FAQs

Q: What is brachioplasty?            
A: It is the medical term for an arm lift. It means arm (brachio) reshaping (plasty).

Q: What is done in arm lift surgery?            
A: The excess upper arm tissue, sometimes referred to as a "bat wing," is removed during brachioplasty. This is done using direct excision (removal by cutting) or a combination of liposuction followed by direct excision.

Q: Is liposuction always done as well?            
A: Depending on the level of correction needed, liposuction may be required to achieve the final desired contour.

Q: Is arm lift surgery painful?            
A: There is discomfort associated with all body contouring procedures. Most patients report that the pain is very tolerable. The great majority of patients are off of prescription pain medicine by a few days after surgery.

Q: What type of anesthesia is used for arm lift surgery?            
A: Arm lifts are usually performed in the operating room under general anesthesia. Additionally, many surgeons inject additional local numbing medicine in the surgical area while you are asleep to provide additional postoperative pain control.

Q: Where is the incision made?            
A: The incision will depend upon how much tissue needs to be removed and whether the tissue is near the armpit or lower down on the arm. The traditional vertical incision goes from the armpit to the elbow. If the excess tissue is limited to the top of the upper arm, you may be a candidate for a short-scar arm lift with a crescent-shaped incision in the armpit area.

Q: Is there any scarring with arm lift surgery?            
A: Yes, there is scarring associated with all body contouring procedures. Many physicians and patients believe this is the biggest downside to an arm lift.

Q: Where is the scar?            
A: In a standard arm lift, the scar is a straight line from the armpit to the elbow. It is placed along the inside of the arm. However, it can still be visible in short sleeve shirts and tank tops. In the short-scar arm lift, the scar is a curved line that can be hidden in the armpit.

Q: How long does it take for the scar to heal?            
A: Initial scar healing takes approximately two weeks. After that time, your surgeon will work with you on scar management including massage and topical therapies to minimize its appearance.

Q: Who is a good candidate for an arm lift?            
A: A patient in overall good health, who has been weight stable for at least one year and desires to improve the contour of their upper arms.

Q: What can I expect in my initial consultation?            
A: Your plastic surgeon will ask about your general medical history and examine your areas of concern. This is the opportunity for you to discuss what bothers you. Together, you will devise a treatment plan that addresses your concerns and is surgically feasible.

Q: How long does the surgery take?            
A: To contour both upper arms, the total length of surgery is approximately three hours.

Q: What will prepare me for surgery?            
A: The best way to prepare for an operation is to understand why you are having the operation, what exactly will be performed, and what your results are likely to be. If there are medical issues such as high blood pressure or diabetes, these should be well controlled prior to surgery. Smokers must stop smoking in order to decrease the risk of wound healing issues. All patients should be nicotine-free for at least six weeks prior to and after surgery.

Q: What are the risks of arm lift surgery?            
A: The risks are similar to most major operations. They include wound healing issues, poor scarring, bleeding, infection, and seroma (fluid collection) formation. In order to prevent fluid accumulation, your surgeon may leave a small drain in place for a few days. In addition, he or she may place your arms in compression garments (similar to ACE wrap sleeves) right in the operating room, which you will wear during your initial recovery.

Q: When can one return to normal activities? Exercising?            
A: Most patients are able to resume their daily routines within two weeks. It takes about four to six weeks to return to your exercise regimen.

Q: Can other procedures be done at the same time?            
A: Yes, short procedures can be combined with an arm lift. In order to maintain the highest level of patient safety, we limit the number of body contouring procedures that can done at once, in order to limit time under anesthesia.

Q: How much does arm lift surgery cost?            
A: Cost varies by location and consists of three components: professional fee for the surgeon, professional fee for anesthesia, and the cost of the operating room. Insurance companies generally do not cover the costs associated with these operations. They are considered cosmetic procedures. Most plastic surgeons have financing plans available.        
 

Here, Sami U. Khan, MD, associate professor of surgery and director of our cosmetic surgery program, answers frequently asked questions about body contouring after major weight loss.

Q: What is body contouring?
A: Body contouring refers to a broad field of plastic surgery procedures that address areas of excess fat and/or skin. Body contouring procedures can be performed in normal-weight patients, patients who have lost significant weight through diet and exercise, and patients who have lost weight after bariatric surgery.

Q: What happens during a body contouring consultation?
A: The body contouring consultation serves two main purposes. It allows the patient to meet the surgeon and express their goals for the body contouring procedure. It also allows the patient to understand the process of staging procedures. The surgeon is able to evaluate the patient's overall medical condition, and assess any potential co-existing medical conditions that may affect the proposed procedures. Usually, the surgeon will assess the patient's concerns and goals and create a plan. Often, these patients will require multiple procedures, which usually are staged. The stages can be reviewed, and timing can be planned.

Q: Is achieving ideal body weight required before body contouring?
A: It is important for weight loss patients to achieve weight stability prior to proceeding with any body contouring procedures. Ideally, patients should be weight stable for a minimum of 12 months. This is important because weight fluctuations, both gain or loss, can affect the aesthetics of body contouring procedures. This can lead to poorer outcomes, and increase the incidence of need for secondary procedures.

Q: How does one prepare for body contouring surgery?
A: Many post-bariatric patients prior to weight loss had weight-associated medical conditions. Prior to any procedures, these patient should have general medical clearance. If a patient is a smoker, they should go through a smoking cessation program. In order to reduce the risk of significant wound healing complications related to alteration in tissue perfusion by nicotine, all patients should be nicotine free for a minimum of six weeks prior to and after any elective surgical procedure. Bariatric patients are at risk for nutritional deficiencies that can affect healing and thus put them at risk for wound healing complications. They should all undergo nutritional assessment, and any deficiencies should be addressed.

Q: What are the risks of body contouring surgery?
A: The risks of body contouring procedures are similar to any other major surgery. The most common complications are related to wound healing, including wound infection, wound breakdown, and seroma formation. Massive weight loss patients often have other medical conditions, related to their previous obesity, including sleep apnea, hypertension, and diabetes that can increase the risk of surgery. Skin quality is altered in patients who were previously obese and have subsequently lost significant weight. This can lead to increased incidence of poor wound healing, scar-related issues including scar migration, and skin laxity leading to aesthetic-related issues, which can all lead to increased need for revision procedures.

Q: What are the body contouring steps?
A: Massive weight loss patients often require multiple surgical procedures to address excess skin and fat throughout their entire body. From the healing and safety standpoint it is not feasible to perform all of these procedures in one operation. Typically, panniculectomy (removal of excess skin and fat from the abdomen) or lower body lift procedures are performed as the first stage. Breast reduction/lift procedures can be combined with either brachioplasty (arm) or medial thigh lift. The remaining procedure can be performed as a third stage. If there is significant facial laxity, a face lift can be performed, often, as the final stage. Typically, the time period between stages is three to six months to allow for recovery and healing.

Q: How long does it take to get back to normal after body contouring?
A: Typically, body contouring procedures require at least three months for the overall cosmetic results to be fully apparent. This allows enough time for all residual swelling to resolve and for soft issue to soften. Scars typically require 12 months to go through the remodeling process, and, because body contouring procedures require significant incisions, they often are apparent during this time period.

Q: How long do the results of body contouring last?
A: The major factor that affects the longevity of results in post-bariatric body contouring is weight fluctuations. This is the main reason that these procedures are delayed until patients are weight stable for a minimum of 12 months. If patients are able to maintain their weight, long-lasting results can be achieved. The main issues in this patient population are related to scar migration and soft tissue laxity leading to contour deformities. These are the result of the altered skin/soft tissue characteristics related to the previous obesity.

Q: How much does body contouring cost? Does insurance cover it?
A: Not all insurances cover body contouring procedures. More insurance companies are specifically excluding body contouring from coverage. The most commonly covered procedure is abdominal panniculectomy.

Q: What makes body contouring at Stony Brook Medicine special?
A: At Stony Brook Medicine, our academic plastic surgeons approach body contouring with a patient-first attitude. Our plastic surgeons are considered leaders in their field. Some of their research activities focus on patient safety, outcomes analysis, and developing state-of-the-art surgery, thus allowing us to incorporate the latest techniques into creating a safe surgical environment in which we can maximize our patients' experience and outcomes.

Q: What is the purpose of breast implants?
A: Breast implants are medical devices used to increase the size and change the shape of the breast. For women who undergo mastectomy for breast cancer, they are the most commonly used method of recreating a breast (reconstructive purpose). For women who desire larger breasts, they are placed behind the existing tissue to augment cup size (cosmetic purpose).

Q: What exactly is a breast implant made of, and what are the different types?
A: The breast implant shell is composed of silicone. The inside fill can be either saline (salt water) or silicone gel. From 1994 to 2006, the FDA did not allow the placement of silicone-filled implants in the United States for cosmetic purposes. During this time, the FDA collected data and concluded that there was no increased risk of connective tissue disorders. Since 2006, both saline and silicone implants were permitted to be used for reconstructive and cosmetic purposes.

Q: What is the difference between a smooth and a textured breast implant?
A: The difference is in the appearance and feel of the shell. Smooth implants have a soft, uniform shell and tend to move more as the capsule doesn't grow into them. Textured implants have a coating, creating in a larger surface area, which causes the capsule to grow them and results in less movement.

Q: What complications can occur with the implants themselves?
A: Local complications include capsular contracture, malposition, and rupture. Some people also experience breast pain, wrinkling, asymmetry, scarring and infection. 

Q: What conditions are associated with having breast implants?
A: Breast implant-associated anaplastic large cell lymphoma and an entity known as breast implant illness.

Q: What is anaplastic large cell lymphoma?
A: Breast implant-associated anaplastic large cell lymphoma, known by the abbreviation BIA-ALCL, is a cancer of the immune system which is most often found in the capsule around the implant. It is NOT a breast cancer. If you have any issues, questions, or concerns, please arrange for a consultation with
one of our plastic surgeons to help you by calling our office at 631-444-8210

Q: What does a woman with breast implants need to look out for in regard to BIA-ALCL?
A: BIA-ALCL usually develops as a swelling of the breast 2 to 28 years after the insertion of breast implants. It most commonly presents as a fluid collecting around the implant. It can also present as a lump in the breast or armpit. If a woman with implants notes that only one breast is enlarging, this is an indication to see a plastic surgeon for an evaluation.

Q: What is breast implant illness?
A: There are many breast implant patients on social media who discuss a wide variety of symptoms that they are experiencing — symptoms which may or may not meet the diagnostic criteria to be categorized as a disease. These patients refer to their symptoms collectively as "breast implant illness." However, there currently is not sufficient evidence to demonstrate an association between breast implants and rheumatologic or connective tissue diseases.

Q: What is the follow-up needed for women with breast implants?
A: Once the plastic surgeon has established that a woman has healed, and her implants have settled, she does not need yearly follow-up just because she has breast implants. However, if the implants were placed for reconstruction following cancer surgery, we do ask patients to see their surgeons yearly. Asymptomatic women without breast changes do not require more than routine follow-up with their primary physician or gynecologist for a yearly breast exam. If a woman with breast implants experiences a change in her breasts — especially if there is swelling or a lump — she should undergo examination and appropriate imaging, including ultrasound and fine-needle aspiration of any peri-implant fluid.

Q: Does a woman with implants need frequent MRI exams to check them?
A: As of last week, the FDA's prior recommendation of MRI screening at three years after implant placement and every two years thereafter was called into question. A breast implant MRI study is rarely covered by insurance companies and only looks at the implant, not the surrounding breast tissue. Even if a silent rupture is identified, most women will not undergo surgery if they are not experiencing issues.The recommendations are moving toward ultrasound, beginning at least five years after the implants are placed. Ultrasound is a good test to look for capsule thickening and peri-implant fluid. If there is a silent rupture suspected on ultrasound, an MRI can further characterize but it is no longer considered the first-line imaging test for screening.

Q: Does having implants change a woman's breast cancer screening?
A: No. It is still recommended that women have a baseline screening mammogram at age 35 and then begin yearly mammograms at age 40. If you have dense breasts, a yearly ultrasound may be recommended in addition.

Q: Is there an expiration date on current breast implants?
A: No ten-year "time limit" exists at which time implants expire and must be removed or replaced. If a woman with breast implants is not experiencing issues, it is unlikely she will need to have another operation.

Q: If a woman wants to remove her breast implants, will health insurance cover the procedure?
A: Breast augmentation is considered cosmetic, and is not covered by insurance companies. As such, removal of breast implants also is not commonly covered by insurance companies. An exception is in the case of previous or current cancer diagnosis for which they will often cover implant surgery.

Q: What is the take home message for women who already have or are considering getting breast implants?
A: Breast implants are not lifetime devices. They will likely require maintenance such as an additional operation at some point. The longer a woman has breast implants, the more likely she is to experience local complications or adverse outcomes requiring re-operation.

Here, our director of breast reconstruction, Duc T. Bui, MD, associate professor of surgery and member of our Plastic and Reconstructive Surgery Division, answers frequently asked questions about breast reconstruction and the DIEP flap procedure.

Q: What are the advantages to having breast reconstruction after mastectomy?
A:  The goals of breast reconstruction are to restore the breast shape, size, and appearance to near normal and to achieve breast symmetry when dressed. It eliminates the need for external prosthesis.  Many studies have shown that breast reconstruction patients have improved quality of life and psychosocial well-being.

Q: What is a "flap" with regard to breast reconstruction?
A: A flap is tissue taken from your body with its blood supply used to reconstruct the breast.  The flap can be pedicled (meaning that the blood supply stays attached to the body) and transferred up to the chest or free (meaning that the blood supply is disconnected and transferred up to the chest and reconnected again with microsurgery).  Common flaps for breast reconstruction are the TRAM flap (tissue taken from the abdomen) and the latissimus flap (tissue taken from the back).

Q: What is a DIEP flap?
A:  A TRAM flap (transverse rectus abdominis myocutaneous) flap consists of skin, fat, rectus muscle, and blood vessels taken from the abdominal wall and transferred to the chest to reconstruct the breast.  Initially, it was pedicled flap, then with the advent of microsurgery, it became a free flap.  A DIEP flap is similar to a TRAM flap but the muscle is spared.  It consists of skin, fat, and blood vessels only. The blood vessels are dissected from the rectus muscle.

Q: What are the advantages to DIEP flap breast reconstruction?
A:  The rectus muscle is not taken, thus less pain, and risk of abdominal weakness or hernia, hence quicker recovery.

Q: How do I know if I am a candidate for a DIEP flap breast reconstruction? Does weight or age make a difference?
A:  If you have enough lower abdominal soft tissue, then you are a candidate for a DIEP flap.  The more weight you have, the more likely you have enough lower abdominal soft tissue.  Age usually does not make a difference.

Q: Where do the skin and other tissue come from for natural-tissue breast reconstruction?
A:  Other options include back (latissimus flap), buttock (gluteal flap), and inner thigh (TUG flap).

Q: When can I have breast reconstruction surgery? Can it be done at the same time as my mastectomy? 
A:  Breast reconstruction can occur immediately after mastectomy or delayed (at a separate time after the mastectomy).  Most women undergo immediate breast reconstruction.

Q: How long after chemotherapy or radiation therapy can DIEP flap breast reconstruction be done?
A: Usually about four to six weeks after chemotherapy.  Usually about six to twelve months after radiation therapy.  You have to wait for the acute effects of radiation to the skin to resolve prior to any breast reconstruction.

Q: Will I have sensation in my reconstructed breast?
A:  No, you will not have normal sensation as before. Compared with an implant, DIEP flap reconstruction provides a more natural look and feel that will mature and change as a woman's body ages, and that won't have to be replaced because of rupture or other problems.

Q: What are the benefits of using my own body's tissue for breast reconstruction compared with having a breast reconstructed with an implant?
A:  It is your own body tissue.  It will give you a more natural look and feel that will mature and change with you as your body ages.  You don't have to worry about replacing it, as may happen with an implant due to implant rupture, infection, or capsular contracture.

Q: What is microsurgery, and why is it used in breast reconstruction?
A:  Free tissue transfer is the transfer of tissue taken from one part of the body and moved to another part of the body far away by detaching the blood vessels and reconnecting the blood vessels using microsurgery.  Microsurgery is surgery performed with use of a microscope to re-connect tiny blood vessels to re-establish blood flow to the flaps.

Q: If I do not want to use, or can't use, my abdomen for a DIEP flap breast reconstruction, are there other flap options?
A: Latissimus flap (from the back) is a possible option, but what is usually requires an implant, gluteal flap (tissue from the buttocks), and TUG (tranverse upper gracilis) flap using tissue from the inner thigh.

Q: Is there a reason why few surgeons perform perforator DIEP flap breast reconstruction?
A:  It involves microsurgery and advanced technical skills to dissect the blood vessels from the rectus muscle.

Q: How long does DIEP flap surgery take to perform?
A:  For unilateral DIEP it takes six to eight hours, and for bilateral DIEP ten to twelve hours. The reason why few breast centers offer DIEP flap breast reconstruction is because the surgery is very complex and the procedure requires very sophisticated, advanced technical skills including microsurgery.

Q: Does the DIEP flap surgery have a higher complication rate than other types of breast reconstruction?
A: DIEP flaps can be associated with more fat necrosis (lump) than muscle-sparing free TRAM flaps.

Q: How long will it take for me to get back to my normal routines and exercise after a DIEP flap breast reconstruction?
A: About four to six weeks.

Q: Is recovery after DIEP flap surgery more painful and difficult than after other types of breast reconstruction?
A: No, it should be less because with DIEP flap surgery the rectus (abdominal) muscle is spared.

Q: What if my breast cancer comes back after I have had a breast reconstruction? Is DIEP flap associated with a higher recurrence rate?
A: No, there are no studies that show breast reconstruction adversely affects detection of breast cancer recurrence, or is associated with a higher recurrence rate.

Q: Will my health insurance plan cover the cost of breast reconstruction with a DIEP flap?
A:  Yes, federal and New York mandates state that insurance plans that cover mastectomy must also cover breast reconstruction deemed appropriate by the plastic reconstructive surgeon and the patient.

Q: What distinguishes DIEP flap breast reconstruction surgery done at Stony Brook?
A:  We do a high volume of microsurgery, including DIEP flap breast reconstruction, with a dedicated microsurgery team.  We also have the state-of-the-art technology and equipment for microsurgery. Read about breast reconstruction at the Carol M. Baldwin Breast Care Center of Stony Brook Medicine.

For more information about our breast reconstruction program, please call 631-444-4666.

Here, Tara L. Huston, MD, associate professor of surgery and a member of our Plastic and Reconstructive Surgery Division, answers a few of the frequently asked questions about breast reduction surgery for women.

Q: What is breast reduction surgery?
A: Also known as reduction mammaplasty, breast reduction surgery reduces the size of the breast and lifts it into a higher position on the chest wall. During the procedure, the surgeon removes excess breast fat, glandular tissue, and skin to achieve the desired breast size and look.

Q: Who is a good candidate for a breast reduction?
A: Women with breasts that are too large for their frame. A popular misconception is that only women with very large breasts are good candidates for a breast reduction.

Q: What are the most common benefits of breast reduction surgery?
A: An immediate end to back and neck pain. After the immediate post-op period, women are able to maintain a more active life with more frequent exercise. Women fit into normal-sized blouses and bras. (See the ASPS before-and-after photo gallery.)

Q: What are the risks involved with breast reduction surgery?
A: Very rarely, some loss of breast tissue may occur as a result of inadequate blood flow to the remaining breast tissue. This occurs more frequently in women who smoke. Occasionally, the reduced breasts are slightly uneven in size. Occasionally, surgical scars remain dark and raised after complete healing has occurred.

Q: Are there different kinds of breast reduction procedures?
A: Yes, different techniques for different sizes and shapes of breasts. Breast reduction surgery is considered reconstructive, not simply cosmetic, surgery.

Q: How much pain is there after breast reduction surgery?
A: Mild to moderate pain may occur. This pain is easily controlled with Tylenol-type products.

Q: How long does it take to get back to normal after breast reduction surgery?
A: The recovery period ranges from several days to a week or two.

Q: What is the long-term outcome like for most people who have breast reduction?
A: No discomfort, a more active lifestyle, and a more youthful appearance.

Q: How much does a breast reduction surgery cost? Will insurance cover it?
A: In many cases, if medical necessity can be demonstrated, insurance companies will cover it. Without insurance a breast reduction is costly.

Q: What makes breast reduction surgery at Stony Brook Medicine special?
A: Stony Brook's plastic surgeons are very experienced in different types of breast reduction procedures. This experience translates into the best possible outcomes. Another plus is the staff is very warm, friendly, and caring, which always helps patients before and after the surgery.

To find out more about breast reduction surgery at Stony Brook, please schedule an appointment with Dr. Huston, or any of our plastic surgeons, by calling 631-444-4666.

Here, Alexander B. Dagum, MD, our chief of plastic and reconstructive surgery, answers frequently asked questions about this condition. A distinguished expert, he is fellowship trained in hand surgery as well as plastic surgery, and board certified in both specialties.Stony Brook Medicine is considered one of the world's foremost institutions when it comes to the treatment of Dupuytren's disease.

Q: What is Dupuytren's disease?
A: Dupuytren's disease is a progressive condition that affects the tissue underneath the skin that is called the fascia. The fascia is responsible for holding the palm skin taught so it does not slide around when one grips or grasps an object. Tough scar is laid down on the fascia that gradually contracts, leading to bent fingers that cannot be straightened.

Q: What causes Dupuytren's disease?
A: The cause is unknown, but there is a genetic component. A positive family history, in particular, plays an important role in the development of Dupuytren's disease. Other factors known to make Dupuytren's disease worse are excessive alcohol consumption, diabetes, smoking, and epilepsy and certain antiepileptic medication.

Q: How is Dupuytren's disease diagnosed?
A: Dupuytren's disease is diagnosed clinically by physical examination. It usually starts with a nodule in the palm underneath the skin that is firm and can initially be painful. There may be associated pits between the nodules that develop subsequent to this.

Q: Who gets Dupuytren's disease?
A: There is a genetic predilection to affect primarily people of Northern European or British descent. That is why it is also known as the Viking disease as it is felt it originated in people of Scandinavian ancestry and subsequently spread from there. However, it has been reported in all races. It affects men more often than woman, and usually starts after age 40.

Q: What happens if Dupuytren's disease goes untreated?
A: The fingers progressively bend and contract, leading to inability to open the hand and decreasing hand function.

Q: Is there a cure for Dupuytren's disease?
A: There is no cure for Dupuytren's disease, but it can be treated with surgery or injections to remove or dissolve, respectively, the cords causing disabling contractures.

Q: What is Dupuytren's contracture?
A: When a hand cord caused by Dupuytren's disease leads to a bent finger that can no longer be fully extended, the condition is called Dupuytren's contracture.

Q: What are the risk factors for Dupuytren's contracture?
A: The risk factors for Dupuytren's contracture are the same as for the disease, but a strong family history, early onset of the disease (before age 40), disease in both right and left hand, associated disease in the knuckle pads, feet, or penis will increase the risk of developing contractures. A history of diabetes, heavy alcohol consumption, smoking, and epilepsy and certain antiepileptic medications will also increase the risk of developing contractures.

Q: How does Dupuytren's contracture impact a person's life?
A: The inability to open the fingers fully may make it difficult to grip and grasp objects such as tools, instruments, a golf club, and so forth. The fingers also may get jammed and injured easily as the person reaches out to grab an object or puts their hand in their pocket.

Q: Can Dupuytren's contracture occur in any finger?
A: Yes, but it most commonly affects the ring finger followed by the small finger.

Q: How is Dupuytren's contracture treated?
A: Traditionally, Dupuytren's contracture is treated with surgery to remove the diseased fascia (tissue) and, thereby, correct the contracture.

Q: Which treatment for Dupuytren's contracture is better: surgical or non-surgical?
A: The early results for surgery versus enzyme injection have been equivalent. The long-term results are not yet available. The disease is not cured and, thus, recurrence or extension of the disease with the same or other contractures occurs in at least 20% of patients.

Q: What is the advantage of having Dupuytren's contracture treated at Stony Brook Medicine?
A: Stony Brook Medicine is considered one of the world's foremost institutions when it comes to the treatment of Dupuytren's disease.
The enzyme (collagenase) treatment known as Xiaflex used throughout the world to treat this disorder non-surgically was developed at Stony Brook.
Surgeons have come from all over the world to learn not only about Dupuytren's disease and its treatment, but also how to use Xiaflex to treat Dupuytren's contracture. Several thousands of patients have been treated here with either surgery or enzyme injection, making Stony Brook Medicine not only the busiest but the most experienced center for Dupuytren's disease in the country.

Here, Tara L. Huston, MD, associate professor of surgery and a member of our Plastic and Reconstructive Surgery Division, answers a few of the frequently asked questions about Mommy Makeover surgery.

Q: What is a Mommy Makeover?
A: "Mommy Makeover" is a term used to describe rejuvenation of the breasts and abdomen. The goal is to address some of the common physical changes that can occur following pregnancy. On the breast, these most commonly include sagging and deflation. On the abdomen, it is often excess skin with stretch marks and bulging.

Q: Who is a good candidate for a Mommy Makeover?
A: A woman in overall good health who has completed her childbearing.

Q: What can I expect in my initial consultation?
A: Your plastic surgeon will ask about your general medical history and examine your areas of concern. This is the opportunity for you to discuss what bothers you. Together, you will devise a treatment plan that addresses your concerns and is surgically feasible.

Q: Is the Mommy Makeover done all at one time?
A: It can be done in one or two stages, depending on how many areas need to be addressed.

Q: What are the different options for a Mommy Makeover?
A: It is some combination of the following: breast lift, with or without augmentation; breast reduction (FAQs); abdominoplasty (also known as a tummy tuck); mini-abdominoplasty (mini tummy tuck); and liposuction.

Q: What happens during the Mommy Makeover surgery?
A: The breasts are lifted. If there is volume loss from pregnancy and breast feeding, this can be remedied with the addition of a breast implant. Alternatively, if the breasts are excessively large and causing discomfort, the size may be reduced. In an abdominoplasty, the abdominal muscles are tightened to strengthen the midsection and narrow the waist. Lastly, the excess lower abdominal skin with stretch marks is removed.

Q: Can I have more kids after my Mommy Makeover?
A: If more children are planned in the near future, it is better to wait, especially on the abdominoplasty. Additional pregnancies are possible following abdominoplasty. However, the final result may not be as good if the tissues are stretched again with another pregnancy.

Q: Will a caesarean section or hysterectomy affect Mommy Makeover results?
A: No, the incision for the abdominoplasty is at the same level on the lower abdomen. Some women have bothersome extra skin that hangs over their caesarean section or hysterectomy incision. An abdominoplasty can remove this scar and skin in order to smooth the contour.

Q: When is the best time to have a Mommy Makeover?
A: When childbearing is complete and a stable weight has been achieved. Significant weight gain or loss after surgery may diminish the final result.

Q: I have a hernia. Can an abdominoplasty be done at the same time as the hernia repair?
A: Hernias at the belly button are very common in women who have had multiple pregnancies or twin/triplet pregnancies. These hernias can be addressed by a general surgeon during the same operation. This combined procedure allows the patient to have a single recovery. Our Plastic and Reconstructive Surgery Division and General Surgery Division work closely to assist patients with this.

Q: What are the risks of Mommy Makeover surgery?
A: The risks are similar to most major operations. They include wound healing, bleeding, infection, and seroma (fluid collection) formation.

Q: What will prepare me for surgery?
A: The best way to prepare for an operation is to understand why you are having the operation, what exactly will be performed, and what your results are likely to be. If there are medical issues such as high blood pressure or diabetes, these should be well controlled prior to surgery. Smokers need to stop smoking in order to decrease the risk of wound healing issues. All patients should be nicotine free for at least six weeks prior to and after surgery.

Q: Where are the incisions?
A: The incisions will depend upon the procedures chosen and the techniques utilized by your surgeon. In general, for a breast lift, there is a circular incision around the areola which is carried straight down toward the fold under the breast. It is sometimes called a "lollipop" scar, as this is the shape. Placement of an implant (augmentation) can be done through this same incision if needed. For the abdominoplasty, there is a linear incision from hip bone to hip bone which can be hidden under the bikini line. Depending on the type of abdominoplasty, there may or may not be a circular scar around the belly button, as well.

Q: Will I have scars?
A: Yes, it is not possible to perform these operations without making incisions and leaving scars. Once the incisions are fully healed, your plastic surgeon will instruct you as to how to minimize the scars and help them fade over time. With careful operative technique and attention to scar management post-operatively, it is our goal to have the finest, smallest scar as possible.

Q: What can I expect after surgery?
A: Depending on the types of surgeries chosen and whether the breast, abdomen, or both are addressed, recovery times will vary. You may go home the same day. Alternatively, your plastic surgeon may recommend an overnight stay if extensive surgery was performed, or if you have other medical issues. Recovery can range from one to four weeks in most cases.

Q: When can I resume normal activities after Mommy Makeover?
A: It is helpful to have friends and family available to assist you in caring for children for the first week after surgery. Recovery can range from one to four weeks in most cases.

Q: How long do I need off from a desk job after a Mommy Makeover?
A: Two to four weeks is the average. Some women feel better sooner and choose to return to work one week after surgery. Patients are asked to refrain from heavy lifting for one month.

Q: How much does a Mommy Makeover cost?
A: Cost varies by location and consists of three components: professional fee for the surgeon, professional fee for anesthesia, and the cost of the operating room. Insurance companies do not cover the costs associated with these operations. They are considered cosmetic procedures. Most plastic surgeons have financing plans available. The one exception is breast reduction. If the breasts are very large, causing shoulder, back, and neck pain, the insurance company will often cover breast reduction surgery to alleviate these symptoms. You should check with your plastic surgeon to see if you would be a candidate for a breast reduction, and the surgeon can work with you and your insurance company.

Q: What is the Stony Brook difference for patients who have a Mommy Makeover?
A: All of our plastic surgeons are board certified in plastic surgery. This certification is relevant because many physicians who are not trained in plastic surgery are now doing "cosmetic surgery." These physicians have not received the approved education, nor have they completed an examination process designed to assess the knowledge, experience, and skills required to provide high-quality patient care in plastic surgery.

Here, Tara L. Huston, MD, assistant professor of surgery and dermatology, and Janet L. Trabosh, RPA-C, both members of our Plastic and Reconstructive Surgery Division, answer frequently asked questions about nipple reconstruction.

Q: What is nipple areolar reconstruction?
A: Nipple reconstruction is the recreation of a nipple and/or areola in the most projecting portion of the breast mound. This can be done both surgically as well as non-surgically, depending on the desired outcome.

Q: Can a woman's natural nipple be reattached to her reconstructed breast?
A: Yes and no. There are many nipple-sparing techniques that we can employ on the day of mastectomy to either preserve or reattach the native nipple [see our "FAQs about Nipple-Sparing Mastectomy"]. This must be decided before the operation, and carried out on the day of mastectomy surgery. On the other hand, when the nipple has been removed with a traditional mastectomy, it cannot be reattached months later.

Q: When can a woman have a nipple reconstruction?
A: Nipple-areolar complex reconstruction may be done any time the nipple-areolar complex is missing. This can be after mastectomy, after central lumpectomy (which includes resection of the nipple-areolar complex, but preservation of the breast), after oncoplastic reduction where the tumor is involving the nipple [see our "FAQs about Oncoplastic Breast Reduction"], or after non-cancer operations where the nipple is absent.

Q: Is nipple reconstruction required after breast reconstruction?
A: No, it is not required. Like every aspect of breast reconstruction, it is a personal choice. Nipple reconstruction can be done at any time after the breast mound has been recreated and the blood supply is re-established. This is usually three months after the permanent implants are in place or following flap surgery. There is no time limit on when nipple-areolar complex can be safely performed. Some women have the procedure done as soon as is possible; some wait 5 to 10 years; and a small percentage decide to forgo it altogether.

Q: Why should a woman have nipple reconstruction?
A: A woman should have nipple-areolar reconstruction if she desires to have it. It is meant to complete the reconstruction and give the reconstructed breast as natural an appearance as is possible. Some women will opt for the non-surgical tattoo technique, as opposed to the surgical technique, where a "bump" is created, because they do not want to wear a bra and do not want to have anything showing through their shirts.

Q: Is nipple reconstruction surgery permanent?
A: All surgery is permanent; however, surgically created nipples may flatten and tattoos may fade, necessitating additional procedures to maintain projection and color.

Q: What is the time difference for nipple reconstruction if a patient needs chemotherapy?
A: Nipple-areolar complex reconstruction is performed after the completion of chemotherapy once the patient has recovered. This is usually the last stage in reconstruction, and chemotherapy is completed at an earlier time point shortly after the initial breast cancer surgery.

Q: How long is the recovery from a nipple reconstruction surgery?
A: The recovery is rather quick. Using tattoo, the patient may return to work the following day. Using a flap technique, the recovery will depend upon where the skin graft is taken from. The newly reconstructed breast mound itself is rather insensate at the site of nipple-areolar complex reconstruction, thus discomfort is very minimal. Most flap techniques require a few days for the initial healing and then back to work. We often recommend a two- to four-week hiatus from intense exercise in order to allow the surgical scars to heal. However, walking is encouraged beginning the evening of the procedure.

Q: What are the surgical nipple reconstruction techniques?
A: The nipple itself is made from a local flap using the skin on the top of the breast. The most common techniques are the C-V and skate flaps.
The areola can be reconstructed with a full-thickness skin graft from a site remote on the body, such as the bra roll, a C-section scar, or, lastly, the inner thigh. This circular graft benefits the patient by giving the areola a topography different that the surrounding breast, and it is able to hide some of the transverse mastectomy scar, if one exists.

Q: What is nipple tattooing?
A: We use a tattoo machine to deposit color into the dermal layer of the skin to tattoo on a nipple-areolar complex. We can do this over a reconstructed nipple to add color to the existing nipple and create a surrounding areolar. We can add color and highlights to an existing reconstructed nipple-areolar complex to add color and highlights for an improved look, and we can also create a 3D nipple tattoo.

Q: What are 3D nipple tattoos?
A: 3D nipple tattoos are created using a tattoo technique that gives the appearance of the areolar complex along with a projected nipple without the projection. Therefore, women can have a projected look when they look at themselves in the mirror unclothed, but without the unwanted projection if they would like to eliminate the need for a bra under their clothes

Q: Is nipple reconstruction covered by insurance? Is nipple tattooing?
A: Yes, both surgical and non-surgical reconstruction of the nipple-areolar complex are procedures covered by most insurance companies.

Q: What is the Stony Brook difference with regard to nipple reconstruction?
A: At Stony Brook Medicine, all of our plastic surgeons are board certified in plastic surgery. They are leaders in their field and avid researchers. Some of this research focuses on nipple-sparing mastectomy, patient safety, and surgical outcomes. It allows us to incorporate the most novel surgical techniques with a safe surgical environment in order to provide our patients with the best surgical outcomes. In addition, our team at Stony Brook can provide 3D nipple tattooing, which is the latest technique for patients who are interested in this option.

Here, Tara L. Huston, MD, associate professor of surgery and member of our Plastic and Reconstructive Surgery Division, answers frequently asked questions about non-surgical facial rejuvenation.

Q: What is facial rejuvenation? Is it for both women and men?
A: Facial rejuvenation covers a broad group of surgical procedures and non-invasive treatments which are designed to make your facial skin and profile look younger and more refreshed. The techniques are commonly employed in both women and men of all ages. In fact, although often associated with women, increasing numbers of men are having facial rejuvenation procedures.

Q: What exactly does non-surgical mean?
A: Non-surgical procedures can be topical, such as creams and peels; injectable, such as toxins and fillers; or laser based, such as CO2 resurfacing. All of these procedures take place in the office setting without the need for an operating room or anesthesia. There are no incisions.

Q: How do non-surgical facial rejuvenation procedures fit in with health and wellness?
A: The goal of non-surgical rejuvenation is to improve how you look and feel about yourself. It is not meant to turn you into someone else, but to help you appear to be the best, most well-rested and refreshed version of you.

Q: What non-surgical options are available for facial rejuvenation?
A: The most common non-surgical procedures are: injection of botulinum toxin (Botox®, Dysport®) to relax muscles and smooth wrinkles; injection of soft-tissue fillers (Juvederm®, Restylane®, Radiesse®) to fill hollow areas and deep lines minimizing the appearance of aging; laser hair removal; chemical peels to smooth the skin; and microdermabrasion, also to rejuvenate the skin.

Q: Are some non-surgical options better than traditional cosmetic surgical procedures?
A: Non-surgical procedures are useful for slight changes, for maintenance of appearance and as adjuncts to surgical treatment. Traditional cosmetic surgery results in a greater degree of change, and is best after the minimally invasive procedures have been used. It also depends on the result a person is looking to achieve. This is why it is important to consult with a board-certified plastic surgeon who is well trained in all aspects of both non-surgical treatments as well as traditional surgical procedures, so that you may be offered the best possible treatment to reach your goals.

Q: Can a facelift be achieved using non-surgical facial rejuvenation procedures?
A: The so-called Liquid Facelift restores volume to areas which have hollowed, and decreases the appearance of wrinkles. It is a combination of toxins to relax specific facial lines and fillers to add volume to key areas.

Q: What is the difference between toxin and facial fillers, which both are injectables?
A: Botulinum toxin (Botox®, Dysport®) is a highly purified neurotoxin that temporarily relaxes muscles. This effect causes facial lines and wrinkles to appear less prominent. It is also used to treat migraine headaches and excess sweating in the armpits and palms. The facial fillers, composed of a naturally-occurring substance in the body called hyaluronan, actually fill tissue in order to restore lost volume, augment lips, and minimize the appearance of deep wrinkles and scars.

Q: How long does it take for the results of a non-surgical rejuvenation to show?
A: Toxins take about three to four days to work. The results with filler are immediate.

Q: How soon can one return to work after a non-surgical rejuvenation procedure?
A: There is no downtime after these procedures. Many can even be done during your lunch hour.

Q: Can makeup be applied immediately after rejuvenation procedures?
A: It is best to wait until the following day in order to apply makeup so that the injection sites may heal.

Q: Do non-surgical rejuvenation procedures produce bruises or flaws on the face?
A: Bruising is a potential after-effect of any injection. It is more common in patients who take blood thinners such as aspirin or herbal remedies.

Q: How many times can non-surgical rejuvenation procedures be repeated?
A: These procedures can be repeated as often as is needed to achieve the desired results. Toxins last anywhere between four and twelve months depending on the anatomic area. Fillers often need replenishment every nine to twelve months. They break down faster in areas that have more movement, such as right around the mouth. A board-certified plastic surgeon is the only physician trained in all aspects of both non-surgical treatments and traditional surgical procedures.

Q: How do the non-surgical methods compare with surgical methods in terms of results, cost, and duration?
A: Non-surgical methods tend to cost less than traditional surgery, allow for a quicker recovery, and produce a more subtle result. It is best to consult with a board-certified plastic surgeon to determine which procedures will allow you to achieve your goals. A cost difference isn’t worth very much if you are not satisfied.

Q: How does one maximize and preserve the results of a skin rejuvenation procedure?
A: All skin benefits from hydration, from rest, and from sun protection at all times!

Q: What is the advantage of having non-surgical rejuvenation procedures performed by a plastic surgeon, instead of a dermatologist or other kind of physician?
A: A board-certified plastic surgeon is the only physician specifically trained in all aspects of both non-surgical treatments and traditional surgical procedures for facial rejuvenation. They have the unique ability to understand and offer both sets of procedures, allowing you to benefit from exactly what you need. If a practitioner only performs injections or only performs surgery, he/she may not have the ability to offer the combination that may be best for you, in terms of your desired goals.

Q: After undergoing non-surgical facial rejuvenation, when do you recommend a patient opt for surgery (if ever)?
A: When you have optimized your improvement with injectable and other non-surgical options, but still feel you are not at your goal, it is a good time to explore surgical options.

Q: Does insurance cover any of these rejuvenation procedures?
A: No, they are considered cosmetic, and cosmetic procedures are not covered.

Q: What is the Stony Brook difference with regard to having non-surgical facial rejuvenation procedures?
A: At Stony Brook Medicine all of our plastic surgeons are board certified in plastic surgery. Our plastic surgeons are leaders in their field and avid innovators. Some of their discovery work focuses on patient safety, treatment outcomes, and cosmetic injectables. It allows them to incorporate the most novel surgical and non-surgical techniques with a safe environment in order to provide our patients with the best outcomes.

Here, Tara L. Huston, MD, associate professor of surgery and a member of our Plastic and Reconstructive Surgery Division, answers frequently asked questions about oncoplastic breast reduction. Both doctors work together often to provide this progressive care at Stony Brook Medicine.

Q: What is oncoplastic breast reduction?
A: Oncoplastic breast reduction is the combination of a traditional lumpectomy with a standard breast reduction. Lumpectomy is the surgical part of breast conservation therapy (see animation) offered to women who wish to save their breasts and avoid mastectomy in the treatment of their breast cancer.
Breast reduction or reduction mammaplasty is a procedure offered to women with heavy, large breasts (macromastia) who would like a decrease in the size of their breasts to increase their comfort.

Q: Is oncoplastic breast reduction an effective treatment of breast cancer? Have clinical trials been conducted to evaluate its effectiveness?
A: Oncoplastic reduction allows large-breasted women to have the same breast tissue removed as they would with lumpectomy. In addition, the oncoplastic reduction is followed by radiation, just as the traditional lumpectomy would be. There is no compromise in cancer care.

Q: How do the long-term results of oncoplastic breast reduction compare with other surgical options, in terms of cancer therapy?
A: In large studies comparing standard breast conservation therapy to oncoplastic reduction, comparable outcomes have been found, demonstrating the equivalent oncologic safety between the two. The difference is in the cosmetic satisfaction, which has been found to be higher in women who undergo this type of immediate reconstruction, as their breast symmetry is much improved.

Q: What are the complications associated with oncoplastic breast reduction?
A: The possible complications are similar to both the lumpectomy and the traditional breast reduction operations. These include bleeding, infection, decrease or increase in nipple sensation, wound healing issues, asymmetry, cosmetic dissatisfaction, and need for further surgery.

Q: What does the breast reduction part of the surgery involve? Are the nipples and areolae moved?
A: Prior to operation, patients are marked in the preoperative holding area with the typical breast reduction pattern markings. The patient then goes to the operating room and goes to sleep with general anesthesia. The breast surgeon begins with removing the tumor and an ample margin of healthy tissue. Oncoplasty generally involves especially good margins, which ensure adequate tumor removal. During this phase, the lymph nodes are checked as well. Either a sentinel lymph node or a complete axillary dissection can be paired with an oncoplastic reduction, depending on what is indicated. When the oncologic surgery is complete, the plastic surgeon comes in, assesses what tissue remains, and reshapes a smaller, more elevated, and naturally rounded breast. The nipple-areolar complex remains attached to the underlying breast tissue in most cases, and is moved up higher on the chest wall. If only one breast is treated for cancer, the other breast is often reduced at the same surgery. This way the patient is able to undergo removal of her cancer and complete her reconstruction in just one operation. This is all done using the patient's own tissue.

Q: What kind of scars are created by the breast reduction?
A: There are two main types of incisions used in breast reduction, the "lollipop" and the Wise or "anchor" pattern. The lollipop scar is a circle around the areola and then a straight line down to the fold under the breast, resembling a lollipop. The anchor is the same circle around the areola and straight line down. However, the line also travels along the fold under the breast. This looks somewhat like an anchor; hence, its name. The baseline shape of the breast, tumor location, and desired postoperative size will help the patient and her surgeons determine which incision is most appropriate.

Q: Who is an ideal candidate for oncoplastic breast reduction?
A: The best candidates require a large-volume resection and have symptoms of macromastia (heavy, large breasts), including chronic headaches, back pain, neck pain, shoulder grooving, or rashes under the breast. Patients with moderate- to large-sized breasts are still potential candidates. Also, oncoplastic reduction is possible in patients who have had prior breast surgery.

Q: Who is not a good candidate for oncoplastic breast reduction?
A: Women with small breasts, patients in whom it is not possible to achieve negative margins with repeated lumpectomy, and women who smoke are not good candidates.

Q: If only one breast is affected by cancer, how is symmetry with the healthy breast achieved?
A: Following completion of the oncoplastic reduction on the side with breast cancer, the opposite breast is then reduced to match in the standard breast-reduction fashion during the same operation. This way there is only one time under anesthesia for the patient.

Q: Since breasts may shrink or tighten as a result of radiation therapy, how can oncoplastic breast reduction ensure symmetry if only one breast requires radiation after surgery?
A: It is impossible to predict how a breast will respond to radiation therapy, whether or not reconstruction has been performed. That said, decrease in the size of the radiation-treated breast is more common. Therefore, we will often leave that side slightly larger in order to account for this. It is rare for a secondary operation to be required to enhance breast symmetry if changes due to radiation are marked.

Q: Is oncoplastic breast reduction only for women who have fully developed breasts? Can younger women qualify?
A: Oncoplastic breast reduction and traditional breast reduction are only possible for women with fully developed breasts. This tends to occur in the late teen years. Mostly all women who are diagnosed with breast cancer are older than this.

Q: What is the Stony Brook difference with regard to having oncoplastic breast reduction?
A: Stony Brook Medicine's breast surgeons are experts in all types of cancer surgery, and our plastic surgeons are very experienced in different types of breast reduction procedures. This collective experience translates into the best possible outcomes.

Q: What exactly is Mohs surgery?
A: Mohs surgery is the most precise way to remove a basal or squamous cell skin cancer. The dermatologic surgeon cuts out (excises) the cancer layer by layer, looking at the tissue that is removed under the microscope until the absence of all cancer cells is confirmed. Mohs surgery offers the highest potential for cure, even if the skin cancer has been previously treated by another method. Basal and squamous cell skin cancer — the two most common kinds of skin cancer — occur on the outer layer of the skin. They are most often found in areas exposed to the sun, such as the head, neck, and arms, but they also can occur elsewhere. In recent years, Mohs surgery is being increasingly used as an alternative to standard excision for certain melanomas. However, not all doctors agree on using Mohs for melanoma, which is the most dangerous form of skin cancer and can penetrate the skin deeply.

Q: Why is Mohs surgery so effective in treating skin cancer?
A: With the Mohs technique, as compared to traditional surgical removal of skin cancer, more of the specimen is able to be evaluated under the microscope. This is the best way to ensure that all of the cancer cells have been removed. The effectiveness of Mohs is near 99%, while traditional surgical removal is slightly lower.

Q: What areas of the body are treatable by Mohs surgery?
A: As Mohs is a tissue-preserving technique, it is most commonly used on areas that are of high functional and aesthetic importance such as the head, neck, hands, feet, and anogenital region.

Q: What is reconstruction following Mohs surgery?
A: The goal of reconstruction following Mohs surgery is to restore form and function to the areas which were treated for skin cancer. For this part, the dermatologic surgeons will often work in concert with plastic surgeons.

Q: What are the options for reconstruction after Mohs surgery?
A: The options for reconstruction depend on the anatomic location, depth, and extent of the Mohs defect. Reconstruction can be as simple as guiding wound healing and allowing the area to contract on its own.

Q: When is reconstruction done after Mohs surgery?
A: Reconstruction is most commonly performed the same day or the day following the Mohs procedure.

Q: How are the different reconstructive procedures done?
A: The great majority of the procedures discussed here are performed in the plastic surgeon's office under local anesthesia. Only a small handful of the cases that we do here at Stony Brook Medicine require a trip to the operating room. This can either be for patient comfort or to close a very large defect.

Q: What is the recovery time for each of these procedures?
A: With most of these reconstructive procedures, the downtime is minimal. Most patients are able to be back to their normal activities by the following day wearing just a band aid. In most cases, over the counter acetaminophen (Tylenol) is sufficient to control the associated discomfort.

Q: Is post-Mohs reconstructive surgery considered cosmetic or medically necessary?
A: When referred by the dermatologic surgeon for post-Mohs reconstruction, most insurance companies consider it medically necessary and do cover the cost of the procedures.

Q: What is the advantage of having post-Mohs reconstructive surgery done at Stony Brook Medicine?
A: Stony Brook Medicine provides comprehensive, multidisciplinary care to patients with skin cancer. We offer screening, surgery, and the option to participate in clinical trials. The availability of clinical trials serves as a hallmark of our ability to offer leading-edge treatment. Our dedicated team of dermatologists, dermatopathologists, surgeons, medical oncologists, and radiation oncologists meets frequently to review cases, and thus we ensure our patients receive all the benefits of multidisciplinary care.

Here, our melanoma surgical experts, Alexander B. Dagum, MD, and Tara L. Huston, MD, discuss what can be done to help prevent skin cancer and how to detect early signs of the disease.

Q: How do I prevent skin cancer?
A: Skin cancer is usually the result of sun exposure and blistering sunburns that occur in childhood in addition to cumulative sun exposure. The most important thing we can do is to protect our children from early sun exposure, although it's never too late to reduce your own risk for skin cancer. Eliminating ongoing sun damage is very important.

Q: Besides early sun exposure, what are some other risk factors for skin cancer?
A: Skin type has a lot to do with it. Fair skin, light hair, and light eyes are risk factors for melanoma. Sun exposure is by far the most common risk factor. The use of tanning salons is also a risk factor. Self-tanning lotions do not pose a risk.

Q: What are the symptoms of skin cancer, and what should people look for?
A: ABCDE is the key. This applies to new or changing moles. A is for asymmetry; B is for irregular borders; C is for color variation; D is for a diameter greater than 6 millimeters (about the size of a pencil eraser); and E is for evolution, or any change in a mole, including itching or bleeding. Any new lesion that bleeds or scabs and does not go away over four weeks should be brought to your physician's attention. When in doubt about a mole, get it checked out … What to look for.

Q: How often should people do self-body checks for changing moles, and how often should they get clinical checkups?
A: People should be aware of their skin and look for any changing moles on a daily basis. People who don't have any history of skin cancer should have a total body skin examination annually by a physician. People with a history of skin cancer, especially melanoma, should be evaluated at least twice a year by a dermatologist and do skin self-checks monthly. It's a lifetime of follow-up evaluations with your doctor, not just because of possible melanoma recurrence, but because of the possibility of other skin cancers as well.

Q: How can people protect themselves against the UVA and UVB rays of the sun?
A: Plan your outdoor activities before 10 am and after 4 pm. Use a broad-spectrum sunscreen with SPF of 30 or higher, and apply over all exposed skin about ten minutes before going out, and reapply every two hours, or sooner if swimming. There is also clothing that now has UV protection in them, including bathing suits for kids. And be sure to wear a hat to protect the scalp and ears. Sun-exposed areas such as the nose and ears are very common spots where skin cancer can develop.

Q: How is skin cancer treated?
A: If you have a lesion that you're worried about, the first step is to see a board-certified dermatologist, who will remove it if it looks suspicious. Most of the basal and squamous cell cancers are handled with local removal by a dermatologist or plastic surgeon, and that's all the treatment needed. If it's what we call a thin melanoma, which is less than one millimeter deep (1/25 of an inch), the treatment is removal with a margin of normal skin around the melanoma.

Q: What distinguishes Stony Brook from other centers in treating skin cancer?
A: Stony Brook provides comprehensive, multidisciplinary care to patients with melanoma. We offer screening, surgery, and the option to participate in local and national clinical trials. In addition, we conduct basic science and translational research, and also provide community education. While clinical trials are not for everyone and participation in them is strictly voluntary, the availability of these trials serves as a hallmark of our ability to offer leading-edge treatment.