Posts Tagged ‘breast augmentation’
Wednesday, July 28th, 2010
Q: I had breast implants originally done about 8 or 9 years ago and am looking to have them redone. My existing breast implants are saline 600cc and I think I am between D and DD depending on the bra. I want them increased but not sure if that is something you do? I know i would like to be DDD cup. I am a body builder and I think it would balance my shape better. Any information back would be great!!
A: Ideally, the size of a breast implant should stay within the base diameter of one’s breast. This produces the most natural looking result and also avoids the potential of the implants bottoming out over time due to loss of tissue support. That being said, some women prefer to go larger than these parameters. While some plastic surgeons have objections to that desire, my feeling is that as long as one realizes there may be a price to be paid long-term with bigger sizes (eventual removal and downsizing with breast skin reduction), then I have no objection.
Since you already have 600cc implants in place, the largest available implants are 800cc, either saline or silicone. At this size increase, that represents a 33% size increase. Saline implants can be further filled up to 960cc, representing an approximate 50% increase over your current size. At these size increases, one should definitely go with a high profile implant to get the base diameter as narrow as possible. Whether these sizes are appropriate are based on your height and chest width and breast augmentation size desires.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast augmentation, dr barry eppley, extreme breast augmentation, indianapolis, large breast implants, plastic surgery
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Tuesday, July 27th, 2010
The recent hullabaloo over the controversial Health Care Reform Act brought to the surface many pertinent issues of our entrepreneurial medical industry. While no piece of legislation will solve most of the really important problems, lost in the fray were economic and legal issues that impact more than just who pays for what and why.
A recent news story from Georgia brings to the surface one of these issues. CBS has reported that a woman almost bled to death during a surgical procedure performed by an ophthalmologist. According to their accounts, the woman awoke during the procedure and heard the doctor calling 911 for help as she was bleeding extensively.
Just this much of the story should raise two pertinent questions. The first being how do you bleed to death from eye surgery? Even the anatomically uninformed would assume there are no major blood vessels around the eye. Contrary to what one would think, he wasn’t performing eye surgery at all. He was performing breast augmentation! And the second question is how was it that she awoke to find herself in this dilemma? She was having it done in the doctor’s office. Luckily, a plastic surgeon was on staff at a nearby ER and helped save her life.
Such a story, while not common, is by no means rare. Today, every medical specialty is suffering from plummeting insurance reimbursements and skyrocketing malpractice premiums. (The Health Care Reform Act has addressed neither of these issues). This sets the stage for economically struggling doctors, and borderline unethical ones as well, to turn to more profitable fee-for-service cosmetic procedures to enhance their income. The public would assume, incorrectly, that there are laws in place to keep doctors practicing outside of their scope of training…but there are not. In most states, Indiana included, there is no law against physicians performing whatever procedure they choose, whether they have qualified training or not. All you need is a valid medical license. Because hospitals protect their own liability and will not allow doctors to perform procedures outside of their training, this can be easily bypassed by performing these procedures in their own office where the only governing body is the providing physician. There is no law against me, a board-certified plastic surgeon, performing Lasik vision correction or cataract removal in my office, even though I have no formal training to do it.
But this disturbing story does not stop there. Months after this event has occurred, the state medical licensing board refuses to suspend his medical license or has yet to even have a formal investigation. This lack of regulatory intervention is not rare. Licensing boards are shockingly slow and often very reluctant to pull any license even when the issue that is being reviewed is one of blatant disregard for the rules and does place patients at risk. The take home message is do not count or give too much credit for any governmental agency looking out for you. The legal roadblocks and delay tactics will often let a rogue doctor continue in practice for years.
The obvious message of the story from Georgia is that the burden is completely up to the patient to determine whether their physician is qualified to perform the cosmetic or plastic surgery procedures they seek. Slick-looking websites and discounted or low-fee incentives can make it easy to overlook the big picture…your safety.
Do your research and bear in mind that most, if not all, physicians in good standing will welcome your questions. An informed patient is a great patient.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast augmentation, dr barry eplpey, indianapolis, qualified plastic surgery
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Monday, July 19th, 2010
Q: My initial breast augmentation was over ten years ago. Two years later, my left breast implant suddenly ruptured. I have had my current saline Mentor Round textured implants in since then and have recently noticed some slight soreness and what seems to be a section that is possibly hardening in the center, all of this is in the left breast again. I do not want to have revision surgery if it is not necessary at this point. I realize that I will again as I am only 35. I am not against it if it is recomended now,I just want to prolong the life of my implants as long as possible. I have read that there are some asthma medications that have been used to treat early stages of capsular contracture with some success. I would like advice on treatment, either trying out the asthma medication or revision surgery or waiting it out to see. I really need advice on what is needed in my situation, an educated opinion would be greatly appreciated. I look to you because your video says you do not believe in selling the surgery, you listen and help clients make informed decisions. That is exactly what I need right now. Thank you very much.
A: Capsular contracture is far less frequent today due to improved implants and the general trend of placing the breast implant under the pectoralis muscle. Even when it was far more prevalent, what causes this excessive scarring and potential breast distortion is not well understood. When medical conditions are not well understood that usually means the treatment(s) for it does not work that well either. Capsular contraction treatment consist only of release and excision (surgery) or a drug medication. The use of Singular, an asthma medication, has been reported to have some success with preventing recurrent capsular contracture. These reports are largely anectodal and are not the result of information of a controlled clinical trial nor is it FDA-approved for this use. From those that report some success with it, it is in the use after a capsulotomy or capsule excision and is given with the intent of prevention. I am not aware that it has any effect on an ongoing or pre-exiting capsular contracture.
Because Singular is expensive and unproven in established or progressive capsular contracture, I would not recommend its use in your case. If the capsular contracture is significant, then surgery should be performed. If it is only minor, which it sounds like, then I would wait it out and see if it becomes more severe.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast augmentation, capsular contracture, dr barry eppley, indianapolis, plastic surgery
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Monday, May 24th, 2010
Q: I have breast implants originally placed in 2002. I got pregnant shortly afterwards and once I delivered my breasts changed afterwards and I developed some drooping. So I went back and had new implants placed in 2007 that were bigger and helped to fill out some loose and droopy skin. After having these implants for a while, I have decided that I want to go back to my original augmentation size. But I fear in doing so that I will get saggy breasts again. What do you recommend?
A: Going up in breast implant size is always easy because loose skin is expanded and filled out. While breast implants alone are often not the sole solution to a really saggy breast, they do help tremendously and are very forgiving of less than ideal breast skin.
Going down in breast implant size, however, is not so forgiving. Even the smallest amount of loose or droopy breast skin will get much worse as the ‘balloon deflates’ so to speak. As a result, some form of breast lift is often needed in many breast implant downsizings. What makes this aesthetically difficult is that this will involve creating breast scars which is another form of a cosmetic breast deformity.
If the nipple is fairly centered on the breast mound, a smaller implant replacement may not involve any type of lift or only a very small one such as a nipple or circumareolar type lift. If the nipple is off-center or points any amount downward, then a more significant lift with breast skin scars may be necessary when the breast implants are down-sized.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: breast augmentation, breast implants, breast lift, dr barry eppley, indianapolis, plastic surgery
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Wednesday, May 12th, 2010
Q : I had saline implants done three years ago in 2007. I had some left breast pain last night and woke up this morning with my left breast almost completely flat. I was mortified. How did this happen? I need to get my implant replaced as soon as possible. How quickly can we get this done?
A: Failure of a breast implant is a lifetime risk for anyone that undergoes breast augmentation. While everyone thinks it just happens to someone else, the statistics say that the risk is 1% per year of implantation. Failure of most breast implants occur spontaneously, meaning that there is no specific reason why or there is nothing that the patient has specifically done to cause it. It just happens from the fatigue of the implant folding back and forth.
Saline breast implants fail in a particularly dramatic fashion, known as deflation. Once the implant shell develops a hole or tear, the saline fluid comes rushing out and the breast goes partially or completely flat. This is one of the few cosmetic ‘emergencies’ that exist from a patient’s perspective.
If this should happen, contact your plastic surgeon immediately. Arrangements should be made to have replacement surgery within a few days. In my Indianapolis plastic surgery practice, we make every effort to get a patient’s deflated implant replaced no later than the next day if possible. If you have a copy of your implant size and serial numbers that is very helpful to get an exact size replacement. In the past ten years, most plastic surgeons provide a plastic card to the patient after surgery that has the lot and serial numbers from the manufacturer. This information is also very useful to find out what your warranty replacement is from the manufacturer, if the implants are not too old. (greater than 10 years)
The good news is that the breast implant replacement surgery is nothing like the original surgery. The pocket has already been made so the surgery is simpler and is comparatively painless from the initial breast augmentation surgery.
Dr. Barry Eppley
Tags: breast augmentation, breast implant deflation, breast implants
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Tuesday, May 11th, 2010
Q: I had breast implants done about 8 to 9 years ago and am looking to have them redone. Thr original size was 600cc implants. I am between D and DD cup size I think…but it depends on the bra. I want them increased but not sure if that is something you do? I know I would like to be DDD cup. I am a body builder as a hobby. I think it would balance my shape better.
A: Breast implant size is a personal choice and no one can really say what size someone should or should not be. Breast implants of 600cc size can be big or not so big depending upon whose chest they are on. For a small person this could be fairly large, for a bigger and broader-chested woman this may only be average looking in size. Most women are interested in having breasts that are in proportion to the size of their body but a few women want more than that.
Within reason, just about any breast implant size can be put in any patient. Whether that final size is in or out of proportion, or what someone really desires, is up to the patient to judge. In my Indianapolis plastic surgery practice, I try and accomodate a woman’s breast implant size desires. That being said, women should know that there are potential long-term consequences for having large breast implants. (i.e., extreme breast augmentation) Over time, the weight and size of the implant may cause tissues to stretch out and a ‘bottoming out’ of the implant may occur as the implant falls on the chest wall. This is known as loss of tissue support. This is why as a general rule it is wise to keep the base width size of the implant within the natural breast base width. Also remember, it is easy to go up in size without significant scar consequences. Should one day the desire arises to go smaller, there will be significant breast scars to remove and tighten the loose skin that the implant has created.
Dr. Barry Eppley
Tags: breast augmentation, breast implants, dr barry eppley, extreme breast augmentation, indianapolis, plastic surgery
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Tuesday, April 27th, 2010
Q: I am interested in breast implants. After I lost all my weight (was originally 198 lbs), I have a muscular body but I have NO BREASTS!!! When I was heavy, my cup size was 40D. Now I wear 32B and you can see my ribs all the way down to my stomach. I workout every other day to stay in shape.
A: One of the few negative side effects of weight loss, like pregnancy, is the loss of breast tissue and volume. The more weight that is lost, the more breast volume that disappears. This is particularly seen after bariatric surgery where the weight loss may be 100 lbs or more. Many such women end up with no breast tissue at all and just two hanging empty skin envelopes.
Breast implants will definitely provide a return of volume but the key question is how much loose skin remains. If the amount of loose skin is only moderate and the nipple position remains at or above the lower breast fold, then an implant alone will be adequate. If, however, the amount of loose and hanging skin is more significant and the nipple is below the lower breast fold or pointing downward, then a breast lift may be needed as well as a breast implant.
Breast augmentation in some weight loss patients presents challenges to the plastic surgeon than one does not usually have in the typical small-breasted female. How much loose skin exists, and the key issue of current nipple position, can turn what appears to be a simple breast implant procedure into a more complex breast implant and lift procedure.
Dr. Barry Eppley
Tags: breast augmentation, breast implants, dr barry eppley, indianapolis, plastic surgery, weight loss
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Monday, April 19th, 2010
Q: I have one breast that is quite a bit larger than the other one. I am way too embarrassed to wear a bathing suit or even go out with men for more than a couple of weeks. (I don’t let my relationships, go to the next level so to speak, in fear that the guy will totally freak out and embarrass me even more if that is possible because I already feel pretty bad about myself!) Anyway I was wondering if you could enlarge just one of my breasts?
A: While few women have breasts that are perfectly symmetric, congenital or developmental breast asymmetry is another matter. In this condition, one breast is significantly larger than the other often by several cup sizes. In its most severe form, there is a medical condition known as Poland’s syndrome where the breast and the underlying chest muscles on one side fail to develop much at all.
All forms of breast asymmetry can be significantly improved through modern breast surgery methods. In some cases, the smaller breast may be merely enlarged by the placement of a breast implant. In other cases, differential enlargement of the breasts will different implants sizes may be better.
Often times, however, the differences between the breasts is more than just that of volume. The larger or more normal breast will have more skin and a different size and position of the nipple on the breast mound. Optimal correction may require adjustment of the more normal breast as well through a lift or nipple elevation.
Dr. Barry Eppley
Tags: breast asymmetry, breast augmentation, breast implant, breast lift, dr barry eppley, indianapolis, plastic surgery
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Monday, April 19th, 2010
Q : I am interested in getting breast implants. I have been saving for years and am so excited to be close to actually getting it done. One worry I have is about the time to recover. I can’t be out of work too long. I have read from some doctor’s advertisements that it can be done with no recovery whatsoever. Is that true? How can that be possible since it is surgery?
A: Breast augmentation is definitely real surgery. While it is a cosmetic operation, it does involve lifting up your main chest muscle (pectoralis) to insert the implant underneath it. Lifting up any muscle in the body is not pain-free and does involve some recovery.
There has been a general change amongst many plastic surgeons over the past decade about what to do after breast implant surgery. In the past, there was the belief that restricting any motion of the arms and chest muscles improves healing around the implant and helps control discomfort. There has been a 180 degree change in recovery philosophy with the recognition that the fastest way to recover from a ‘pulled muscle’ is to use it rather than restrict it.
As a result, contemporary recovery techniques after breast augmentation use an aggressive physical therapy approach. Early and frequent arm range of motion and a ‘get up and go’ approach is now used. Pain medications are either not used or restricted and one begins immediate use of non-narcotic anti-inflammatory medications. From a marketing standpoint, these have become known as ‘no recovery’, ‘rapid recovery’ or ‘easy aug’ breast augmentation methods. Suggesting that there is no recovery is a bit overstated but it is certainly much easier than it used to be.
It is certainly possible today to be sufficiently recovered after breast implants to be back at a non-physical job within a few days. A heavier labor position may take a one week or two to have sufficient recovery to work unrestricted and relatively pain-free.
Dr. Barry Eppley
Tags: breast augmentation, breast augmentation recovery, breast implants, dr barry eppley, indianapolis, plastic surgery
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Monday, April 12th, 2010
Q: I am interested in getting breast implants. I am 34 years old, have had three children and my breasts are just not what they used to be. They are smaller and now droop. They are disgusting to look at and are nothing like they used to be when they were nice C cups and round. I want to get implants so my breasts can look like they did before. Is this possible?
A: The concept of looking like you did before is an understandable one but may not always be possible. The reason is that the breast skin and breast tissue you now have is different than what it used to be.
Women considering breast augmentation almost always fall into two main types; those who have always had little breast tissue whether they have ever been pregnant or not (type 1)…and those women who have lost their natural breasts and have developed droopy smaller breasts due to childbearing and nursing. (type 2) The results of placing a breast implant will be different for each type of patient. Type 1 patients will do fine with a breast implant alone and will often get the more ideal breast shape result. Type 2 patients may need a breast lift in addition to an implant to get a better shape with a good nipple position. It is this consideration of a lift and breast mound scarring that will often catch the Type 2 patient by surprise.
It is important to appreciate what a breast implant can and can not do. Implants do a superb job of making the breast mound bigger. But they have very little ‘lifting’ ability. The only lift effect that can occur is from inflation of the breast mound and this will move the nipple up a little. The operative word here is…a little. Significant movement upward of the nipple for most breast ptosis patients is a matter of at least several centimeters, not millimiters.
Dr. Barry Eppley
Tags: braest ptosis, breast augmentation, breast implants, breast lift, dr barry eppley, indianapolis, plastic surgery
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