8 Reasons Your Breast Augmentation at Rucker MD Plastic Surgery Clinic will be Easy and Speedy.

If the only thing that is separating you from the breast augmentation you've always wanted is the length of recovery time and the pain, this post is for you. Our patients often come to us with these exact concerns, and with having performed several thousands of breast augmentation procedures, we now have patients rating their pain level from a 2 to a 5 on a scale of 1 to 10, 10 being most painful.  I attribute these low pain levels and speedy recovery times to the following factors: 

1. Each augmented breast is routinely injected with anesthesia before the patient awakens from the procedure. This technique gives a four hour, pain-free period and allows our patients to easily start their oral pain medication, allowing a smoother transition in pain control. 
2. Our patients are instructed to take their pain pills every 4 to 6 hours after surgery for the first 24 hours. This helps to give a uniform level of pain control and helps to avoid cycles of increasing pain that may happen within the first 24 hours. 
3. All of our patients are prescribed a muscle relaxant which helps to reduce the overall incidence of muscular spasm, which can contribute to the pain level.
4. We routinely give our patients anti-nausea medication to help avoid nausea caused by the anesthetic.  
5. Our patients are instructed to sleep in a “Lazy Boy” position, with the head slightly elevated so as to put less pressure on the chest and to reduce the discomfort caused by trying to sit up.
6. Each patient is given specific instructions for a gradual return to normal activity over a 2 to 3 week period. This helps to avoid setbacks in recovery that are usually caused by over-activity. 
7. All of our patients are instructed to wear a support bra to help avoid the movement of the breasts during routine daily activities. 
8. The incision used to introduce the implant is made as small as possible so as to also help reduce the level of post-operative discomfort.

With these pain reduction methods, our patients have described the breast augmentation procedure to be less stressful and much less painful.  Less muscle spasm, less post-operative nausea and a smaller incision all help to produce a faster and smoother recovery.

To set up a consultation with Dr. Rucker, call the Rucker MD Plastic Surgery Clinic at 800.456.8222 and check out the website at http://www.ruckermd.com  

Doctor, do I need a breast lift with my augmentation? And what is the difference between silicone and saline?

It’s hard to give the best answer without the benefit of an examination, however, there are three general complaints you may have that will indicate whether you need a breast lift with your breast augmentation.
Three good indicators are:

• You feel you have lost fullness on the upper portion of your breasts
• You feel a push-up bra is a necessity
• You feel going braless is not an option

Before.

After.

A good at-home test to decide whether a lift is right for you is to place your index finger beneath the fold of your breast and point upwards toward your nipple.  If your finger tip protrudes over the upper portion of your areola or above it, then a lift is probably needed, however, a detailed examination by your plastic surgeon is recommended.

If a lift is needed, but not done with your augmentation, your breast sagging may appear more pronounced after your breast augmentation procedure. In my experience, 75% of my patients that opted for a breast lift also chose a breast augmentation. A breast augmentation and breast lift combination may be the best option for you if your goals include any of the following:

• Regaining a "perky”  look
• Improving your cleavage
• Being  able to go braless

Your next decision may be choosing between a saline versus a silicone implant. I personally believe that current saline and traditional gel-filled implants will be obsolete in the near future.  I use the Sientra  “Gummy Bear” implant.  The benefits of this new implant option include a natural feel, less complications in the event of rupture and a probable less chance of scarring around implant. See video for more details. Choose wisely.

“Some people think that women with perky, well-formed breasts are stupid. Actually, it’s quite the opposite. Women with perky breasts make men stupid.”

To schedule a consultation, call us at 800.456.8222 and visit our website www.ruckermd.com 

The Future of Breast Augmentation.

Silicone or saline? That is the question that many women on the market for a breast augmentation face. When weighing the options, there have always been strong arguments for both sides. Thanks to new technology, the future of breast augmentation is here with a new implant that has the best of both worlds.

Up until five years ago, the salt water filled implant (saline) has been the preferred implant. The standard silicone implant has since returned to favor, but there has always been that lingering doubt of what happens if it leaks. 

Saline Implant Benefits:

• Non-toxic in the event of leakage since it is filled with salt water.
• Size can be varied by merely adding more fluid to enlarge it.

Saline Implant Drawbacks:

• Does not feel natural.
• Tends to reveal itself more by producing ridges on the breast.
• Higher chance of leakage.

Over the past five years, many of my patients have chosen the silicone-filled implant because it does feel much more natural, and it tends to not show the ridges beneath the skin that the saline implant does. Nonetheless, it still causes some concerns if there was leakage, and the silicone was to leak into the breast tissue.

Currently, I feel the saline-filled implant and the standard silicone gel filled implants will be obsolete within the next two years. This is due to the current availability of the revolutionary high tension, gel implant – AKA the “Gummy Bear” implant. The term is coined from the fact that when cut in half, the breast implants are able to retain their shape with no leakage, similar to the popular gummy bear candies.

The benefits of the “Gummy Bear” implant are so pronounced that it has become my implant of choice.

"Gummy Bear" Implant BENEFITS: 

• Smaller chance of a leakage of gel into the body if a rupture is to occur.

• Natural feel, similar to the gel-filled implant.

• Multiple shapes and sizes offered.

• Cost is very comparable to the standard gel-filled implant.

• Some studies suggest that there may be less of a chance of scarring around the Sientra “Gummy Bear” implant.

With these suggestions and information in mind, it is important to remember that a consult with your plastic surgeon is highly recommended to determine your personalized needs. For more information or to set up an appointment, please call 715.833.1068 and speak to our patient coordinator.

It's here! PROFILES Summer 2013!

Check out the latest issue of PROFILES magazine to read up on:

• The Future of Breast Augmentation by Joseph Rucker, MD, FACS
• Benefits of Stem Cells in your Skin Care Regimen
• Menopause & You by Donna Schoenfelder, MD
• Help! I have ACNE SCARRING
• Group Workouts You Will LOVE by Lori Heck, ASPIRE Personal Training
• Feed Your Skin! by Tammy Schofield, MS, RD
• The Enza Medispa summer specials!

Doctor, What Size and Type of Implant would you Recommend?

When choosing a breast implant, there are two major factors one must consider (1) what size implant is best for me and (2) what type of implant should I choose. The following information is meant to guide you in making an educated decision

IMPLANT SIZE: While there is no specific chart that will display exactly what size implant should be used, most surgeons will have a general suggestion for each of their patients. The surgeon must make a determination based on the cup size that the patient desires as well as the body size of the patient. Generally I offer the suggestions listed below:

• Small statured women (<5'3") with an A cup requesting a C cup. My implant range suggestions are between 280cc to 380cc
• Medium statured women (>5'3") with an A cup requesting a C+ cup size. My implant range suggestion is between 380cc and 480cc
• Large statured women (>5'8") with an A cup requesting a C+ cup to a D cup. My implant range is between 480cc and 540cc

IMPLANT TYPE: When it comes to implant type, I personally think the saline filled implant and the standard silicone gel filled implants will be obsolete within the next two years. This is due to the many benefits of the revolutionary Sientra "Gummy Bear" Implant. The benefits of the Sientra implant are so pronounced that it has become my implant of choice due to the following reasons:

• There is a smaller chance of a leakage of gel into the body if a rupture is to occur
• Has a natural feel similar to the gel filled implant
• There are multiple shapes and sizes offered
• The cost is very comparable to the standard gel filled implant
• Some studies suggest that there may be less of a chance of scarring around the Sientra implant

With these suggestions and information in mind, it is important to remember that a consult with your plastic surgeon is highly recommended to determine your personalized needs. For more information or to set up an appointment for a consultation with Dr. Rucker, please call our offices: 715-832-1774. All inquiries are welcome and can be answered by an experienced Rucker MD staff. 

5 Factors That Contribute to A More Natural Appearance and Feel in your Breast Augmentation

1. Scar Around Implant - If a scar develops around the implant, this can result in a firmer feel and a less-than-natural appearance. I routinely use an antibiotic rinse in the implant pocket during the augmentation to combat this problem and have seen the occurrence of this capsular contraction around the implant to be much less frequent.  

2. Over the Muscle vs. Under the Muscle - I have a personal preference to place the implant beneath the chest wall muscle. In the 1,500 breast augmentations I have performed I have placed the implant in the space beneath the muscle in 95% of my patients. My reasons for sub-muscular placement are as follows:

• A more natural appearance
• Easier to detect any breast lumps, which may appear at a later date
• Less concern with breast feeding
• Less of a chance of scarring around the implant
• Less of a chance of seeing rippling on the side of the breast

3. Silicone vs. Saline - 90% of my patients has chosen Silicone over Saline for their implants. A significant number of patients that have chosen Saline over Silicone return in 1 to 3 years and request an exchange to Silicone implants. My rationale for choosing Silicone over Saline is:

• Silicone is much more natural feeling
• In my experience, there is less of a chance of leakage
• There is a smaller chance of detecting rippling on the side of the breast with the use of Silicone.

4. The Size of the Breast Skin Envelope - This is a less-mentioned, but very important factor.  If the breast skin has been stretched during pregnancy, it is more difficult to obtain a natural feel and appearance without doing a breast lift at the same time as the augmentation. The lift coupled with the augmentation produces a much more natural appearance and a more perky appearance of the breast. 

5. Smaller Normal Breast Tissue vs. Larger Normal Breast Tissue - The amount of breast tissue prior to the augmentation contributes significantly to a natural feel after augmentation. The implant is more easily hidden in the larger breast tissue and takes on a more natural feel and appearance.

Profiles Fall / Winter 2012

The NEW Profiles is here! Click below to see our online edition.

• 1st Annual Pink Ribbon Charity Golf Classic Recap
• Giving Mother Nature a Boost
• Saying Good-Bye to Wrinkles
• Tips for Luscious Lips
• Eating Healthy for the Holidays
• Botox Blunders

Also check out our specials on the back-page for the Enza Medispa.

Watch your mail-box or check out these newspapers for your own copy:
Nov 7th: Pioneer Press, New Richmond News, River Falls Journal, & Hudson Star Observer
Nov 10th: Leader Telegram
Nov 11th: Chippewa Herald

Open publication

Breast Augmentation

Many females with small breasts are dissatisfied with their body image. Breast Augmentation (augmentation mammoplasty) is a procedure designed to enhance fullness by enlarging a woman’s breast through the surgical placement of a breast implant.

The primary goal is to:

• Enlarge a naturally small breast, which is often an an inherited condition

• Restore breast volume lost following a pregnancy or weight loss

• Achieve better symmetry when breasts are moderately disproportionate in size and shape

Augmentation mammoplasty, also referred to as breast enhancement or breast enlargement, involves placing silicone or saline breast implants either behind the breast tissue (illust. B) or beneath the chest muscle (illust. A) to add size, shape and fullness to the breast and to make the body more proportional.

Implant placed behind the chest
wall muscle.

Implant placed above the chest
wall muscle. 

Breast augmentation does not correct sagging breasts. Women who desire to improve contour as well as increase fullness, may want to consider a breast lift in conjunction with breast augmentation.

The best candidate: Adult woman of any age can benefit from breast augmentation. It is recommended that breasts be fully developed prior to the procedure. Breast augmentation does not generally interfere with a woman’s ability to breast feed. Good candidates for breast augmentation are defined as:

• Women who have a personal desire for enhanced breast size; not influenced by the opinions or desire of others.

• Healthy women who do not have a life-threatening illness or medical condition that can hamper healing.

• Women with a positive outlook and specific goals in mind for improving their own body image.

All patients will need a pre-operative consultation to review their medical history and perform a physical examination to determine if they are indeed, a candidate for the surgery. During this consultation, the procedure, recovery, expected outcome and possible risks or complications are discussed.

The Procedure: Breast augmentation is performed under a general anesthetic on an Out Patient basis. In the preoperative area, any last minute concerns are discussed and the chest wall is carefully marked to ensure accurate implant placement. Although there are several ways to insert the implant, I prefer to make a small (2-inch) incision beneath the breast. The implant is then placed behind the chest wall muscle. (illust. A) I prefer this approach for several reasons:

• It is easier to develop the pocket to house the implant

• To avoid the nerve which gives sensation to the nipple

• No nipple areola distortion, which may occur when placing the entrance incision around the nipple.

• Placement of the implant behind the chest wall muscle gives a more natural look.

The procedure takes approximately one hour. A support bra is then placed on the patient and they are discharged home, usually 2-3 hours after the procedure.

                                                before                                                 after

                                               before                                                 after

Breast Implants: The implants differ, being filled either with saline (salt water) or silicone gel and come in varying sizes and shapes. In my experience, 80% of our patients prefer the feel and shape of the silicone.

Recovery Time: Most patients rate the pain level as a 5 on a scale of 1 to 10. Patients are given written instructions and prescriptions for pain control and an antibiotic. Light activity is tolerated well in the first week. We see the patient one week after their procedure, when dressings and sutures are removed, recovery and activity levels are reviewed and an anticipated date for returning to work is discussed. Light employment is tolerated after two weeks, heavy lifting and regular activity in 3 to 5 weeks. Patients are given instructions for care of sutures to help prevent excessive scarring. A final consultation is scheduled five months after their procedure.

Patients are happy with breast augmentation and often experience an increase in self-esteem and confidence. Most go from an A or B cup to a C plus cup after the procedure. You may review pictures of breast augmentation cases at ruckermd.com.

Visit Dr. Rucker on RealSelf for answers and tips to the following questions:

2 Days After Mastopexy and a Breast Augmentation; Hematoma Maybe Seroma?
Are my Expectations Possible for Breast Size/Look?
What Size Would You Be For My Frame to get From B to C?
Are my Breast Implants Too Close Together?
Breast Lift or Just Nipple Reduction?

To schedule an appointment or for information regarding breast augmentation, visit www.ruckermd.com or call 800.456.8222 or 715.833.2116

Mommy Makeover

Childbearing can be one of life’s most rewarding experiences, but it can also take a toll on the mother’s body, often causing women to lose their hourglass figures. Each woman is affected differently, with age and genetics playing a significant role in how her body recovers. Even with the assistance of a personal trainer and a proper diet plan, both of which I strongly recommend, many women may find it difficult to get it all back together after pregnancy. This can cause a dilemma for mothers. They may feel guilty for thinking about themselves at a time when they feel they should be focused on their family. Many of our patients find that it’s essential to focus on both.

They want to feel good, look youthful and sexy and regain their self-confidence. They realize that having a positive self-image can also improve their relationships with loved ones.

Mrs. M, now 38, didn’t like her shape after pregnancy. “I lost fullness up top, I had badly stretched skin and nothing was where it was supposed to be, even though I was doing endless sit-ups,” she said. “ I just wanted my body back.”
A Mommy Makeover is a combination of plastic surgery procedures that may include a breast reduction or breast lift (with or without breast implants), a tummy tuck and liposuction. These procedures lift and tighten slackened skin and reduce the unwanted, hard to remove pregnancy fat.

Before

After

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Breast Reduction

This procedure has been helpful for women with large pendulous breasts who have medical problems caused by the excess weight of the breasts, which can often occur after pregnancy. These problems can include:
• Back and neck pain
• Skin irritation beneath the breast
• Skeletal deformities
• Bra strap irritation
• Breathing problems
• Occasional tingling sensation in the hands

The goals of breast reduction are to:
• Make your breasts look balanced when you are wearing a bra
• Regain your younger breast contour
• Reduce the size of the nipple areola to fit the smaller breast size
• Reduce the overall breast size to reduce the associated symptoms and to make the breast proportional to the rest of the body
Breast reduction is performed in a hospital under general anesthetic. Care is taken to make the breasts symmetrical and to preserve sensation to the nipple, as well as, hopefully, the ability to breast feed. Both of these goals are addressed by leaving the nipple areola attached to a pedicle of breast tissue. Through this pedicle run the nerves and vessels that help preserve sensation and a good blood supply to the nipple areola.
All incisions are closed under limited tension, resulting in a smaller breast and areola and a lifted breast contour. We have found that if symptoms are well documented, most of these procedures can usually be covered by insurance. Please visit my website, www.ruckermd.com, to view before and after pictures of breast reduction patients.

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Breast Lift
You’ve nurtured your children, now, your body could use a little help getting back to normal. Stretched and sagging breasts are common after child rearing. The breast lift (mastopexy) has become one of the most requested procedures in plastic surgery, with approximately 100,000 breast lift procedures performed in the U.S. in 2007.

Over time, a woman’s breasts lose their youthful shape and fullness. These changes may be the result of pregnancy, breast-feeding, weight fluctuations, aging and the natural effects of gravity. Heredity can also contribute to breast sagging. Many women are born with poor skin elasticity resulting in a loss of breast firmness.

A breast lift raises and firms the breast by removing excess skin and tightening the surrounding breast to reshape and support the new breast. The nipple areola may become enlarged over time. A breast lift will reduce the areola to place it in better proportion with the newly shaped breast. The goals of the breast lift are to improve a female breast that:
• Sags or is pendulous, but is proportionate with the body frame
• Has lost firmness and skin elasticity
• Has a flatter elongated shape
• Has a nipple and areola that point downward
As with breast reduction, we do not detach the nipple areola complex during a breast lift, in an effort to maintain nipple sensation later. It has been my experience that most patients want to be a “perky ‘C’ cup” after a breast lift. This is an outpatient procedure when performed by itself.

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Liposuction 

After pregnancy, unwanted, fat deposits on the hips, thighs, abdomen and buttocks can be extremely difficult to remove, even with an exercise and dietary program. Liposuction can be performed on any part of the body to remove fat deposits and sculpt a more pleasing contour. This procedure is best for someone of normal weight with good skin tone. Several areas can be reduced at the same time. Because the fat cells are permanently removed, the bulge cannot come back in that place. Your new figure should be a motivation to exercise and be mindful of a healthy diet. Liposuction is usually performed on an outpatient basis under general anesthesia, taking approximately 1-3 hours. Body contouring procedures are considered cosmetic and not covered by insurance.

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Tummy Tuck (Abdominoplasty)

The human body is more like plastic than rubber. Childbirth may leave you with loose abdominal skin and stretched abdominal muscles. The tummy tuck (abdominoplasty) procedure helps to flatten your abdomen by removing excess skin and fatty tissue. Tummy tuck should not be confused with liposuction, although your surgeon may elect to perform liposuction to improve the overall results.
Tummy tuck is the recommended treatment for sagging or projecting lower abdominal wall tissues. Good candidates are women who have muscles and skin stretched by multiple pregnancies, and men and women, who, after massive weight loss, still have excessive fat deposits or loose skin in the abdominal area. The procedure is usually done as an outpatient under a general anesthetic and will take 1-2 hours. 


There are several options for tummy tuck.

Your surgeon will examine you and then discuss your desired results and the anticipated outcome for each.
Complete abdominoplasty. The incision is made in the lower abdominal wall area, from hipbone to hipbone. Excess tissues beneath the umbilicus (belly button) are removed and the scar is hidden beneath the panty line.
Belt abdominoplasty is usually for patients who have lost a considerable amount of weight. The laxity of the skin and fatty tissues occurs on the abdomen and around to the back requiring a circumferential excision of these tissues to get the best result.
Partial or mini abdominoplasty is often performed on patients whose fat deposits are located in a small area beneath the belly button. This procedure can be done in the office with IV sedation.

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What are the risks of having multiple procedures?

Several studies have found that the combined Mommy Makeover procedure was not significantly more risky for the patient than a single procedure would be. It is important to stress that these procedures are best performed by Board Certified plastic surgeons at a fully-equipped surgical facility. I believe that the best way to avoid complications is to select my patients carefully. We try to avoid performing these procedures on patients with any significant medical problems that may compromise their recovery.

The benefits to the patient of performing multiple, carefully selected procedures as opposed to several separate procedures are:
1. A reduced overall time under anesthetic
2. Downtime for recoveries can be combined, especially when time away from work and other responsibilities is an issue
3. Reduced cost for combined use of surgical facilities, 
anesthesia, and medical staff.