Park Meadows Cosmetic Surgery Blog

An abdominoplasty or tummy tuck is usually not covered by insurance as medically necessary. Many women after pregnancy, who have excessive skin and fat in the lower tummy, also have spreading of the muscles. In the tummy tuck operation, the skin and fat are removed and the muscles are tightened to give a flatter abdomen. When the muscles are spread apart so that there is a hernia (bulging of fat or intestine through the abdominal wall) then insurance may cover the repair which could include a tummy tuck at the same time. If there is an indication for a hysterectomy or other abdominal surgery, a tummy tuck could be coordinated at the same time but it may or may not be covered. Bariatric surgery or surgery to treat obesity will sometimes cause extra hanging skin after the patient has significant weight loss. Insurance may cover the weight reduction surgery but usually does not cover the contouring surgery to remove the skin, which in most cases requires an abdominoplasty. The best solution to the question is to have a consultation and have the surgeon’s office perform a predetermination to see if it is covered under the patient’s policy.

Randolph C. Robinson, M.D., D.D.S., F.A.A.C.S.

Utilization of pain–pump in breast augmentation procedures

Breast augmentation procedures have continued to rise over the last decade.
Since 1992 the number of breast augmentations has increased over 450%, the largest increase in plastic surgical procedures. The growing demand for breast augmentation procedures is always an on going effort to obtain better results with less recovery and using newer and more innovative techniques. Where as the desire for the particular size or shape of the breast is an intimately personal decision, all patients share in a common the initial post operative discomfort associated with these procedures.

Breast augmentation unlike many other plastic surgical procedures has relatively short down time associated with it. However, the first 3-4 days post augmentation can be difficult with regard to pain control. Classically, pain control has been managed for centuries with utilization of narcotics analgesia. In recent years Various other surgical disciplines have began using implantable pain devices to Deliver numbing pain medications directly to the surgical site.

Non-narcotic pain pumps have been used for sometime in abdominoplasty, “tummy tuck” procedures as well as other cosmetic procedures. Recently, these pumps have been approved for use in breast augmentation and breast reconstruction procedures.

There are a variety of catheters available on the market one of which is
The “ON-Q Pain Buster.” ON-Q PainBuster is a high-tech balloon-type pump that is filled with a non-narcotic numbing medication (local anesthetic) that continuously infuses a small amount of medication into your area of discomfort for the critical days following surgery. The ON-Q pain pump and catheter system utilizes a patented technology to administer a controlled amount of pain solution directly into the region the augmentation has been performed. implanted for 3 days after which they can be easily removed by the patient or the physician with little or no discomfort. You may wear the pain pump externally in a fanny pack or clipped to your clothing during your recovery.

During surgery, the surgeon implants a tiny catheter around the surgical area. The catheter remains implanted for 3 days after which they can easily be removed by the patient or the physician with little or no discomfort. You may wear the pain pump externally in a fanny pack or clipped to your clothing during your recovery.

During your recovery when the catheters are in place the utilization of pain medications, such as narcotics, is significantly decreased. Typically without a pain pump, patients will take 1-2 narcotic tablets every 3-4 hours for the first 3-5 days after surgery. It is not uncommon from an anecdotal stand point to see patients who only take 3-4 pills over a 4 day period while the catheter is in place. This decrease in use of narcotics to manage pain allows patients to lead a more active lifestyle, in the initial post operative recovery, still remaining well within the safe limitations of activity

Studies have clearly demonstrated that utilization of pain pumps and catheters in breast augmentation can:

• Decrease pain
• Increase patient satisfaction
• Significantly decrease use of narcotics
• Reduce narcotic side-effects which may include nausea, vomiting and constipation
• Help you get back to your normal activities faster

I believe utilization of the catheters is a dramatic advantage in the armamentarium of the surgeons seeking to provide optimum results and outcomes for patients desiring augmentation.

-Jeremy Z. Williams, M.D.

Dr. Williams has recently been named an Assistant Clinical Professor in the Department of Surgery, Division of Plastic and Reconstruction Surgery at the University of Colorado at Denver Health Science Center and School of Medicine. Dr. Williams has had a lifelong interest in academic plastic surgery. Most recently, Dr. Williams has spent approximately seven years at the Johns Hopkins Hospital in Baltimore, Maryland (ranked by U.S. News & World Report as America’s #1 hospital for the last 15 years). Dr. Williams hopes to continue and maintain his pursuits both in academic and teaching capacities through his affiliation with the University of Colorado. In addition, he maintains an active interest in the pursuit of new innovations through research in the field of plastic and reconstructive surgery.