Frequently Asked Questions
Below are some of the most frequently asked questions our patients have, as well as questions you should ask your surgeon if you are considering having plastic surgery.
If you have additional questions that you feel others might also be interested in, please share them with us and we will do our best to get them answered and posted in this frequently asked questions section of the site.
Am I a good candidate for plastic surgery?
Before getting into any matters of experience, credentials, or outcomes, ask the surgeon if you are a good candidate for the procedure you are considering. The plastic surgeon's answer should be informed and educational and not put any pressure on you to undergo the procedure or any additional surgeries. This first question can tell you a lot about the plastic surgeon you are considering.
What board certifications does the plastic surgeon have?
Board certifications can be confusing and most doctors offering plastic surgery claim to be certified. In most states, including Oklahoma, doctors can practice plastic surgery without a board certification. For plastic surgeons, certification from the American Board of Plastic Surgery is your best bet. Many doctors practicing as plastic surgeons are certified, but often not from the ABPS. Ask to see a copy of the surgeon's certification. Dr. Greg Ratliff is a board-certified plastic surgeon.
What training has the plastic surgeon completed?
In addition to American Board of Plastic Surgery certification, ask the plastic surgeon if he or she has completed an accredited residency, specifically in plastic surgery. These programs traditionally last three years and include intensive training in plastic and reconstructive procedures. You can simply ask to see their diplomas and certifications to confirm their training.
How many times has the plastic surgeon performed this specific procedure?
Be specific. Ask exactly how many times the surgeon has performed the procedure you are considering. This experience is essential in your decision. Ask about outcomes, success rates, and complications from performing the procedure.
How long has the doctor been in practice and performing the procedure you are considering?
A plastic surgeon's experience is a key indicator of his or her skills and the potential outcome of your procedure. Ask the surgeon how long he or she has been in practice and how many times he or she has performed the procedure you are considering. You will want a plastic surgeon who is very experienced in performing the specific surgery you are considering. Also, ask to speak with several former patients about their outcomes and their experiences with the physician.
Ask to see before and after photos of former patients.
Experience and qualifications are very important, but just as important are results. You will likely be shown a few before and after photos of previous patients. Before making a decision, ask to see dozens, even hundreds of before and after photos of patients. This will allow you to both confirm positive outcomes for other patients and that the surgeon has indeed performed the procedure a number of times. Again, ask to speak with several patients about their experience with the surgeon.
What is the instance of complications resulting from the surgery?
Ask the plastic surgeon to share complication rates and any specific complications patients have experienced after having the procedure you are considering. In general, complications from plastic surgery are low, but every surgeon has had them, and if they are not willing to share this information with you, then perhaps there are other issues they are not sharing with you.
Is the facility accredited?
Plastic Surgery Center of Tulsa is accredited by AAAASF (American Association for Accreditation of Ambulatory Surgery Facilities). Only ASPS board certified plastic surgeons can be accredited by AAAASF.
Which hospitals have granted privileges to the surgeon?
While most plastic and cosmetic procedures take place in the physician's office or in outpatient surgical settings, many invasive procedures still require they be performed in a hospital. Ask the surgeon which hospitals have granted him or her privileges to operate. You can then check with the hospital simply by calling and asking for the credentialing office. This will confirm that the plastic surgeon meets the requirements of the hospital to be on the staff.
Who performs anesthesia during surgeries?
Ask the surgeon who performs sedation in the operating room. Anesthesia is an extremely important aspect of surgery and assuring that all proper protocols and procedures are followed is vital. Paying acute attention to details, such as blood pressure and heart rate, plays an important part in the success of the procedure and health of the patient. Ask if the surgeon gives sedation/anesthesia or if it is performed by a nurse anesthetist or certified anesthesiologist.
What are the financing options?
Since plastic and cosmetic surgery is primarily an elective procedure, financing is the responsibility of the patient. Ask the plastic surgeon's office what forms of payment they accept, if they have alternate financing arrangements, such as payment plans or approved lenders. All costs and financing should be worked out prior to any procedure.
What size implant is the "right" one, so I won't be too big or too small?
Sizing implants is actually a complex problem. Different surgeons use different algorithms for arriving at the final size, but the common decision points are these:
- Patient desire. If you want to be a DD size, by all means say so. During your consultation, the more precise you are, the better your surgeon can understand what your goal is.
- Chest dimensions. To get to the same bra cup size, a tall narrow chest will require a different implant size than a short wide chest. The shape of the ribs also is important in how the implants project, or stick out (straight ahead or more toward the side).
- The diameter (width) of the actual breast tissue. This is one of the main determining factors of appropriate size. As an example, if your breast measures 12 centimeters wide, implants from 11.5 to 12.5 cm wide would probably be appropriate. The diameter determines the amount of fluid the implant will hold.
- The volume of the existing natural breast. If you are starting at a C cup, getting to a D cup takes less implant than if you are starting at an A cup.
All of these factors are weighed together to arrive at the "right" implant for a more predictable result for any given body. Beware of the surgeon who takes a quick glance at you and says, " Oh, I think a 450cc implant will work fine," without measuring or talking to you. The doctor is either an idiot or a genius, and we all know which there are more of in the world.
I don't want a really wide (or really tight) cleavage. How do I avoid that?
Unfortunately, the distance between the breasts before implants is the same as the distance after implants. This is mainly determined by the width of the breast bone (sternum). If you push your breasts gently together and look at where they are attached to your chest wall in the middle, you can get an approximation of how far apart they will be after surgery.
I want the really round implant look. How do I get that?
Usually one or all of three factors accomplishes this:
- Large implants placed on top of the muscle under very thin or small breasts, leaving little or no coverage of the implant by anything but skin.
- Very large implants placed under the muscle, also stretching the coverage so that it is very thin.
- Capsular contracture. This is the most common complication of breast implant surgery and is basically a tight bag of scar tissue forming around the implant and squeezing it into a ball.
I want a really natural look, not a round implant look. How do I get that?
See the question above.
- Use moderate or small size implants that do not overstretch the tissue.
- Place them over or under the muscle as needed to get good tissue coverage over the implant.
- Do not be one of the 2-6% of people who get a capsular contracture.
Should I put the implants over the muscle or under the muscle?
This has a complex answer. Basically, there are two main points to consider:
- Coverage. If there is little or no breast tissue in the upper half of the breast (above the nipple), it is usually best to put the implant under the muscle tissue to maximize the tissue covering it. This also helps make the "entry" from the collarbone downward into the breast smoother and more natural, like a teardrop. For women with a significant amount of natural breast tissue, however, it is sometimes better to place the implant on top of the muscle so that it will drop with the breast over time and continue to look natural.
- Breast cancer. Most Radiologists agree that it is easier to do mammograms with implants under the muscle. If you have a family history of breast cancer (first degree female relative on your mother's side with breast cancer), you have a personal increased risk. Implants under the muscle are probably the wise choice, even if it compromises the cosmetic result slightly.
What about breast implants and cancer?
Breast implants play no role in increasing or decreasing your risk for breast cancer. Mammograms after implants require four views instead of the usual two, but radiologists are mixe don whether implants decrease detection of cancer with mammography.
A recently found connection with a very rare type of lymphoma has been noted. There is more information on the status of this ongoing reserach here. More Information.
How long does the surgery take?
This varies depending on the surgeon and the anesthesia provider. You can expect to be in the operating room from 45-90 minutes total. The actual surgery takes about 35-55 minutes; the rest of the time is spent getting monitors on, putting you to sleep or getting you numb and putting on dressings after the surgery.
What kind of anesthesia is best?
This procedure can be done under local (numbing injections), twilight sedation (IV drugs) or general anesthesia (totally asleep). Your surgeon will have a preference and it is usually best to go along with this as it decreases the tension level in the OR. Personally, I prefer general anesthesia using a mask because it avoids any pain and the sore throat associated with a breathing tube. However, my operating time is somewhat faster than most (25-30 minutes), so this works well in my OR.
How much blood will I lose?
Usually around 20-30cc, which is about half of a shot glass full. (And no, I am not a vampire)
What if I'm on my period?
Makes no difference to the surgical procedure or the results. In addition, the stress of surgery may throw you "off cycle" for a month or two, causing you to start early or late. Doing a pregnancy test before surgery may help you with worries after surgery if this happens.
Will it hurt?
Yes. This is surgery.
How much will it hurt?
Changes in operative technique have drastically improved the postop pain level. I used to tell patients this was a 12 on the 1-to-10 scale, but now it's more like a 2-3.
How soon will I look "normal"?
Your breasts will be swollen for 6-8 weeks, and they will feel tight for 6-9 months before dropping into place. The process is faster for over the muscle than it is for under the muscle placement.
Will I need a special bra?
Your surgeon will usually put you in whatever garment or dressing is best for the first week after surgery. After that, the choice varies widely, from nothing at all (to encourage settling) all the way to specially constructed and reinforced surgical bras (think Madonna's golden cones). Most of the time there is a specific reason for the choice, but ask your surgeon why. This is one area that can be explained or negotiated.
What about bathing?
Usually a shower only for the first week, since bath water has high concentrations of bacteria and can cause wound infections. The first shower is usually allowed after 48 hours, to give the incision time to seal. Avoiding long, hot showers early on (first 1-2 weeks) helps decrease the swelling and the risk of post-op bleeding.
What about complications?
There are many potential problems, but only three major surgically related problems: Bleeding (hematoma), infection and implant malposition. Later complications during the healing process include capsular contracture (scar tightening around the implant), rippling and implant deflation. Please note that a "complication" is not necessarily a surgeon's mistake; all of these problems are known risks of the surgery and can occur no matter how well the surgery is done. Your surgeon should inform you of these and other risks and the percentage of times they occur.
What kind of pain medicine will I get?
Most of the time, you will get a narcotic level drug (meperidine, morphine, oxycodone) for the first few days, a transition drug for the next week and then anti-inflammatory drugs (ibuprofen, acetominophen) for another week if necessary. Some surgeons also give a muscle relaxer if the implants are under the muscle and some give an antibiotic for the first few days post-op.
How do I know if I am a good candidate for a mommy makeover?
The easiest way is to come in for a free consultation. That gets you the most information in the shortest period of time. Generally speaking, each area of the body needs to be evaluated on its own. For example, you may only need breast implants and not a lift, or you may need so much lift that the implants have to go in three months later to allow the breast to heal between procedures. The abdomen procedure needed (liposuction or tummy tuck) is more related to the amount of excess skin and the laxity of the abdominal muscle wall.
Why is it best to have these procedures at one time instead of individually?
The best reason to combine is to minimize recovery time. It's not that you heal any faster, it's that you only go through the process once. A tummy tuck, breast lift and breast implants each requires 7-10 days to comfortably get back to a desk job and longer for more physical work. And since we're talking Moms here, it's a physical job! Doing the procedures separately then requires 21-30 days of total off time from your life, as compared with 7-10 days when combined.
The second reason is anesthesia risk. The riskiest time of anesthesia is the going to sleep and the waking up. The period while you're under is the most stable. So, having one anesthetic (one go to sleep and one wakeup) is better than doing them all separate (three and three).
My children are still very young, should I still consider a Mommy Makeover now?
In a word, yes! Although you make think you are busy now, wait until they are all in soccer, ballet, football, after school stuff, etc., etc. Young children do need Mommy more, so the recovery period requires some additional help for you, but most kids understand mommy's “ouchie” and actually like to help you for a change!
In addition, you will heal faster while you are younger and you get to enjoy the benefits of the makeover for longer, until advancing “maturity” gets you.
How long after having my last baby should I wait to have a Mommy Makeover?
Let your body get back to as close to normal as possible. Lose as much of your weight gain as you can (stability for 3 months is a good guideline), stop breastfeeding so the breasts return to normal (2-3 months after stopping) and exercise to get your cardio status back to pre-baby. Most Moms are usually back to near normal by 4-5 months with the exception of breastfeeding.
I still plan to have more children. Should I consider a Mommy Makeover now?
It depends on how long you're planning to wait. If the interval between children is 2-3 years, you should think about putting it off, since by the time you heal you'll be pregnant or trying again! On the other hand, if you had children young and aren't planning to have more for several years, enjoy a restored look for those years.
If you are planning more children, there is a change to the tummy tuck procedure. Because the repair involves putting the midline muscle back together with sutures and it's this area that stretches the most with pregnancy, a Mommy Makeover in women anticipating more children is limited to tightening only the skin and is somewhat less effective. It's a compromise that allows a much improved look, but preserves the pregnancy option.
Also, most women can still breastfeed after implants or a lift. The success rate is not quite as high as before these procedures, but it's certainly still an option you keep.
How long does a complete Mommy Makeover take (the actual surgeries)?
This will vary with the combination needed. All three together (implants, lift and tummy tuck) will take 4-5 hours of time in the operating room and another hour or so in the recovery room before you head for home.
How long is the recovery period if I have all three procedures together?
Recovery is a progressive thing. The first 10-14 days you are on “House Arrest”, limited to moving around the house. The next two weeks you can walk for exercise, work a desk job and be primary caretaker for kids, although you are limited to <20 pounds lifting. Weeks 5 and 6 allow more vigorous exercise with no pounding or bouncing (think running and aerobics). After 8 weeks you are free to do anything. It may make you sore, but it is very difficult to tear anything loose at this point.
Will my scars from the Mommy Makeover be visible.
Yes, but they will be strategically located to be hidden in clothes, even in a two piece swim suit (except the belly button). Most scars will stay red for up to 9 months, but eventually fade to white.
Will I need to return to your office for follow-up visits?
Our usual routine includes visits at 4 days, 7-10 days, 3 weeks, 6 weeks, 3 months and 6 months. For our far out of town patients, we encourage you to stay in town for the first week and can do the remainder with phone calls and e-mailed pictures if all is going well. If things are not as expected, you may have to make a trip back for evaluation and further treatment.
Can I have breast augmentation without having a breast lift?
Absolutely. If you don't need a breast lift you don't get one. Breasts that are up on the chest wall and have only lost volume can be treated with implants alone. However, the reverse is not true; if you need a breast lift but only want implants the answer is no because the result is aesthetically awful. Implants can only push forward and are placed on the chest where the breast is supposed to be. If your breast mass is lower than that, it ends up hanging off the front of the implant and looks pretty bad (think Snoopy's nose).
How much weight should I lose before having a Mommy Makeover?
The guideline we use is to be within 10% of your goal weight. For example, if your goal is 150 pounds, 10% is 15 pounds. Any weight below 165 pounds allows further loss down to the goal of 150 without compromising the surgery result.
Will I need to wear special clothing after the surgeries?
We provide all of the garments for the immediate postop period. They can be bulky and require the use of your “fat clothes” wardrobe. Some people choose to switch to spandex body suits (e.g. Spanx) for week 4-6. These are available at local department stores.
Will I lose any sensation where the surgery is performed?
Some skin areas will be numb postop, but this usually resolves within the first year. The one exception is the nipple/areola area, which has about a 2% chance of sensation being permanently lost. The nipple has only one nerve supplying it, and if that nerve is cut or stretched, all sensation is lost. Unfortunately, where the nerve exits the ribs is somewhat unpredictable, so sparing the nerve is not always possible.
Do you offer a Daddy makeover for my husband?
No special pricing, but if he had a sympathy weight gain of 50-60 pounds, some liposuction might be useful!
Is it ok if I call it a Granny Makeover?
Sure. If 50 is the new 40, what's in a name? Looking good knows no boundaries!