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Archive for the ‘Breast Surgery’ Category

The BRA- Thinking Big While Going Smaller

Monday, September 26th, 2016

One of my favorite operations in plastic surgery has always been Breast Reduction.  It is the only operation I still do that is not purely cosmetic.  It has been done for over 100 years, though techniques have changed.

I had always been very happy with my results, and still think my traditional breast reduction results compare to any I have seen.  The one thing I did not like, and is a limitation in breast lifts as well, is the lack of fullness in the upper part of the breast to make it seem more full and youthful.

Patients come to me because they have very large and heavy breasts, and want to remove the extra weight, and lift them so they appear more attractive.  What they want to look like is someone who had breast implants.  That’s when I got inspired.

Why not do a breast reduction and put in an implant at the same time? Breast Reduction Augmentation- BRA.  Of course, you need to be very careful technically to insure you preserve sensation and blood supply to the areaola and nipple.

I have performed the BRA about 30 times now, and have been more than thrilled with the results.  Implant selection and care with the size is crucial. I hope to publish my series soon.

So, going smaller does not mean it is necessarily a reduction alone.  Sometimes you need to go back a little farther to move ahead..

Early Results With Inspira Breast Implants

Monday, August 8th, 2016

Another breast augmentation blog!  Whenever something new comes out, I do my due diligence and report back to my patients.  When I was informed of the Natrelle Inspira line, I naturally read all I could and spoke to my implant people. I have been using these implants for 6 months, not exclusively, and find that they are not the only answer, but a very helpful tool in my implant arsenal.

Inspira is a silicone gel based breast implant of the traditional type.  It is not a highly cohesive gel, or gummy bear type.  What distinguishes it from the standard or classic gels is that the same dimension shell is filled to a higher percentage.  This results in a bit more fullness.

Inspira implants come in different profiles, which further adds to the options for custom tailoring each procedure to each patient.  I can select many different implants for the same size breast and create different looks depending on the personality and desires of each patient.

I find that for the patient who wants that little bit more upper pole fullness without looking fake, it is an excellent option.  My patient satisfaction has been extremely high so far, and I have not yet had a capsular contraction.  This most likely will happen at some point.

I would be happy to offer my advice to those of you who are considering breast augmentation.  Inspira may not be right for you, but it is worth considering.  The search for the perfect implant continues.

Aug August

Monday, August 1st, 2016

It is August already, and as Summer marches on, I am reminded of the Summer of 1998.  It was my second year in practice, and I was not as well known as I am now.  For some strange reason, I got an influx of patients for breast implant surgery.

I was so excited that my practice was growing, and that I was making it happen for myself.  With no real money and a lot of school loans, I had managed to survive a whole year as a solo plastic surgeon in Manhattan.  I could feed myself and afford rent on a one bedroom apartment outside the city.  Sadly, this was similar to when I was a resident in terms of my disposable income.

I had always been very good at selecting breast implant sizes, even as a student.  Spatially, I could see a woman and a photo of what she wanted in terms of breast size, and instantly know the implant size required.  I never use sizers during surgery, nor do I order multiple sizes for a single patient.  I had been fortunate to have a patient or two who didn’t mind sharing the fact that they had surgery with me.

It came to pass that in that month, I had a string of days where nearly all the cases were breast augmentations.  At that time, it was far and away a record for most implants in a single month.  We called it “Aug August.”

Now, I sometimes do that many implant cases in a week.  Don’t worry, the breast is yet to come.

Size Does Matter

Monday, May 18th, 2015

As I finish my 18th year in private practice at Yager Esthetics, one of the procedures I do most is breast augmentation (implants). I have placed many thousands of them, and I feel it is a procedure I do very well. Patient satisfaction is extremely high, but it is not 100%. Unfortunately, it is not due to what I do in the operating room. That would be easy to address.

While I make every effort to educate patients as to the full range of options, the risks and benefits of the surgery, and demonstrate my style of a natural looking breast in proportion to the body, some patients do not listen as well as I think they do.

I spend a long time at the initial consult informing the patient of all the approaches and implant types, as well as pointing out asymmetries and differences between the existing breasts. I let the patient make all the decisions, and then we decide if I am comfortable with those choices. At the preoperative visit, we go over all of this again, and really get into the size.

I have found the best way to gauge size is to show a series of before and afters of patients with similar bodies, and not reveal the bra size. I simply ask if they like the size, prefer bigger or smaller. Once we find this information, I tell them the approximate size they have chosen. I stress the fact that the bra size is not important, it is how they feel when they look in the mirror. With this approach, 98% of my patients are happy.

The 2% who want something else are usually not truly unhappy with the size, but unhappy in life. When the implants do not fix life’s problems, it is easier to blame the surgery than face the issues of bad relationships and personal issues. Even still, I try to help them.

Breast implant surgery in the right patient can transform your physical being, and even lift your self esteem. Size does matter, but being happy with yourself is more important.

Breast Reduction with Implants?

Tuesday, May 5th, 2015

When I first opened my private practice in 1997, the thought of putting breast implants into a woman who was having a breast reduction was ridiculous, bordering malpractice. If you have more than enough volume, just leave the right amount behind and avoid the potential complications of breast implants altogether.

As regular readers of my blog know, I am constantly reevaluating my results, in the attempt to further enhance what is possible while remaining safe. The only disappointment in breast reduction results has been a lack of fullness in the upper part of the breast, the same as in breast lift surgeries. What could I do?

I have, over the years, found that adding an implant to breast lifts increased patient satisfaction, as the breast appeared more youthful with the extra volume up top. I had corrected old overreduced breast with implants before as well. Why not add an implant to the reductions, just reducing a little more to achieve the same volume in a different distribution?

There are technical considerations, as you have to be careful with the blood supply to the nipple, and the surgery needs experience and careful planning. It costs more, and you have to consider the additional risks of having breast implants, such as leakage and hardening.

Just like in life, the things that sound crazy to you when you are young sometimes make a lot of sense as you get older.