Dr. Mukund Jagannathan

Presently Working As:

Currently, he holds the prestigious positions of Professor and Head of the Department of Plastic Surgery at LTMMC, Mumbai, and serves as a Consultant/Chief Plastic Surgeon at multiple hospitals in Mumbai including Apollo Spectra Hospital, Zynova Shalby Hospital, Surya Hospital.

His Achievements:

Dr. Jagannathan actively contributes to the field, serving on the Editorial Board of the Indian Journal of Plastic Surgery and reviewing articles for international plastic surgery journals. His scholarly achievements include approximately 35 international publications. Notably, he is an esteemed International Member of the American Society of Plastic Surgeons and a life member of APSI (Association of Plastic Surgeons of India).

Beyond the operating room, Dr. Jagannathan is a multifaceted individual. An accomplished singer and National champion in Bridge, he exemplifies a well-rounded approach to life. His diverse interests add a unique dimension to his personality, showcasing that excellence transcends professional boundaries.

Dr. Mukund Jagannathan has achieved noteworthy milestones in his career, including being honored as the Ethicon Visiting Professor of Plastic Surgery in 2011 for his outstanding contributions to academics and teaching. He has also been recognized as an expert in the field, serving as an invited speaker at conferences in Bahrain in 2006 and Muscat in 2007, where he delivered numerous presentations and educational lectures over the past decade.

In 2000, Dr. Jagannathan was awarded the Hargobind scholarship for a fellowship at the Institute for Craniofacial and Reconstructive Surgery at Providence Hospital, Southfield, Michigan, under the expert guidance of Dr. Ian Jackson.

Fellowships & Advanced Trainings:

• Fellowship for Aesthetic and Reconstructive Surgery, Michigan, USA
• Aesthetic surgery training, Manhattan EET Hospital, USA
• Aesthetic surgery training, Newport Beach Medical College, USA
• Specialized training for Body lifts in MWL patients after weight loss surgery, USA
• Aesthetic surgery specialized Training under Dr. Rollin Daniel, USA
• Plastic surgery training- Georgetown Hospital, Washington DC, USA

Memberships:

• International member of the American Society of Plastic Surgeons (ASPS)
• All India Association of Plastic Surgeons
• Association of Plastic Surgeons of India
• Association of Medical Consultants

Frequently Asked Questions:

Dr. Mukund Jagannathan addresses frequently asked questions, offering insights to enhance understanding of the subject of plastic surgery in India.

1. Why BMI is an important indicator for tummy tuck surgery?

   BMI or Body mass index is a metric that utilizes your height and weight to determine the appropriateness of your body weight. It is a very, very important aspect. To give a background, a BMI of 25 to 30 is considered as overweight, above 30 it is obese, and above 35 is considered as morbid obesity. While a BMI is not an absolute indicator of surgical procedures, please remember that when your BMI is more than 32, or 33, you are dealing with a lot of fat. Fat is not a good structure to hold sutures and there are a lot of chances of wound problems, wound disruption, small sinuses, and discharges for a long time, which are seen when you operate on a patient with a very large BMI.

   Ideally, we want patients with less than 30 BMIs, but I do realize that in many cases, this is not a very practical approach. But surgically speaking, yes, there is no doubt that the best results are those obtained when the body mass index is as close to normal as possible. Now, this is the difficulty we have in explaining to patients why they are going to get a compromised result. Though we do our best because of the body, you must respect the physiology of the body.

   You cannot make skin and fat do things that it is not programmed to do. So, when we say that you are not ready for surgery as a surgeon, please believe it. We are not trying to discourage you or postpone. We are looking at your best interest and we are looking at the possibility of giving you the best possible results. Your health and your well-being are the most important factors. I have said this enough number of times because I genuinely believe that is the bottom line.

   So, you may have expectations that are probably not achievable realistically. When the surgeon says, do not do this or wait for some time, listen to him, because our job is to operate. When we tell you that you are probably better off by waiting for some time, it must be true.

2. Which surgery should post-bariatric patients opt for? Tummy Tuck vs. Lower Body Lift.

   We are now seeing a lot of patients following massive weight loss. Most of them are following bariatric surgery procedures. Some of them are spontaneous weight loss by a very rigid diet and exercise schedule. You must understand what the deformity of massive weight loss involves. The skin has already been stretched beyond the physiological limit.

   Now, when you do liposuction on such patients, the skin has lost its ability to interact, which means that following massive weight loss, it is almost always an excisional type of surgery. When I say excisional, I mean the removal of large amounts of skin. What are the areas it affects? It affects the breasts, the arms, the upper body, the back, the waist, the tummy, the hips, the buttocks, and the thighs. Because when tissue is emptied of fat, it is going to sag.

   Gravity is the greatest enemy and is going to sag. Ideally, what we are left with is empty areas that have been completely devoid of fat, which we are now dealing only with skin excess. Now, here is where there is a very common misperception of patients. When the descent occurs in the lower trunk following massive weight loss, it descends. Imagine a lampshade. It is narrow on top and broad below.

   This is how the descent of skin and tissue occurs. So, a simple tummy tuck is not going to work for the simple reason that there is a 360-degree laxity of skin. This is something that must be understood. Only doing a tummy tuck is not going to address the laxity of the flanks. It is not going to address the laxity of the descent of the buttocks and the loose skin around the waist.

   So almost all these patients who have had significant weight loss following either bariatric surgery or otherwise need what is called a belt lipectomy or a lower body lift. These terms are frequently used together synonymously, but there are some minor differences between the two. In other words, you need to pull up the lower body as a whole and you will have a 360-degree scar. Anything short of this is a compromise.

   If the patient says, I do not want a 360-degree scar, I am willing to accept the fact that my buttocks still have dropped and they have not been raised. We can accede to their demand, provided they realize what they are going in for.

3. Which aesthetic surgery to go for post-bariatric Massive Weight Loss?

   A Body lift is the 'Go To' procedure after Massive Weight Loss. The body lift procedure is basically divided into an Upper Body Lift and a Lower Body Lift or Belt Lipectomy.

   When we talk of the upper body, the deformities of the breast are not isolated from the chest/ back. They involve the breast, the lateral chest, the upper back, and the arms. So typically, for a total trunk and breast and arms contouring, you need two procedures. And the belt lipectomy is always the start of it. It will be followed six months later by what is called an upper body lift, which deals with the breast, the upper body, and the arms, which can be combined and still manage to keep the procedure within five, five, and a half hour.

   You cannot do both procedures together because they work in different directions. The inner thighs are a third area, and invariably we have noticed that unless you are very, very fast as a surgeon, it is not possible to combine these procedures.

   So, when you are talking about massive weight loss and you want to address everything, in my mind, you are looking at a minimum of three procedures staggered over six months. The other concept about massive weight loss is that many patients do not achieve their ideal weight. This is a huge problem because the tissues are laden with fat.

   As I mentioned, liposuction is not a serious procedure. To give a result, liposuction may be added to some parts of the resection of tissues to thin the flap slightly while suturing the fat. Nature of the fat changes. It becomes stringy and becomes fibrous, and your efforts for liposuction are going to be more, which means that you can potentially cause skin damage. So, if you have not reached the target weight, we are going to have a problem, because we are never going to be able to give you the kind of result that you want. Maybe you need to revisit the bariatric surgeon and have a good look at where the procedure has not worked.

4. When to undergo Lower body lift after bariatric surgery?

   Following bariatric surgery, weight loss is a continuous process, the patients continue to lose weight as long as 18 months post-surgery. So, going by the book, one needs to wait for a minimum of 18 months post-surgery, and be weight stable for three months so that when we are planning the removal of a chunk of tissue, we are basing it on our current examination and the pliability of the scale.

   Now, were we to do it under your current weight, and later let us find out that you either put on weight or lose weight, then the results are going to change, which is why weight stability and maintenance of the weight for appropriate periods is the single greatest factor.

5. What are the benefits of plastic surgery in India compared to other medical tourism destinations?

   We are, of course, aware of the burgeoning, shall we say, medical tourism that is prevalent in several parts of the world. Now, in Western countries, elective surgery, especially aesthetic surgery, is all self-paid. And it proves to be very costly for people to spend money on this. Naturally, they start looking for alternatives. With the opening of the European common market. There are a lot of centers, even in Eastern Europe. India is a popular center. Southeast Asia, especially Thailand, and Turkey, are very popular centers.

   Now, what differentiates the quality of care in these places I really cannot comment upon. All I can talk about is the standard of care that we have available in our country. Most of us plastic surgeons are well-trained in the art and science of plastic surgery with several years of experience under our belt. Insofar as the experience is concerned, it varies from person to person.

   But overall, I would say that the standard of medical care in India, especially for medical tourism, is very high. We are not a fly-by-night operation. We are not a cottage hospital. Most of the places we operate in are dedicated sectors that take into account the needs and the sensitivities of overseas patients.

   We have a very strict protocol for infection management and management of any postoperative sequelae or complications, if they do occur. We have highly qualified specialists in other departments to take care of such patients. In addition, patients go through a very, very rigorous preoperative checkup. And only if we get 100% fitness, and they are what are called class one patients, where surgically the risk of operating is very, very minimal, only then do we even begin to undertake the procedures. We do not operate on high-risk patients because this is elective surgery.

   We do not take any chances. We are very careful about our patient screen. Many patients are on a lot of medications from before. And we diligently check with our anesthetist and our physician. About possible drug interactions that may occur because of people already taking many medications. As I said, most of us are very careful about these things. We do not compromise.

   For me, the patient's well-being comes first. The patient's health comes first. Results are relatively secondary. There are going to be some sequelae that may have to be dealt with later. We try to make sure that the patient stays here for an appropriate period, depending upon the nature of the procedure that is prescribed and we do not want the patient to go home carrying some complications which has to be dealt with at their place of residence.

   We have many, many qualified and very competent doctors who are there to help you and keep your expectations reasonable. We will do our best. Of course, we will go out of our way to help you as far as possible.

6. What can one expect from a Mommy makeover procedure in India?

   Mommy makeovers deal with the sequelae of multiple pregnancies. And as you know, pregnancy takes a toll on the lady. There are various areas which need attention. Most people have the impression that you can just operate in a couple of hours and reverse everything that has been the result of multiple pregnancies. Please understand that these changes that have taken place in the body are over a substantial period.

   We cannot just snap our fingers and say that everything is going to be corrected. Now, what are the limits to procedures? What are my safety standards? I will be very frank. I try to make sure that any surgery is not more than four and a half to 5 hours. I believe that the longer the surgery, especially when the patient is completely under anesthesia, the greater the chances of postoperative complications. Therefore, if I feel that any surgery is going beyond five and a half hours, if I am combining procedures, I like to split it up. Yes, I do understand that it can affect the budget of the patient, it can affect the stay of the patient. But I reiterate that patient safety comes first.

   Some procedures entail what is called obligatory blood loss. If you have a large tummy and you are removing a chunk of tissue from the lower abdomen, that itself contains a lot of blood and fluid. So preoperative fitness and continuing fitness for the next days are very important. So, to get back to my original topic of a mommy makeover, unless the deformity, I use the word deformity, is very mild, inevitably it leads to multiple procedures. This is what patients need to understand, that the reason we are staggering the procedures is simply for the safety of the patients, not for our convenience.

   If this is understood, it may entail a longer duration of stay. It may entail a second visit as part of another procedure that cannot be combined and work against each other, so you need to keep a gap of a minimum of six months. Sometimes some procedures need to be staggered for best results. For example, if you have a patient with a very large tummy because of a lot of fat, it is a little risky to combine extensive liposuction with a tummy tuck.

   Liposuction is almost always a complement to a tummy tuck, which is why it is known as lipo abdominoplasty. But there are certain safety limits that I do not cross, and if I feel that the volume of fat is simply too much, I have recommended in the past that we do it in stages. Again, keep in mind the idea of getting the best possible result in the safest possible way.