Dr. Suzanne Quardt

LIPOSUCTION

How much fat do you need to have liposuction?

The perfect candidate for liposuction is someone who is in generally good shape and at almost their goal weight but has a localized area they want to address. You can actually have too much fat to have a lipo procedure. The other thing you have to assess is overlying skin. The people who have better quality skin, meaning their skin is supple and elastic, are going to have a better result and their skin is going to snap back after the surgery. I have to explain to people like the mom who has the stretched out tummy with tons of stretchmarks and just wants liposuction that we can do that and make the areas flatter but I can't guarantee her skin is going to snap back. In fact, skin might be even a little looser in that area. But some moms might just be happy that it's flatter and they can fit in their jeans.

BREAST LIFT

Can I have a baby after tummy tuck or breast implant or breast lift?

The first question I ask people when they want a tummy tuck is, 'Are you done having kids? because it doesn't make sense to tighten all those muscles and then stretch them out with a pregnancy. It might put your baby at a little more risk because those muscles can't stretch out as easily and there might be pressure on the uterus and that's unpredictable. With that said there have been women who have gotten pregnant after a tummy tuck just because it happened but realistically you want to be done. For breast implants sometimes I'll recommend waiting on breast surgery, especially if they need implants and a lift, until you're done having kids if you really know you want to breastfeed. The breasts just change so much with breast feeding. They get full, they deflate and they're going to change. If you got a nice aesthetic breast surgery and then you breast fed your breasts will swell and then get droopy again and you might be completely unhappy with how they look after. If breastfeeding is something that is critical to you and you know you want to do then just wait because you don't want to do anything that jeopardizes that chance. But for women who say, 'You know what, it doesn't really matter to me and I really want to get my breasts fixed and if I do have another baby and need a revision after another child I'm OK with that. I'm tired of how they look now and for how long they've looked like this then I'll go along with the surgery as long as they're well informed.

How can I tell if I need a breast lift, a breast lift and breast implants or just breast implants? Is there an easy formula?

We evaluate how much lift you need by how saggy the breast is. If the nipple is above the level of the inframammary fold, or above that crease, they're normal, the nipple's at a normal position and you just need implants. If the nipple has dropped right to the level of the fold then you have grade one ptosis or mild sagginess. Sometimes that can be treated with an implant alone if you go big enough on the implant because adding that volume will elevate the nipple position. If your nipple is hanging below the level of the inframammary fold it's grade two ptosis, or moderate ptosis. If it's pointing down at the floor it's grade three, the severest grade, you will absolutely need a lift and if you don't get the lift at the same time you will likely be very unhappy with the results. If you just put bigger implants over the muscle we'll put in big ones and you won't need a lift. The complaint then becomes 'I used to have small saggy breasts and now I have big saggy breasts and those are even worse and harder to fix. So once you have a stretched out saggy breast from a big implant that was placed a few years ago that's even more difficult to fix so it's better to do it correctly the first time.

Is it the doctor's decision or the patient's choice whether to use a silicone or saline implant in a breast lift?

I discuss the risks and benefits of them both with the patient because it's a very enlightening discussion then I listen to what they tell me. So the woman who says I really absolutely want a natural looking and feeling breast, they're going to get a more natural looking and feeling breast with a silicone implant. If they're very thin, you know some women you can see their ribs and upper chest because they're really skinny and they say they want a natural breast, then the saline can be even more invisible in that upper region because it has more projection in the upper pole than the silicone. I actually hold up the implants during a consult to show a patient that a silicone implant will drop like a tear drop shape when you hold it on its side and that's like when you're standing up. It just has a more natural slope.

How do I decide if I want my breast implants over or under the muscle?

The most common standard of care these days is putting it in the dual plane. That is when we elevate the pectoralis muscle and release it medially and inferiorly so the implant is going below the muscle, the upper portion of the implant. But the lower portion of the implant is really going under the breast tissue so that's why it's called the dual plane, it is under the muscle but for a lot of women, based on their anatomy, if you put it completely under the muscle the implant would be way too high and it would look funny. If you put it completely over the chest muscle and only under the breast there have been some studies that say you might have a higher rate of capsular contracture or hardening of the breast. And that's the major nemesis with breast implant surgery. People come in worried about rupture and safety and they don't even think about the hardening and that's the most common reason people need breast revisions, because they got hard or firm. Of course there are some exceptions to every rule. For a surfer, pro tennis player or golfer, I will put their implant above the muscle because I don't want to touch their pectoralis muscle and mess with their swing or their stroke. They have an athletic advantage for a reason and I don't want to disturb that.

BREAST IMPLANTS

Can I have a baby after tummy tuck or breast implant or breast lift?

The first question I ask people when they want a tummy tuck is, 'Are you done having kids? because it doesn't make sense to tighten all those muscles and then stretch them out with a pregnancy. It might put your baby at a little more risk because those muscles can't stretch out as easily and there might be pressure on the uterus and that's unpredictable. With that said there have been women who have gotten pregnant after a tummy tuck just because it happened but realistically you want to be done. For breast implants sometimes I'll recommend waiting on breast surgery, especially if they need implants and a lift, until you're done having kids if you really know you want to breastfeed. The breasts just change so much with breast feeding. They get full, they deflate and they're going to change. If you got a nice aesthetic breast surgery and then you breast fed your breasts will swell and then get droopy again and you might be completely unhappy with how they look after. If breastfeeding is something that is critical to you and you know you want to do then just wait because you don't want to do anything that jeopardizes that chance. But for women who say, 'You know what, it doesn't really matter to me and I really want to get my breasts fixed and if I do have another baby and need a revision after another child I'm OK with that. I'm tired of how they look now and for how long they've looked like this then I'll go along with the surgery as long as they're well informed.

How can I tell if I need a breast lift, a breast lift and breast implants or just breast implants? Is there an easy formula?

We evaluate how much lift you need by how saggy the breast is. If the nipple is above the level of the inframammary fold, or above that crease, they're normal, the nipple's at a normal position and you just need implants. If the nipple has dropped right to the level of the fold then you have grade one ptosis or mild sagginess. Sometimes that can be treated with an implant alone if you go big enough on the implant because adding that volume will elevate the nipple position. If your nipple is hanging below the level of the inframammary fold it's grade two ptosis, or moderate ptosis. If it's pointing down at the floor it's grade three, the severest grade, you will absolutely need a lift and if you don't get the lift at the same time you will likely be very unhappy with the results. If you just put bigger implants over the muscle we'll put in big ones and you won't need a lift. The complaint then becomes 'I used to have small saggy breasts and now I have big saggy breasts and those are even worse and harder to fix. So once you have a stretched out saggy breast from a big implant that was placed a few years ago that's even more difficult to fix so it's better to do it correctly the first time.

How do I decide if I want my breast implants over or under the muscle?

The most common standard of care these days is putting it in the dual plane. That is when we elevate the pectoralis muscle and release it medially and inferiorly so the implant is going below the muscle, the upper portion of the implant. But the lower portion of the implant is really going under the breast tissue so that's why it's called the dual plane, it is under the muscle but for a lot of women, based on their anatomy, if you put it completely under the muscle the implant would be way too high and it would look funny. If you put it completely over the chest muscle and only under the breast there have been some studies that say you might have a higher rate of capsular contracture or hardening of the breast. And that's the major nemesis with breast implant surgery. People come in worried about rupture and safety and they don't even think about the hardening and that's the most common reason people need breast revisions, because they got hard or firm. Of course there are some exceptions to every rule. For a surfer, pro tennis player or golfer, I will put their implant above the muscle because I don't want to touch their pectoralis muscle and mess with their swing or their stroke. They have an athletic advantage for a reason and I don't want to disturb that.

BREAST AUGMENTATION

Can I have a baby after tummy tuck or breast implant or breast lift?

The first question I ask people when they want a tummy tuck is, 'Are you done having kids? because it doesn't make sense to tighten all those muscles and then stretch them out with a pregnancy. It might put your baby at a little more risk because those muscles can't stretch out as easily and there might be pressure on the uterus and that's unpredictable. With that said there have been women who have gotten pregnant after a tummy tuck just because it happened but realistically you want to be done. For breast implants sometimes I'll recommend waiting on breast surgery, especially if they need implants and a lift, until you're done having kids if you really know you want to breastfeed. The breasts just change so much with breast feeding. They get full, they deflate and they're going to change. If you got a nice aesthetic breast surgery and then you breast fed your breasts will swell and then get droopy again and you might be completely unhappy with how they look after. If breastfeeding is something that is critical to you and you know you want to do then just wait because you don't want to do anything that jeopardizes that chance. But for women who say, 'You know what, it doesn't really matter to me and I really want to get my breasts fixed and if I do have another baby and need a revision after another child I'm OK with that. I'm tired of how they look now and for how long they've looked like this then I'll go along with the surgery as long as they're well informed.

TUMMY TUCK

Can I have a baby after tummy tuck or breast implant or breast lift?

The first question I ask people when they want a tummy tuck is, 'Are you done having kids? because it doesn't make sense to tighten all those muscles and then stretch them out with a pregnancy. It might put your baby at a little more risk because those muscles can't stretch out as easily and there might be pressure on the uterus and that's unpredictable. With that said there have been women who have gotten pregnant after a tummy tuck just because it happened but realistically you want to be done. For breast implants sometimes I'll recommend waiting on breast surgery, especially if they need implants and a lift, until you're done having kids if you really know you want to breastfeed. The breasts just change so much with breast feeding. They get full, they deflate and they're going to change. If you got a nice aesthetic breast surgery and then you breast fed your breasts will swell and then get droopy again and you might be completely unhappy with how they look after. If breastfeeding is something that is critical to you and you know you want to do then just wait because you don't want to do anything that jeopardizes that chance. But for women who say, 'You know what, it doesn't really matter to me and I really want to get my breasts fixed and if I do have another baby and need a revision after another child I'm OK with that. I'm tired of how they look now and for how long they've looked like this then I'll go along with the surgery as long as they're well informed.

How does a woman with little downtime get a tummy tuck? Is there a good alternative?

You have to enough time off for recovery. Moms are so used to doing everything for everyone else and are quick to neglect the recovery part and that's why I make sure they have a good support system at home because they need that time for the body to heal and have a good recovery. If you don't have the time available then you don't do that degree of surgery. There are noninvasive procedures out there that claim to get rid of fat. Zeltiq is a fat freezing procedure. There are noninvasive skin tightener and body tightening procedures but they're not going to give you the degree of results that a tummy tuck will give you. They don't have downtime but are alternatives that will help you look a little bit better, just not dramatically better.

If had a C-section would you go in for a tummy tuck through the C-section scar?

I try to go through an old scar or cut out an old scar completely, depending on where your new scar will lie. On the morning of surgery I have patients bring in a pair of bikini bottoms or underwear that they know they would like to wear and I mark them out so I keep the new incisional line within those boundaries.

Can you fix my odd-looking belly button during a tummy tuck?

We take your old belly button and put it through a new opening because we move the skin down. So for women who have what I call a frowny face belly button that looks kind of sad we create a nice fresh one. We cut around the old one and I tag it with a stitch. So it's really your old belly button but the opening for it to come out is cut new so we can cut it in a more aesthetic shape, like a smaller opening that can either be like an oval shape or a triangular shape if the woman is older. We even do an upside down triangular shape if the woman is older so it kind of looks a little hooded, and a little more natural because you don't want the belly button of a 21 year old if you're 56 or maybe you do!

FACELIFT

Is a mini tummy tuck good for someone who doesn't have a lot of downtime to recover from a bigger surgery?

A mini tummy tuck is good for the perfect patient. It's someone who has some excess fat and skin and poochiness of their abdomen below the belly button. The belly button still looks decent, the upper abdomen looks fine, their issues are in their lower tummy. That's the patient that you can just work on through an old C-section scar if they have one, or even cut out that scar. The difference is you only elevate the abdominal flap up to the level of the belly button but you don't go higher than that. You can still tighten the muscles of the lower abdomen with sutures and you can then pull and remove the excess skin and fat and then you can even liposuction the upper abdomen and any other areas so they can get an excellent result. If we do a mini tummy tuck with liposuction of the upper abdomen, hips, flanks, inner thighs, those people are going to have a longer recovery than someone who just gets the mini tummy tuck.

SKIN TIGHTENERS

How does a woman with little downtime get a tummy tuck? Is there a good alternative?

You have to enough time off for recovery. Moms are so used to doing everything for everyone else and are quick to neglect the recovery part and that's why I make sure they have a good support system at home because they need that time for the body to heal and have a good recovery. If you don't have the time available then you don't do that degree of surgery. There are noninvasive procedures out there that claim to get rid of fat. Zeltiq is a fat freezing procedure. There are noninvasive skin tightener and body tightening procedures but they're not going to give you the degree of results that a tummy tuck will give you. They don't have downtime but are alternatives that will help you look a little bit better, just not dramatically better.

MOMMY MAKEOVER

I've heard the term mommy makeover and wonder what that covers.

It's really a catch-all phrase to describe a combination of post-partum body contouring procedures to aid mothers in gaining their pre-maternity figures. If pregnancy stretches out the abdominal wall and the muscles separate, no amount of exercise will fix that. Another big problem is the stretc marks that occur when the skin has been stretched to the point that the dermis actually breaks. The best stretchmark treatment is to cut them out. If someone presents with enough severity of stretched out abdomen and lax, damaged skin, we can remove all that with an abdominoplasty or tummy tuck. That's probably one of the most common procedures performed because that's where women carry their baby and a lot of the damage to their abdominal wall appears. A lot of times during my exam I'll check to see if they have any umbilical hernia or other ventral herniation, which is a weakening in the abdominal wall fascia that you want repaired at the same time as a tummy tuck. We can get a pre-authorization to have that portion of the surgery covered. Oftentimes if you have a hernia repair done by a general surgeon, it might not be fixed through the lower incision we do to make it aesthetically nice. And of course a mommy makeover could include a breast lift, breast implants or even a breast reduction.

What can you do to fix my breasts during a mommy makeover and is there such a thing as too many procedures at once?

Mommy makeover is a combination of procedures and we see how many can be done safely at one time. Oftentimes we combine it with breast surgery. I always ask what the largest a patient was when she was pregnant and full of milk, what her bra size is now, and what size she ideally wants to be. There are some breast lifts that are minor that we can go above the nipple, just lift it up a little, then there's more involved where we go all the way around the areola and we can make the areolas smaller because they can get stretched out over time, and then there's the more involved lift where we go all the way around the nipple and vertical, or lollipop because the scar looks like a lollipop. The last we call an anchor scar because it goes around the nipple, down the front of the breast and under the inframammary fold. So yes the breasts can definitely be fixed in a mommy makeover and the amount of procedures and the length of them just depends on what you need done.

What's the recovery from a mommy makeover?

It can be lengthy, of course the more procedures you do the longer the recovery. I tell patients to expect the first one to two weeks are really just to get over the pain and start to feel like yourself again. In the first week you have drains if you have a tummy tuck procedure. I insert a pain pump at the time of the tummy tuck and it drips a numbing medicine called Marcaine. What hurts in a tummy tuck is sewing those muscles together. I still give narcotic pain medication but I really feel like the pump helps patients feel more comfortable so they can walk more comfortably. They can breathe better because when you're in a lot of pain you can tighten up when you breathe. The pain pump I use now delivers prevention for 72 hours. When I do see them on the 3rd day and pull the pain pump maybe one drain can come out and the other can come out the following week. In the first two weeks you're really just trying to get comfortable, get back to your normal eating and walking around. You're going to have drains and be wearing a binder. You can't do any heavy lifting or strenuous activity for two to four weeks. After four weeks you're feeling pretty good, you've weaned yourself off of pain medication, you're walking around, you're back to eating. Incisional care is very simple, people can shower because all of the sutures I use are internal or absorbable. I give surgical soap to wash incisions with and then have patients just put antibiotic ointment over the incisions once a day. There's a binder for a tummy tuck and a surgical bra for breast surgery and a garment for liposuction.

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Mommy Makeover

Superb Symmetry

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Expert Insight

Mommy Makeover

Superb Symmetry

A Better Body

Philosophy

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Q&A

LIPOSUCTION

How much fat do you need to have liposuction?

BREAST LIFT

Can I have a baby after tummy tuck or breast implant or breast lift?

How can I tell if I need a breast lift, a breast lift and breast implants or just breast implants? Is there an easy formula?

Is it the doctor's decision or the patient's choice whether to use a silicone or saline implant in a breast lift?

How do I decide if I want my breast implants over or under the muscle?

BREAST IMPLANTS

Can I have a baby after tummy tuck or breast implant or breast lift?

How can I tell if I need a breast lift, a breast lift and breast implants or just breast implants? Is there an easy formula?

How do I decide if I want my breast implants over or under the muscle?

BREAST AUGMENTATION

Can I have a baby after tummy tuck or breast implant or breast lift?

TUMMY TUCK

Can I have a baby after tummy tuck or breast implant or breast lift?

How does a woman with little downtime get a tummy tuck? Is there a good alternative?

If had a C-section would you go in for a tummy tuck through the C-section scar?

Can you fix my odd-looking belly button during a tummy tuck?

FACELIFT

Is a mini tummy tuck good for someone who doesn't have a lot of downtime to recover from a bigger surgery?

SKIN TIGHTENERS

How does a woman with little downtime get a tummy tuck? Is there a good alternative?

MOMMY MAKEOVER

I've heard the term mommy makeover and wonder what that covers.

What can you do to fix my breasts during a mommy makeover and is there such a thing as too many procedures at once?

What's the recovery from a mommy makeover?

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