How do I check credentials?
important credential of a qualified plastic surgeon is
certification by the American Board of Plastic Surgery (ABPS) or
to be a fellow Royal College of Physicians and Surgeons (FRCS)
. Unfortunately, in most states any
physician with a medical license can perform plastic surgery
even if they are certified in another specialty or not board
certified at all. Contact the American Society of Plastic
& Reconstructive Surgeons at www.plasticsurgery.org
or call 800-635-0635 to verify any surgeon youíre considering
is certified by the American Board of Plastic Surgery. That way
you can find out if someone holds the proper certification and
when they got itÖ..so you have an idea of experience.
This at least lets you know youíre working with someone who
trained exclusively to, and is devoted to, doing only plastic
surgery. I hold both certifications since I got my FRCS when I
is the most common complication you've seen?
are really rare and women are generally very pleased with their
results. I have seen a few hematomas. This is a collection of
fluid or blood in the pocket, usually in the first 24 hours,
causing the breast to become swollen, tense and painful.
Thatís why we put you in a compression bra, ask that you avoid
aspirin products for 10 days before surgery and advise that you
take it easy for the first three days. The few times
Iíve seen this happen weíve traced it back to something like
taking Midol for cramps not realizing it's loaded with aspirin.
Although it's more painful than usual, most of the time the body
will absorb the fluid over time and you donít have to do
anything. However, if the swelling continued to increase or the
pain was not tolerable, you might have to go back to the
operating room to remove the fluid and relieve the pressure.
Of course, any return to the OR would mean additional expense
common is implant rupture or leaking?
everyone will need their implants replaced at some time.
We seem to see it happen around the 5-10 year mark. You
didnít do anything wrong, I didnít do anything wrongÖ. it
just happens. An implant is just like any other manufactured
device in that it has the potential (the literature says 7%) for
failure. Iíve been using saline implants exclusively since the
early 90ís. Your body absorbs any salt water that leaks out
but it means a return trip to the operating room and additional
expense, time off work, etc. By todayís standards, the implant
company provides a replacement and some financial compensation
but who knows what the policy will be in the future. There is
also an additional surgeonís fee.
about implant warranty and replacement?
most important thing is that you can provide us your implant
serial numbers. You will be given a serial number card at
the time of surgery. Put copies of this in different
places so you can always find itÖ..even 30 years later. Also,
be sure that you send the warranty papers off within the
requested time frame. By todayís standards, depending on
timing, etc., it is unusual for a patient to have much, if any,
out of pocket expense pertaining to implant
replacementÖÖ..providing they have the serial numbers.
My fee for replacement is typically 50% of the going rate for
augmentation. You pay the surgeonís fee, OR and
anesthesia and send your bills in to the implant company for
your reimbursement. You can get information regarding the
amount of your reimbursement from your original warranty papers
or off the internet.
what is an implant made of?
implant is basically an empty plastic bag filled with saline
(salt water similar to whatís in your body) at the time of
surgery. A silicon implant has silicone on the inside instead of
saline. They come in different shapes and sizes. I use a
tester implant during surgery to determine what size implant
best suits your needs.
shape of implant do you use?
shape of the breast is primarily determined by the shape of the
pocket that will hold the implant and the forces of gravity. I
use a round implant. Because of gravity, a round implant takes
on a teardrop shape regardless of itís orientation within the
pocket. We want the implant to have softness and be able to move
with your breast so itís not stitched or tethered in anyway.
Some physicians use contour shaped implants that are thinner at
the top and fuller at the bottom (teardrop shaped) but Iíve
always been concerned, and Iíve seen reports, of the rotation
of a contour implant causing an odd shape to the breast. One way
isnít wrong or right, we surgeons all have our favorite way of
doing various procedures based on our positive experiences.
do some implants look so obvious?
my opinion, this is largely due to two reasons. Letís face it,
the space on your chest I have to work with is limited by the
size of your chest, how your skin attaches to your sternum in
the clevage area and how much skin elasticity you have. If too
large an implant is used the look will always be somewhat
stuffed or over done. We can always give someone a breast
proportional and womanly but we canít do the Dolly Parton
thing, even if you wanted it. Also, to some extent, the shape
and position of the breast we start with influences the look we
end up with.
second thing is that the muscle the implant generally goes under
actually starts at the collar bone. In the early stages, when
the breast is swollen and the skin has not loosened up yet, it
tends to pancake or flatten the implant out - pushing it up
higher in the pocket than we prefer. Thatís why almost all my
patients will be asked to wear an elastic strap across the top
of the breast (on top the bra) to give downward pressure and
hold the implant in the bottom of the pocket. This isnít
comfortable, you canít wear a V-neck shirt or it will show
and, in general, patients donít like this. If you donít wear
it as directed; however, the profile might stay higher than we
like which makes the breast have a full look in the top. Most
people have to wear the strap for about two to three weeks.
donít you like the incision under the armpit, around the
nipple or in the belly button?
donít know, maybe Iím just set in my ways or old fashioned
but I really donít like the idea of doing "long distance
surgery and not being able to try on an implant." Picture
this. If I go from the armpit or the belly button, I have to
make a tunnel to the breast. Once I get to the breast area, I
pretty much have to work by feel. I have to make sure my muscle
dissection stays in the right plane, create a precise and evenly
shaped pocket, control any bleeding or oozing, insert and then
fill the implant through the tunnel then get out of Dodge. This
just seems like too much to me, all for the price of a small
scar. The only approach I use is the incision under the breast.
In my experience, this incision heals nicely, gives me great
access and visibility, has few complications or sensation
changes and I can fine tune the size by using tester implants
first instead of trying to guess what size implant is best for
you. Patients just donít complain about this small scar.
I donít like using the approach around the nipple because of a
higher chance of disturbing the sensation.
if I change my mind?
can be removed quite easily as an outpatient.
is between you and your OB/GYN. Some recommend that if you're 40
or older, itís not a bad idea.
if I get pregnant?
breast will do just what they would ordinarily. Research says
itís safe, but we recommend that you not breast feed.
long will I be at the surgery center and what do I take with me?
usually there a full morning or afternoon or however long it
takes before youíve met the criteria for discharge.
Donít wear makeup or jewelry. Wear loose, comfortable clothing
that opens up the front and slip on shoes.
I participate in sports as usual?
the initial healing period, itís life like usual. Whether you
jog, lift weights, etc., just start slow and work back up to
your regular intensity gradually. I donít see any reason
for women to work their pecs to an extreme. If you flex
the pec you may see the implant move.
all my friends and co-workers notice?
women say that nobody seemed to notice specific changes but you
may get compliments on an outfit youíve worn for years that no
one ever noticed before. You may weigh exactly the same but
someone will compliment a weight gain or loss or ask how long
youíve been working out. So
if youíre doing this for any reason other than just how
youíll feel about you, pass, because to tell you the truth,
youíre the only person itís really that important to.
I have to be concerned about cancer or other diseases?
more than usual according to the current independent research.
Recent studies have laid to rest the concerns that silicone may
be a significant health risk. Research data has shown women with
breast implants are no more likely than the rest of the
population to develop cancer, immunologic or neurologic
diseases. Itís too much to print here, but If you want more
information on the research visit www.plasticsurgery.org
and click on the Plastic Surgery Information Service page.
can I do to speed my recovery?
your chest hurts, you will have a tendency to tense up, take
shallow breaths and stiffen your upper body. It helps if you
make a conscious effort to breathe normally and relax your
much pain can I expect?
give you adequate pain medication but, just like any other
surgery, the first few days can be quite intense. After
this you may have soreness that gradually diminishes over the
next couple of weeks.
have a mitral vavle prolaspe. Is this a problem?
Valve prolaspe is not a a contraindication to surgery. You will
be given antibiotics through the IV at the time of surgery.
I have to stop my medications?
medications that concern me are aspirin products for bleeding
reasons and some antipsychotic drugs and diet pills have to be
stopped before surgery since they have the potential to make the
blood pressure drop too low when mixed with certain general
anesthetics. Also, avoid herbal remedies for three weeks before
diabetic. Is this a problem?
just means you need a little special attention.
breast sensation is a big part of my sex life. Is it
likely to change?
awhile after surgery the sensation may be heightened or dull.
This is due to the tissues being stretched. It is very rare for
anyone to have any permanent sensation change using the incision
beneath the breast.