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Breast Enlargement
Breast enlargement, or augmentation mammoplasty, enhances the body contour of a woman who is unhappy with her small breast size. Other purposes of this procedure include:
- To correct reduction in breast volume after pregnancy.
- To balance a difference in breast size.
- As a reconstructive technique following breast surgery.
Augmentation mammoplasty is done on an outpatient basis in our surgical center, under general anesthesia. An implant (prosthesis) is placed through an incision, under the breast tissue or under the muscle. The incision can be made under the breast, around the nipple or under the arm. A breast implant is composed of an outer silicone shell filled with saline (the FDA has restricted the use of silicone gel implants). The outer surface may be smooth or textured, and implants come in various shapes to meet the individual woman's needs.
When the implant is placed sub muscularly under the breast, there is a lower chance of contracture (contraction of the tissue capsule surrounding the implant), and mammography is more reliable. There is also less risk of visible or palpable implant edges. However, some believe the implant has a more natural appearance when placed above the muscle, under the breast tissue. Your plastic surgeon can help you decide which placement and type of implant will work best.
Determining Implant Size
The shape of your augmented breasts depends on the implant. Implants may be round or teardrop-shaped (anatomical). The choice depends on the look you want to achieve: Anatomical implants produce a gentle slope, whereas round implants create a round curve in the upper part of the breast. Another factor to consider prior to surgery is breast width, which determines the amount of "cleavage" between your breasts and the outer curves, which you may want to balance with your hips.
Realistic expectations of this procedure are important. Women often think of breast size in terms of bra cup size. If you are currently a size "A" and wish to be a size "C", there must be adequate existing breast tissue coverage; otherwise you will be warned of visible or palpable implant edges and other possible risks.
Post Operative Care
You must have someone drive you home and stay with you for 24 hours after surgery. You will experience some pain the first day or two that is easily controlled with pain pills. Some tightness in the breast area is also normal as your body adjusts to the implants.
You can move about freely after surgery. Wear a bra at all times (except when showering) during the first 2 weeks following surgery. Avoid heavy lifting for 2-3 weeks. Moderate exercise such as walking or stationary biking is allowed after the third week. Vigorous exercise such as jogging or aerobics may be resumed at 4-6 weeks. You will most likely be able to return to work within a few days, but you will need to avoid any strenuous activity for at least a couple of weeks.
During recovery, the breasts will be somewhat swollen. Within a few weeks, the actual shape and size will be evident. You may notice some asymmetry; however most breasts are naturally somewhat asymmetrical.
Possible Complications
Delayed wound healing may occur in persons with diabetes, history of radiation, autoimmune disease or smokers. Other complications include capsular contracture, bleeding, infection, or irregularity of the skin. It is important to have a thorough medical evaluation beforehand to address these potential risks. You also need to know that even a small hole in an implant can cause the saline to leak out, resulting in a "flat" implant and necessitating surgical replacement.
About silicone gel implants: The FDA placed a hold on silicone implants in 1992 to further investigate their safety and effectiveness. They have since been replaced by saline (salt water) implants. There has been much discussion about the possibility of silicone and in particular silicone gel, being related to autoimmune disease. However, a large study of women with and without breast implants conducted at the Mayo Clinic showed that autoimmune disease occurred with the same frequency in both groups. It is not known what causes autoimmune diseases, seen in middle-age women.
Augmentation mammoplasty is a safe procedure that has produced pleasing and satisfying results for many women. Those who are psychologically stable and have realistic expectations benefit the most. A preliminary consultation can help you determine whether breast augmentation is right for you.
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Breast Lift
Breast lift surgery, or mastopexy, restores a more youthful appearance to a woman's breasts. Over the years breasts can lose their shape and firmness due to pregnancy, nursing and loss of skin elasticity, causing them to sag. Mastopexy will raise and reshape breasts, slowing the effects of aging and gravity. This procedure can reduce the size of the areola, the darker skin surrounding the nipple.
Mastopexy is commonly performed in conjunction with breast augmentation (implants) to increase breast firmness and size. This may appeal to women who have lost breast volume after pregnancy. Pregnancy and nursing often result in stretched skin and therefore decreased volume. If you are planning a future pregnancy, it is advisable to postpone your breast lift as pregnancy will likely cause further stretching.
As with all plastic surgery, realistic expectations and emotional stability are important. Though breasts of any size can be lifted, women with smaller breasts enjoy longer lasting results.
The Procedure
Though not a simple operation, mastopexy is normally safe when performed by a qualified plastic surgeon. Mastopexy is occasionally performed in a hospital, but more often is done in an outpatient facility. Breast lifts are usually performed under general anesthesia. Local anesthesia may be used with a sedative if the incision is small; you'll be awake but relaxed, and will feel minimal discomfort.
The surgery may take between 1 1/2 to 3 1/2 hours.
A more common approach involves an incision along the natural contour of the breast where excess skin will be removed. The nipple and areola are then repositioned. The skin surrounding the areola is brought together to reshape the breast, with stitches around the areola and the lower breast area.
Possible Complications
As with any surgery, there are possible complications. A patient may suffer an adverse reaction to the anesthesia (rare), or experience bleeding and infection following a breast lift, causing scars to widen. Poor healing and wider scars are more common with patients who smoke.
Because milk ducts are left intact, mastopexy will not affect your ability to breast-feed.
For best results, follow your physician's advice both before and after surgery.
After Surgery: What to Expect
After surgery, your stitches will be covered with gauze and an elastic bandage or a surgical bra will hold the breasts in place. Your breasts will be bruised, swollen, and you may experience some mild discomfort for a couple of days. Your doctor may prescribe pain medication. A soft support bra replaces the bandages or surgical bra after a few days. In the recovery stage, it is important to wear the bra at all times.
After a week or two, the stitches will be removed. Some noticeable, permanent scarring is normal, but easily covered by your bra or bathing suit. The scars may be red and lumpy for a few months, eventually fading and becoming less obvious. The procedure can also leave you with unevenly positioned nipples, or a permanent loss of feeling in your nipples or breasts.
To ensure proper healing, plan to stay at home for at least a week before returning to work. You will need to avoid lifting anything over your head for 3-4 weeks and avoid strenuous sports for a month.
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Liposuction
Liposuction is a very common, popular procedure. It is designed for the permanent removal of fatty tissue, commonly referred to as "cellulite." It is an elective procedure that allows the plastic surgeon to remove undesirable, subcutaneous fat in isolated areas that do not respond to diet and exercise. These areas include the hips, thighs, abdomen, knees, ankles, face and neck.
Liposuction is most successful in people with good skin tone who have fatty deposits. It is not a treatment for obesity. If weight gain occurs following liposuction, the fat will be deposited in areas that have not been treated. The procedure can be repeated, if necessary. To maintain the safety of the procedure, there is a limit on how much can be done at one time.
A variety of factors can affect the results: Physical condition, genetic makeup, diet, exercise, smoking, alcohol intake, and skin elasticity.
Body contours made irregular by fat can be improved by this procedure; it cannot correct contours that are irregular for other reasons, such as muscle weakness or hernia. However, combined with other procedures, liposuction can correct these other deformities with good results.
The Procedure
Liposuction is performed under general anesthesia on an outpatient basis. Very small cannulas are used to minimize any chance of skin ripping or indentations. All patients have this performed using the tumesient technique. Ultrasonic liposuction is used in most cases to enhance the overall result. The procedure may take an hour or more, depending on how many areas are involved.
Recovery
Recovery from liposuction is relatively easy. Expect a fair amount of swelling and bruising in the following two weeks. You will wear special garments provided to apply pressure, minimize swelling and provide support while healing. These garments also assist in retraction of the skin. Stitches will be removed in a week to 10 days.
Results are recognizable almost immediately and will continue to improve as swelling subsides. The day after surgery you should be up and walking around. Increase your activity daily until full activity is resumed at 2-4 weeks. You will be ready to return to office work in 3-5 days and more active employment at 10-14 days. Avoid the sun until all bruising has subsided. A sunscreen should be used routinely; it is easy to get sunburned during recovery because of decreased sensation.
Possible Complications
As with any surgical procedure, complications can occur. Cosmetic complications include contour irregularities, skin discoloration, asymmetry, scar tissue, tape burns, collection of blood or fluid under the skin. Uncommon complications include loss of sensation, skin breakdown, fat embolism serious infection or shock. There is a limit to the amount of fat that can be safely removed in a given procedure. Occasionally, a second procedure is required.
Following liposuction, the scar will go through a maturation process, during the first 8-12 weeks they may be red and possibly raised. The scars will mature over 6-2 months and become pale, flat and soft. You may experience numbness, burning, tingling around the incision site. These symptoms are almost always temporary.
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Tummy Tuck
Abdominoplasty, or a "tummy tuck," is designed to correct a protruding abdomen resulting from weak abdominal muscles, weight gain or pregnancy. Obesity causes the skin to lose its elasticity. These conditions may not respond well to diet or exercise if the skin and underlying muscles have been stretched.
With abdominoplasty, the abdominal wall muscles are tightened and excess fatty tissue and skin are removed to improve the body contour. The goal is a narrower, flatter abdomen. Realistic expectations are important. Abdominoplasty is not a substitute for weight loss.
Dr. Wald considers age, obesity and smoking habits when evaluating a candidate for this procedure.
Before Surgery
We will take a complete medical history and conduct a careful examination to evaluate your general, overall health. Ideally, the abdominoplasty patient has no health problems, and wishes only to remove an excess deposit of fat or loose abdominal skin. Patients on a weight-loss plan should be close to their target weight before having the operation. Women planning future pregnancies should delay abdominoplasty, as pregnancy may promote further abdominal stretching.
Photographs will be taken before and after surgery.
Antibiotics will be prescribed prior to surgery to prevent infection. To minimize the possibility of excess bleeding, you will need to avoid taking drugs containing aspirin.
The Procedure
Abdominoplasty is performed using general anesthesia. You may be given medication beforehand so you will feel relaxed. The surgery usually takes 2-3 hours, depending on the patient's overall condition. You may be released after a few hours, but are encouraged to stay overnight in our outpatient surgicenter.
The procedure is most commonly performed by making a U-shaped incision in the lower abdomen. A second incision is made around the navel. The skin and fat is then separated from the abdominal wall.
Loose, stretched out muscles are tightened with sutures, and excess skin and fat are removed. The skin is lowered over the abdomen and the navel is reconstructed. The incisions are then sutured together. Drains are often inserted to eliminate fluid buildup, and an abdominal binder is applied to the area.
Recovery: What to Expect
You may experience some discomfort immediately following surgery that can be controlled with pain pills. Some swelling is normal. You will be given special instructions for showering and changing your dressings. You may also be required to wear a support garment.
The speed of recovery varies over a 2-4 week period. Allow at least 2-4 weeks to recuperate before returning to work.
Some scarring is also normal. It often takes 3-12 months before the scars begin to fade.
Though the recovery period is longer than that of other cosmetic procedures, the rewards are great for a patient previously distressed by a protruding abdomen. Those who follow a proper exercise routine and healthy diet will benefit from abdominoplasty the most.
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Rhinoplasty
Dr. Wald performs rhinoplasty in order to reshape the nose. Appearance can be improved for those people who are dissatisfied with the shape and size of their nose. Nasal reconstruction was one of the first cosmetic procedures ever developed and is among those most frequently performed today. Rhinoplasty is a surgical procedure in which deformities of the nose are corrected by removing, rearranging or reshaping bone or cartilage.
Reasons for Surgery
Reasons include reducing the size of the nose, removal of bumps as well as improving the angle of a nose. Conditions may be natural or due to external trauma to the face. This operation will also help patients who have difficulty breathing. The operation can be performed on all age groups, including teens and the elderly.
Before Surgery
A medical history along with a careful examination is conducted in order to evaluate your general health. We will discuss with you the way your nose can look in relation to your other facial features. Pre-operative instructions may include the elimination of certain drugs that contain aspirin in order to minimize the possibility of excess bleeding. Antibiotics may be prescribed before surgery to prevent infection.
Method of Surgery
Surgery is usually performed under IV sedation, which is both extremely comfortable and results in less swelling and bruising than general anesthesia. In most cases involving a reduction in shape or size of the nose, angle or removal of a hump, the skin of the nose is separated from the underlying skeleton of bone and cartilage. The bone and cartilage are then reshaped and the skin re-draped over the surface. Patients who have a deviated septum may benefit by correction of this problem. The incisions are placed inside the nose, unless the surgeon uses an open approach, in which case the incisions are made across the tissue between the nostrils. In cases where the nostrils flare, the surgeon may make an incision at the junction between the nose and the skin of the upper lip to narrow the flared appearance. It is not unusual to combine rhinoplasty with chin augmentation to improve the profile.
Post-Operative Information
The recovery takes one to two weeks. Most people resume their normal activities within a week or two. Following surgery, a lightweight splint is applied to maintain the new shape of the nose. The splint is removed within a week. Nasal splints may be inserted at the time of surgery to protect the septum. These are removed within a week. There is always some stuffiness of the nose, especially when work has been done on the nasal septum.
Pain is minimal and is controlled with medications. Bruising occurs around the eyes, but begins to fade within a few days. Discoloration usually disappears in two weeks.
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Facelift
Facelift surgery, or a rhytidectomy, is designed to restore a more youthful appearance by removing major wrinkles and sagging skin. It involves tightening of the facial and neck muscles as well as the removal of any excess skin.
The skin begins to wrinkle and sag as a result of age, sun exposure and genetics. Children and young adults have smooth, round faces due to evenly distributed fatty tissues in facial contours. Over time, the skin sags and folds are the chin, jawline and neck become prominent. Not only does a facelift improve facial appearance but also has a dramatic effect on the neck, enhancing its contour and profile.
A facelift can make a patient look 5 to 10 years younger.
Dramatic as the end results are, this is not a simple procedure. It requires a week to 10 days of recovery.
Before Surgery
We will evaluate your medical history in order to determine your overall health.
Dr. Wald will discuss with you how your face can look and what you can expect from surgery. Our objective is to create a natural appearance that is pleasing to you. Before and After photographs will reveal what the surgery has accomplished.
Preoperative Instructions
Avoid drugs that contain aspirin several weeks prior to surgery to minimize excess bleeding. You may be required to take antibiotics to prevent infection. You may be instructed to shampoo your hair the night before surgery. A small amount of hair may be shaved around your ears and temples.
The Procedure
A facelift is frequently performed in conjunction with blepharoplasty (eyelid surgery), forehead lift, chin augmentation, and/or liposuction, to create an overall rejuvenation of the face. The procedure can be repeated as gravity continues its effects after the first surgery.
Facelifts are performed in outpatient surgical centers or in an accredited physician's office. Local anesthesia with intravenous sedation is most commonly used, with premedication to help you relax. General anesthesia is generally not required but can be used if desired.
The surgeon will make incisions inside the hairline at the temple, in front of the ear, then around the earlobe and behind the ear, ending at the scalp area. Excess skin is removed and sagging muscles and connective tissues are tightened. In some cases, fatty deposits are removed from beneath the chin and neck. Incisions are closed with small sutures.
The procedure may take up to 5 hours depending on whether any other procedures are performed at the same time.
Post Operative Care
It is necessary to have someone drive you home and stay with you for the first 24 hours. Initially you will have a large dressing wrapped around your head. You may have surgical drains attached to bulbs hanging at your neck. These will be removed in approximately 24 hours. Stitches around the ears will be loosened or removed in a few days. The scalp sutures will be removed in 7-10 days.
To minimize scarring, the doctor may remove the sutures in stages. Scarring fades quickly. Swelling and discoloration decrease within two weeks. Tightness in your face will be present for several weeks and there may be slight changes in your hair pattern around the incision.
We recommend that you avoid the sun for several weeks after surgery.
Complications following facelift are rare. These include bleeding, infection, loss of skin behind the ears, facial nerve injury, discoloration of the skin, numbness, asymmetry and scarring. Infection is rare due to the large blood supply to the face. As mentioned, the risk of bleeding is greater if you take aspirin or blood thinners within 2 weeks of the surgery. The risk of wound complications increases in diabetics, persons with a history of radiation, autoimmune and collagen disease as well as in smokers.
By following pre- and post-operative instructions, you will minimize potential problems.
Recovery: What to Expect
In the weeks following surgery, the facial skin and area around the ear may be numb. There may also be some temporary discoloration as healing begins, which may take a few months to disappear. Occasionally, the facial nerve is bruised during surgery, resulting in temporary loss of function or sensation. However, actual permanent damage to the facial nerve is rare.
The healing process is gradual, so you will not notice final results for up to 6 months. A single procedure often achieves the desired results. Most patients who have had facelifts are pleased with their new, more youthful appearance.
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Male Cosmetic Surgery
Our society places a high value on looking young and fit. Today, men of all ages and all walks of life are requesting plastic surgery for cosmetic reasons which include: a more balanced nose, a rejuvenated face, or a trimmer waistline. The procedures used to achieve these goals must take skin thickness, beard growth and body type into account.
Planning your surgery
Good communication between you and your plastic surgeon is essential. In your initial consultation, you'll be asked to explain in detail why you want the procedure and how you hope to look and feel afterward. It's important to set aside any awkwardness you might feel, and speak candidly about the changes you'd like to see. You should feel completely assured that you and your surgeon understand one another.
Your doctor will also evaluate your health, conduct a physical exam, take pre-operative photographs, and explain which surgical techniques are most appropriate for you. You'll discuss the type of anesthesia to be used, the type of facility where the surgery will be performed, the possible risks, and the costs involved. Medical insurance usually doesn't cover cosmetic procedures. However, some plastic surgeons offer special financing plans for cosmetic surgery or accept credit cards.
Tell your surgeon if any part of the consultation makes you uncomfortable, or if you have any special privacy requests. Above all, it's important to have realistic expectations about your surgery.
The surgery
Your consultation will extensively cover information on your operation. Dr. Wald will discuss a number of factors that may influence your surgery. Make sure you fully understand these considerations.
Facial surgery
If you are planning facial surgery or neck surgery, your doctor will evaluate your entire head-face-neck region. Is the hairline receding? How full are the sideburns? Does the beard-growing skin extend up the cheeks or down the neck? Are there facial scars? Is the skin sun-damaged? Is the neck skin loose or drooping? In general, male facial skin has a richer blood supply than female facial skin. Men's faces tend to bleed more during surgery and are at greater risk for forming a temporary collection or pooling of blood under the skin, called a hematoma, after surgery. Also, any residual scarring may be more difficult for men to hide, since they don't wear make-up or style their hair toward their faces, as many women do.
Hair growth and beard growth may play a major role in the outcome of a facelift.
If you are balding or have thinning hair, surgical artistry may be required to hide the facelift incision, especially in the temple area. If the hair-bearing skin of your upper neck is pulled behind your ears during surgery, you may find that you must shave behind your ears or the back of your neck. However, sometimes electrolysis can correct this problem. Be sure to discuss these possibilities with your surgeon.
A fatty or "jowly" area beneath the chin is also a concern for many men. In younger patients, liposuction alone may be sufficient to correct the problem. Older patients may require a full facelift and necklift, which may include the removal of excess skin and tightening the platysma muscles, which run down each side of the neck. These muscles are usually thicker in men than they are in women, but do not pose a greater challenge for your plastic surgeon.
"Refinishing" treatments for facial skin
Shaving must be postponed for about 3 weeks after a skin-smoothing treatment such as chemical peel or dermabrasion. Because these procedures strip away the surface layers of skin, you can expect your faces to remain sensitive, swollen and bright pink for several weeks after surgery. Some men are happy that the beard growth helps conceal the rednessóespecially if they feel uncomfortable using camouflage make-up. Men who feel self-conscious about their condition are also advised to give up alcoholic drinks for about 4 weeks. Alcohol causes the areas of treated facial skin to become noticeably red and flushed.
Changing the facial features
Cosmetic procedures such as eyelid surgery, nose surgery, and facial-implant surgery are performed essentially the same way for men and women. However, it's important to let your surgeon know if you are seeking a more masculine look to your facial featuresóa chin with better projection, more prominent cheekbones, a stronger nose.
Hair replacement
The primary consideration for men contemplating hair-replacement surgery is the time involved. Natural-appearing hair replacement usually requires multiple surgical procedures, with long recovery intervals. A full regimen of hair transplants may last anywhere from 18 months to 2 years or more. You should be aware that incisions or transplant sites might be noticeable to others, especially in the early stages of the hair transplant process. If your work or lifestyle isn't compatible with a long treatment period, ask your surgeon about alternatives to hair-transplant options, such as flap surgery or scalp reduction.
Liposuction/body contouring
The ideal male body shape is considered to be trim and athletic-looking, with broad shoulders and chest, a flat abdomen, and a narrow hip-thigh area. However, as men age, areas of fat tend to accumulate around the abdomen, the flanks ("love handles"), the breast area (a condition called gynecomastia), and along the chin and neck. Men sometimes seek liposuction to remove these fatty areas that are resistant to diet and exercise.
In many cases, liposuction alone can effectively correct these problem areas. Men retain their skin elasticity longer than women do, and the areas of fat beneath the skin tend to be firmer and more vascular. Because of these and other factors, liposuction in men is usually very effective. Men who have some loose, hanging skin as well as areas of excess fat may opt for a traditional excision procedure (surgical skin removal) in addition to liposuction. An excision may also be performed on gynecomastia patients whose breast enlargement is made up of mostly glandular tissue, rather than fat.
Abdomen reduction
A full abdominoplasty or "tummy tuck" is an option for men with hanging abdominal skin (usually the result of massive weight loss), loose abdominal muscles, and/or neglected hernias. It is a major surgical procedure that removes excess fat, tightens the muscles of the abdominal wall, and trims the waistline. Men who have a full abdominoplasty are often surprised at the long recovery period. Some patients aren't able to return to work up to 4 weeks after surgery. Men with good skin elasticity who have only a moderate amount of excess abdominal fat may benefit from liposuction alone.
Muscle-enhancing surgery
In recent years, plastic surgeons have developed ways of improving muscle contour with cosmetic implants and "sculpting" techniques. Calf implants, which were originally developed to restore leg contour in accident or polio victims, are now sometimes used to create cosmetic fullness in the lower leg. Similarly, pectoral implants, which are used to build the chests of men with Poland's syndrome, can also be used to "bulk out" the existing pectoral muscles of healthy men. A small number of doctors have begun offering their male patients abdominal etching, a new liposuction technique that creates a muscular, rippled appearance in the abdominal area. Men who consider cosmetic muscle enhancement should keep in mind that these procedures are still relatively new.
After your surgery
The days and weeks immediately following your surgery are critical to obtaining a good final result. Therefore, it's essential that you follow your doctor's instructions. This may mean taking adequate time off work; wearing bandages or tight compression garments; getting enough rest; staying out of the sun; saying no to alcohol and cigarettes; and avoiding strenuous activity, exercise, sports, and even sex.
However, plastic surgeons understand that it's sometimes difficult for men, who are programmed by society to be stoic, to remain in bed for very long or to accept help from others during recovery. Studies have shown that men often deny their pain and feel foolish about asking for help after surgery. Men who reject help may have an especially difficult recovery if post-operative depression sets in during the weeks following surgery.
To avoid post-operative problems, it's important that you arrange to have a support person available to help youóboth physically and emotionallyófor about a week after surgery. If you get the help and rest you need, you'll improve your chances of a quicker recoveryóand see your results sooner.
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Endoscopic Plastic Surgery
Endoscopic surgery has been used for decades in various procedures, including gallbladder removal, tubal ligation, and knee surgery. This type of surgery is performed with the aid of an endoscope, a special viewing instrument that allows a surgeon to see images of the body's internal structures through very small incisions. In the world of plastic surgery, endoscopic instruments have recently been introduced. Endoscopy is now being used on a limited basis for both cosmetic and reconstructive procedures.
If you have any questions concerning endoscopy, please feel free to ask the doctor.
The Endoscope
An endoscope functions as a viewing device. It consists of a tubular probe fitted with a tiny camera and bright light, which is inserted through a small incision; and a viewing screen to magnify the transmitted images of the body's internal structures. The surgeon watches the screen while moving the tube through the surgical area.
Advantages of Endoscopy
Because it involves smaller incisions, endoscopy leaves very minimal scarring. To insert the probe, only a few incisions less than one inch long are required. Shorter incisions also reduce risk of sensory loss due to nerve damage. Also, bleeding, bruising and swelling may be significantly reduced.
Furthermore, the recovery period tends to be shorter with no need for an overnight hospital stay. Many endoscopic procedures can be performed on an outpatient basis under local anesthesia with sedation.
Special consideration and risks
The endoscopic approach has only recently been applied to plastic surgery procedures. There are some known risks, which vary in severity depending on the procedure being performed. These include infection, fluid accumulation beneath the skin (which must be drained), blood vessel damage, nerve damage or loss of feeling, internal perforation injury, and skin injury.
And, keep in mind that if a complication occurs at any time during the operation your surgeon may have to switch to an open procedure, which will result in a more extensive scar and a longer recovery period. However, to date, such complications are rare, estimated to occur in less that 5 percent of all endoscopic procedures.
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