“Everything I do is about responding to the body as it changes over time, and to each patient’s changing needs,” observes plastic surgeon Dr. Cindy Wu, who specializes in breast and body surgery with Cynthia Gregg Face & Body Specialists in Cary. “That is because, just as our bodies change as we grow and age, our relationship with our bodies changes.

“Typically,” says Dr. Wu, “my patients seek surgery in order to adjust to choices they’ve made previously and to optimize their health—and plastic surgery can be a part of that process. Breast alterations and surgeries that address problems following weight loss are among the most common procedures sought.”

Breast Surgery: Adjusting to Body Changes

Breast surgery, in particular, illustrates the physical and psychological changes occurring at different stages in a woman’s life.

“Our breasts change as we age,” explains Dr. Wu. “Elasticity of the skin and connective ligaments declines; as with all skin, collagen degrades over time. In the breast, that results in sagging of the nipple because the skin supporting the nipple is not as taut. The loss of elasticity will also cause the skin at the bottom of the breast to sag, creating uncomfortable skin-on-skin contact between the breast and upper abdomen.”

The other major change as breasts age is a loss of volume in the upper part of the breast—especially in women who have breastfed or lost weight. “That loss of volume is a major reason women seek plastic surgery,” notes Dr. Wu, “and we can offer different options for restoring volume.”

Personal Choices

“Although women have similar reasons for choosing to alter their breasts,” says Dr. Wu, “each patient has a different life story, a unique physiology. That is what I love about surgery of this kind—it is incredibly personal, affecting how we feel internally and how we present ourselves to the world. Those things change over time, just as our bodies change over time.”

Implants are a good example. “What I’ve found,” says Dr. Wu, “is that women follow a kind of lifecycle for implants. In their 20s and 30s, they want larger breasts, so that’s when they get implants. When they have children or are done having children, they may have their implants replaced with a lift because they might have some sagging. Later—after their children have grown—they want their implants out. That’s the lifecycle I often see.

“In fact, I’m seeing increased numbers of women who want their implants removed,” notes Dr. Wu, “They’re older and more fit; maybe they’ve lost weight or have a different breast aesthetic. Or maybe they have health problems that they attribute to their implants—implants they’ve had for 20 years. Their reasons are varied and the surgeries required are varied as well.

“Removing implants typically involves creating new breasts to match where they are in their lives. We might, for example, do a lift at the same time. We might replace the volume with some fat transfer. And some women simply want the implants removed. So there are options. My job is to restore their breasts to a more natural aesthetic, one that’s aligned with their current, active lifestyle.”

Changing Lives and Changing Technologies

Not only do women’s lives and bodies change, implants also change. “Breast implants,” Dr. Wu explains, “are not made to be lifetime devices. So, at some point in your life you may want to switch them out for another pair. Today’s implants are designed to last more than a decade, and, in many cases, can remain in good shape for 20 years or more.  Every patient is different, of course, and although the risk of rupture is low, it increases by about one percent each year. So, the older your implants, the greater your risk of rupture or other complications. Currently, we recommend that, at around 10 or 12 years, women should have a discussion with a plastic surgeon about electively replacing their implants.

“And breast augmentation options have changed as well,” she says. “Implants have historically been the primary choice. Now we can also restore volume with fat grafting, which is an ideal choice for women who want a smaller increase in volume and a softer, more natural look. Again, where a woman is in her life, and how her body has changed over time will influence the choices made.”

Weight Loss and Body Contouring

“Another significant way that our bodies change over time,” says Dr. Wu, “is reflected in fluctuations in weight. We gradually add weight as we age, and for some people those gradual, steady weight increases add up considerably.

“Many people will work hard to reverse that problem—using diet and exercise to take off the excess pounds. Unfortunately, major weight loss, while beneficial, results in other problems that can’t be fixed with diet and exercise, but which we can address surgically.”

For example, significant weight loss results in loose skin, since the skin loses much of its elasticity over time. And some pockets of fat are diet and exercise resistant. “Liposuction and a tummy tuck can help to address some of these post-weight-loss problems,” says Dr. Wu, “but there are limits. Intra-abdominal  fat, for example, cannot be removed surgically.”

Dr. Wu also cautions that body-contouring surgery—addressing multiple areas of the body—is complex, and poses certain problems. “For one thing, it cannot be accomplished in a single surgery. In fact, it’s dangerous to do so, because it requires too much time under anesthesia, increasing your risk of blood clots. Also, your recovery would be really hard because you have incisions all over your body.

“So, we need to do these surgeries in stages. Most people want to remove excess abdominal skin first because that’s usually the most bothersome. Then they’ll want to do the arms and might do the breasts at the same time; that’s reasonable. The tummy tuck is usually done by itself. The last surgery is the thigh lift—because it is the most onerous, and recovery is more difficult as well.”

Problem Choices for Surgery

There are certain lifestyle choices, says Dr. Wu, that are of special concern with respect to surgery. “For example, I won’t perform surgery on a smoker. Nicotine—in all forms, including vaping—poses major risks for any surgery since it distorts a patient’s immune system and can delay healing, increasing the risk of infection at the wound site.

“In the case of plastic surgery, it’s especially problematic. The skin is an end organ. All your blood vessels, your small capillaries—the last place that it touches—is your skin. So what happens if we do your surgery and the nicotine in your system closes off the capillaries? Your skin is going to die; you’re going to have an open wound.”

“Alcohol use also poses surgical risks,” adds Dr. Wu “So, I won’t perform surgery on a current alcoholic, and require abstinence of those who have previously had alcohol use disorder. Those with alcohol abuse need more anesthesia, and they usually have higher pain medication requirements, making recovery very painful.”