Ask the Plastic Surgeon

Q:  My gynecologist has advised me to have a hysterectomy soon. For the past several years I've been thinking about having a tummy tuck. Can I have both of these procedures done at the same time and, if so, will I save money? It would be a nice perk to benefit in a good way from having to undergo surgery.

A:  Combining both of those operations can be a very practical idea in terms of recuperation time. Your ability to recuperate from both procedures at the same time will save you valuable time away from work or family. Unfortunately, as for cost savings, you probably won't save much. Some facilities will discount the cosmetic-related charges if the cosmetic procedure is done along with an insured procedure. With the shift toward managed care, insurance companies are more diligent about making sure cosmetic procedures are not paid with insurance monies. Each entity (surgeon, facility, anesthetist, etc.) is required to charge separately for each procedure, which prevents cosmetic procedures being submitted for payment along with reimbursable procedures.

Q:  I am planning to have a breast enlargement. In preparation, I've been doing some research on the internet and have noticed several references to not wearing an underwire bra for varying periods of time after the surgery. Most attractive bras are underwires and I'm looking forward to getting some sexy new bras after my surgery. Can you please tell me why underwire is so bad and how long I'll have to wait to wear this type of bra?

A: Don't worry. You won't have to bid your underwire bras goodbye forever - just during the post-operative healing phase and for a few months thereafter. Wearing an underwire bra during the critical healing phase, or too soon post-operatively, can cause changes in the implant pocket size which can impact your breast shape and/or the implant placement. If this occurs, the breasts can become asymmetric (uneven in size) or hard.
Let me explain why this happens. The underwire in the bra presses against the chest wall around the breasts which can potentially cause the implant pocket (area in your chest that the implant is inserted into) to heal in the shape and placement of the underwire. If the underwire is too small, it can make the implant pocket heal too small for the implant causing the breast to become very firm.
    Following breast augmentation (enlargement) surgery, and throughout the healing phase, I recommend that my patients wear a supportive bra but not one that is too restrictive. If you like the look of an underwire bra, you can remove the underwire and continue using the bra. Once you are past the healing phase, which generally lasts a few months, you may go back to wearing underwire bras although I suggest not wearing one on a daily basis. Most women report that they are quite pleased with their new contour after breast augmentation, so you may find that you can achieve your "lifted" look without the need for underwire anymore.

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