fun – And the Scoop on Skin Cancers


Wearing a Hat is added sun protection!

Last time I wrote about Sun Protection but didn’t take the time to tell you about the cancers the Suns’ UV rays can cause. First, know that skin cancer is the most common form of cancer in the United States (500,000+ per year), and that more than 90% of skin cancer is caused by the sun’s UV rays.  Melanoma and Non-Melanoma’s are the most common types, but they are highly curable if treated early.  We all are at risk…but some of us more so than others. Read On!

You could be at higher risk for skin cancer if any or all of the following applies to you:

  • You have lighter natural skin color
  • IF there’s Family and/or Personal history of skin cancer
  • You have daily Sun exposure through work and play
  • You have a history of early life sunburns
  • Skin that burns, freckles, reddens easily, or becomes painful in the sun
  • You have Blue or green eyes & Blonde or red hair and/or…
  • Certain types & a large number of moles
  • Some prescription drugs cause more susceptibility to UV rays

The three common names for skin cancer are:  Basal Cell Carcinoma, Squamous Cell Carcinoma, and Malignant Melanoma.

Now, I’m not going into the treatments, just know that if you develop symptoms such as a small, shiny lump, a spot or mole that is red and firm, or a sore/spot that bleeds and becomes crusty – and won’t heal…. you need to get checked out immediately.

OK – Here’s a review on “Summer Sun Protection” –

  1. HATS – DON’T LEAVE HOME WITHOUT ONE
  2. SUN GLASSES – CRITICAL FOR EYE PROTECTION
  3. SUN PROTECTION GARMENTS/PRODUCTS (like used in water sports)
  4. SUNBLOCKS – they work optimally when used with the rest of these!

Now, go have some fun!

Dr. Davison

BOTOX® Cosmetic Summer Update


Botox has been around now for two plus decades and is one the most popular wrinkle treatments for both men and women. It’s also been used in therapeutic medical treatments, hundred of thousands of them worldwide for several decades. It’s safe and it works! One ten minute treatment and a few tiny injections gets results you can see in just a few days…and the results are long lasting. In fact, the latest news is that Botox users are reporting longer lasting results, with fewer injections, after about 20 months of usage. In case you don’t know, here’s how Botox works:

  • Blocks muscle contractions …prevents line/wrinkle formation
  • Blocks muscle motion to smooth out existing lines & wrinkles
  • Botox Relaxes facial folds
  • It Restores a refreshed, youthful facial appearance
  • Botox Smooths away tense, worn appearance
  • Gets Results you can see in a few days
  • Is an office treatment that’s virtually downtime free! It’s All About the Injector!!!!

You can go to spas and get different injectable filler treatments, but do you want to risk your face to a non-expert injector? Look, no two faces are alike and the facial anatomy is quite amazing with muscles, tissues and nerves that help you put your “best face forward” everyday. A bad treatment can be bad news! I individualize every single treatment I do. This requires an excellent knowledge and understanding of the complex facial anatomy, the right dosages and expert injection techniques. Please don’t risk the possible downsides, by using an unskilled injector, to what can otherwise be a great experience. I am an “expert injector” specially trained and skilled in all injectable treatments. I think Botox is great…and I want you to enjoy the best results possible so that you can go through the summer looking relaxed, refreshed and youthful. OK. Come on in and let’s get you set for the rest of your summer…so you can feel and look terrific.You can learn more by visiting our website or calling us. http://davinciplastic.com/nonsurgical-botox.htm

Click her to see video on Botox Patients

Dr. Davison

UVA…UVB…SPF… So what does it all mean?


Sunscreen protection at the beach!

Industry terms can often be confusing.  So, since we all love our fun in the sun,  let me explain briefly these words so you can understand the importance of arming yourself with protective products this summer.  First, you already know there are lots of products out there…different brands tout different benefits so it’s difficult to choose the right product. But, you need to know this and arm your beach bag with great products that will help protect your skin from the sun’s damaging rays.  Here we go:

  • UVA…the aging rays cause premature signs of aging with excess sun exposure. UVA rays are stronger in the early morning and late afternoon.
  • UVB…the burning rays that result in “sunburns.”  The UVB rays are stronger in the late morning and early afternoon.
  • SUNBLOCK…is a topical application that actually scatters or deflects the rays of the sun.  Key ingredients to look for are Titanium Dioxide and/or Zinc Dioxide.  We carry excellent products…so ask us to recommend the right one for you!
  • BROAD SPECTRUM SUN PRODUCTS…offer both UVA and UVB protection.
  • SPF… refers to Sun Protection Factor offered by each product.  For example an SPF 30 means you can remain in the sun 30 times longer while using the product than you could without wearing it.  The testing to determine the “factor” involves how long it takes to redden the skin without product versus with product applied. Thus, SPF 30, SPF 50 etc. Two more important factors include “daily use” meaning those products are formulated to offer incidental exposure like getting in and out of your car…walking from a parking lot into a store…that kind of scenario.   “Active Use” products are designed to protect during long periods of sun exposure.  The SPF levels are higher and labeling may indicate for “sports” usage, or long wearing.  These are great for children.

 OK.  Now go have some fun in the sun…but not until you’ve armed yourself. We can help with your needs there.  More next time!

Summer Fun In The Sun…Safely


It’s unavoidable and I know it…so let me give you some common sense tips for protection while you play in the sun this summer. First know that lotions and  Sunblocks work optimally when used along with hats, sun glasses and sun protection garments.

Sun protection and sun screen at the beach

Sun Protection

Our environment is changing and this alters the way the sun affects us.  So gear up for those outings and you can keep your skin looking good while minimizing damage.  Here’s my short list:

  • HATS…there are many inexpensive/expensive glamorous hats today that can “dress up” any outfit…even a bathing suit.  Wide brim hats are a terrific way to block sun rays from your face and neck.  Gardeners have worn them for years to avoid excess sun exposure.
  • SUN GLASSES …are an absolute must!  They can be stylish and still protect your precious eyes and the skin tissue surrounding the eye area.  Glasses also prevent “squinting” which causes those fine lines that form around the eye.  The eye area is one of the first on the face to show aging dramatically.  Beware…and protect it!
  • SUN PROTECTION GARMENTS & PRODUCTS…These garments have been used in water sports for many years now.  Most are available in every size and style imaginable. They can provide up to SPF 50 or even greater, are light weight,can be worn in the water or on land for play/sports and are great for extended periods of time during sun exposure.  The great benefit (especially for children) is that reapplication is not needed when wearing these garments.  A newer “wash in “ product is available and can be “washed into” any garment.  This can add SPF 30 for your regular outdoor clothing.

With schools out…vacations in progress and lots of time planned in the summer sun….please take the time to absorb this info ….and APPLY it.  Have a great time!