Waist Training, Liposuction or Tummy Tuck: What really works? (Part 1)

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Patients are always asking me about the effectiveness of waist training; Jessica Alba, Brooke Burke and Khloe Kardasian swear by it, but recently after Kim Kardashian posted an Instragram photo showing herself all cinched up in a waist trainer it seems like the questions have really been flying. Does waist training really work? What can I do to narrow my waistline? Here are the facts.

Left: Classic tight laced corset style  Right: Malaysian Bengkung belly binding

Left: Classic tight laced corset style Right: Malaysian Bengkung belly binding

First of all waist training is really nothing new, it harkens back at least to the 1500s when corsets first came in vogue and maybe even further back in Asian and African traditions of pre-natal and post-natal belly binding.

 

Left: Exercise Waist Trainer (Spandex with hook-and-eye closure)  Right:  Corset Waist Trainer (Metal boning structure and lace up closure)

Left: Exercise Waist Trainer (Spandex with hook-and-eye closure) Right: Corset Waist Trainer (Metal boning structure and lace up closure)

Secondly, there is a difference between exercise waist training (the latest rage) and waist training. Exercise waist training involves wearing the equivalent of the Incredible Hulk of spandex around your waist during exercise. Actual waist training involves lacing yourself up in a corset with metal boning and laces for several hours daily and gradually reducing down to smaller corsets over time.

Waist Training

Illustration of the changes that occur to the internal organs during the corsetting process.

Illustration of the changes that occur to the internal organs during the corsetting process.

1.  If you stop your waist will pop (back out to its original size that is).

True waist training must be continued on a daily basis in order to maintain the result. People may begin to see “semi-permanent” changes with >4 and up to 23 hours of corseting 7 days a week. Several changes occur when you wear a corset, your internal organs are displaced lower down into your abdomen allowing tightening around the rib cage and the waistline. The ribs have some level of bendability, so with enough continuous pressure the ribs may begin to angle downward and inward and the bone and cartilage begin to remodel. However, as soon as corseting is stopped the tissues will all return to their normal pre-corseted shape. If you are only laced up for a few hours a day the changes will only last a few hours, if you are laced up for longer periods the changes may last for a few months. Bottom line is that the changes are not permanent.

 Exercise Waist Training

2.  There is no permanent waist reduction that occurs with wearing an exercise waist trainer during your workout.

The manufacturers of these products cite core compression, increased perspiration, and targeted fat burning over the abdomen thereby reducing the waistline. This practice does not increase fat loss over the abdomen. You will see some temporary reduction in inches due to compression and increased perspiration, quite simply water loss. The only way to burn fat is by increasing your aerobic exercise reducing calories and eating clean. This leads to fat loss all over your body. Remember, the formula to seeing changes in your body is 30% exercise and 70% diet.

3.  There are risks to exercise waist training. If the garment is worn too tightly it inhibits your ability to breathe at a time when your breathing rate is increased to satisfy your body’s need for increased oxygen. Oxygen is part of the fuel your muscle uses to create energy to function during a workout. Some women wear their waist trainer so tightly they actually faint during their work out due to lack of oxygen.

4.  Liposuction and Tummy Tuck procedures are surgical ways to achieve a whittled down waistline.

You may find that in spite of having a healthy diet, engaging in regular exercise, and maintaining a healthy body weight, you may still have love handles or some resistant fat and skin over the abdomen. This is true in particular for many women after child birth, as we discussed before in Erasing the Tiger Stripes: 3 Steps to Restoring Your Pre-baby Body there can be some post-pregnancy changes that the gym and certainly the exercise waist trainer cannot fix. Diastasis-RectiFor example, many women also develop a rectus diastasis after pregnancy. A rectus diastasis occurs when space develops between the two rectus abdominus muscles (six-pack muscles) as a result of being stretched during pregnancy causing the abdomen to protrude. Although core exercises will strengthen the muscle and improve the overall abdominal shape they cannot mend the gap; the abdomen will always be wider than before. Exercise waist training will certainly not improve this problem but liposuction or a tummy tuck can.

5.  Liposuction can achieve targeted fat reduction over the abdomen.

6.  During a tummy tuck we actually do tighten the muscles, creating an INTERNAL CORSET. If you have a rectus diastasis part of the tummy tuck procedure involves bringing the muscles back together thereby tightening the abdomen and narrowing the mid section.

 

Are you a candidate for Liposuction or a Tummy Tuck (Abdominoplasty)?

1.  Do you have a normal body weight?

A tummy tuck or liposuction does not replace weight loss. These procedures are for contouring and shaping. If you are more than 20% above your normal body weight or more than 50lbs overweight you are not a candidate for surgery. Remember removing the fat over the abdomen does not decrease the internal fat around your organs that is responsible for the increased risk of heart disease and diabetes.

2.  Is your weight stable?

You must have a healthy diet and regular exercise regimen to maintain a stable weight. If you are still gaining weight you need to get that under control first.

3.  Do you have extra skin and fat over your abdomen?

If the extra skin and tissue hangs over causing a fold on your abdomen you are likely a candidate for a tummy tuck. If you have extra fat but no extra skin, liposuction may be a better option.

4.  Have you finished having children?

You can still have liposuction if you are planning another pregnancy, but if you are interested in a tummy tuck you should wait until afterwards. Of course if you are a man or are using a surrogate you do not have any of these worries!

Don’t forget that you can eat your way right back out of your liposuction or tummy tuck. There is no trade off for a healthy diet and regular exercise. After we have done our part to give you a flat tight tummy you still have to do your part to maintain it. So protect your investment by watching what you eat and hitting the gym. Learn more about what to expect before, during and after liposuction or tummy tuck surgery.

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From Gynecomastia to Gladiator: Overcoming Male Breast Enlargement

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Summertime equals skin time; not just for the ladies but for the men who want to be liberated from their shirts and feel the sun on their chest. Many men do this without even a thought, but for many others doing so causes self-consciousness, embarrassment and discomfort. The first thing that is important for you to know if you are suffering with this problem is that you are not alone. Many of my male patients come in with concerns about enlarged breast tissue. Luckily social media provides a platform for sharing and removing the sense of isolation which sometimes accompanies this problem. I applaud people like Chris Pineda for making this video to share his struggle.

Normal Male Chest vs. Male with Gynecomastia

Do I have gynecomastia?

☑︎Do you have excess breast tissue?
x Are you obese?

If you are a male with excess breast tissue and you are not obese you most likely have gynecomastia. Gynecomastia consists of increased breast tissue and some fat. There are varying grades of severity of this enlargement.

 

Grade I Minimal increase in breast tissue, no sagging/extra skin

Grade II Moderate increase in breast tissue, no sagging/extra skinGynecomastia: Grades of Severity

Grade III Moderate increase in breast tissue, with moderate sagging/extra skin

Grade IV Severe increase in breast tissue, with moderate or severe sagging/extra skin

 

What causes gynecomastia?

Short-term causes:

Some causes of male breast enlargement are transient and resolve on their own. Male breast enlargement is very common during certain stages of life: infancy, adolescence, and mature-age. The thought is that this is caused by an imbalance in hormone levels between estrogen (the female hormone) and testosterone (the male hormone). During pregnancy a male infant is affected by the estrogen from their mother’s blood causing an increase in the breast tissue. After birth the estrogen levels decrease and the gynecomastia resolves. As many as 66% of all male adolescents experience gynecomastia of one or both breasts at some point. So if you are a teenage male experiencing this problem remember that it is quite common. The teenage years are full of shifts in hormone levels, an imbalance between estrogen and testosterone for a limited amount of time can cause breast enlargement. As the hormone balance returns the breast enlargement usually resolves within 6 months to 2 years. Mature age unfortunately is the only exception here, the imbalance in testosterone and estrogen that comes with age ( > 65 years) does not resolve.

Long-term causes:

Some causes of male breast enlargement may be idiopathic, meaning inherent to the person with no specific cause. Others are due to medications, drugs, and illness.

What to watch out for:

Medications
Many medications can cause this problem for example Zantac (cimetidine), Prilosec
(omeprazole), Aldactone (spirinolactone), Vasotec (enalapril). Changing your
medication may be an option.
Drugs of Abuse
Drugs of abuse such as marijuana, heroin, anabolic steroids can cause breast enlargement, so remember that as you light up or shoot up you may be increasing that breast tissue.
Thyroid Abnormalities
High or low thyroid levels can also contribute to this problem.
Liver Failure
Alcohol abuse and hepatitis are common reasons for liver failure. If you start noticing
yellowing of your eyes of skin you may be in serious danger of liver failure which can
lead to breast growth.
Testicular Tumors
Tumors of the testicles can release hormones causing an upset in normal hormone
levels and increasing breast growth.

 

How do I get treatment?

It is important that you visit your PCP so that they can rule out medication side effects or severe illness.

1. See your PCP
Your PCP will review your medications, examine you including performing a testicular exam, send off any necessary labs, and possibly send you for some imaging studies as well.

2. Get a referral to a Plastic Surgeon
If all the possible causes of gynecomastia have been eliminated or there is no improvement within 1 year of removing the offending agent it means that you require surgical treatment for gynecomastia.

 

What is the Surgical Treatment?

1. Liposuction

This is the most common method of treatment for gynecomastia and can be used for most grades. One or two tiny access incisions are made and then liposuction is performed to remove the breast tissue. Even for those patients who have some sagging and extra skin we often start with liposuction alone and allow 6-12 months to allow for healing and shrinking of the skin. If additional skin needs to be removed or the nipple needs to be elevated that can be done during a second short surgery.

2. Direct Removal of Breast Tissue

At times there is very dense/thick breast tissue which cannot be removed with liposuction alone. In these instances a small incision is made under the skin of the areola and the breast tissue is removed directly through that incision.

 

What about Insurance?

Although it is the best method of treatment insurance companies do not cover the use of liposuction for treating gynecomastia. Some companies will however cover the costs for direct excision. Consult with a plastic surgeon to find out your options.