The BRA- Thinking Big While Going Smaller

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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..

Making Sense of Brazilian Butt Lift Results

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The Brazilian Butt Lift, or “BBL”, has been quite popular over the last few years.  I did my first liposuction with fat transfer as a medical student in 1989.  It was amazing to think that you could move fat from one part of the body and have it survive and live elsewhere.

This is my 20th year in private practice, and I do between 150 and 200 BBL’s a year.  I have probably done close to 2000 by now.  Experience has taught me how to do the operation technically well, I have learned how patient care afterwards can affect the final results, and how to give a realistic expectation to a patient.  So how come some people are disappointed with the results? I have broken it down into a few categories which I will share with you.

Sometimes the response from significant other or friends and family is not as great as the patient is looking for.  You spend money and hope that the whole world will be positive and supportive.  Unfortunately, people can be jealous or cruel, and the only way to not operate on these patients is to meet there whole social circle- not practical.

Others are looking for the impossible, despite them yessing you to death when you explain the limits of the procedure.  You need to be realistic and understand what is expected if you truly want to be satisfied.  Satisfaction comes from within you, and it is a choice.

Lastly, sometimes the result is less than what the surgeon expects, given body metabolism or quality and quantity of fat.  This is an unfortunate possibility in a procedure where no matter how well the fat is placed, for some reason the body can’t support it.  I always explain this possibility.

I would say 100% of my patients have improvement, and 90% are satisfied and happy with the change.  If social support systems were good, and patients were all realistic, I think it would be 99%.  I still think it is an amazing procedure, and I love making curves.

Back to School 2016

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As the kids return to school, and teachers begin to work again, the beginning of September is a great time for me to work on learning.  After four years of college, four years of medical school, and 5 years of training in Plastic Surgery, even starting my 20th year of private practice does not mean I know it all.

Every 3 years, I must complete 150 credits of continuing medical education just to maintain my license.  In addition, to remain a Board Certified Plastic Surgeon, I have to do a Maintenance of Certification program in 10 year cycles.  This involves courses, certifications and an exam.

Next year is my exam year, and I will be doing the Cosmetic Plastic Surgery module, as that has been my sole focus for my career.  While I still remain competent in all areas of Plastic and Reconstructive Surgery, I have not performed many of the procedures in decades.

This year, I am on a mission to explore new areas of practice, as well as critically assess what I do best and where I can improve.  I have never seen a perfect result in plastic surgery, be it my own work or others.  I do not think it is impossible, but I like the challenge of getting as close as humanly possible while remaining safe.

I invite you to assess your own work, whatever it may be.  I am sure there are courses or videos that might expand your abilities, as there are for me.  Let us all return to school and learn for a lifetime.  School is definitely in session.