And cut and stab
— With the help of modern plastic surgery, almost any defect can be changed. Does it happen that a patient wants to change globally, thinks that everything is wrong with him and everything definitely needs to be redone: the nose, the ears, the shape of the chest and the proportions of the body?
— It is better not to take such a patient for surgical intervention.
Because we can change him, he will spend a lot of money, but his life will not change, because his problems are not related to his appearance (as he thinks). And then the syndrome of increased expectation is inevitable: he expected that after the operation everything in his life would change, but nothing changed. It would be more correct to refer such a person for psychological help to specialists who would change his inner world - and then he will look at himself differently.
— What if a person has a certain aesthetic idea of appearance, of what it should be, and for him this is objective?
— We are in consultations and are trying to sort out all these issues with the patient. It is very important to listen to him: what he wants to change and what he seeks to achieve through this surgical intervention. And see if it is possible to help him with this, whether surgical intervention will give him what he wants to get as a result.
It happens that a person wants to achieve something that, due to anatomy, is simply impossible or possible, but not in the way he imagines it.
Take blepharoplasty for example: there are bags, there is excess skin under the lower eyelids and there are crow's feet. The patient wants to remove both bags and skin, and to avoid crow's feet. But, unfortunately, this cannot be done with the help of blepharoplasty - it can remove excess skin, paraorbital fatty hernias, correct the nasolacrimal groove, and tighten the molar area. But it does not affect crow’s feet in any way; when you smile, small wrinkles will remain. Other methods of aesthetic medicine, such as Dysport injections, will help. Therefore, we try to work with the participation of cosmetologists. Plastic surgery does its job, cosmetology does its own. Working in unison allows you to achieve excellent results. Plastic surgeons deal with the correction of age-related, anatomical, organic defects resulting from injuries, and cosmetologists deal with the quality of the skin.
If we get an excellent result after blepharoplasty or a circular facelift, but don’t take care of the skin, the patient will not look good.
After a circular lift, for example, the skin develops dryness and thinning - when you smile, there will be a lot of wrinkles if you don’t do the same mesotherapy, don’t inject Dysport and don’t perform skincare procedures.
— How long does the effect of blepharoplasty last? Did you do it forever or for some time?
— It all depends on the patient’s lifestyle: how he will behave in the postoperative period, whether he will visit a cosmetologist or do home care to maintain the quality of his skin, whether he has or does not have bad habits, stress factors—there are a lot of reasons that affect the result. For one person it will last for 20 years, and for the second one can do it again after two years.
Upon discharge, our patient receives detailed recommendations on what he should do to recover, how to behave in the early and late postoperative period, and how to maintain the desired result of the operation for as long as possible.
The whole truth about liposuction
- It turns out that there is no magic pill so that once you are young?
“We need to approach the problem from all sides.” And objectively determine what we can give the patient so that there are no inflated expectations and disappointments.
Many people think that they came to liposuction weighing 130 kg, but should leave with 80 kg. Obese patients with metabolic syndrome (a complex of metabolic disorders in which there is an increased risk of developing cardiovascular diseases and type II diabetes) should not be taken. First, gastroenterologists and nutritionists should work with them - adjust eating behavior, reduce weight, improve metabolism, solve health problems, and then, after stabilizing the weight, plastic surgeons do their job - excise what is sagging, remove the skin-fat apron ( abdominoplasty), “fat traps” using liposuction.
- “Fat traps”?
- When the patient adjusted his eating behavior, lost weight, but some local problem remained - hypertrophied adipose tissue in the abdomen, sides, “breeches” - we call them “fat traps”. A woman is losing weight, she’s losing weight, she already weighs 50 kg, but there are still places that she just can’t cope with - then we remove these local problems.
— How much fat can be removed as much as possible in one operation?
— In the literature you can see different data. If we talk about real practice, three to five liters can be removed without harm to health. And not because we feel sorry for removing more, but because we take into account, first of all, bleeding and possible blood loss. Because the main credo of not only plastic surgery, but all surgery, all medicine is to do no harm. Acceptable blood loss is 300−500 ml, no more. If you stick to this, nothing bad will happen.
— And if you don’t stick to it, what are the consequences?
— What if we pump out not five, but 10 liters? Blood loss of a liter and a half and intensive care, the way out of which is not so simple, because the patient’s hemoglobin level decreases and the immune system fails. If bacteria are nearby, this can lead to sepsis. And not only.
In practice, we perform an operation, and during the process we look: 3-5 liters have been pumped out - there is no blood loss, we can still pump out. The decision is made in real time, we focus on blood loss and decide along the way. But, as a rule, we remove no more than five liters - according to all canons, this is considered safe for the patient. And five liters is enough for a person to immediately see the difference. If, of course, he weighs 130 kg, he will not see the difference, but if he weighs 80-90 kg, of course, he will see changes if he treats two or three zones to the state he wants.
- And what next?
“He saw the effect, he had the idea that he needed to go further, and many (80 percent of such patients) then go to a nutritionist, gastroenterologist, and start playing sports. For them, this operation becomes the starting point - we gave the person the opportunity to look better, and then he goes on his own. And when such a combination happens, it's great!
Causes of small breasts
Often the answer to the question of why a woman has small breast size lies in the constitutional characteristics of the body. Short and asthenic women usually have small breasts, although exceptions are possible. Causes of micromastia:
- genetic predisposition to underdevelopment of glandular tissue of the mammary glands;
- a sharp decrease in the production of sex hormones by the ovaries during puberty due to severe somatic, infectious or endocrine disorders;
- surgical interventions on the pelvic organs and ovaries, in the mammary glands during childhood or adolescence;
- excess male sex hormones (androgens and especially testosterone) in a woman’s body;
- pronounced weight loss.
Promotion
Lipofilling is a means of correction
— Today, lipofilling is becoming more and more popular: is it really possible to pump up the buttocks, chest, or create “abs” on the stomach, or is it all a mythology?
— Lipofilling corrects some minor defects. Let's say we performed a sectoral resection of the mammary gland, leaving a hole. You can easily pump your own fat tissue there and even out the breast structure. It is also possible to enlarge the mammary gland using lipofilling - in a certain area (pump up the top a little, bottom a little). But it will not be possible to increase it by two or three sizes in one operation. Several steps will be required.
In addition, you need to know that after you have done lipofilling and got some results, time will pass and the adipose tissue will shrink, 30-40 percent of the original volume. Therefore, most often we act like this: we uploaded it, it took root, and repeated it a few months later. It took root and was repeated a few months later. And so we achieve the desired volume.
You can’t do cubes and mammary glands in one stage, but in several stages, yes. But it’s not possible to enlarge breasts from size zero to size 4 through lipofilling, and there’s no point in doing it: several operations, several anesthesia - why? When can implants be placed and the desired volume obtained in one operation? But as a means of correction, lipofilling is an excellent tool.
Types of micromastia
Usually, small breast size only brings aesthetic inconvenience to a woman. From a functional point of view, mammary glands of any size produce a sufficient amount of breast milk during lactation. In addition, breasts increase significantly during pregnancy and lactation. There are several types of micromastia in women:
- bilateral - both mammary glands are equally small in size, there is no pronounced asymmetry;
- unilateral - with this form of pathology, one mammary gland has a normal size and shape, and the second is significantly reduced.
There are complex forms of micromastia, when both breasts are reduced, but the degree of their development is different.
Do breast implants burst?
— Today on the Internet there is a heated discussion about the story of Lera Kudryavtseva, whose implants (according to her statement) burst, and silicone leaked into her breasts for years. And also her calls to everyone who has implants to urgently get them out, and to those who were going to put them in to abandon this idea or at least seriously think about whether it’s worth it, because doctors are silent about the fact that implants burst and they don’t work lifelong...
— To seriously answer this question, you need to look at Lera Kudryavtseva’s medical history: what implant was placed, what implantation technique was used, and most importantly, the clinic, when did it all start, how did it proceed? Because sometimes patients can say whatever they want, including for PR. And the media are capable of inflating any “hot” story to a crazy state, without inviting any experts or anyone who is competent in the matter to the investigation.
Was at least one medical document shown in this whole story? Ultrasound, tests, doctors' reports? Is there objective data? Or just words?
Today, all implants from serious manufacturers come with a quality certificate and a lifetime warranty. The design of the implants is such that the silicone remains inside the capsule, even if the implant ruptures, subjected to mechanical pressure or damage - the silicone flows into the capsule, not into the breast. Leakage into some areas of the breast is unrealistic with modern implants, but I don’t know what kind of implant she was given 15 years ago.
Moreover, I will never believe it if a person says: I had an operation, everything was fine and then, out of the blue, the implant ruptured. And especially that it was slowly leaking for four or five years. If the silicone leaked, there were probably clinical manifestations, there must be a fistula, and where there is a fistula, there is an infection, and where there is an infection, there is a temperature of 39 and all the possible consequences of sepsis. For years, this problem cannot remain silent. And if it does, it’s amazing to walk around for four or five years and do nothing. This means that the person is either not telling something or is simply deceiving.
— But can an implant burst?
- Maybe, but for this you need a reason: a car accident, a fall while skiing, a strong blow - an injury to this area. It won’t just burst out of the blue, it needs a mechanical factor.
In my practice there was a situation when we changed implants for a patient. After breast prosthetics, she had two or three births; after rough manipulation while massaging the mammary gland after the last birth, she noted deformation in one mammary gland. When we changed the implants, we saw that in one mammary gland the implant had turned over, and in the other there would be an intracapsular rupture - it ruptured, but the silicone ended up within the capsule. We just replaced the implants. I don't remember any other cases.
Features of breast structure with micromastia
With a very small breast size, the typical cone-shaped gland does not form; only the areolas and nipples can be contoured.
Such a pathology can only be determined after adulthood, since by this period the breasts stop growing and forming. Micromastia affects up to 35% of women of childbearing age. An extreme variant of the pathology is also possible - amastia - almost complete atrophy of the mammary glands, in which there are not even rudiments of glandular tissue in the breast. But this is extremely rare.
Get what you want and stay healthy
— Is there any age limit up to which you accept patients for rejuvenation operations?
— There are contraindications for any type of surgical intervention, including plastic surgery. First of all, these are chronic diseases in the acute stage, such as hypertension, heart attacks and strokes. Therefore, it is more correct to say that the limitation is not age, but health status. It happens that we turn away young people, and sometimes we accept them for surgery even after 85 years.
I am primarily a doctor, a general surgeon, I took up plastic surgery as one of the methods of general surgery and therefore I always decide the issue from the point of view of the patient’s health and how he will live later.
For us, plastic surgeons, a generally healthy person is placed on the operating table - he is operated on for relative medical reasons, not because he has a disease that requires treatment or is life-threatening. Relative indications are not entirely medical, sometimes subjective. A person with bags under his eyes can live and feel great physically; this will not affect his health, it will only affect his quality of life. And this healthy person, lying on the operating table, must also get up from it healthy, and even beautiful, satisfied with his appearance.
Therefore, when taking a patient for surgery, we calculate all the factors: health status, risks of the operation, carefully study the tests, choose an anesthetic regimen, because the main thing, I repeat, is that the person gets what he wanted, and also remains healthy.
You can make an appointment for a consultation with Irina Vladimirovna Shmarina by calling 8 (383) 284-30-53.
Until September 30, 2021, the Pasman Clinic offers the following offers:
- blepharoplasty of the upper and lower eyelids “all inclusive” for 85,000 rubles;
- abdominoplasty “all inclusive” for 190,000 rubles;
- breast augmentation “all inclusive” for 195,000 rubles;
- liposuction and lipofilling from 45,000 rubles (the cost is determined after consultation and depends on the area and category of complexity of the operation).
Pasman Clinic Archives
Pasman Clinic Archives
Pasman Clinic Archives
Especially for out-of-town patients, there are preliminary remote consultations via WhatsApp or Skype. All information by phone 8 (383) 284-30-53.
"Clinic Pasman"
Address: Novosibirsk, st. Karamzina, 92 Tel.: +7 (383) 284-30-53 Website: pasman-clinic.ru Instagram: @clinicpasman
License LO-54−01−006086 dated 11/11/2020.
Reference
Irina Vladimirovna Shmarina performs all types of mammoplasty, rejuvenation operations (including blepharoplasty of the upper and lower eyelids, circular facelift), abdominoplasty (including elimination of discrepancy of the rectus abdominis muscles, navel transposition), umbilical ring plastic surgery (author’s techniques), liposuction (all areas) and lipofilling (autotransplantation of one’s own adipose tissue), curator and chief physician of the reality show “Tuning in Pasman”.
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