Day of Surgery

Pre-Operative Marking

Prior to your surgery, you will have the opportunity to speak with Dr Motykie about any part of your surgical procedure and/or recovery process. You will be asked to change into a surgical gown and Dr Motykie will place surgical markings on your chest. All markings are performed in the standing position to ensure proper reference points such as your current nipple height and breast fold location. Lastly, wear loose fitting clothing the day of your surgery that is easy to get in and out of such as sweat pants and a shirt that zippers in the front.

Anesthesia and Operating Facility

For almost all breast lift and augmentation techniques you will most likely receive general anesthesia (you are asleep) for your own personal comfort, safety and surgical ease. It is Dr Motykie’s opinion that the safest and most effective way to perform breast surgery is under general anesthesia since it allows for ease of breast pocket creation, relaxation of the chest muscles, additional comfort as well as allowing you to be sat up during surgery to assess final breast volume, symmetry and shape. It is not in your best interest to undergo breast surgery using awake anesthesia.

Dr. Motykie uses only Board Certified Anesthesiologists to administer anesthesia and monitor your safety during your surgery. You may be given medication before reaching the operating room so you will feel relaxed before surgery. The surgery takes approximately one hour to perform in its entirety. Every surgery is performed in a fully accredited, state of the art (AAAASF) surgical facility where your safety, comfort and privacy are of the utmost importance. Deep vein thrombosis (blood clots) precautions are taken with every patient and include a minimum of anti-embolic stockings and sequential compression devices (SCDs) on the lower extremities during the entire length of your procedure.

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Surgical

After general anesthesia is administered (you are put to sleep), an incision is made for removal of your previously placed implant and placement of a breast implant sizer. The breast implant pocket is assessed and pocket modifications are made that could include lateral pocket tightening, capsular contracture (scar tissue) release, internal lifting, cleavage correction and internal pocket symmetry procedures. The best location for placement of the breast implant sizer is underneath the chest muscle in order to preserve the natural, healthy blood supply to the overlying nipples. This is done on both sides of the chest and the breast implant sizers are then filled to the desired volume.

The breast lift procedure is then performed utilizing the previously made markings that were drawn by Dr Motykie prior to your surgery. The standard technique for those with severe ptosis is with an anchor-shaped incision that surrounds the areola, descends vertically to the where the breast crease meets the rib cage and then crosses along the lower portion of the breast at its natural crease (inframammary fold). Dr Motykie is very careful to not extend the incisions beyond the bikini line or into the cleavage (the “bikini triangle”). The breast mound is then reshaped and the patient is sat upright in the operating room to assess the overall breast shape and symmetry.

The patient is sat upright in the operating room in order to better evaluate the final implant position, breast shape and breast symmetry before choosing the size and shape of the permanent breast implants. Because a breast lift procedure is performed along with revision of the breast augmentation, any final breast size can be chosen for the breasts. If a patient desires to have smaller breasts, smaller breast implants (or none at all) may be used during the replacement surgery.

If a patient desires larger breasts, larger implants may be used during the surgery. Implant type may also be changed from silicone to saline or vice versa. Once the final size and shape of the implants has been determined, the patient is laid down once again, the implant sizers are removed and the permanent breast implants are placed into the breast pockets. Either saline or silicone gel-filled breast implants can be inserted through this incision although saline implants may be preferable due to their superior ability to adjust for asymmetries as well as help shape the breast mound. The breast lift incisions are closed with fine dissolvable sutures that are placed underneath the skin to minimize post-operative scarring. Once the procedure is completed, small surgical tapes will be placed over the incision sites. A surgical brassiere and compression ACE wrap is placed before you leave the operating room in order to help decrease swelling and bruising after the procedure.

Recovery Room

After surgery you will be brought to the recovery area where you will be allowed to rest and completely recover from anesthesia. Nurses will be on staff by your bedside to make sure you are recovering properly as well as being able to provide you with pain medications and small amounts of water and/or ice chips while you are becoming more awake and alert. After you have fully recovered from anesthesia, you may be released to home with a responsible adult or you may choose to stay overnight in an outpatient recovery retreat where there are nurses on staff 24hrs to assist you with post-operative care and medications.

The most comfortable position to recover in after surgery is a reclining chair with your head elevated. Over the first night you will most likely find yourself having to use the bathroom frequently. This is normal and is due to the intravenous fluids you received during your surgical procedure. Leave all dressings intact until the next morning when you will return to Dr Motykie’s office to have your dressings changed and receive further instruction for the rest of the week. The night following your surgery, you may experience some pain and discomfort that can be controlled with your prescribed pain medication. The majority of the sutures used during your surgery will be dissolvable and all of them are covered by thin surgical tape that should be left in place for the first week after your surgery.

To find out more about Breast Augmentation Revision please contact us at 310-246-2355

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Pre-Operative Marking

Anesthesia and Operating Facility

For almost all breast augmentation techniques you most likely receive general anesthesia (you are asleep) for your own personal comfort, safety and surgical ease. It is Dr Motykie’s opinion that the safest and most effective way to perform revision breast surgery is under general anesthesia since it allows for ease of breast pocket creation, relaxation of the chest muscles, additional comfort as well as allowing you to be sat up during surgery to assess final breast volume, symmetry and shape. It is not in your best interest to undergo breast surgery using awake anesthesia.

Surgical

After general anesthesia is administered (you are put to sleep), an incision is made around the nipple (Benelli procedure) in order to gain access to the breast implant pocket. The breast implant pocket is entered, the current implant is removed and precise pocket modifications are made that could include lateral pocket tightening, capsular contracture (scar tissue) release, internal lifting, cleavage correction and internal pocket symmetry procedures. The best location for placement of the breast implant sizer is underneath the chest muscle in order to preserve the natural, healthy blood supply to the overlying nipple. This is done on both sides of the chest and the breast implant sizers are then filled to the desired volume. The Benelli lift is then completed by placing a permanent purse-string suture around the outside of the areolar incision. The periareolar scar is generally well accepted and it is certainly more readily accepted and less visible than the scars of the traditional mastopexy. The amount of lift obtained from the procedure is limited by the fact that more aggressive skin resection can lead to flattening of the breast, distortion of the areola and spreading/pleating of the scar. The fundamental step for achieving success with this approach is placement of the permanent purse-string suture around the areola prior to closure in order to prevent its expansion/spreading during the recovery process. You will then be sat up in order to better evaluate the breast shape and breast symmetry before choosing the size and shape of your new breast implants. Once the final size and shape of your implants has been determined, you are once again laid down flat upon the operating table, the implant sizers are removed and the permanent breast implants are placed into the breast pockets. Both saline and silicone gel-filled breast implants can be inserted through this incision. The purse-string suture is tightened until the desired size of your areolas is obtained on each side. Once the procedure is completed, small surgical tapes will be placed over your incision sites and you will be fitted into a surgical brassiere and compression ACE wrap after the procedure.

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Recovery Room

To find out more about Breast Asymmetry Correction please contact us at 310-246-2355

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Pre-Operative Marking

Anesthesia and Operating Facility

Surgical

After general anesthesia is administered (you are put to sleep), an incision is made in the location that was decided upon prior to surgery. The peri-areolar incisionis generally the first choice of highly experienced surgeons for revision breast surgery since it offers a variety of major advantages. To begin with, the peri-areolar incision offers the best access to the breast pocket as well as the options to lower the breast fold (dual plane technique), several unique concurrent mastopexy techniques and breast reshaping in cases of breast asymmetry and deformity (tubular and constricted). In addition, the breast pocket can be developed under direct vision allowing less risk of bleeding and improved avoidance of nerves (preserve nipple sensation) as well as breast reshaping options and ability to adjust the breast fold. The peri-areolar technique also allows for more precise pocket modification and achievement of excellent breast pocket shape, symmetry and creation of cleavage. Both saline or silicone gel-filled breast implants can be inserted through this incision and the only true contraindication to this technique is a patient with very small areolas. An inframammary incision can also be utilized for breast revision surgery, but the axillary and transumbilical incisions are not typically utilized due to poor pocket visibility inability to provide direct excess to the entire pocket for adjustment of size, shape and/or symmetry. After the incision, the necessary corrective procedure is performed to the breast pockets, folds and/or scar tissue. A breast implant sizer is then inserted into the breast pocket and centered behind the nipple. Most times the best result and least risk of complications comes from have the greatest visibility of the breast pocket which is why the periareolar technique is often preferred for revision breast surgery by experienced surgeons.

After the breast implant sizer has been inserted in to the breast pocket, you will be sat up in order to better evaluate the final implant position, breast shape and breast symmetry before choosing the size and shape of your new breast implants since gravity can alter the position of the implant relative to the breast mound. Once the final size and shape of your implants has been determined, the implant sizers are removed and the permanent breast implants are placed in to the breast pockets. In some cases of revision surgery, surgical drains may be placed in to the breast pocket in order to decrease the risk of scar tissue formation within the breast pocket after the surgery. Once the procedure is completed, small surgical tapes will be placed over your incision sites and you will be fitted into a surgical brassiere and compression ACE wrap in order to help decrease swelling and bruising after the procedure.

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Recovery Room

To find out more about breast surgery please contact us at 310-246-2355

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Tummy Tuck Beverly Hills | Abdominoplasty Los Angeles

Pre-Operative marking prior to your surgery, you will have the opportunity to speak
with Dr Motykie about any part of your surgical procedure and/or recovery process. You
will be asked to change into a surgical gown and Dr Motykie will place surgical markings
on your abdomen that will be the approximate location and length of your incision as
well as indicate all possible areas of accompanying liposuction. You may want to bring a
pair of your own swimwear or underwear to help place your incision hidden below your
own personal “bikini line.”All markings for abdominoplasty are performed in the standing position to ensure a properly placed belly button and appropriate incision location. Dr. Motykie places great importance on making your scar as minimal in length as possible and he strives to keep all of your incisions in well hidden locations for you personally.

Anesthesia and Operating Facility for almost all abdominal contouring techniques
you will most likely receive general anesthesia (you are asleep) for your own
personal comfort, safety and surgical ease. Dr. Motykie uses only Board Certified
Anesthesiologists to administer anesthesia and monitor your safety during your
surgery. You may be given medication before reaching the operating room so you will
feel relaxed before surgery. The surgery takes approximately 3-4 hours to perform
depending on the complexity of your procedure. Dr Motykie performs his surgery in
a fully accredited (AAAASF) surgical facility where your safety and privacy are of the
utmost importance. Deep vein thrombosis (blood clot) precautions are taken with every
patient and include a minimum of anti-embolic stockings and sequential compression
devices (SCDs) on the lower extremities during the entire length of your procedure.

Surgical Procedure An abdominoplasty is most commonly performed by making

horizontally-oriented incision below your bikini line. The shape and length of your
incision will be determined by the degree of correction necessary.

In a mini abdominoplasty, excess skin of the lower abdomen is removed and the lower
abdominal muscles may be tightened. The incision may possibly be shorter along the
lower abdomen than in a full abdominoplasty depending on the amount of loose skin
present pre-operatively. Your belly button is not moved because the skin and muscles
of the upper abdominal are not addressed during this surgery. Any excess abdominal
skin is removed at the end of the procedure and your incision is closed with dissolvable
sutures that are placed underneath the skin.

In a full abdominoplasty, all three layers of the abdomen are addressed which include
tightening ofthe abdominal muscles, removing excess fat through liposuction and
removing loose skin and stretch marks by direct excision. During the procedure, the
abdominal muscles are pulled together and repaired to a more normal anatomical
position. This technique is very akin to an “internal corset” because as the abdominal
muscles are drawn together, your waistline is narrowed. In addition, a second incision
is made around your belly button in order to address any loose skin and repair the
muscles of the upper abdomen. After the muscles have been repaired, the creation
of a realistic “belly button” is essential to having a natural looking abdomen after your
tummy tuck procedure. The belly button is often the signature creation of the plastic
surgeon since there are many different techniques currently available to create a
realistic appearing belly button. The belly button is often the only thing that is visible
after a tummy tuck because the other abdominal incision is hidden below the bikini line.
Therefore, an “attractive” belly button is essential to a satisfactory outcome. A wide array
of sizes, shapes and positions of a “natural” appearing belly button are seen and this
diversity must be identified and maintained after surgery. In other words, your new belly
button should not appear too large, too thin, too shallow or too deep. After your belly
button is complete, any excess abdominal skin is removed and your incision is closed
with dissolvable sutures that are placed underneath the skin.

Dr. Motykie commonly performs liposuction in conjunction with both full and mini
abdominoplasty procedures in order to help create a well contoured abdominal profile
and waistline post-operatively. The mons pubis represents a distinct aesthetic unit
and it is always addressed accordingly during surgery. Two drains are typically placed
below the level of the abdominal incision in order to collect any swelling fluid that may
accumulate over the next few days of recovery. A pain pump is also placed which leaks
numbing solution onto the repaired abdominal muscles in order to significantly improve
post-operative comfort. At the conclusion of the procedure small sticky tapes are placed
over the incision and an abdominal binder is placed in order to provide support and
compression of the abdominal area post-operatively.The end goal of ever surgery is a
narrower, flatter, firmer abdomen with a naturally appearing belly button.

Recovery Room After surgery you will be brought to the recovery area where you are allowed to rest and completely recover from anesthesia. Nurses will be on staff by

your bedside to make sure you are recovering properly as well as being able to provide
you with pain medications and small amounts of water and/or ice chips while you are
becoming more awake and alert. After you have fully recovered from anesthesia, you
may be released to home with a responsible adult although we often encourage our
abdominoplasty patients to stay overnight in an outpatient recovery retreat where there
are nurses on staff 24hrs to assist you with post-operative care and medications.Some
patients decide to return home after one night in the recovery retreat while others prefer
to stay for two to three days.

The most comfortable position to recover in after surgery is a reclining chair with your
knees in a slightly flexed position. Over the first night you will most likely find yourself
having to use the bathroom frequently. This is normal and is due to the intravenous
fluids you received from your IV during your surgical procedure. Leave all garments
intact until the next morning when you will return to Dr Motykie’s office in order to
have your dressings changed and receive further instruction for the rest of the week.
The “anti”-pain pump which was placed during your surgery will help to “numb” your
abdomen for the first few days after surgery. This pump self-administers the numbing
solution which will significantly decrease your need for oral prescription pain medications during your early post-operative recovery period. The night following your surgery, you may experience some pain and discomfort which can be controlled with your prescribed pain medication.

The majority of the sutures used during your surgery will be placed underneath your skin
in order to create a very thin scar. None of these sutures need to be removed after your
surgery and all of them are covered by thin surgical tape that is left in place for the first
week after your surgery.

Abdominal Body Contouring Surgery
The Consultation
Pre-Operative Period
Day of Surgery
Post Operative 1 day | 1 week | 1 Month | Long Term
Combined Procedures
Revision Abdominoplasty

To find out more about these body contouring procedures please contact us at 310-246-2355

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