May 15th, 2013 Miguel A. Delgado Jr, MD
Dr. Miguel Delgado in surgery
There are different situations where a secondary breast reduction may be requested. One would be the young patient who may have had a reduction mammoplasty before she finished developing. Another may be the patient who gained weight after her original surgery and the remaining fat cells have grown larger. Then there is the patient who just wishes to be smaller than from the original surgery.
In most cases, a secondary procedure can be done. It is a little trickier, and close attention needs to be made regarding breast shape and blood supply of the nipple/areolar complex, which has been disrupted from the original surgery.
If the surgery is going to be done by a different surgeon, it is helpful to have the original operative report. Sometimes that is not possible, but it can still be done safely and efficiently as long as selection of the secondary surgeon is made carefully. Be sure to find a Board Certified Plastic Surgeon that specializes in breast surgery, ask a lot of questions and be sure to see before and after pictures of actual patients of the surgeon.
April 30th, 2013 Miguel A. Delgado Jr, MD
San Francisco, California-Many patients are concerned about how weight loss either before or after breast reduction surgery will affect their breasts. The amount of breast tissue versus fat varies with every patient. For some weight loss will make a difference in their breast size and for others it may not change much.
There are pros and cons to each situation, and it would be wise to discuss this in detail with your surgeon at the time of your consultation and explain what has happened in the past when you have lost or gained weight and how it affected your breasts.
The pros of losing the weight before your surgery are; if you are able to maintain a stable, desirable weight you will achieve the best long term results and likelihood of secondary surgery is greatly reduced. The cons of losing weight prior to surgery may mean if you have lost enough breast tissue and fat you may no longer qualify for medical insurance coverage, and now it may be considered a cosmetic procedure.
The pros of losing weight after surgery are, it is easier to do now that you can exercise without large bouncing breasts. Motivation increases as a better body image is emerging. The cons are a weight loss of 20 pounds or more can make a significant change in the breasts possibly requiring another surgery to address loose skin and loss of fullness.
Some women may decide to lose weight before surgery but then are never able to achieve their goal and are doomed to always have large breasts. Women that go ahead and have a breast reduction are among the most satisfied patients even if it may mean they will need another surgery in the future due to weight loss. Breast reduction surgery can be done more than once, so waiting to lose weight is not necessary.
April 15th, 2013 Miguel A. Delgado Jr, MD
This is a 19-year-old female, 5 feet 2 inches, 130 pounds, she underwent a vertical short scar breast reduction reducing her size from a DDD to a C cup. She is seen approximately six months after surgery with nicely healing scars.
San Francisco, California-After some cosmetic surgery procedures it is difficult to see the results right away due to swelling and bruising. With breast reduction surgery you will not see what the end result is going to be for several weeks and possibly months, however, removal of excess breast tissue will immediately relieve back and neck pain. Bruising will last 1 to 2 weeks. Swelling can take several weeks to resolve and the breasts need to settle into their new position. To keep swelling in check, it is essential to sleep with the head and back elevated, and strenuous exercise should be avoided for 3 to 4 weeks.
Sensitivity of the breast skin and/or numbness of the nipples is common as the breasts heal. It is not unheard of for these sensations to last for up to a year. Women who have had breast reduction surgery need to be patient to see the final outcome and allow themselves to adjust to their new image.
In my practice, I have found that women who have had reduction mammoplasty surgery are among the most satisfied patients, as are men that have had gynecomastia surgery, which is male breast reduction.
March 30th, 2013 Miguel A. Delgado Jr, MD
Large breasted San Francisco Bay Area women who have struggled with getting a bra to fit properly need to be sure after their breast reduction surgery that they have bras that fit correctly to give their new breasts support.
It is believed that 80% of women wear the wrong size bra. Different brands and styles vary with their sizing, so you need to try on the bras.
When shopping in Marin County for a new bra, it should fit snugly on the last hook so that as the bra stretches with age it can be adjusted. If you gain or lose weight, check to see if you need a new bra size. Cup size needs to be changed when the band size changes. Every band size you go down, you want to increase the cup size by one in order to keep the same cup capacity. Band size should remain the same unless you gain or lose weight. Cup size will change with breast reduction surgery.
To get your band size, take a measuring tape and wrap it around your rib cage right below your breasts. The method of adding 4 or 5 inches to the band size is from the 1930’s and does not work on modern bras.
To get the correct cup size there should not be any wrinkling of the fabric, it should be filled out. On the other hand, the cup should not have any spillage or “double boob” if so, the cup is too small.
For under-wire bras, the under-wire should not be resting on breast tissue, but on the ribs. If you have armpit rolls or back rolls, the band is probably too big and the cups too small.
A properly fitted bra should not have straps digging into your shoulders; the straps should provide only 10% of the support, and the band 90%. If you find your bra strap riding up in back, you need a smaller band size.
According to Wikipedia, about 10% to 25% of women in Western cultures do not wear bras, and some reports show that wearing a bra does not prevent sagging breasts. Ultimately, it is up to the reduction mammoplasty patient to determine what is most comfortable for her.
March 15th, 2013 Miguel A. Delgado Jr, MD
Many Marin County women are concerned about the scars created by breast reduction surgery. This is probably the most common concern of women who are contemplating a reduction mammoplasty. I don’t think I know of any woman who has regretted having the surgery as the benefits far outweigh any negative aspect.
The good news is that there is scar management available that is recommended to all patients. With time, most incisions heal with the resulting scar nearly invisible; however, this can take up to a year. Patients who actively participate in their scar care seem to have the best results. Each patient is instructed as to the best method for their healing.
In general, I recommend the use of silicone sheeting once the incisions have healed and there isn’t any broken skin or wounds, usually after about 10 days. Silicone sheeting is cut to cover
the incision and then taped into place. The sheeting can be removed before showering, and should be cleaned daily using mild, non-oil based soap such as Ivory or Neutrogena. Each strip may be reused until it shows excessive wear or reduced adhesion. It will probably need to be replaced every 10 to 14 days. It is recommended that the sheeting be used for 2 to 3 months.
It is very important to avoid sun exposure on the incisions for several months; sun can cause the pigment of the skin to darken and the scar may thicken.
February 28th, 2013 Miguel A. Delgado Jr, MD
Before and After Reduction Mammoplasty
Numerous San Francisco Bay Area women ask if a reduction mammoplasty can be done without large scars. This is probably the main reason that breast reduction surgery for some Marin County women is indefinitely postponed. With any surgery, there will be resulting scars. It is the cosmetic plastic surgeons goal to make all scars as hidden and invisible as possible.
There are different ways to do breast reduction surgery, some with more prominent scars than others. Each patient is individual and at the time of the consultation Dr. Delgado discusses which procedure will work the best to get the best results. He will explain in detail what can be expected, and he will show many before and after pictures.
With traditional breast reduction surgery, the resulting scars are either the “inverted T” or the “anchor”. The incision goes around the areola then vertically to the breast crease and across the breast crease, thus is the shape of an inverted T or an anchor. This procedure is the “gold standard” for breast reduction for women with breasts of significant size. It has been observed that women who have had this procedure are thrilled with their results. Most note that after the incisions have healed that they fade and are barely noticeable.
For the woman that has moderate sized breasts, the short scar breast reduction is a great technique that avoids the incision that goes across the inferior breast crease. It is also known as the “vertical” or the “lollipop” breast reduction.
Lastly, the least invasive of all would be breast reduction by liposuction. Liposuction has only a small incision for the cannula, resulting in a very small scar. This procedure seems to work the best for younger women with minimal to moderate breast enlargement with normal skin elasticity and minimal sagging.
As one of the leading breast reduction specialists of Northern California, Dr. Delgado is very sensitive to the concerns of women regarding scars. For each patient he minimizes them as much as possible and follows up with scar treatment after surgery consisting of silicone gel sheeting.
Which ever procedure is done, most women are thrilled with their new breasts and are among the most satisfied plastic surgery patients.
February 15th, 2013 Miguel A. Delgado Jr, MD
Before and After Breast Reduction on the older woman
Marin County women wanting a reduction mammoplasty, also known as breast reduction surgery, ask” How old is too old for surgery?”
Age is less a factor than the health of the patient. A woman in her 60’s or even 70’s can be a good candidate. She must be in good health and not have any problems that would interfere with healing or anesthesia. She should get clearance from her family physician who will probably want a complete physical including blood tests and an EKG.
Older San Francisco Bay Area women seem to be the most pleased with the surgery as they have suffered with the symptoms of their large pendulous breasts the longest. For her to be finally be free from back, neck and shoulder pain in of itself is huge. Instead of constant disappointment of trying on clothes that never fit right, women are thrilled to be able to go shopping and buy clothes off the rack. The most common complaint I have heard is that they wish they had the surgery sooner.
For whatever reason the surgery had to be postponed, maybe financial or emotional, if the older woman has made the decision she wants to proceed with cosmetic plastic surgery later in life, as long as she has approval from her doctor, there is no reason why she can’t.
January 30th, 2013 Miguel A. Delgado Jr, MD
Marin Cosmetic Surgery Center
Women who have made the decision to proceed with a reduction mammoplasty, also known as breast reduction surgery, have some important decisions to make and at the top of the list is choosing the right surgeon. You want a surgeon that is Board certified in Plastic Surgery and a breast reduction specialist. A close second is the facility where the surgery is to take place. As a member of the American Board of Plastic Surgery, the surgeon is required to operate only in a certified or state licensed ambulatory surgery center or hospital. This is for the safety of the patient.
Ask for a tour of the surgical facility, note if it is organized and clean. See if the attitude of the staff is respectful and professional.
Marin Cosmetic Surgery Center (MCSC) is not only state licensed, but is certified by the American Association for Accreditation of Ambulatory Surgery Facilities (Quad A) which means it meets the highest standards of safety. The accrediting organization verifies that national standards are met and maintained such as; reviewing policies and procedures, safety, equipment, etc. They also verify that the surgeon has hospital privileges should an emergency arise. Credentials of all staff members are verified.
Dr. Randy Gaynor
Board Certified Anesthesiologist
Complimenting Dr. Delgado’s highly trained staff is Dr. Randy Gaynor. Dr. Gaynor is a Board Certified Anesthesiologist who has been with MCSC since its inception in 2001. Dr. Gaynor’s popularity with the patients is well documented with reports of his kind and caring manner. It has been noted that he spends a great deal of time with each patient explaining what they can expect in surgery and answer any questions they may have. He is also available to patients by phone or in person prior to surgery to address any concerns.
MCSC offers the patient privacy with a separate entrance directly into the surgery center avoiding the waiting room of the main office. Should a patient require an overnight stay, no less than two caregivers will be provided with one being a Registered Nurse with post operative training including advanced cardiac life support (ACLS) certification. With only one operating room with the highest of standards, the incidence of infection is very low to almost non-existent; infection and complications caused by infection are some of the greatest risks in surgery. Marin Cosmetic Surgery Center offers the ultimate in concierge medical care, serving the San Francisco Bay Area including; Marin County, Sonoma, and Napa since 2001.
January 15th, 2013 Miguel A. Delgado Jr, MD
It is getting harder to get approval for breast reduction surgery (also known as reduction mammoplasty); as things are changing with medical insurance companies. Dr. Delgado, a breast reduction surgery specialist explains to his patients that many policies now have an exclusion clause or their criteria are difficult to meet. After all avenues have been exhausted and insurance is not possible, what other alternatives are there?
Some San Francisco Bay Area patients take out an equity line of credit on their home which usually will get them the best interest rate, some use credit cards, although the interest rate can be quite high, but if you plan on paying it off quickly, this can be the fastest and easiest way.
We accept Care Credit for financing and are able to help patients apply right in the office, or you can apply online. Care Credit offers many different plans depending on the amount you want to borrow and the length of time for the loan. We have many patients that have been happy with this resolution so that they can proceed with their breast reduction surgery.
December 29th, 2012 Miguel A. Delgado Jr, MD
Many San Francisco Bay Area women with large breasts have back, neck and shoulder pain. Large breasts can increase stress on the spine. The force of gravity causes the front of the body to pull forward which causes the normal curve of the spine to straighten out causing widespread muscular pain.
Women looking to eliminate back pain want to know how painful a breast reduction mammoplasty might be. The surgery itself is done under general anesthesia; the patient is asleep and feels no pain during surgery. There is not any dissection of chest muscle (as there is for a breast augmentation) and so is generally much less painful. Since pain thresholds are different for everyone, the patient is given prescription pain medication to keep her comfortable. Most women only need the stronger pain medication for a day or two after surgery and then switch to “over the counter” analgesics such as Tylenol. Of course, any side effects or severe prolonged pain needs to be reported immediately.
Women with large pendulous breasts notice the immediate relief after surgery from back, neck and shoulder pain, and many say it is easier to breathe with the weight reduced off their chest. After expected general soreness for a few days, the biggest complaint I’ve gotten is that the patient wishes she had the surgery sooner.