Breast Augmentation and Liposuction Blog - Dr. Bottger

Poly Implant Prostheses (PIP) Defective Breast Implants

2012-01-09T11:55:00.000-08:00

Over the last couple months, French officials have been grappling with the magnitude of the defective Poly Implant Prostheses silicone breast implants. Since a 2010 inspection revealed numerous quality problems at the French manufacturer's facility, and the company has gone bankrupt, hundreds of thousands of women may be facing the hard choice of whether to remove their potentially dangerous breast implants.

It is important to note that these breast implants were never approved for use in the US, so unless you received your breast augmentation abroad, you likely do not have to worry about the potential risk.

Inspections and interviews with personnel from PIP have revealed numerous problems with this brand of French-made breast implants. The first concern is that the rupture rate for these breast implants may be very high.

At this point, we do not have any reliable figures to say just how high. Speaking anecdotally, one surgeon noted that the breast implant rupture rate may be as high as 10% in the first year, compared to almost no spontaneous ruptures in the first year among other breast implant manufacturers. Other figures are even more worrying. One study of 453 patients who received this breast implant showed rupture rates between 16 and 34 percent. Another report comes from a British hospital where half of the patients receiving the PIP breast implants experienced a rupture. In contrast, one British plastic surgery practice says there is no concern about PIP implants. They said their observed rupture rate is only about 1.3% in the first four years.

An additional concern with PIP breast implants is the quality of material used for filling the breast implants. The British tabloid Daily Mail reported that many of the breast implants were filled with a silicone gel commonly used for filling mattresses, rather than the medical grade silicone that should be used for breast implants. A company has come forward stating that it supplied the manufacturer with the silicone, which is supposed to be used for weatherproofing and paints.

It is unknown whether the industrial grade silicone is more likely to result in more serious side effects than medical grade silicone, but there have been numerous anecdotal reports of cancers and other illnesses related to the PIP industrial grade silicone. Remember, the FDA has stated that there is no evidence of breast cancer associated with the silicone breast implants used in this country.

The PIP breast implant scare is another reminder that looking for cheap breast augmentation by traveling overseas is not worth it. Nor is it worth working with a local breast surgeon who is not a board-certified plastic surgeon and therefore bound to use the highest-quality materials in performing your breast augmentation.

If you are considering breast augmentation and want to learn more about what makes the breast implants we use safer than these French-made ones, please schedule a consultation with Philadelphia plastic surgeon Dr. David A. Bottger today.

Want to Keep Your Nipples after Breast Surgery? Quit Smoking.

2011-12-14T14:40:00.000-08:00

How serious is your surgeon when he tells you to quit smoking in preparation for your plastic surgery? Very. If you cannot quit smoking for your breast surgery, whether it is breast augmentation or a breast lift, you put yourself at risk for serious postsurgical complications. How serious?

Consider the recent memoir by Dr. Anthony Youn, who talks about the potential complications related to smoking around breast surgery. He says he has personally seen a woman's nipples almost turn black and fall off following a breast lift. When the woman's nipples turned purple, the precursor to black, they used the only treatment option available to save her nipples: leeches.

Why leeches? The problem with smoking is that it impairs your body's ability to remove blood from a treatment area, especially in the skin, and when the blood can't be removed, it prevents the supply of fresh blood from reaching the area, so the tissues will die. Leeches remove the excess blood so fresh blood will flow. Leeches give your body time to grow new blood vessels to replace the failed ones. To work properly, the leeches may have to be applied for several days.

This is less common in breast augmentation, but tissue necrosis (death) is a tangible risk whenever a smoker has surgery. So when your surgeon tells you to quit, take that recommendation seriously.

Another recommendation to take seriously is to always work with a board-certified plastic surgeon. In Philadelphia, please contact plastic surgeon Dr. David A. Bottger for a consultation today.

Acellular Dermal Matrix: A Better Method for Breast Reconstruction?

2011-11-30T08:46:00.000-08:00

In recent years, there has been a significant increase in the use of acellular dermal matrix (ADM) in breast implant-based breast reconstruction. The increased popularity of this material is due to a number of perceived advantages. However, according to a recent review of the scientific literature, there is little objective evidence to support these claims.

ADM is material prepared from the skin of various animals. The dermal cells are removed, leaving only a framework of collagen material that can then serve as a scaffolding in many types of reconstructive procedures, providing structural support and a framework for cells to grow on. One common source of ADM is cadavers, but fetal cows and pigs are also used as donors for ADM.

In breast implant-based breast reconstruction, ADM is supposed to give numerous benefits. It is supposed to provide support for the implant or expander in the early phases of recovery, before the body's tissues are recovered. This allows, according to claims, for better aesthetic outcomes, fewer expansions, and larger breast implants during breast reconstruction.

In a recent review of all studies done on the use of ADM in breast reconstruction, researchers found no support for most of the claims made about the use of ADM, including reducing or eliminating the need for expanders, the use of larger initial fill volumes, faster time to completion, decreased rate of revision, and improved aesthetic outcome. However, the researchers did find evidence for decreased rate of capsular contracture, which is significant for breast reconstruction, which generally faced an even higher rate of the condition than breast augmentation patients.

Board-certified plastic surgeon Dr. David A. Bottger does not perform breast reconstruction, but he does utilize breast implants for breast augmentation, and continues to evaluate the use of advanced techniques to improve outcomes. To talk to Dr. Bottger about breast augmentation, please schedule a consultation today.

Obesity Linked to Complications of Breast Surgery

2011-10-31T13:12:00.000-07:00

We have long known that obesity increased the risk of complications from body contouring surgery like tummy tuck or liposuction. Now a study published in the November issue of Plastic and Reconstructive surgery, the official journal of the American Society of Plastic Surgeons, shows that obese women are also at a significantly increased risk for complications after breast surgery.

The study looked at data from about 8000 women who had elective breast surgery, and found that obese patients had a 12-fold increase in risk of complications following breast surgery. Although this study is an important one, it is worth noting that the study did not look at breast augmentation or breast lift. It only looked at procedures covered by insurance. About 80% of the obese women in the study and 64% of the nonobese women were undergoing breast reduction surgery, with 10% of obese and 24% of nonobese women undergoing breast reconstruction. The complication rates were compared within the same procedure.

The overall rate of complications for obese women was 18% and 2% for nonobese women. After eliminating other factors, researchers calculated the relative risk at 11.8 times higher for obese women.

This is another reminder that if you are considering plastic surgery, it is important for you to reach a stable weight at or near your ideal weight before seeking surgery.

To learn more about breast surgery and possible complications, please contact Philadelphia board-certified plastic surgeon Dr. David A. Bottger today for a consultation.

Did Researchers Find the Ideal Breast Shape?

2011-10-27T12:36:00.000-07:00

In attempt to describe ideals of beauty, the primary drivers have generally been evolutionary psychologists, who frame their results in terms of their particular grinding wheel, proving that the evolutionary forces that shaped humans in the Holocene still impact us today. Now, though, a plastic surgeon has described what he claims is the "ideal breast shape."

Before we get to considering his results, let's consider the noble goals of his quest. As a plastic surgeon, he performed many revision breast augmentation surgeries, correcting the poor results that women received from other surgeons. One of the things he found was that patients often got results whose shape they found unattractive, in part because they knew how to talk about breast implant size, but were unable to describe their ideal shape to their surgeon, whose ideal of breast shape was often based on personal formulas or poorly defined. To correct this, the British plastic surgeon sought to define the breast shape that most would agree were attractive.

To attempt to define the ideal breast shape, the plastic surgeon started by looking at The Sun's daily Page 3 girls. For most of the world, Page 3 means little, but Britons have been accustomed to seeing a topless girl on Page 3 of the Sun tabloid since 1970. In the early years, there were no restrictions, but since the early 90s, only women with natural breasts have been allowed on Page 3, and it is this feature that inspired the plastic surgeon to look at the Page 3 models to determine the ideal breast shape.

The surgeon selected 100 models and a computer was used to analyze the dimensions and proportions of each breast and found that there were four common features. First, the nipple meridian (a horizontal line drawn at the level of the nipple) divided the breast into two uneven parts, with 45% of the breast volume above the meridian and 55% below the nipple. Next, the upper surface of the breast was either straight or slightly concave. The nipple pointed slightly upward at an angle of about 20º, while the lower pole of the breast had a tight concave curve.

Next, to test whether these parameters actually described an ideal breast, the surgeon asked women to rate the attractiveness of before and after photos of breast augmentation patients. He found that when results deviated from these described features, they were considered less attractive.

Although we are a long way from being able to state that these factors actually represent an "ideal breast," they do give plastic surgeons and patients considering breast augmentation a better starting place for discussing breast shape than they have ever had in the past. This is crucial because nearly as many women seek breast augmentation to improve the shape of their breasts as to increase the size.

You can read the study in the August 2011 issue of the Journal of Plastic, Reconstructive, & Aesthetic Surgery.

To discuss your shape and size goals from breast augmentation with a Philadelphia board certified plastic surgeon, please contact Dr. David A. Bottger today.

New Study Sheds Light on Capsular Contracture Risk

2011-09-29T12:14:00.000-07:00

A new study published in the Journal of Plastic, Reconstructive, & Aesthetic Surgery is one of the largest studies to look at capsular contracture risk factors. Capsular contracture occurs when the body's scar capsule contracts around the breast implant, causing painful deformation of the breast. With a sample size similar to the population of the combined core studies by Mentor and Allergan on silicone gel breast implants, this study is a good snapshot of what factors impact capsular contracture rates.

The study looked at a series of 1400 breast augmentations performed by a single surgeon between March 1995 and March 2009. The goal of the study was to explore the impact various factors had on the incidence of capsular contracture. With mysteries still surrounding the exact cause and mechanism of capsular contracture, this study gives some interesting insights. The study population had an overall capsular contracture rate of about 26.9%, with 376 incidents of capsular contracture. The article is currently in press and the abstract does not define whether researchers were considering all instances of capsular contracture or just severe capsular contracture, Baker grade III/IV.

Factors the researchers found were not related to an increased risk of capsular contracture:

BMI >30
Fill volume >350 ml
Smoking
Alcohol consumption

On the other hand, these factors were associated with an increased risk of capsular contracture:

Implant type (silicone increases risk)
Pregnancy
Infection
Delayed hematoma

Most of these factors have long been associated with capsular contracture, but the researchers reported that this is the first time pregnancy has been implicated as a risk factor in capsular contracture.

Although the study population is large, the fact that it's only one surgeon's experience is a major limitation on how much stock we can give the results. As we know, capsular contracture is influenced by many subtle factors that vary widely from surgeon to surgeon, so one surgeon's experience may not be predictive of the general population.

If you have more questions about capsular contracture and other risks of breast augmentation, please schedule a consultation with Philadelphia board-certified plastic surgeon Dr. David A. Bottger.

Could Polyurethane-Coated Breast Implants Eliminate Capsular Contracture Risk?

2011-08-30T23:22:00.000-07:00

Currently, there are only two types of breast implants approved for breast augmentation in the United States: silicone gel breast implants and saline breast implants. These two types of breast implants are available with two types of shells, either smooth or textured. It was once hoped that textured implants would help reduce the risk of capsular contracture, one of the more common adverse events that lead to reoperation of breast implants. Unfortunately, this did not prove to be the case, and now textured implant shells are less commonly used.

Now, though, there may be another option that could eliminate this particular risk of breast augmentation: polyurethane-coated breast implants. These implants are currently being studied in Europe for use in breast reconstruction. The problem with using breast implants for immediate reconstruction is that you may not know whether you will need radiotherapy or not. And if you do go through radiotherapy, your risk of capsular contracture can increase dramatically. This makes immediate reconstruction with breast implants problematic and puts a high value on finding a solution that will reduce or eliminate the risk of capsular contracture.

Results of one study focused on polyurethane coated breast implants were published in the July issue of the European Journal of Plastic Surgery. The results showed that none of the breast reconstructions using polyurethane-coated breast implants experienced capsular contracture unless the patient underwent radiotherapy. And if patients underwent radiotherapy, the risk of severe capsular contracture was significantly reduced when compared to textured implants (6.3% vs. 21.7%).

The study population was very small and these results should be considered preliminary, but they are promising. If polyurethane-coated breast implants can eliminate the risk of capsular contracture, they can significantly reduce the need for subsequent surgeries following breast augmentation.

The field of plastic surgery is constantly changing. If you want to learn more about the latest developments in breast augmentation and how they can help you get the best results, please contact board-certified Philadelphia plastic surgeon Dr. David A. Bottger.

Why Women Have Breast Implants Removed

2011-07-15T13:07:00.000-07:00

Breast implant revision surgery is a common adverse result of breast augmentation. For women having primary breast augmentation, the breast implant removal rate is up to 20%. Why would women want to have their silicone gel breast implants removed? The table below summarizes the most common reasons, according to the FDA's recent safety update:

Reason for Removal	Allergan (%)	Mentor (%)
Capsular Contracture	32%	19%
Patient request for style/size change	20%	53%
Rupture	17 %	4.4%
Sagging (Ptosis)	7.7%	0
Malposition	7.1%	0
Asymmetry	4.5%	1.5%

The difference between the Allergan and Mentor studies were obviously very significant. The Mentor study had a much higher rate for style or size changes, and a much lower rate for capsular contracture and virtually all other complications. However, it should be noted that two factors could contribute to this difference.

First, the Mentor study has currently only reported results for 8 years after surgery, whereas the Allergan study has reported results for 10 years after surgery. This is because the Allergan study began enrolling patients 20 months earlier than the Mentor study, and is highly significant because the incidence of breast augmentation complications have been shown to increase with time. If an additional 100 women report removal in the final two years of the Mentor study it will bring the two studies' overall implant removal rates in line with one another, and could significantly alter the proportion of removal reasons.

Second, the Mentor study had a very large number (over 10%) of women having breast implants removed for "other" reasons. It's hard to know what this might mean, but if we could assign them to actual reasons for removal, the proportions might seem more similar.

When considering breast augmentation, it is vital to consider the possible complications associated with breast implants. Philadelphia plastic surgeon Dr. David Bottger believes it is crucial that every patient understand these complications prior to having surgery.

To learn more about the safety of breast implants, please schedule a consultation with Dr. Bottger to discuss your concerns in person.

FDA Issues Update on Silicone Gel Breast Implant Safety

2011-06-23T15:50:00.000-07:00

The FDA has released a safety update on silicone gel breast implants, the first since the lifting of the moratorium in November 2006. The update is derived from results of a 10-year study of Allergan's silicone gel breast implants and an 8-year study of Mentor's silicone gel breast implants, enrolling a total of nearly 2000 patients. The report looks at silicone gel breast implants as medical devices, not at breast augmentation as a cosmetic surgery, so it looks at only part of the story for women considering breast augmentation. However, this aspect of breast implants is extremely important, and we will take several months to consider a number of elements in the report to help women understand the potential risks and complications of breast augmentations.

To me, the most crucial statement by the FDA is "The benefits and risks of breast implants are sufficiently well understood for women to make informed decisions about their use." After decades of uncertainty about possible diseases or conditions related to breast implants, the FDA now feels we know enough about them to make definitive recommendations, and eliminate lingering doubts about autoimmune and connective tissue disorders.

Here is a summary of the report's other key findings:

"Silicone gel breast implants have a reasonable assurance of safety and effectiveness," "Despite frequent local complications and adverse outcomes."
Risks of complications and adverse outcomes increase with time: "Women with breast implants will need to monitor their breasts for local complications for the rest of their lives."
The most frequent complications and adverse outcomes are:

Capsular contracture
Reoperation
Implant removal

Breast implants may increase the risk of anaplastic large cell lymphoma (not breast cancer), which nonetheless remains very small
Up to 20% of breast augmentation patients are expected to need a second surgery within the first 8 to 10 years, but routine replacement is not necessary
There is no association between silicone gel breast implants and connective tissue disease, breast cancer, or reproductive problems, but it remains possible that very rare or very slow-developing conditions may not be detectable in the current data
MRI remains the only effective method for detecting silent rupture of silicone gel breast implants

The FDA also notes that very low follow-up rates (66% for the Allergan study and 58% for the Mentor study) may limit our ability to interpret the data.

If you are considering breast augmentation and want to learn more about what these results mean for you, please schedule a consultation with board-certified plastic surgeon Dr. David A. Bottger today to have your questions answered in person.

New Study May Support Theory of Autoimmune Response to Silicone Breast Implants

2011-04-25T15:22:00.000-07:00

When silicone breast implants were temporarily removed from the market for cosmetic breast augmentation in the 1990s, one of the more serious charges leveled against them was that they caused autoimmune disorders. Women complained of numerous nonspecific symptoms, a sickness that affected their entire body, whose cause could not be determined, but the women and some scientists linked the symptoms to their silicone breast implants. Lawsuits ensued, breast implants were pulled off the market, and Dow-Corning and other breast implant manufacturers gave a huge cash settlement to victims.

However, more than a decade after the ban went into effect, research failed to turn up any positive connections between silicone breast implants and autoimmune or other systemic disorders, so silicone breast implants were put back on the market for cosmetic breast augmentation.

Now, though, one study claims to have discovered evidence that silicone breast implants trigger systemic inflammation. The small study, published in the March 2011 issue of the Archives of Plastic Surgery, looked at the levels of C-reactive protein, which is connected to inflammation, in the blood of 24 breast implant patients, and 28 liposuction patients. The study found that women receiving breast implants saw a much, much larger increase in their blood serum levels of C-reactive protein. Although there was no accompanying complications or increases in antibodies that might be associated with an autoimmune response, the authors caution that long-term monitoring for immunogenicity of silicone breast implants is warranted.

If you are considering breast augmentation with breast implants, you should work with a surgeon who can give you the information you need to make a fully informed decision. To talk to Dr. David A. Bottger in Philadelphia, please schedule a consultation today.

What type of scarring is expected after breast reduction surgery?

2011-03-30T11:13:00.000-07:00

The scars resulting from breast reduction surgery depend on the method performed. Two general techniques are most frequently performed: the vertical ,superior pedicle technique, and the inferior pedicle, Wise pattern technique.

The vertical technique is used mostly in smaller and more moderate size reductions. The resulting scar is characterized by a lolly pop shape extending around the areola with a vertical component extending from the bottom of the areola to the fold at the bottom of the breast(inframammary fold). A limited horizontal component may also be necessary in the fold region.

The inferior pedicle, Wize pattern technique is employed in larger breast reductions and in those requiring larger amounts of skin excision. The resulting scar has an anchor configuration, extending around the areolar with a vertical central component and a much longer horizontal component in the lower breast fold region.

The quality of the scar in any given patient is dependent on their own individual healing process and varies from patient to patient. In most cases the scars are very acceptable and don’t require any revisional procedures.

Will my breast reduction be covered by insurance?

2011-03-28T11:13:00.001-07:00

In many cases breast reduction surgery is covered by insurance. A number of criteria typically need to be met for insurance coverage. A history which includes symptoms related to extreme breast size, such as back, neck and/or shoulder pain is important to elicit. This will in many cases be associated with interference in the ability to exercise. Failure of different interventions to relieve symptoms such as medications or physical therapy is important to document. An estimation of proposed breast weight to be removed as well as a photograph are also required. Some insurance companies will additionally require an evaluation by a second surgeon.

“Bottoming Out” of Breast Implants

2011-01-04T07:26:00.000-08:00

Unfortunately , in a small percentage of breast augmentation patients a phenomenon known as bottoming out may occur.

Bottoming out occurs when breast implants have sunk beneath the natural crease line between the breast and the chest. The breasts will appear low and the nipples will appear excessively high on the breast mound. This may be the result of a technical error in pocket dissection at the original surgery or result from factors involving the post operative healing and each patients individual anatomic characteristics Significantly bottomed out breast implants will require a revision breast augmentation surgery.

Choosing a qualified and experienced plastic surgeon, like Dr. Bottger, to perform a breast augmentation revision to correct bottoming out is the most important decision you can make to fix this problem. Dr. Bottger is uniquely qualified due to his dual certification in general surgery and plastic surgery. He is certified by the American Board of Plastic Surgery, as well as the American Board of Surgery.

If you are interested in learning about breast augmentation revision surgery to fix bottoming out, please contact Philadelphia plastic surgeon Dr. Bottger to schedule an initial consultation.

Breast Aysmmetry

2010-12-29T08:06:00.000-08:00

There are many reasons as to why women choose to undergo breast augmentation surgery. One of these reasons is to correct breast asymmetry.

Asymmetric breasts can cause you to be uncomfortable, both with the way they look in clothes and with how bras fit. If you have asymmetric breasts, you may be a good candidate for breast augmentation surgery.

Candidates for breast augmentation surgery are over 18 and in good health. Women who have lost volume due to breast feeding or weight loss are also candidates for breast augmentation. Finally, breast augmentation can restore youthful perkiness to breasts that sag due to age.

There are two types of breast implants that can help with breast asymmetry: silicone and saline. Silicone implants are considered to look and feel more natural. One of the drawbacks of silicone implants is that they require a larger incision through which to place the breast implant. Saline implants require a smaller incision and are filled after being placed, allowing Dr. Bottger to be more precise with correcting your asymmetrical breasts.

Recovery after breast augmentation will take a few months. You will need to wear a special bra or compression garment for the first week, after which you will be able to return to most of your normal activities. It can take up to three months before you see the final results of your breast augmentation as the breast implants settle.

If you are interested in breast augmentation in Philadelphia, Pennsylvania, please contact experienced plastic surgeon Dr. David A. Bottger today. He will be happy to address any questions you have during a breast augmentation consultation.

What is breast implant capsular contracture and how can it be prevented?

2010-12-27T07:51:00.000-08:00

Following implant placement the body creates a thin capsule around the implant composed of connective tissue and muscle fibers. In some patients the capsule will tighten around the implant creating increased firmness of the breast. Usually this is fairly mild and not an issue. In some patients, however, the breasts may get harder and take on a more unnatural shape and at times even be associated with discomfort or pain. If this were to occur, partial or complete removal of the capsule would be required and at times movement of the implants to a different plane.

The cause of capsular contracture is not entirely known, but a number of theories exist. One contends that bacteria may contaminate the implant surface creating a “biofilm” which induces capsular tightening. Another theory postulates that excess blood in the implant pocket during surgery can lead to contracture. Using techniques which minimize potential contamination of the implant and produce a bloodless pocket should reduce the chances of capsular contracture. Additionally, placement of the implant under the pectoralis muscle is also felt to reduce the chances of significant capsular contracture.

Liposuction of Bra Bulge

2010-12-25T08:04:00.000-08:00

Breast enhancement is a very popular elective plastic surgery procedure today. Many women choose breast augmentation to help them look and feel better, giving them the curves they have always dreamed of.

Most women are unaware that they could achieve their desired result of a subtle enhancement with a liposuction procedure. Liposuction around the breasts, rib cage, and waist can improve the look of your breasts, making them appear larger, without placement of a foreign body.

There are many reasons to choose liposuction over breast implant placement. Some women are uncomfortable with the idea of placing a foreign object inside their bodies, or some women may find that they are uncomfortable with the potential risks, or the fact that their breast implants will need to be replaced down the road.

Liposuction is a procedure where fat deposits are removed in a skillful manner, sculpting your body. Dr. Bottger can smooth out bumps and remove areas of excess fat, creating a beautiful silhouette and the appearance of larger breasts.

Recovery from liposuction requires patience. You will be required to wear a compression garment for a few weeks. Once that is removed, you will be able to see roughly 60% to 70% of the final outcome. After three months, you should be fully healed. You will have follow-up appointments with Dr. Bottger to monitor the healing process.

If you are interested in liposuction in Philadelphia, please contact experienced board-certified plastic surgeon Dr. Bottger today. He can answer any questions you have during an initial consultation.

Should I be concerned that the breast implants will rupture?

2010-12-23T07:50:00.000-08:00

Although breast implants are quite durable, over time implant rupture is always a possibility due to long term wear and tear. Depending on the type of implant this may manifest in several ways. In the case of saline implants a rupture would result in a gradual reduction in breast size and a general softening of the breast. This does not represent a health risk but would require replacement of the implant. In the case of silicone gel implants a rupture may present in several ways. One would be the development of a tight or calcified implant capsule which would present as a firmer or harder feel to the breast. Another presentation would be a shape change of the breast. Although requiring reoperation for replacement, there is no scientific evidence that silicone implant rupture produces any health risk.

Belly Fat Linked to Diabetes

2010-12-21T08:02:00.000-08:00

Obesity plagues millions of people in the United States. Unfortunately, with the rise in obesity we have also experienced a rise in the number of Type 2 diabetes cases diagnosed each year. Type 2 diabetes manifests itself in those who are already adults as a result of diet and is the most common form of diabetes in this country.

It is a well known fact that belly fat is correlated with an increased risk of developing Type 2 diabetes. Reducing of abdominal fat through diet and exercise is key to reducing your risk for being diagnosed with Type 2 diabetes. While proper diet and exercise can get you a long way towards losing the weight and finding the right curves for you, sometimes it falls short. When diet and exercise have not given you all of the results you desire, liposuction can help.

It is important to understand that liposuction is not used to treat obesity and it is not a cure for Type 2 diabetes. However, this plastic surgery procedure can accentuate the weight loss that has already occurred. Liposuction uses a cannula inserted through small incisions to remove fat cells from the indicated site.
The reduction in weight through diet, exercise, and liposuction all work toward keeping the patient healthy and getting their diabetes under control. Although the fat cells have been removed, weight can return if the patient reverts to old lifestyle choices.

It you have Type 2 diabetes, speak to you physician about ways to control it through diet and exercise. If you are looking to lose stubborn pockets of fat that diet and exercise don’t seem to touch, Please contact Philadelphia liposuction surgeon Dr. Bottger today to schedule a consultation today.

When can I start exercising after breast augmentation?

2010-12-20T07:50:00.000-08:00

The first week following breast augmentation surgery activities of daily living are fine, but it is best to avoid strenuous exercising. After the first week distance walking is acceptable and by the second week use of a stationary bike or elliptical trainer. By the third post operative week it is reasonable to begin full workouts including aerobics and weight lifting.

Botox Alternative Xeomin Now Available in U.S.

2010-12-18T08:00:00.000-08:00

BOTOX ® Cosmetic has been the most popular choice for people who want to get rid of wrinkles for several years. It is safe, affordable, and effective. However, a new BOTOX® Cosmetic alternative called Xeomin has become available in the U.S. It was approved by the FDA in August 2010 to treat blepharospasm, or involuntary blinking or spasms of the eyes.

Both BOTOX ® Cosmetic and Xeomin are by-products of the bacterium Colstridium botulinum, called Botulinum toxin type A. Botulinum toxin type A temporarily paralyzes facial muscles by preventing the exchange of nerve signals between the brain and muscles. The resulting restricted facial movement prevents wrinkles above the area of paralysis.

What sets Xeomin apart from injectables like BOTOX ® Cosmetic and Dysport is that it does not have to be refrigerated before use, and it does not contain additives. Because it only contains Botulinum toxin type A, there is a smaller risk of people developing antibodies against Xeomin. Effects of Xeomin will show within one week and the results last from three to six months.

There is minimal recovery time associated with injectables like BOTOX® Cosmetic or Xeomin. These facial rejuvenation procedures can be done in a 30 minute office session so that you can get back to your busy schedule.

If you have considered BOTOX ® Cosmetic and are interested to learn more about the new alternative, Xeomin, please contact Philadelphia plastic surgeon Dr. Bottger. He proudly serves Philadelphia, West Chester, and Bryn Mawr, Pennsylvania.

What are the risks of breast augmentation surgery?

2010-12-16T07:47:00.000-08:00

Breast augmentation is usually free from major complications. Like any surgery, however, a number of complications are possible. These include infection, hematoma, capsular contracture, nipple numbness, asymmetry, and implant deflation or rupture. Although reoperation may be necessary, none of these complications represent a major health risk to the patient.

How long do breast implants last?

2010-12-13T07:45:00.000-08:00

Breast implants are very durable and in general will not require replacement for many years. In the case of saline implants, deflation would be an indication for replacement. This would present itself as a gradual decrease in breast size and a softening of the feel of the breast. The rate of implant deflation is approximately 1% per year. Deflation is harmless, but will require reoperation to replace the implant. In the case of silicone gel implants a rupture in the implant shell may not necessarily be obvious. The body naturally creates a scar tissue capsule around the implant and when disruption in the shell occurs the silicone gel, which is quite thick and cohesive, is usually contained by the capsule. In this situation a capsular contracture may occur, manifested by increased firmness in the breast. A change in breast shape may also occur. This would necessitate implant replacement. There is no evidence that rupture of silicone breast implants represents a health risk.

Cosmetic Procedures for Baby Boomers on the Rise

2010-12-10T07:58:00.000-08:00

Baby Boomers, determined to continue looking as young as they feel, have been turning to plastic surgery in higher numbers than other generations. They have led the demand for facelifts, BOTOX ® Cosmetic, and other surgical and non-surgical procedures designed to undo aging.

The demand for injectable fillers such as Juvederm and the very popular BOTOX ® Cosmetic more than doubled between 2008 and 2009, in part due to the demand from this one group of people. They have also helped increase demand for facelifts, which increased 44% between 2008 and 2009 alone.

The Baby Boomers have also taken to skin rejuvenation techniques, such as chemical peels. Chemical peels remove the top layer of skin, revealing a fresh, youthful layer of skin beneath.

There are also possible economic reasons Baby Boomers have driven the increase in cosmetic procedures during a down economy. Competition for jobs is fierce and some people may feel the need to look younger while competing with a younger crowd for jobs. Study after study has shown that looking good increases self-confidence, and by getting rid of wrinkles or other signs of aging, Baby Boomers can continue to show they have what it takes to prospective employers.

If you are considering a facelift or injectable fillers procedure to help retain your youth, please contact experienced Philadelphia plastic surgeon Dr. Bottger. Dr. Bottger proudly serves Philadelphia, West Chester, and Bryn Mawr, Pennsylvania.

How do you determine what size th implant shoul be?

2010-12-08T07:00:00.000-08:00

Determination of breast implant size is accomplished during the preoperative visit and utilizes a number of methods.
First, the patient is asked what general bra size she would like to be and reviews before and after photographs of a number of patients of similar height, weight and breast size.
At the same time the breast diameter is measured. This provides valuable information to determine which implants have the appropriate dimensions to optimally fill and contour the chest.
The final modality involves trying on progressively larger implant sizers which are actual breast implants in a special sizing bra and evaluating the appearance in the mirror in a tighter fitting shirt.
When all these modalities are utilized patients are generally very pleased with their final postoperative volume.

Are there risks in getting very large implants?

2010-12-01T07:00:00.000-08:00

Depending on expectations of final breast size there is a spectrum of breast implant volumes appropriate for any given patient. Chest dimensions are very important in the evaluation of appropriate implants. When excessively large implants are used not only can the result be more disproportionate and potentially unnatural in appearance, but the implants can stretch the skin envelope and increase the amount of breast sagging and distortion over time.

What is the difference between textured and smooth implants? Which is best?

2010-11-29T07:00:00.000-08:00

Smooth walled implants are all generally spherical in shape and have three different projections from low to high profile. High profile implants which have a smaller base diameter and more central projection are used for women with narrower chest walls.
Textured implants which have a rougher feeling surface come in both round and anatomic or tear drop shapes. Textured surfaces were developed to try to reduce the incidence of capsular contracture, a condition creating a firmer or harder breast. Some studies have supported this advantage, but others have not. There are, however, some disadvantages to textured implants, which include a higher incidence of visible rippling of the breast skin. and also a higher rupture or deflation rate.

What is the difference between round and contoured implants? Which is best?

2010-11-24T07:00:00.000-08:00

Breast implants come in two general types: round and contoured or anatomic implants.
Round implants are more spherical in shape and may have either smooth walled or textured surfaces. Contoured or anatomic implants have a tear drop shape. In order to maintain this shape a textured surface must be employed. It was originally felt that anatomic implants would give a more natural slope
in the upper breast and a better overall shape. Round implants, however, because of the fluid or filler shift to the lower pole of the implant also become tear drop shaped in the upright position. Therefore, there is no significant advantage in breast shape with the contoured implant. Using round implants also avoids the disadvantages of contoured implants which include shape distortions if there is any post operative rotation of the device, as well as a potentially higher incidence of implant rupture because of traction on the textured surface.

What types of anesthesia do you use for breast augmentation?

2010-11-22T11:14:00.000-08:00

Breast augmentation is performed in an out patient surgery center and typically under general anesthesia. Local anesthesia with sedation can be used in select patients, but it is harder to obtain the optimal degree of anesthesia and muscle relaxation with this method.

Breast Augmentation and Breastfeeding

2010-07-20T11:57:00.000-07:00

Breast Augmentation

Breast Augmentation, also known as breast implants or enlargement, is the procedure used to alter the shape and/or size of a woman’s breasts. It is one of the leading cosmetic procedures in the United States. The two most common forms of breast augmentation are saline and silicone-gel implants. Although there are other types of implants that exist as alternatives today, these two most common types have proven more effective. Saline implants are made of a saline liquid in a silicone shell and silicone-gel implants are made of a viscous silicone-gel in a silicone shell.

Breastfeeding

Although Breast Augmentation is such a common procedure, many women have concerns about the procedure and possible difficulties that they might encounter. Often times when someone is considering Breast Augmentation, breastfeeding is an influential factor in the decision-making process. Although women usually find the positive aspects of Breast Augmentation to outweigh the negative aspects, there are discomforts that can arise from breastfeeding after receiving a Breast Augmentation procedure. With certain types of Breast Augmentation, breastfeeding will not be affected; however, with other types it may be. Most women who have implants that are inserted over the muscle cannot produce an efficient enough milk supply; about half of women who have implants that are inserted under the breast or near the armpit can produce enough milk.

Because Breast Augmentation is a surgical procedure there is risk of damaging nerves or milk ducts in the breasts. If either is damaged during a procedure there are several symptoms that can occur such as; breasts may not be capable of producing enough milk, more or less sensitivity in the nipples or more extreme breast engorgement that is accompanied by severe cases of pain, fever and chills. Like any other procedure, there are possible negative effects; however with the help of a good medical professional, all breastfeeding issues are avoidable.

If you live in the New Town Square area and want to find out more information about Philadelphia Breast Augmentation please contact our breast augmentation surgeon, Dr. David Bottger today.

How long does it take for breast augmentation scars to heal and fade?

2010-06-26T07:52:00.000-07:00

Incisions from breast implant surgery are closed with dissolvable sutures and are typically completely healed after one week. The scars will remain red for a period of time, but by a year have usually faded and assumed their final appearance . Final scar appearance is variable but is usually good and scar revision is not commonly necessary.

If you are interested in undergoing breast implant surgery we encourage you to view our breast implant before and after gallery to see transformations patients of Philadelphia Breast Augmentation Surgeon Dr. Bottger have achieved.

How much recovery time should I expect with breast augmentation?

2010-06-25T07:50:00.000-07:00

Recovery from breast augmentation surgery varies from patient to patient. Narcotic pain medications such as percocet may be required for several days. Most patients are able to return to an office work setting in four to seven days. Physical activity can be gradually increased with return to full workouts and sports after approximately three weeks.

To learn more about what to expect following breast augmentation surgery, please contact us today to schedule a consultation with at our Philadelphia Plastic Surgery practice.

What are the possible incision locations with breast implants? Is one better than the other?

2010-06-24T07:43:00.000-07:00

Multiple incision options exist for breast augmentation, depending upon the type and size of breast implant.

Saline breast implants can be inserted through either an inframammary or crease incision, an areolar incision or an axillary or arm pit incision. The scars from any of these incisions are usually good and minimally visible. A transumbilical approach is also possible with saline breast implants. Placing the implants under the muscle, which is the preferred plane in most patients, is, however, more difficult through this approach. Because visibility of the pocket dissection is impaired, there is a higher incidence of potential unrecognized bleeding and asymmetric pocket dissection, increasing the possible need for revision surgery.

Silicone breast implants are a bit different due to the fact that they are prefilled and require somewhat larger incisions for placement than saline implants which are actually filled after placement into the pockets at surgery. Although other incisions can be used depending on individual anatomy, the inframammary, or crease incision, is usually the preferred incision with silicone gel breast implants.

If you are interested in receiving breast implants, please view our breast augmentation before and after gallery to see results Philadelphia Breast Augmentation surgeon Dr. Bottger's patients have achieved.

Will breast implants effect future pregnancy?

2010-06-23T07:41:00.000-07:00

There is no scientific evidence that breast implants, whether saline or silicone gel, have any negative impact on the developing fetus. Moreover, no evidence exists that breast implants are associated with any systemic disease in humans.

To learn more about what to expect after breast implant surgery, please contact our Philadelphia Plastic Surgery office to schedule a consultation.

Does breast augmentation cause changes in nipple or breast sensitivity?

2010-06-22T07:36:00.000-07:00

Most patients undergoing breast augmentation do not have a change in nipple sensation. There is, however, a possibility of changes in nipple or breast sensation. Mostly, this relates to stretching of nerves entering the lateral aspect of breast tissue when the breast implant pocket is developed. Some cosmetic surgeons believe that incisions made in the areolar area may produce a higher incidence of numbness or change in sensation, although this has not been proven.

If you are considering breast augmentation surgery, please contact our Philadelphia Breast Augmentation Surgeon Dr. David Bottger to schedule a confidential consultation and have all of your surgery questions answered.

Mommy Makeover

2010-06-18T13:46:00.000-07:00

If you have finally finished losing those unwelcome pounds, or know you won’t be having any more children, it may be time to consider having a mommy makeover, one of the most popular contouring procedures. More and more women are opting for this combination of breast augmentation and breast lift with tummy tuck and liposuction procedures that takes care of several problem areas at once.

Pregnancy and breastfeeding can cause a woman’s breasts to enlarge. Post-partum mothers and those who have completed breastfeeding often find that their breasts have lost their firm and perky shape and become droopy or somewhat flattened. Obese women often find similar changes once they have lost weight.

Waistlines develop love handles, bellies sag, as do hips, thighs and buttocks. All of these areas can be trimmed and lifted, leaving you with a new contour that is both attractive and functional. Most women claim they feel better about themselves and their appearance, and tend to take better care of their appearance as a result.

Dr. Bottger can help you reshape your body and get a new lift on life at the same time, as he's done for countless other women.

If you are ready for a new you and a mommy makeover, please contact cosmetic surgeon Dr. David Bottger at one of his Pennsylvania plastic surgery clinics in Philadelphia, PA - Bryn Mawr, West Chester, or Newtown Square for a consultation.

How much pain can I expect to be in after breast augmentation?

2010-06-11T14:23:00.000-07:00

Post operative pain after breast augmentation varies from patient to patient. When the submuscular approach is utilized pain is typically more severe than with the subglandular approach. Most patients will require oral medications such as percocet for several days for adequate pain control. After this, NSAIDs are usually sufficient.

If you are considering breast augmentation surgery, please schedule a consultation with Philadelphia plastic surgeon Dr. David Bottger to have all of your questions answered.

How long do breast implants last?

2010-06-10T14:18:00.000-07:00

Both saline and silicone gel breast implants have considerable longevity. There is a misconception that breast implants need to be replaced every ten years, but this is not the case. Replacement is only necessary if there is a clinical problem. The generally accepted deflation rate for saline implants is 1% per year. This would amount to an approximately 10% deflation rate for any given implant at 10 years. In the event of deflation the saline will be harmlessly absorbed, the breast volume will be lost, and the implant will need to be replaced.

The exact rupture rate of silicone gel implants, although less than saline breast implants, is not definitively known. In the event of disruption, because modern implants are composed of very thick gel and because the body creates a scar capsule around the breast implant, there may be no significant change in the appearance or feel of the breast. Alternatively, there may be a development of breast firmness or a shape change, In that event, breast implant replacement would be required.

If you are considering breast implants, please contact our Philadelphia cosmetic surgery office to schedule an initial consultation with Dr. Bottger.

Can I still get a mammogram with breast implants?

2010-06-09T14:16:00.000-07:00

Mammograms at the appropriate age are recommended after breast augmentation. A slightly different technique is employed which utilizes extra tangential views to maximize visibility of deeper breast tissue. A small amount of deeper tissue is not completely visualized with both saline and silicone gel breast implants. Although this may represent a theoretical negative, there is no increased incidence of breast cancer or delayed diagnosis of breast cancer in women who have undergone breast augmentation.

Do breasts really make noise after breast augmentation?

2010-06-08T14:14:00.000-07:00

In the early post operative period following breast augmentation a number of unusual sensations and noises may occur. A "sloshing" sensation and sound may be experienced. This occurs due to air and fluid surrounding the breast implants in the early post operative period. This is a harmless phenomenon and the air and fluid will reabsorb over the first week or so and the sound will disappear.

If you are considering breast augmentation surgery, please contact Philadelphia breast surgeon Dr. David Bottger today to schedule a confidential consultation.

Mommy Makeover

2010-06-08T08:29:00.000-07:00

If you have finally finished losing those unwelcome pounds, or know you won't be having any more children, it may be time to consider having a mommy makeover, one of the most popular contouring procedures. More and more women are opting for this combination of breast augmentation and breast lift with tummy tuck and liposuction procedures that takes care of several problem areas at once.

Pregnancy and breastfeeding can cause a woman’s breasts to enlarge. Post-partum mothers and those who have completed breastfeeding often find that their breasts have lost their firm and perky shape and become droopy or somewhat flattened. Obese women often find similar changes once they have lost weight.

Waistlines develop love handles, bellies sag, as do hips, thighs and buttocks. All of these areas can be trimmed and lifted, leaving you with a new contour that is both attractive and functional. Most women claim they feel better about themselves and their appearance, and tend to take better care of their appearance as a result.

Dr. Bottger can help you reshape your body and get a new lift on life at the same time, as he’s done for countless other women.

If you are ready for a new you and a mommy makeover, please contact cosmetic surgeon Dr. David Bottger at one of his Pennsylvania plastic surgery clinics in Philadelphia, PA - Bryn Mawr, West Chester, or Newtown Square for a consultation.

What is the best plane for breast implant placement?

2010-06-07T14:08:00.000-07:00

There are two potential planes for breast implant placement with some minor variations - the subglandular and the submuscular planes. In the subglandular procedure the implant is placed above the pectoralis major muscle. An advantage of this procedure is less post operative pain. Also, this location can potentially "fill out" a breast with natural sagging more effectively than the submuscular position.

The disadvantage of this the subglandular placement approach in breast augmentation is the fact that there is less soft tissue coverage of the breast implant which, particularly with saline implants, could lead to greater implant palpability or visibility, also known as rippling. Additionally, the incidence of capsular contracture or breast firmness may be higher.

The submuscular plane involves placing the breast implant involve placing the implant under the pectoralis muscle. This results in the upper two-thirds to three-fourths of the breast implant under the pectoralis muscle and the lower one third to one fourth of the implant under the breast tissue. The advantage of this approach is greater soft tissue coverage to reduce palpability and visibility of the implant. This becomes more important when using saline implants, particularly in very thin women.

The submuscular position is more painful, but in most cases , is Philadelphia Plastic Surgeon, Dr. Bottger's preferred approach.

How does rippling occur with breast implants?

2010-05-25T14:02:00.000-07:00

Rippling occurs when the edges and folds of a breast implant become visible on the skin surface. It is characterized by visible irregularities or depressions after breast augmentation, typically in the lower medial and lateral aspects of the breast skin. It occurs mostly with saline implants and is very uncommon with silicone gel implants. Rippling is much more prevalent in very thin patients with minimal breast tissue.

The best way to avoid rippling is to utilize silicone gel implants in the submuscular plane for breast augmentation, particularly in patients who are very thin.

How do you determine what size the breast implants should be?

2010-05-24T14:05:00.000-07:00

A number of methods are used to determine optimum breast implant size for any given patient. The first is to ask the patient what final cup size she would like to be. This is certainly fairly subjective, but gives a general idea of patient expectations.

During the physical examination, a measurement is made of the breast diameter which identifies the base diameter of the most appropriate breast implants for the patient. Showing examples of patients of similar height, weight and chest size is also helpful in getting an idea of patient expectations.

The final method to determine what the breast implant size should be is, during the consultation, to have the patient try various implant sizers in a special bra and assess for herself what final volumes look the most appropriate in clothing.

Philadelphia Plastic Surgeon Dr. Bottger can help you determine which breast implant size will help you to meet your appearance goals. Please contact us today to schedule a consultation.

Which type of breast implant is more natural feeling and why?

2010-05-21T14:05:00.000-07:00

Regardless of the type of implant chosen, augmented breasts are typically somewhat firmer than natural breasts. A number of factors will influence the degree of softness in any given patient.

The more innate breast tissue present before surgery, in general, the softer and more natural the breasts are likely to feel post operatively. When there is very little breast tissue, the breast implant itself comprises the majority of the volume and the firmer the result is likely to be.

The type of breast implant can also have an effect on firmness. In general, saline implants have a somewhat firmer feel than silicone gel implants.

Over time an augmented breast can develop a tightening of the scar capsule which forms around the breast implant creating an increased breast firmness known as a capsular contracture.The chances of this occurring are reduced by placing the implant in the submuscular plane.

If you would like to discover how breast implants can help you enhance your figure, schedule a consultation with Dr. Bottger today.

Will breast implants effect breast feeding in the future?

2010-05-20T14:06:00.000-07:00

In both subglandular and submuscular breast augmentation the implants are placed underneath the breast tissue. Because there is no interference with the ducts connecting the breast tissue to the nipple, there is no anatomic reason that breast feeding should be interfered with. Some women, regardless of breast size, inherently have difficulty breast feeding with or without breast implants.

If you are interested in learning more about breast implants, contact us to schedule a consultation with Dr. Bottger today.

What is symmastia?

2010-05-19T14:06:00.000-07:00

Synmastia is a condition which can occur after breast augmentation where the breasts lose the natural separation in the mid sternal area, essentially "blending" together, creating a very unfavorable appearance. It typically results when breast implant pocket dissection is carried too far toward the center of the chest. When the placement is in the submuscular plane it occurs when the fibers of the pectoralis muscle have been separated from their sternal attachments allowing medial displacement of the implants so that the implants sit very close to each other.

The condition may be more common when excessively large and or wide implants are utilized. The condition is avoided by proper implant pocket dissection, respecting the medial attachments of the pectoralis muscle.

To learn more about breast implants, read our breast augmentation common questions section.

Do you need to wear compression garments or a girdle after liposuction?

2010-05-10T08:21:00.000-07:00

In most cases after liposuction a compression garment is placed over the area treated. The initial garment at surgery is fairly sturdy and tight fitting. This helps to reduce the level of post operative swelling and accelerates the achievement of the final post operative appearance.

Usually after two weeks of the heavier garment, a lighter compression garment may be utilized for two to three more weeks. In both cases the garments are very form fitting and well concealed under any clothing.

For more information about liposuction, please visit our common questions about liposuction page.

Will there a scar from the liposuction incision site?

2010-05-07T08:17:00.000-07:00

Incisions used for liposuction are quite small, typically less than one centimeter. They are usually placed in less exposed areas which makes them much less visible. Initially they may appear red in color but over time fade to a white color. The process of final scar maturation can take up to one year. These scars are usually small and of good quality and the need for revisional surgery is uncommon.

If you are interested in liposuction, take a closer look at our liposuction before and after gallery and contact us to schedule a consultation.

When can you begin regular exercise after liposuction surgery?

2010-05-06T08:14:00.000-07:00

Walking distances can usually be resumed within days after a liposuction procedure. Depending on one's level of discomfort, more extensive levels of exercise can be phased in after a week. Exercise after this point, regardless of the level, will not have a detrimental effect on the final results.

Schedule an initial consultation with Philadelphia cosmetic surgeon Dr. Bottger to learn how liposuction can give you the look you want.

How does weight gain after liposuction effect the results?

2010-05-05T08:19:00.000-07:00

Liposuction is essentially a sculpting procedure which results in a permanent change in the shape and proportion of any given area. Once the fat cells are removed from an individual area no new fat cells are created in that area. Weight gain results in an increase in the fat volume of each individual fat cell. This would result in all the fat cells of the body becoming proportionately larger. All body areas would, therefore, increase somewhat in size, but the liposuctioned areas would always maintain their relative decreased projection and the overall improved contours would be maintained.

If you are considering liposuction surgery, please contact Dr. Bottger's Philadelphia office to schedule a consultation today.

Is there soreness and bruising after liposuction?

2010-05-04T08:09:00.000-07:00

After a liposuction procedure there is usually some soreness. Typically it is moderate and not severe and usually fades away in less than a week.The hip and lower back areas are usually the most sensitive. Pain medications such as percocet are prescribed for the first few days and after that Tylenol or NSAIDs, such as Motrin, are usually sufficient.

Some degree of bruising is usually present after most liposuction procedures. Use of the tumescent technique will minimize the degree of bruising and in most cases it is not excessive. Bruising has typically resolved by the second week after surgery. By the third post operative week approximately 50% of the final result is evident. By the third month any residual swelling has resolved and the final result is evident.

Liposuction vs. Abdominoplasty

2010-05-03T14:13:00.000-07:00

Many people confuse liposuction with abdominoplasty, but these are two entirely distinct procedures. Cosmetic surgeon Dr. David Bottger performs both procedures on a regular basis, and often together in a combined procedure for his patients.

Liposuction is the removal of fat from under the skin in localized areas on the hips, thighs, calves, ankles, arms, neck, back or abdomen. This is generally done by inserting a cannula through a small incision, then using the cannula to break up the fat and suction it away.

Abdominoplasty is surgery to remove excess skin. Often, when people lose large amounts of weight their skin doesn’t fully shrink back to its original shape. What remains is loose skin or sagging bulges. Abdominoplasty, also called tummy tuck, is a procedure that removes the excess skin, flattens and contours the abdomen.

Together, these two procedures can be used to reshape the skin and sculpt it so that it follows the contour of your muscles in a most flattering way. Abdominoplasty can involve areas just below the belly-button, or both above and below, depending upon the amount of loose skin present.

If you would like to learn more about liposuction and abdominoplasty please contact Dr. Bottger for a consultation in any of the Pennsylvania communities of Philadelphia, Bryn Mawr, West Chester, Newtown Square.

Lifestyle Changes After Tummy Tuck

2010-04-10T10:53:00.000-07:00

Patients choose to have a tummy tuck for a couple of reasons. While men and women alike end up with excess sagging skin after losing weight, some women experience sagging abdominal skin after pregnancy. Those who have already lost enough weight to develop this problem will appreciate the need for lifestyle changes after having a tummy tuck. Fortunately, having lost so much weight, they have already made the most significant changes before their surgery.

Other lifestyle changes that contribute to good tummy tuck outcomes include quitting smoking and reducing, if not eliminating, alcohol consumption. Good skin care, healthy diet and plenty of balanced exercise will maintain the benefits of tummy tuck surgery. Drink plenty of water to keep your skin and tissues well hydrated, elastic, and strong.

As a patient of Dr. David Bottger you will receive his help in developing a personalized care plan that will ensure the best healing results as well as long-term maintenance of your new physique. You need only adhere to the plan to see maximum results from your surgery.

If you, like so many others have decided that it’s finally time to get rid of sagging tummy tissue please contact cosmetic surgeon, David Bottger, M.D. for a personalized tummy tuck consult at one of his Philadelphia, Bryn Mawr, West Chester Newtown Square offices.

Realistic Expectations for Breast Augmentation

2010-03-20T10:51:00.000-07:00

Dr. Bottger is known for thoroughly evaluating and preparing his patients for their plastic surgery outcomes. He knows that when patients have the most realistic expectation for breast augmentation results possible they are most likely to be satisfied with their new look.

Dr. Bottger will give you the most thorough examination and evaluation, listening to you to determine what you want to accomplish and why it is important to you. He will consider dozens of factors including your health, physical attributes such as body type, skin type, lifestyle, and much more to decide how to help you reach your goals. You will have the opportunity to look over his before and after breast augmentation photos. Your preferences will give him a clearer idea of how you envision your body could be.

After reviewing all of the factors that will affect your outcome, he will help you develop a set of realistic expectations for your breast augmentation. Depending upon your age and other factors, these may or may not be what you’d originally hoped for, but they will be as realistic as possible.

Knowing that you might not look 30 again when you’re 50, but that you will have a more attractive contour is far more satisfactory than having the same results but being disappointed because you had expected more improvement or different results than was possible.

If you are in the Philadelphia, Newtown Square, Bryn Mawr or West Chester, PA area please contact plastic surgeon Dr. David Bottger, M.D. for a consultation and learn more about realistic expectations for breast augmentation.

Breast Enlargement Surgery and Age

2010-02-20T10:49:00.000-08:00

Many women have questions about breast enlargement surgery. Many of these questions are specifically about breast enlargement surgery and age-related concerns.

Age is definitely a serious consideration. Too young and results could end up being regrettable later on. Too old and results may disappoint immediately.

While the optimal age range is between 18 and 50 years old, your personal health, plans for future pregnancies, lifestyle, job, general health and current breast health have as much to do with your breast enlargement decision as your age.

Cosmetic surgeon, Dr. David Bottger evaluates these and other personal factors during each consultation. During your examination he will take all of your personal goals into consideration in respect to your age when preparing his recommendations.

If you are under 18, you will probably be told to wait a few years before making such a life-affecting decision. You may have different wants later. However, if your breasts are asymmetrical or misshapen, you may be an excellent candidate for early surgery.

If you are approaching 50 years old, Dr. Bottger will have some special recommendations for your based upon your full medical history and your expectations. You can expect better results if you’ve taken excellent care of your body and skin throughout your life. However, as we age, our skin and muscles begin to deteriorate. Achieving our former look or taking 20 years off our age may not be a realistic goal.

If you think you would benefit from breast enlargement surgery and have questions about how your age will affect your outcome, please contact Dr. David Bottger plastic surgeon to schedule an appointment at one of his clinics in Philadelphia, Newtown Square, Bryn Mawr or West Chester, PA.

"What's New" in Plastic Surgery - Seattle Meeting

2010-01-21T13:36:00.000-08:00

A number of newer trends emerged at the recent American Society of Plastic Surgeons meeting in Seattle.

In regard to facial rejuvenation more emphasis is being placed on volume and restoration in the form of fat grafting. By using very small cannula's, fat removed by liposuction, typically from the abdomen, is injected into the face. Such volume restoration to the upper and lower eyelids may circumvent the need for more aggressive class blepharoplasty procedures which actually remove fat and may produce a more gaunt or skeletalized appearance. Grafting of the cheek regions may also be added to various face lifting techniques to recreate the volume associated with a youthful face.

A number of panels and discussions focused on newer techniques for fat removal. Smart and slim liposuction utilizes a laser attached cannula's which vaporize fat cells. The resultant liquefied fat is subsequently removed by standard aspiration.

Bodylite is a new device which utilizes radio waves to break up and destroy or "melt" fat cells. This device has not yet been approved by the FDA for use in the United States.

Supposed advantages of these newer techniques include reduced bruising and swelling and potentially increased skin tightening. Thus far, however, no definitive evidence was shown showing that the newer liposuction methods produce any better results than can be obtained with standard tumescent technique.

Water jet liposuction is another new technique that utilizes a high pressure spray of a saline solution to dislodge and remove fat cells. Supposed advantages are requirements for less tumescent infiltration potentially making the endpoint of the procedure easier to determine, as well as potentially less bruising. As with the other new devices no evidence has been presented showing superior results than standard tumescent technique.

New Innovation for Breast Augmentation Surgery

2010-01-21T12:08:00.000-08:00

A new innovation has recently been introduced for the placement of silicone gel implants in breast augmentation. The device is remarkably simple, resembling the funnels used by pastry chefs to decorate cakes. The breast implant is placed into the funnel, the funnel tip is inserted into the incision, and the implant is virtually "squeezed" into the dissected pocket, almost like a liquid. The device provides a number of advantages. The first is less trauma to the breast implant. Normally placement of a gel implant requires a fair amount of aggressive manipulation, which has the potential of damaging or weakening the implant shell. This trauma could theoretically lead to a greater chance for ultimate implant rupture.

Also, the Keller funnel allows placement of the implant without the device touching the skin or operative field. This is significant in that contamination of the implant shell with bacteria is felt to be a major cause of capsular contracture, leading to firm or hard beasts. The final advantage of the device is the ability to utilize smaller incisions and therefore, have shorter final scars. This, also, allows for more incisional placement options.

I have found this device to be of great value in my silicone gel breast augmentation patients.

Size Matters – Choosing the Right Breast Implant Size

2010-01-11T09:05:00.001-08:00

According to one study, 34% of women who chose breast implant reoperation sought a larger implant. Clearly, the expense, exposure to surgery and recovery time involved make choosing the right breast implant size the first time an important matter.

Dr. Bottger's expertise in helping each woman achieve her preferred look covers choosing the size, shape and placement of the implants. While the trend is toward smaller, more proportional implants, he will determine the best technique to obtain whatever contour you prefer, the first time.

Before having breast implant surgery, it's best to be at an optimal weight. Losing weight after breast implant surgery can affect the tautness and shape of your breasts. It's best to lose excess weight first.

If you are considering any other body enhancements such as a tummy tuck, or future pregnancies and breastfeeding, it's very important to discuss this with Dr. Bottger. Breastfeeding is an especially important consideration. Although most women have no problems breastfeeding after having breast implants, you will want to know how your implants might affect your breastfeeding plans.

Please contact cosmetic surgeon, David Bottger, M.D. at one of his Pennsylvania plastic surgery offices in Philadelphia, Newtown Square, Bryn Mawr, or West Chester when you are ready for your breast implant size consultation.

Share Your Experiences

2010-01-07T09:11:00.001-08:00

Online customer reviews are a popular resource for people looking for a cosmetic surgeon. Some websites are solely dedicated to online opinions, while others have specific areas where you can post your opinion.

We highly value your opinions! Below are a list of websites that make it easy for you to share honest feedback about your experience with Dr. David A. Bottger. Please take a minute to share your opinion and post a review of your experience with our office at these review sites:

Google - Google uses a rating system that allows you to assign up to five stars for excellent service and write a quick review to share your experience. Visit our profile and share your opinion.
Citysearch - Visit our office profile, click on the "Write a Review" link in the upper right corner of the profile, rank our office and share a short review.
Yelp - Yelp.com also uses the five star rating system and review area. Go directly to our profile to rate our office and share your opinion.

We hope you had a positive experience with Dr. David A. Bottger. Thank you for taking the time to share your experience.

What is the Best Age for Breast Augmentation?

2009-07-28T11:02:00.000-07:00

For breast augmentation, the U.S. Food and Drug Administration (FDA) approves saline-filled breast implants for women age 18 and older and silicone-filled implants for women age 22 and older. These are age recommendations, not legal restrictions, and teens under age 18 are actually able to get breast augmentation as long as they have parental consent.

There are many reasons why it may be inappropriate for teens to undergo breast augmentation surgery:

Women's breasts can continue to develop into the 20s, so the breasts they have at age 16 may look completely different at 23.
Teenagers may not be mature enough to fully understand the potential risks and complications that can arise as a result of breast implants.
On average, breast implants have a lifespan of 10 years, so getting implants at a young age can possibly require many additional surgeries over the patient's lifetime.
Breast implants can impede milk production after pregnancy, so women who plan to become pregnant in the future may have difficulties breastfeeding.
Body image is a hot topic with teenage girls, and some may feel that breast implants will help to make them more popular. This is not a healthy reason to get implants.

According to a February 2009 article, "the Italian Health Ministry is considering banning teenagers from undergoing breast augmentation surgery, citing the health risks" or medical complications that can occur when a woman is not fully mature. For now, there are no age bans in the United States.

The debate over what age is the appropriate age for breast augmentation will continue as long as there is no definitive legal restriction. If you are considering breast implants for your teenager and would like to discuss the decision with Dr. David Bottger, please contact us today for a free breast implant age analysis consultation. We serve patients in Delaware and in and around the Philadelphia, Pennsylvania area.

Proper Placement of Breast Implants on the Chest

2009-07-18T11:04:00.000-07:00

There is no definitive right or wrong answer when it comes to breast implant placement on the chest. Depending on the patient’s physical characteristics, activity level and the type of implant being used, the patient and surgeon should work together to determine the best placement of the implants to achieve the desired results.

Implant Placement Options

There are several choices when it comes to implant placement:

Subglandular plane, located under the breast tissue
Submuscular plane, located under the pectoralis muscle or chest wall
Dual plane, located under both the breast tissue and pectoralis muscle

Subglandular Plane

This location allows for a very natural appearance and movement, and cleavage can be easily created. However, capsular contracture is often more common in this location and mammography results can be difficult to accurately interpret.

Submuscular Plane

This is the preferred location for saline implants because it is less likely to:

Show rippling
Interfere with mammograms
Cause capsular contracture

Dual Plane

Dual plane placement creates very aesthetically pleasing, natural-looking breasts that have a natural slope to the top of the breasts.

What works well for one patient may not be the right answer for another. Breast implant placement is a very personal decision that should be discussed in depth with your cosmetic surgeon.

If you would like a free breast implant consultation with a reputable cosmetic surgeon to discuss these and other breast implant options, please contact cosmetic surgeon Dr. David Bottger today.

How to Know When You Need to Remove or Replace Implants

2009-07-12T11:05:00.000-07:00

Most women who have breast augmentation surgery from a reputable, experienced cosmetic surgeon like Dr. Bottger are very happy with the results. However, even the most satisfied patients may require implant removal or replacement at some point during the lifetime of the implants, which is on average 10 years.

There are certain circumstances in which implant removal or replacement is essential:

Implant rupture: Saline implant ruptures are usually very obvious, as the solution will be easily and safely absorbed into the body causing the implant to deflate. Silicone ruptures are not always as evident, which is why occasional testing is recommended to ensure that the foreign substance is not entering the body.
Capsular contracture: This complication can occur when the tissue lining that forms around the implant begins to shrink and subsequently squeezes the implant. The implant can become hard and painful for the patient as well as visibly distorted.
Implant rippling: Often occurring in women who have thin, soft breast tissue, implant folds, creases and wrinkles can sometimes be visually apparent. These distortions can be very distressing for the patient.

Other problems that can warrant removal or replacement include:

Asymmetry
Infection
Bleeding
Poor wound healing
Breast sagging or drooping

Some women simply wish to return to their “normal” size and request that their implants be removed.

If you are unhappy with your breast implants and are considering removal or replacement, please contact Pennsylvania cosmetic surgeon Dr. David Bottger today for a free consultation to discuss your situation and the options available.

Double Bubble Breast Surgery

2009-07-08T11:06:00.000-07:00

In breast augmentation surgery, one of the decisions that the patient and surgeon must make together is where to place the breast implants on the chest:

Under the breast tissue, called the subglandular plane
Under the pectoralis muscle, called the submuscular plane
Under both the breast tissue and pectoralis muscle, called the dual plane

Each of these locations has its own set of advantages and disadvantages. Likewise, some locations are better than others depending on the type of implant being inserted.

A phenomenon called “double bubble” is one breast implant complication that can arise when implants are placed under the pectoralis muscle or on the submuscular plane. If the patient’s breasts begin to sag or droop after the implant is placed, the implant will typically stay in place as the breast tissue drops below. The patient may then be left with what may appear like two breast creases or two breasts.

The double bubble can also occur:

After a patient has experienced breast sagging after pregnancy and/or breastfeeding
As a result of capsular contracture, where the scar tissue around the implant begins to constrict, creating painful or hardened breasts
If the patient has tubular-shaped breasts
If the patient has a constricted breast crease

Depending on the severity, a double bubble can be corrected by a breast lift, implant removal or replacement.

If you would like to learn more about the potential risks and complications of breast implant surgery, please contact our office today to arrange a breast augmentation consultation with cosmetic surgeon Dr. David Bottger.

Breast Lift vs. Breast Augmentation

2009-06-29T11:07:00.000-07:00

Breast lifts and breast augmentation are two separate cosmetic surgery options to help women enhance, enlarge or contour their breasts. Sometimes these procedures are used in conjunction to achieve the desired results and sometimes only one procedure is necessary.

Breast Lift

A breast lift can help reverse the effects of aging, pregnancy or weight loss. Over time and after such major life experiences, the skin of the breasts can lose elasticity and succumb to gravity leaving breasts that sag or droop. Also called mastopexy, a breast lift involves the removal of excess skin and the repositioning of the nipple to reshape the breasts. The breasts will be perkier, firmer and look more youthful; however, they will not be larger in size.

There are two different types of incision methods that can be used for the breast lift procedure, depending on the severity:

Donut, which results in an areola scar only
Vertical, which results in a scar that circles the areola and extends vertically to the fold of the breast

Breast Augmentation

Breast augmentation, also called augmentation mammaplasty, is used to enlarge and reshape a woman’s breasts. Typically, this procedure alone will not correct sagging breasts, although there are always exceptions.

Women who choose breast augmentation have many important choices to make, including:

Saline or silicone implants
Size and shape of the implants
Incision location
Placement of the implants on the chest

If you would like to enhance or enlarge your breasts and would like to know which procedure might be right for you, please contact Philadelphia breast surgeon Dr. Bottger today for a free consultation.

Realistic Expectations for Plastic Surgery

2009-06-27T11:08:00.000-07:00

Plastic surgery can help both men and women change physical attributes about themselves that they find undesirable. Before embarking on any type of cosmetic surgery, the patient should discuss his or her final outcome expectations with the surgeon so everyone has a realistic understanding about the surgery possibilities and limitations.

Women considering breast augmentation surgery should have open and honest discussions with the surgeon regarding:

Size, shape and texture: There are different types of implants available, and each will look and feel differently.
Scarring: Depending on the incision location, the incision scars may or may not be visible.
Recovery time: Patients should wait 3 weeks to resume strenuous activity, and the breasts may not be fully healed and shaped until several months after surgery.
Replacement: Implants do not last a lifetime, and the average lifespan is 10 years. It is possible that the implants may need to be replaced due to deflation or other complications.
Sagging: A breast lift may be necessary to correct sagging breasts. Typically breast implants alone will not fix this problem.

Breast augmentation is an invasive surgery that carries potential risks and complications. Patients should be fully aware of these risks before making the important decision to undergo surgery.

If you are considering breast augmentation surgery and would like to meet with board-certified plastic surgeon Dr. David Bottger to discuss your expectations, please visit our “contact us” page for a free breast implant expectations consultation. We serve patients in and around Philadelphia, PA and all of Delaware.

Importance of Honesty with Your Plastic Surgeon

2009-06-22T11:08:00.000-07:00

It is for a patient’s own safety that plastic surgeons ask a variety of screening questions and/or do medical testing prior to performing surgeries. By understanding each patient inside and out, the surgeon has a better chance of reducing any risks or complications that can occur.

Surgeons should inquire about:

Medical history: Plastic surgeons should be fully informed about patient’s medical history in order to determine which type of surgery, if any, is appropriate and safe for the patient.
Psychological disorders: Mental illnesses, such as Body Dysmorphic Disorder, can give people warped self-images, making them poor candidates for plastic surgery. These individuals may believe that the surgeries will make them happier, when in actuality the surgeries may have the reverse effect.
Substance abuse: Individuals with substance abuse problems may suffer from depression and undergo plastic surgery for the wrong reasons. The healing time for these patients can also be greatly lengthened, adding to the patient’s depression and despair.
Medications: The surgeon should know about all medications the patient is taking prior to, during and after surgery. Even herbal medications and vitamins have been known to cause complications and delay or prevent proper healing.

The more honest you are with your surgeon, the better chance you have for a successful surgery and desired outcome.

If you would like to discuss plastic surgery options and live in the Philadelphia or Bryn Mawr, Pennsylvania area, please contact cosmetic surgeon Dr. David Bottger today for a plastic surgery consultation.

Choosing the Right Breast Implant Size

2009-06-12T07:53:00.000-07:00

Some women may be surprised to learn that silicone and saline breast implants are not created with bra cup sizes in mind. Because there is no absolute industry standard among bra manufacturers on cup sizes, it would be virtually impossible for implant manufacturers to create a D-size implant, for example, that perfectly fit every D-size bra on the market.

Breast implants are classified by the volume of saline solution or silicone gel that is injected into the implant shell. Breast implants range in size, depending on how large the woman would like her breasts to look. Typically, implants range in size from 250cc (cubic centimeters) to 1200cc with 350cc being one of the most popular implant sizes.

Each woman’s own unique body type will determine how much saline or silicone will be necessary to create the desired breast size. A 350cc implant on one woman may have a completely different effect on a different woman. However, as a rule of thumb, each 150cc-175cc of implant may increase a woman’s bra size one cup.

Pennsylvania and Delaware-area cosmetic surgeon, Dr. David Bottger, is experienced in helping women determine the right breast implant size for their body shape, breast shape, lifestyle and final expectations. If you would like to learn more about the different methods used to select the right implant size, please contact our office for a free breast implant sizing consultation.

Benefits of Plastic Surgery in the Spring

2009-04-28T15:39:00.000-07:00

Springtime is a time of renewal as people begin to shed their heavy winter clothing and start to enjoy the beautiful sunshine. Just as the trees and flowers embark on their blooming and growth patterns, so do many people elect to have cosmetic surgery procedures during the spring months.

Why is spring cosmetic surgery so popular?

We all know that once spring has sprung, summer is close behind. Summer is equated with lighter, smaller clothing options, revealing bathing suits and outdoor gatherings with family and friends. By undergoing plastic surgery in the spring, patients will be prepared to look and feel their absolute best during the summer months.

What types of springtime surgeries are popular?

Virtually any type of plastic surgery can help people gain or regain self-confidence and feel more comfortable in their bodies. Dr. Bottger routinely provides a variety of cosmetic surgery procedures to patients in the spring including:

Liposuction
Tummy tucks
Breast augmentation/lifts
Male and female breast reduction
Thigh or arm lifts
BOTOX® or facial fillers
Laser skin resurfacing
Facelifts or other facial procedures

If you are interested in reshaping or enhancing any part of your face or body, please contact Philadelphia, New Jersey and Delaware cosmetic surgeon Dr. Bottger for a plastic surgery consultation.

Breast Augmentation and Mammograms

2009-04-26T15:51:00.000-07:00

Any time you schedule a mammogram appointment, one of the first questions the office should ask is whether or not you have breast implants. This is an important question because breast implants can affect both the mammogram results as well as how the mammogram is performed.

Problems surrounding mammograms on implants

Tumors can be hidden from view by implants
Cancerous changes may go undetected
There is a slight risk of implant rupture
The images may be difficult to interpret

All women should get yearly mammograms after age 40. However, if you are considering breast augmentation and you are under age 40, it may be beneficial to have an early baseline mammogram to ensure that the pre-operative breasts are healthy. These baseline pre-implant results can be compared with future mammogram results on the breasts with implants. This may help radiologists detect any inconsistencies or tumors that would have otherwise been missed.

With our without implants, mammograms are one of the best ways to identify early stages of breast cancer and help increase a woman’s chance of survival.

To learn more about breast implants and mammograms, please contact Philadelphia, Pennsylvania, New Jersey and Delaware cosmetic surgeon Dr. Bottger for a free breast augmentation consultation.

Find Your Perfect Size

2009-04-24T15:49:00.000-07:00

Women considering breast augmentation have many different decisions to make prior to surgery. Detailed consultations with an experienced cosmetic surgeon like Philadelphia, Pennsylvania cosmetic surgeon Dr. Bottger will help patients determine:

• Which type of implant to use: silicone or saline
• Where to place the implant: under the breast tissue or under the chest wall/pectoralis muscle
• Where the incision will be placed
• What size of implant to choose

Because each woman is unique and has different expectations for the final result following breast augmentation, finding the perfect breast implant size is not an exact science. However, Dr. Bottger utilizes a variety of methods to help guide each patient toward making the right decision.

Methods

• Before and after photos: Dr. Bottger has performed breast augmentation on hundreds of patients with different body types. Viewing photos of similar bodies can help new patients get an idea of how the surgery will enhance their own bodies.
• Measuring breast dimensions: These measurements will show what size(s) of implants will be most aesthetically pleasing on the new patient’s body frame.
• Implant sizers: Different sized implants placed in bras are worn by the patient to simulate how the new breasts will look in regular clothing.

In short, there is no “perfect” breast implant size. If you are considering changing your appearance through breast augmentation, please contact our office today for a breast enlargement consultation.

Difference between Plastic and Cosmetic Surgeons

2009-04-21T15:47:00.000-07:00

Most people use the terms “plastic surgery” and “cosmetic surgery” interchangeably. The American Society of Plastic Surgeons explains that “the word ‘plastic’ in ‘plastic surgery’ does not mean ‘artificial,’ but is derived from the ancient Greek word ‘plasticos,’ which means to mold or give form.”

The umbrella term “plastic surgery” encompasses both cosmetic surgery as well as reconstructive surgery. These terms can be defined as:

• Cosmetic surgery: elective procedures that a person chooses to alter his or her outward appearance. Examples include breast augmentation, liposuction, tummy tucks, injectable fillers, etc.
• Reconstructive surgery: necessary surgical procedures to help improve or restore normal functions or create a normal outward appearance for a person. Examples of reconstructive scenarios include cleft-lip, hand or other deformities; growths; lacerations; etc.

Unfortunately, virtually any doctor can hang a plastic surgeon sign on his door and perform these intricate surgeries, even though he or she has not undergone the proper training and received the appropriate certifications.

Before undergoing any type of plastic surgery procedure, do your research. Make sure that the surgeon you choose is:

• Certified by the American Board of Plastic Surgery
• A member of the American Society of Plastic Surgeons
• A member of the American Society of Aesthetic Plastic Surgery

Philadelphia, Pennsylvania cosmetic surgeon Dr. Bottger is a board-certified cosmetic surgeon who has helped hundreds of patients achieve the face and body they desire. If you would like to learn more about the different cosmetic surgery options available, please contact our office for an initial cosmetic surgery consultation.

Liposuction

2009-03-30T10:05:00.000-07:00

Deposits of stubborn, excess fat can make an otherwise confident person feel insecure about his or her appearance. When diet and exercise programs fail to help a person achieve the desired body contours, liposuction is a viable alternative.

Liposuction involves making small incisions in the body to insert a small tube (cannula) and suction out excess fat. There are a variety of different liposuction methods available, including methods which utilize ultrasound waves or power-driven cannulas to help break up the fat prior to its removal. Dr. Bottger generally utilizes the standard suction method combined with a tumescent technique to constrict blood vessels and reduce bleeding to produce excellent results.

It is important to note that liposuction does not tighten loose skin and it does not improve cellulite.

Is liposuction only for the stomach area?

No. Liposuction can be performed on many different areas of the body, including the:

• Abdomen
• Thighs
• Hips
• Waist
• Knees
• Back
• Arms
• Neck
• Calves
• Ankles

If you have been considering liposuction and would like to know if you are a good candidate for this surgery, please contact Philadelphia, Pennsylvania cosmetic surgeon Dr. Bottger to arrange a free liposuction consultation.

Tummy Tuck

2009-03-20T09:24:00.000-07:00

Most men and women desire a flat, toned tummy. Unfortunately, this physical trait can be hard to come by, especially for women who have experienced the effects that pregnancy can leave on their midsections. If you have been struggling with sculpting your abdomen, despite healthy eating habits and regular exercise, a tummy tuck (abdominoplasty) procedure might be the answer.

Mini Tummy Tuck

A mini-abdominoplasty is performed only on the lower abdomen, below the navel. Even though it is sometimes called a “scar-less” tummy tuck, it is still necessary to make a small incision to remove excess skin and fat deposits. There is generally no need for belly button repositioning with this procedure. Candidates for this procedure are those who have a slight abdominal pooch.

Full Tummy Tuck

The more common full abdominoplasty procedure helps to remove excess fat and skin throughout the entire abdominal wall. The abdominal muscles are also tightened as a result, creating a firmer, more desirable profile. Liposuction is often combined with abdominoplasty to ultimately create the desired body shape.

When performed by a skilled, knowledgeable surgeon like Philadelphia, New Jersey and Delaware cosmetic surgeon Dr. Bottger, tummy tucks are a safe, effective way to enhance your body. To arrange a tummy tuck consultation, please contact our office today.

Gummy Bear Implants

2009-03-11T09:21:00.000-07:00

Cohesive gel breast implants, commonly referred to as gummy bear implants, are a type of silicone gel implant for breast augmentation that is firmer and thicker than regular silicone. As its nickname implies, gummy bear implants are soft, firm, pliable and strong. (However, they are not bear-shaped or multicolored.)

Advantages

Gummy bear implants have some advantages over regular silicone and saline implants, including:

• Cohesive gel is more stable and durable.
• If the implant is ruptured or cut, the gel will not ooze but will stay in place and the implant will retain its shape.
• The consistency is more like breast tissue than saline implants.
• Capsular contracture (scar tissue compression that can lead to tight, hard breasts) is less likely to occur in non-ruptured implants.

Disadvantages

Although the disadvantages are few, patients should be aware that:

• A larger surgical incision is required for implant placement.
• The implant cannot be inserted through the belly button as in transumbilical breast augmentation.
• The initial cost is higher than with regular silicon or saline implants.

If you would like to learn more about gummy bear implants, please contact Pennsylvania, New Jersey, and Delaware cosmetic surgeon Dr. Bottger to arrange a consultation and learn which type of implant is right for you.

Breast Augmentation Facts

2009-03-06T09:17:00.000-08:00

Breast augmentation, also known as augmentation mammoplasty, can enhance and enlarge the size and shape of a woman’s breasts. This surgical procedure has become very popular for a variety of women who:

• Want to reconstruct their breasts following a disease or accident
• Wish to balance the size or shape of their breasts in relation to their body size
• Simply want larger breasts

Breast Surgery Facts

Before undergoing breast augmentation, it is important to be aware of and fully understand all of the facts about breast enlargement surgery.

• Types of augmentation: saline or silicone gel
• Type of surgical procedure: invasive outpatient surgery which requires small incisions
• Anesthesia type: general
• Implant location: implants can be placed either above or below the pectoralis muscle
• Average cost: $3,000-$10,000
• Average procedure length: 1-2 hours
• Average recovery time: 1-2 weeks
• Possible risks: implant rupture; capsular contracture resulting in hard, tight breasts; infection; rippling; sensation loss
• Augmentation lifespan: most breast implants will last, on average, for 10 years; however, this varies greatly from woman to woman

If you are considering breast augmentation and would like to learn all of the facts, please contact Philadelphia cosmetic surgeon Dr. Bottger to schedule your initial breast enlargement consultation.

Maintaining Breast Health Before and After Surgery

2009-02-23T11:42:00.000-08:00

Mammograms and self breast exams are central to maintaining good breast health—both before and after any type of breast enhancement surgery. Following the age of 40, a screening mammogram is strongly recommended every one to two years, taking personal risk factors into account.

Make Sure to Get Routine Mammograms

Patients should be aware that depending on how breast implants are placed, they can to some extent decrease the effectiveness of mammogram procedures. This makes mammograms even more important, however, as research strongly indicates that mammograms effectively screen for breast cancer—even when women have had their breasts augmented. Tell the nurse, technician, or doctor performing the mammogram about your implants before the screening.

Take Time to Locate an Experienced Facility

Once you have obtained your implants, it is important that you take the time to identify a breast screening facility where large numbers of mammograms are performed each year. The population of women screened should include a substantial group of women who have had their breasts augmented. Radiologists at the facility should have experience interpreting mammogram results on women who have implants, as this is a somewhat more complex process. If you have had silicone implants placed, an imaging exam (MRI) should be performed three years after implant placement and every two years after that to look for any possible ruptured areas on the implants.

If you live in the Philadelphia, Pennsylvania area and are considering a breast enhancement procedure, please contact Dr. Bottger’s office at 610.520.1929 today to schedule an appointment.

Choosing the Right Implant Size & Implant Cup Size

2009-02-16T11:40:00.000-08:00

Choosing the right implant size and implant cup size is a critical decision to avoid additional corrective surgeries down the road. Dr. Bottger works hard to assist his patients in selecting the right implant initially because more surgeries mean additional unnecessary risks. The vast majority of patients are delighted with the outcome of their breast augmentation surgery; however, if women do elect to have a second surgery, the reason typically centers around breast implant size.

Dr. Bottger carefully discusses what breast size is actually sustainable for each patient’s unique frame and skeletal structure. Skin tone is also involved in the determination. Some patients may not have enough flexibility to their skin to manage the larger implants.

You can help make a decision on breast implant size by taking stock of daily activities that may be affected by your enlarged breasts. You can also help by collecting pictures of women who have a similar build to you, but with breasts that think are attractive. You should consider trying on clothes that you like with a bra stuffed with different volumes of dry rice. ¾ cup of rice is about 185 cubic centimeters (cc, the unit used to measure the size of breast implants), approximately the amount the American Society of Plastic Surgeons estimates will take most women up one bra cup size.

Only a careful examination by Dr. Bottger can make certain that a patient’s frame and skin type is appropriate to your desired breast implant type. Visualization methods are good to help you get your mind clear on what you are looking for, but don't get your heart set on anything before talking to a board-certified plastic surgeon.

If you live in the Philadelphia, Pennsylvania area and would like to properly prepare for implant placement with a skilled and experienced cosmetic surgeon, please contact Dr. Bottger’s office at 610.520.1929 today to schedule an appointment.

Reconstructive Breast Surgery

2009-02-09T08:50:00.000-08:00

Reconstructing a woman’s breast or breasts following a mastectomy is quite common these days. Many women feel the procedure helps them feel more whole again after the trauma of cancer. Two methods are typically used to restore the breast: implant reconstructions and restorations using the patient’s own tissues.

Implant Type Restorations

Dr. Bottger creates a breast mound by using an implant. Saline or silicone implants are placed under the skin and pectoral muscle to build a new breast.

Restorations with the Woman's Own Tissue

Using tissue from the abdomen, back, buttock or upper thigh, Dr. Bottger creates a new breast in this manner. Abdominal tissue is the most common source, and the procedure is called the T.R.A.M. flap.

Breast reconstruction techniques differ in how complex the procedures are, length of procedure and time until full recovery. Each patient should review these issues with Dr. Bottger so that the most appropriate method can be chosen. Most women find the breast reconstruction procedure very satisfying and a contributing factor to their healing and well being following breast cancer.

If you live in the Philadelphia, Pennsylvania area and would like to learn more about how you could benefit from breast reconstruction surgery, please contact Dr. Bottger’s office at 610.520.1929 today to schedule an appointment.

A Breast Lift Can Restore a Youthful Look

2009-02-02T08:46:00.000-08:00

Over time, gravity can take its toll even on the most pert figure, bringing about considerable drooping and sagging. Pregnancy, diminished skin elasticity and weight loss can all add to this effect.

Today’s breast lift procedures can do wonders toward restoring your original appearance—or towards improving your current look. One key advantage of a breast lift procedure is that you can couple it with building up your breasts through breast augmentation or reducing their size through breast reduction. This way you can achieve exactly the look you want.

The breast lift, or mastopexy procedure, requires Dr. Bottger to place the nipple and breast tissue on a higher level at the breast fold level, considered the ideal positioning for breast appearance. Dr. Bottger then contours the skin beneath the nipple to create a new breast shape. Breast implants can be employed at the same time for enlarging the breasts; this will be the patient’s personal decision and will also be based on the amount of breast tissue that is present to work with.

If you live in the Philadelphia, Pennsylvania area and would like to learn more about what a breast lift procedure might offer you, please contact Dr. Bottger’s office at 610.520.1929 today to schedule an appointment.

Help for Inverted Nipples

2009-01-26T14:40:00.000-08:00

Around ten to twenty percent of women have some degree of what are known as inverted nipples. Health risks are not a concern to those impacted, but for new mothers wishing to nurse, the condition can obviously be troublesome, and some women do not like the appearance of their inverted nipples.

Inverted nipples are connected to breast tissue beneath them by connective tissue bands. A loosening or breakage of these connections can again cause the nipple to protrude.

For women with mildly inverted nipples, sometimes called "shy nipples," many nonsurgical options exist. Solutions may involve bringing the nipple out with ice or other stimulating procedures. Pregnant women who are preparing their breasts for breast feeding can use an implement called a breast shell that is placed inside the bra; breast shells are plastic discs that have a hole in the middle where the nipple is allowed to protrude. A dome covers the disc to let air circulate underneath, coaxing the nipple to pull outward.

Cosmetic surgeon Dr. David Bottger also assists women with this condition if other methods fail. Surgical intervention can definitely improve the appearance of the nipples, but may not improve a woman's chance of breastfeeding.

If you live in the Philadelphia, Pennsylvania area, Dr. Bottger can help you decide the best procedure to treat your inverted nipples. Please contact Dr. Bottger’s office at 610.520.1929 today to schedule an appointment.

Incision options

2009-01-16T14:38:00.000-08:00

One of the decisions you will make when you elect to have breast implant surgery is what type of incision to have. A consultation with Dr. Bottger will help you make the best choice. Incision type is based on a few key factors:

The type of breast implant you choose
Your personal preference
Your unique physical characteristics

Inframmary

This incision along the fold under the breast and is one to two inches long; the scar is well hidden and this procedure works with all types of implants.

Periareolar

The periareolar incision creates a scar on the areola’s lower border. This fine scar is generally almost invisible. This is often not the best method for patients with small areolas.

Axillary

The axillary incision is in the armpit where an endoscopic system is used to create the pockets that will hold the implants.

If you live in the Philadelphia, Pennsylvania area, Dr. Bottger can help you decide on an incision type that will best meet your needs. Please contact Dr. Bottger’s office at 610.520.1929 today to schedule an appointment.

Relief from Pain and Embarrassment with Breast reduction

2009-01-09T14:36:00.000-08:00

Many women with overly large breasts experience discomfort, health problems and chronic pain and embarrassment from their breasts. Their bra straps may dig into their shoulders and moisture may accumulate under the breasts, creating constant irritation. They may experience breathing difficulties and an inability to participate in certain sports. Unwanted attention may also be a part of their daily lives, along with chronic back, neck and shoulder pain.

A Proven Solution

Breast reduction procedures have become more and more common and provide a tried and tested means of surgically reducing breast size while eliminating all of the difficulties of overly large breasts. Dr. David Bottger performs many such procedures in his Philadelphia area clinic.

A Great Outcome

The procedure to reduce breast size typically requires that excess breast tissue be excised and breast skin made more taut; the result is that the breasts become smaller, less heavy and more firm. The surgical techniques Dr. Bottger uses will give you a natural-looking breast shape and reduce pain in the shoulders, back and neck due to breast size and volume. The most frequent reason for breast reduction is relief from physical pain rather than cosmetic enhancements, but often, the surgery will improve the outward appearance of the breasts.

If you live in the Philadelphia, Pennsylvania area, Dr. Bottger can help you determine if breast reduction surgery is right for you. Please contact the office of Dr. Bottger at 610.520.1929 today to schedule an appointment.

Silicone Implants: Advantages and Disadvantages

2009-01-02T14:34:00.000-08:00

After several years of controversy regarding silicone breast implants, current scientific evidence has not been able to determine any correlation between implants and systemic disease in humans. Because of this, silicone gel implants are back on the market in the United States (and they have been in constant use in other countries). Women now have a clear choice between silicone and saline implants when choosing implant surgery.

Advantages of silicone implants

Gel implants offer the advantage of a much softer, more natural feel and oftentimes, appear much more similar to a natural breast. A key benefit is that only a very slim chance exists for rippling of the skin with silicone implants, making them a great answer for thin patients with less of a subcutaneous layer. Also, silicone implants typically last longer without needing to be replaced.

Disadvantages of silicone implants

One of the silicone gel implant’s small disadvantages is that it requires a bit of a larger incision (5 cm versus 4 cm); this generally makes the inframammary approach the necessary surgical technique. A ruptured gel implant is also harder to detect, which is why women are encouraged to undergo regular MRIs to check for a ruptured implant. Finally, gel implants are somewhat more expensive.

If you live in the Philadelphia, Pennsylvania area, Dr. David Bottger can help you explore which implant type would best meet your needs. Please contact the office of Dr. Bottger at 610.520.1929 today to schedule an appointment.

Techniques to Reduce Nipple Prominence

2008-12-31T08:22:00.000-08:00

The appearance of a woman's nipples is key to the overall look of her breasts, and many women undergo nipple restructuring procedures either as a part of or related to breast augmentation surgery, a breast reduction or a breast lift.

Some women are dissatisfied with the size of their nipples in relation to their breasts. A variety of studies have set out to determine the ideal size of the areola and nipple in relation to the rest of the breast, but in actuality, the correctness of nipple size is determined by what a woman feels comfortable with. Dr. Bottger offers women the option of having large nipples reduced in size through nipple reduction surgery.

The surgical techniques used to reduce nipple size include removal of only the top portion of the nipple, which is then sutured with small incisions. Another nipple reduction technique removes a cylinder of skin from around the nipple, then inserts the nipple into the breast tissue and closes the skin with sutures.

Nipple sensation generally remains normal following a nipple reduction, and breast feeding capability is not impacted.

If you live in the Philadelphia, Pennsylvania area and would like to learn more about nipple reduction techniques, please contact the office of Dr. David Bottger at 610.520.1929 today to schedule an appointment.

Correcting Asymmetric Breasts

2008-12-26T08:17:00.000-08:00

Women’s right and left breasts are often different in size and shape. Usually, a woman can notice these differences herself, but they are not very apparent to others. If the size difference becomes apparent suddenly, women must first explore whether or not a growth of some kind in one breast may be causing it to appear larger than the other. A visit to the doctor is essential to rule out any breast masses that might be causing the size differential.

If a breast mass or cyst is ruled out, the rule-of thumb to determine the severity of the differential is that most breast size differences are under a bra cup size and as such are not in need of surgical correction. However, if you believe your breasts vary more than one cup size in volume, you may wish to have a consultation with experienced cosmetic surgeon Dr. David Bottger. He can help you evaluate the need for corrective surgery.

The factors that influence breast appearance are size, breast shape and breast and nipple position when a women is in an upright position. Surgery to correct breast asymmetry may mean that one or both breasts are surgically treated; correction could involve breast reduction of one or both breasts, or augmentation of one breast in deficient areas and reduction in size of the other. Sometimes breast sagging can be treated while Dr. Bottger corrects the size difference.

If you live in the Philadelphia, Pennsylvania area and would like to learn more about surgery to correct breast asymmetry, please contact the office of Dr. David Bottger at 610.520.1929 today to schedule an appointment.

Breast Augmentation

2008-12-21T08:14:00.000-08:00

Procedures to augment the breast are designed to enhance the shape and size of the female breast. If breasts sag, a procedure called a breast lift can be utilized in concert with a breast augmentation to achieve optimal results.

Typically breast augmentation surgery is performed in one of two ways. When initiating breast augmentation surgery, Dr. Bottger makes a small incision in a concealed area and a saline or silicone gel implant is positioned behind the breast. Depending on the patient and Dr. Bottger’s decision after consultation, the implant may either be inserted above or below the muscle. The time it takes for a patient to resume normal activities after breast implant surgery is dependent upon the type of procedure utilized.

Dr. Bottger helps his patients make informed choices on the many factors to consider surrounding the breast enlargement procedure, including:

Size
Contour
Type of placement
Incision type
Silicone or saline implants

A patient’s body type and personal goals influence these decisions—as can Dr. Bottger’s recommendations based on his years of professional experience. Dr. Bottger can also make you aware of what to expect from breast augmentation surgery, including recovery period, risks and more.

If you live in the Philadelphia, Pennsylvania area and would like to learn more about breast augmentation, please contact the office of Dr. David Bottger at 610.520.1929 today to schedule an appointment.

Saline Implants: Advantages and Disadvantages

2008-12-16T14:09:00.000-08:00

Women today can choose from different implant types when they elect to undergo breast augmentation surgery. Typically that choice involves silicone versus saline implants.

Advantages of Saline Implants
Saline implants have some advantages over silicone/gel implants. One advantage is that a smaller incision is required for saline implant placement; thus, more incision options present themselves. Since saline implants are filled when they are placed, any asymmetry of the breasts can be addressed at the time of placement by raising or lowering the amount of fluid in the implant.

Disadvantages of Saline Implants today
Some of saline implants’ disadvantages can involve a much more firm feel and an appearance that can sometimes seem less natural. Also, rippling that is apparent to the eye and by touch can sometimes occur with saline implants and be quite considerable. The problem is very unlikely to develop with silicone/gel implants. Thin patients are more likely to experience this effect.

If you live in the Philadelphia, Pennsylvania area and would like to explore which implant type would best meet your needs, please contact the office of Dr. David Bottger at 610.520.1929 today to schedule an appointment.

Get Ready for the Holidays with Injectables

2008-11-06T10:17:00.000-08:00

Non-invasive cosmetic surgery is popular both for its effectiveness and its short or non-existent downtime. Halloween is really the beginning of the holiday season and if you would like to quickly improve your appearance before Thanksgiving, you have many choices in how to do it.

Injectables are among the "lunchtime" treatments you may have heard about, which give immediate results. We offer several very effective injectable fillers. They each work differently, but in general they all create volume beneath the skin which smoothes the skin surface.

As we age the body produces less collagen - a fibrous protein which helps support the skin. Elastin is another natural protein and gives elasticity to the skin. The skin's middle layer, the dermis, has a matrix of collagen and elastin like scaffolding. Collagen and elastin are abundant in youthful skin but their reduced production is a contributing cause to wrinkle-formation as we age.

Injectable fillers provide increased volume which substitutes for the loss of collagen and elastin. The results last six months or perhaps longer. We offer Restylane(R) and Radiesse(R) which smooth out frown lines, nasolabial folds and other wrinkles around the mouth and cheeks. We also offer Juvederm(tm) which is effective in smoothing out the fine lines which form around the lips, as well as other fine lines on the face.

BOTOX(R)
BOTOX(R) is an injectable, but not an injectable filler. It does not work by providing volume beneath the skin. Instead, it temporarily paralyzes the muscle where it is injected. It blocks the nerve messages traveling from the brain which tell the muscle to contract, and this prevents the muscle from contracting for as long as the BOTOX(R) is in effect.

Most often it is used for frown lines and horizontal forehead lines, although it can also be used around the mouth. Repeat treatments can "retrain" the muscle to some extent. If you have a series of BOTOX(R) injections, not only does the skin remain smooth for lack of muscle contraction, but also the muscle remains relaxed for all that time. This may break an old habit of frowning or squinting which has caused the wrinkles.

You can see some Before and After photos in our BOTOX(R) Gallery.

Injectables, whether dermal fillers or BOTOX(R), can rejuvenate the face and give you a refreshed, more wide-awake look. Treatments last only about 15 minutes and are done with local anesthetics.

If you would like to know more about the injectable fillers we offer or about BOTOX(R), please call or email our cosmetic surgery office to schedule a personal consultation.

Breast Augmentation

2008-10-31T10:39:00.000-07:00

Breast augmentation can be a life-changing event giving you a tremendous boost in self-confidence, but it is not something to rush into. There are important choices to make in planning your surgery and they require some thought. Dr. Bottger will discuss all the options with you and make his recommendations. For best results it's important that you also understand these options and why one is better than another in your particular case.

Type of implant
You can choose saline or silicone gel implants and each has advantages and disadvantages. The choice will take into account your lifestyle, surgery goals, size of implant desired and other factors that need to be discussed with Dr. Bottger.

Location of the Incisions
There are four choices for where to make the incisions, all of which will hide the resulting scars well. Dr. Bottger offers three of these choices which you can read about on our Incision Options page.

Implant Size
Implants are not sized like bras, as 34B, 36C, and more. They are sized according to the number of cubic centimeters of fill they contain. Silicone gel implants come pre-filled. Saline implants are inserted empty and then filled; they can also be adjusted later. But they still have certain sizes according to the maximum volume of saline solution they can safely hold.

Implant Shape
Breast implants can be round or shaped like a pear. It depends on what sort of look you want, how much cleavage, how large your breasts are already, and other factors which you can discuss with Dr. Bottger.

Implant Placement
Your breast implants can be positioned either beneath the breast tissue but over the pectoral muscle, or beneath both. Again there are several aspects to this decision and it is an individual matter you can work out with Dr. Bottger.

For more information, please refer to the Before and After Photos of some of our patients and our Breast Augmentation Questions page.

If you would like a personal consultation about breast augmentation, please contact our cosmetic surgery office today.

Rhytec Portrait Plasma Skin Resurfacing

2008-07-25T08:15:00.000-07:00

Rhytec Portrait Plasma Skin Resurfacing

By destroying the outer layers of skin that have been damaged by age, acne or the environment, Rhytec Portrait Plasma skin resurfacing is one of the latest procedures to give you the smoothest skin possible.

Destruction of the outer layers of skin through heat created by ionized nitrogen gas “remodels” your skin’s collagen and prompts your body to generate new layers of skin that are unaffected by the problems or conditions your previous skin layers had. It can take seven to ten days for improved skin conditions to become apparent.

Rhytec Portrait Plasma skin resurfacing can:

1.Correct spots and pigmentation problems

2.Reduce or remove creases, lines, and wrinkles

3.Improve skin damaged by the sun

4.Treat scars caused by acne

5.Tighten skin which has lost elasticity through aging

If you are interested in finding out more about how Rhytec Portrait Plasma skin resurfacing can help you, please contact Dr. Bottger to set up an initial consultation.

Welcome

2008-06-30T11:28:00.000-07:00

Welcome to Dr. Bottgers Blog