Your Questions
Your Questions
Q: Dr Eppley I am currently in Iraq and my wife and I have been researching breast augmentation for her upon my return. She has had two children over 4 years and, as a result, has since lost much of her perkiness. She is currently 32 yrs old and is 5′ 3″ and weighs 124lbs and is a 34C. She wanting to go to a 34DD. We are currently stationed in Texas. We do not mind traveling if the price is right. If you could let me know the prices and also how long we would have to stay. We want the procedure to be done this summer but we could also wait until fall when I am on leave.
A: Thank you for your inquiry. I will have my assistant pass along the costs for breast augmentation through our Patriot Plastic Surgery program. In general, the cost is about 20% less that that of the average cost of the procedure. Several important questions to know is whether she prefers saline vs silicone implants as that has a major influence on costs of the procedure. (up to 20% in cost differential) Also with C cup breasts, having two children and having lost her perkiness, does she have any significant ptosis? (breast sagging) If she does, implants alone will not lift a breast up or move the nipples upward. Implants add volume and will only make the way her breasts look now bigger.regards. So the potential issue of a some form of breast lift may be needed although it is impossible for me to say without at least seeing some pictures of her.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hi I actually live a few hours away and before I set up a consultation, there are a few questions I have. I am currently a small A cup and am wanting to go to a C cup. I was wondering how much that would be, just an estimate is fine. I know you can’t tell me exactly and also I was wondering how the payments work and what kind of insurance you take. I have Medicaid. i hope to hear from you soon. Thank you!
A: When it comes to the expense of breast augmentation, there are numerous misconceptions about that aspect of the surgery. The cost of getting breast implants is the same regardless of the size of the implant used. Cost differences in implants do exist, but it is based on the type of breast implant selected not its size. Saline implants will cost less than silicone gel as the cost of the devices from the manufacturer is different. Many patients do finance their breast surgery through outside companies such as Care Credit. Plastic surgeons do not finance the cost of the surgery for patients nor can patients make monthly payments until their breast implant surgery is paid off. Payment for the surgery must be all paid up front which is why patients acquire the necessary funds from a financing company and pay them back over time with interest. No health insurance covers breast augmentation or any breast implant surgery unless it is associated with reconstruction from breast cancer.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I would love to have breast augmentation before my 21th birthday which is later this spring. My preferred approach would be breast augmentation with an incision through armpit area But I also considering the option of an inframammary incision using Memory gel breast implants. Which do you think would be better for me? Thank you.
A: Breast augmentation poses multiple choices for prospective patients to consider. These options are driven by implant choice which can secondarily control the placement of the necessary incision. Saline breast implants are often placed through a small armpit incision because they are inserted deflated and then inflated once into position. Silicone gel breast implants, unless they are very small, can not be placed through the ampit because they are inserted pre-filled or fully inflated. Thus, they are usually placed through a lower breast crease or inframammary fold incision.
But the incision is not the most important part of the breast augmentation procedure, the implant is. All incisions heal really well and are rarely of any secondary cosmetic consequence. Therefore, it is important to understand fully the differences between saline and silicone gel implants. While both work well and do an equally good job at making a larger breast, there are some important minor differences in them that are relevant in the long-term. This is especially pertinent to you at your young age since you will live to see them. These include such risks as implant deflation (saline) and silent rupture. (silicone) You will be replacing these implants at least once on your long remaining lifetime so understanding these differences is important to you.
Dr. Barry Eppley
Indianapolis, Indiana
Plastic surgery, unlike some medical specialties, seems to always find its way into the news. 2010 was no exception in this regard. As a plastic surgeon, most of the items that become newsworthy were an incredible mix of the freaky, incredulous and even fantastic events.
Breasts always seem to make the news and the more freaky seems to be better. Whether it is basketball-size implants of quadruple FFFF proportions, dancers subject to IRS scrutiny trying to write off their surgery, or breast augmentation as part of a marathon makeover (aka Heidi Montag), women who seek their ten minutes of fame marr the perception of an otherwise highly successful body contouring surgery. While the real breast augmentation news this coming year will be the introduction of a new form-stable (gummy bear) implants, this will likely be overshadowed by the media’s never-ending focus on celebrities, their breasts and Hollywood’s version of silicone valley.
There is always the continued incredulous news of patients suffering complications and even death at the hands of so-called cosmetic surgeons. This seems to be most evidenced with liposuction, largely due to its popularity and the larger body surface areas that it treats. There is an obvious difference in the size of the trauma to the body from abdominal and thigh liposuction from that of a nosejob or eyelid surgery for example. Liposuction attracts a large number of inexperienced and often unscrupulous practitioners because of the relative ‘simplicity’ of the procedure and easy access to new liposuction devices. It only takes a medical license and a credit card to buy the newer laser liposuction machines. Equipment manufacturers are more interested in sales than safety as evidenced by their marketing and selling behavior. Patients died last year from one coast to the other at the hands of doctors with dubious credentials. The public would think that better regulations would exist but they would be wrong. Doing your homework is your best protection.
Botox continues to show its fantastic benefits and those are not only in those worried about their frown lines or crow’s feet. Last year Botox was approved by the FDA for the treatment of migraines. For some migraine sufferers, Botox injections can be a miracle even if its effects are only temporary. The benefits of Botox have translated into an actual migraine surgery procedure developed by plastic surgeons. If Botox injections relieve one’s migraines, a relatively simple muscular decompression around the nerve trigger points can provide a more permanent amelioration of one’s migraine pain and frequency of attacks. It’s a rare example of a cosmetic treatment turning into a really useful medical or reconstructive surgery, usually that works in reverse.
One other piece of fantastic plastic surgery news from last year has been the emergence of face transplants. While once thought impossible and something more akin to a movie or science fiction, more and more partial or complete face transplants are being done around the world. While the patients who need them are last resort problems of massive facial deformities and tissue loss, that is the history also of all organ transplants which are commonplace today. From the extreme technical advances of today come spinoffs that will benefit many more facial reconstruction patients in the future.
No telling what this coming year will bring, but if past history is any predictor of future events, plastic surgery will continue to make the headlines…let us hope it is largely in the fantastic category.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I have had two babies in three years and have lost nearly 50 lbs through an aggressive diet and execise program. While I have defnitely seen some body changes, I am not happy with the way my breasts and stomach look. I thought with all of this working out that my stomach would look better. I have loose skin and stretch amrks around my belly buttonm and my breasts droop and are floppy. I have read about a plastic surgery procedure called the Mommy Makeover. What is sone in this procedure and can it be done all in one surgery. I am worried about recovery time and getting back into the gym for my workouts. Thanks!
A: The Mommy Makeover has become a popular plastic surgery procedure amongst mothers between the ages of around 25 to 45, although it can be done at any age. It has gotten this catchy name because the procedures involved help reverse the effects that pregnancy has ravaged on a woman’s body. These procedures have been commonly done for many decades so they are not new. They have just been put together and ‘packaged’ for this specific set of female body problems, that being the breasts and the stomach areas. Breasts frequently have lost volume (deflated) and sag and the tummy has loose skin and stretch marks. The combination of breast reshaping (implants with or without a lift) and some form of a tummy tuck (with or without liposuction) is the backbone of a Mommy Makeover. They are almost always done together if a patient’s economics permits. While this combination of a breast augmentation and tummy tuck will have a dramatic change on one’s body, you must tone down the concern about getting back to working out as soon as possible. This is a setup for after surgery problems. It is understandable that you have an addiction to working out as you would not have gotten this far without doing so. But that same addiction, which you think is good, is not so good after this kind of surgery. You must mentally plan on 6 weeks before getting back to working out like you are now. Remember that in a span of a few hours you are going to make changes that you can’t do by working out for the rest of your life. The risk is not worth it for a few extra workouts that, in the big picture, will gain you nothing.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am interested in getting a breast augmentation but also have concerns about my nose. I think a rhinoplasty would almost help me as much as the breast augmentation in both appearance and my self-confidence. My questions is can I do them at the same time and is there any discount on getting more than one surgery at the same time?
A: Multiple operations during a single plastic surgery encounter is very common. Since one is going to be asleep under general anesthesia, it just makes sense to do as much as is medically safe and reasonable from a recovery standpoint. I have seen all sorts of different types of plastic surgery procedures put together and there really is no limitation as to what can be combined. The only limitation is whether the plastic surgeon feels comfortable doing all that the patient needs…and that the patient is healthy and can tolerate the surgery.
Breast augmentation is a relatively short operation, generally an hour or so, while rhinoplasty can take two or three hours to do depending on what type of rhinoplasty it is. These two operations combined are well within a safe operative time period of 3 or 4 hours and can even be done as an outpatient. I have performed these two plastic surgery procedures together more than one time. Younger women are exactly the type of patient who would commonly have one or both of these cosmetic concerns.
Any time multiple cosmetic procedures are combined, there is some economy to be had in both recovery and costs.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am considering breast augmentation but am just insure about what size to go to. I have been an A cup all my life and have no real idea what would like right on me. Do you have any suggestions to offer in choosing size?
A: When it comes to breast size, beauty is truly in the eyes of the beholder. While there are certainly trends in each culture that reflect the ‘average breast size’, that has little to do quite frankly with what you want for yourself and how you want to look.
Breasts should be proportionate to a woman’s body frame and build. The historic concept of 36-24-36 inches, though quite exaggerated, basically refers to breast size being equal to the hips, with a significant narrower waist in between. This creates that classic hourglass figure but that may not be right for everyone and probably is more uncommon than common.
It is important to consider a woman’s body build in determining the most suitable breast size because if one’s arms or tummy is bulky then the breasts will have to be bigger to give the right profile. In thinner women smaller sized breasts will give the same look of fullness in the breasts.
With all of that being said, the one single parameter that seems to work for most patients is to choose a breast size (implant) whose base width matches the natural base width of your breast. This is a simple horizontal measurement. As breast implants increase in diameter as they get bigger, having an implant that is no wider than your natural breast will never give one a final breast size that is too big. (which is the most common fear of most breast augmentation patients before surgery.
Dr. Barry Eppley
Indianapolis Indiana
Q: Hi there. I read your blog about rippling in implants. I had breast implants 10 years ago and over the last few years I have noted rippling. I am not sure if I had saline implants or silicone but I want to know if it is possible to inject more saline or silicone into the implant to rectify this problem.
A: The physical characteristic of rippling in saline breast implants is quite normal. Not every women will feel the rippling unless they had scant breast tissue prior to their augmentation. It will always be felt on the side of the breast where the tissue is the thinnest. While most plastic surgeons overfill saline breast implants to lessen rippling, it inevitably occurs over time as the containment bag relaxes a little. (just like a stretched rubber band) The manufacturers generally recommend that a saline implant can be filled up to about 20% over its base volume size. (e.g., a 500cc implant can be safely inflated to 600cc)
More saline can be added to the implant at a later date through a simple procedure. This can help decrease the amount of rippling. But one has to be careful to not place too much volume as the implant can get a very hard feel which is quite unnatural.
Silicone implants generally have little to no rippling as they do not contain a liquid filler but a gel material. This reacts with the containment bag differently as is not prone to the same amount of rippling as that of saline implants.
Dr. Barry Eppley
Indianapolis Indiana
Q: I have been researching getting breast implants for some time. I know the differences between saline and silicone types of implants but am confused about these ‘gummy bear’ implants. I know it is some form of silicone but it is the best type of implant to get? Why is it different and are there any known problems with it? Is it the best type of breast implant to have?
A: The first thing to appreciate is that there are numerous type of breast implants from which to choose. They all will work and are FDA-approved with the exception of the gummy bear implant to which you refer. It has yet to be shown that there is one type of breast implant that is superior to any of the others. They all have some advantages and disadvantages and each woman has to weigh out those implant differences to determine what is the best breast implant for them. If there was one specific type of breast implant that was definitely superior that would be the only one that I would be using in my Indianapolis plastic surgery practice.
The gummy bear implant is a different type of silicone that is more firm than regular cohesive silicone gel. Hence the name gummy bear as it resembles this consistency. It is a textured anatomic implant that remains under clinical trials through the sponsoring company Allergan. It has not received FDA-approval as of yet. Because of its textured surface and its more form consistency, it must be placed through a larger lower breast fold incision than would be used for either saline or cohesive gel breast implants. Whether its added firmness is an advantage in cosmetic breast augmentation is a matter of debate. Its physical properties seem to offer advantages in breast reconstruction where the breast tissue may be thinner and more prone to contracture deformity. Gummy bear implants can and do ‘fracture’, requiring removal and replacement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, I’m 20 yrs old and currently in my junior year at college. I just found out earlier this year I have a breast deformity called ‘Constricted Breasts”. I knew something was wrong growing up when I wasn’t developing as I should. So I asked my doctors, at 18, about that, and he told me that when I get 20, my breasts should be fully developed. Well I’m 20 now, and they still look the same as they did in 7th grade. I have already tried to see if my insurance would cover a breast augmentation procedure, but they won’t, and my heart just sunk. It hurts so bad. It causes me mental, physical, and emotional pain. Just talking about it I burst into tears. My self-esteem is low, and I am not happy with the way they look and I also find myself cringing when I look down at them. I’m contacting you because I’ve seen your work here and I’m very impressed. I don’t want to seem as if I’m begging, but please, would you grant me with a free procedure? Being in a low-middle class family and in college, at times it’s really hard to make ends meet. I really don’t have anybody around me that understands the way I feel, or where I’m coming from, but you would make me smile from the inside out if you did this. I will be so blessed, and you can possibly change my life forever. From my heart, please consider this procedure for me. I can’t explain how happy I will be if you did this for me.
Thanks for your time, and I hope that for your kindness of your heart, you will make me happy.
A: I have great empathy for the concerns you have about your breasts, and wish that providing you with a free procedure were an easy choice. Given the number of women who come into our office with similar concerns about their bodies, I can understand how connected self-esteem and a positive self-image are. Providing surgery for free may seem like a simple and straightforward thing to do, but there are many factors involved that make the concept of ‘donated’ surgery not exactly free. While any plastic surgeon can give away his time at no cost, a surgeon’s fee represents just a fraction of the total costs of surgery. The cost of the breast implants, use of the operating room, and the fee for the anesthesiologist expertise are other cost factors that must be accounted for and paid. The surgery center, implant company and anesthesiologist are under no obligation to provide services and materials at their expense for a cosmetic procedure. Often times, these costs make up more than that of the surgeon’s normal fee.
One obscure but significant cost of any surgery is the potential medical-legal responsibility that exists in every state. Unfortunately, donating surgery does not equal any waiver of responsibility on the surgeon’s part. Should any untoward events happen, such as a rare but possible complication, the surgeon is still liable and responsible. The possibility exists too, for the need for revisional surgery after the initial procedure and the question then becomes is the surgeon again expected to waive his or her fees? There are no forms or waivers that a patient can sign that can legally hold harmless the physician for the services that he or she has provided.
While a plastic surgeon may choose to donate his or her skill and experience for free, the rest of the costs of surgery remain, and are usually out of the surgeon’s control.
Dr. Barry Eppley
Indianapolis, Indiana
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
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
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
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
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
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
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
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
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
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
Q: Hello, I have a few questions.I’m interested in getting my leftover fat from my entire body put into my boobs. I’d like to get my bmi to be just at 18, although it is at a 20 right now. I was just wondering if anyone would be willing to even work with me since I weigh around 115 and am 5’3″.
A: Breast augmentation using injectable fat rather than a synthetic implant remains in an ‘experimental’ or an investigative phase currently. Since it does not involve an implant and uses your own natural tissue, it is understandable to think that it is a safer and perhaps better procedure.
While fat may be natural, it is not a predictable implant material particularly in the volumes needed for breast augmentation. No standard techniques exist for fat preparation or injection methods and very different results can occur in various hands. At the least, much if not all of the fat can be absorbed rendering it a waste of time. At the worst, the fat may make the breast lumpy with cyst formations or develop sterile pools of liquid fat. What impact fat injections have on mammogram imaging and breast cancer detection remains unknown and not studied.
While much of this discussion sounds negative, the concept of using fat for breast augmentation has appeal and work is ongoing in this area. The only FDA-approved clinical trial that I know of is with the BRAVA system in which injectable fat is stimulated after surgery with an external low-level suction device. Otherwise, any clinical work that is being done is occurring in an independent fashion as an individual-precribed surgery amongst a handful of practitioners.
With the low BMI and body fat that this patient has, she would not be a good candidate for the procedure even if it was proven and widely used. A simple breast implant is so much easier and more predictable that fat injections, which for now, remain as a more complicated and morbid approach for breast augmentation.
Dr. Barry Eppley
Identity theft is a growing problem that now threatens just about everyone, even if you don’t spend a lot of time online. It is a huge problem with risks that are estimated to place most Americans as having a 1 in 4 chance of being victimized in the next five years. With credit card and social security numbers flying around in cyberspace by the billions, it is a wonder that those risks are not even higher.
Plastic surgery faces its own identity theft problem but of a different nature. In the most noteworthy case of plastic surgery identity theft to date, an American in the Middle East was recently arrested posing as a renowned U.S. plastic surgeon. Shockingly, he had operated on scores of patients in his Dubai villa. There he allegedly performed numerous cosmetic surgery procedures with primitive surgical equipment and lack of any sterile conditions. To no surprise, several of his patients (victims) have suffered serious complications requiring additional surgery and medical care.
This former Oregon physician was impersonating and using the good reputation of a plastic surgeon in Washington, D.C. who performs several surgeries per year at the American Academy of Cosmetic Surgery Hospital in Dubai. Aside from facing legal charges in Dubai, this fake plastic surgeon is wanted in the U.S. by the FBI and Interpol on charges of drug trafficking and numerous other crimes from when he held a medical license in Oregon.
While this identity theft story seems remote and far from the American medical scene, plastic surgery identity theft occurs more regularly here…but it is of a more subtle and insidious nature. With the ongoing erosion of medical fee reimbursements and increasing practice revenues and regulation demands (which is only going to continue to worsen, particularly with the passage of the new Health Care Reform Act), some physicians search for methods of cash only services. No seemingly ‘riper fruit’ currently exists than that of cosmetic services. (although weight loss is a close second) Between public interest and the all-to-willing drug and device manufacturers to sell to anyone with a medical license and a credit card, there is a dearth of cosmetic surgery providers with quite dissimilar education and training backgrounds.
While many of these cosmetic surgery ‘adopters’ are largely involved in office-based injection and laser treatments, some perform invasive surgery which is within their legal right as a licensed physician. As long as you hold a valid medical license, you can do almost anything in your office which is largely unregulated unlike a hospital or surgery center. A great illustration of this phenomenon can be read in the April 7th issue of The New York Times where a California physician (non-plastic surgeon) was interviewed touting his breast augmentation surgery technique under local anesthesia. Claiming that patients can now have a say in the breast implant selection process, he teaches weekend courses to physicians of any background (the articles states mainly family practice and Ob-Gyn docs) who are willing to pay.
The argument that women want to be awake and watch their surgery being performed is fundamentally flawed. I know of no female patients who want to sign up for that experience. But the underlying premise for such surgery under local anesthesia was not revealed in the article. Without proper training and credentials, an uunregulated office environment is the only place he could ever perform such procedures. And without an anesthesiologist, the only option is local anesthesia. Hardly good reasons for choosing a surgical method or even offering the procedure.
Dr. Barry Eppley
Breast implants are a very common plastic surgery procedure that has not waned in popularity despite the recession. While they are unparalleled in making an instant body change, they have also make news for other interesting and unfortunate reasons. In the past year, these are the noteworthy breast implant stories you may not have read.
This week a California woman was sentenced to six months in jail and required to pay monetary reimbursement for ‘stealing’ breast implants as well as other cosmetic surgery back in 2008. Under an assumed name, the 30 year-old woman used a credit line in someone else’s name to obtain $12,000 in plastic surgery which included breast implants and liposuction at a plastic surgery center in Huntingdon Beach California. She pleaded guilty to burglary, grand theft and identity theft for using another woman’s personal information to obtain the surgery. How did she get caught you may ask? Police tracked her down using the serial numbers from her old implants, which she had removed when the new ones were put in.
In a similar scenario, but much more tragic, you may remember the murder of model Jasmine Fiore last August in California. The Playboy model mysteriously disappeared and was later found mutilated. With missing teeth and fingertips, she was initially unable to be identified as was the intent of the murderer. She was later identified by something her assailant had overlooked…literally…the serial numbers on her breast implants.
Proving that many criminals are dumb, most implantable medical devices today have serial numbers for tracking purposes as an FDA requirement. Usually the benefit of them on breast implants is for replacement and warranty reasons, but they also serve nicely as a human identification method that is more precise than fingerprints or dental records.
On a happier note, it was reported that a silicone breast implant saved the life of a California woman who was shot in the chest. A woman working in a Beverly Hills dental office last July was struck by a bullet after one of the employee’s estranged husband entered the office and killed her with a handgun. On exiting, the gunman ran into another employee and shot her in the chest. Unlike her co-worker, she miraculously survived. According to the Los Angeles Times, one of her breast implants stopped the bullet and prevented any fragments from getting as far as her heart. A physician who took care of her at the hospital stated that the bullet fragments were just millimeters from her heart.
A forearms expert was later quoted as saying that the breast implant probably slowed down the bullet enough that it caused it to stop short of the heart. While its an appealing story, that is not likely. A silicone gel or saline breast implant would not slow any bullet fired at close range. Breast implants have the stopping power similar to that of Jell-O. More likely her sternum or ribs was the reason that the bullet was deterred from going any deeper. The intervening breast implant, however, is happy no doubt to take the credit.
Breast augmentation and the implants needed to do them have weaved their way into the mainstream of American society, sometimes in ways not exactly as intended.
Dr. Barry Eppley
While plastic surgery is comprised of hundreds of different procedures that are used to correct problems all over the body, they are all true medical operations and treatments. Yet some of the most popular cosmetic treatments have almost as much in common with a retail or commercial product as they do with being a medical procedure.
Botox as a non-surgical procedure and breast augmentation as a surgical operation have begun to acquire many retail product characteristics over the past decade. Both are highly marketed and promoted, so much so that few people in the world would not recognize what they are. From billboards to magazines, and endless exposure on the internet, the offering of services and the recruitment for paying customers is extensive. Some of these are from the commercial product suppliers on a national front and many others are from physicians on a local basis. Such enticements are right in line with what has also occurred in the pharmaceutical industry by the manufacturers for certain prescription medications.
Unlike most drugs, however, Botox and breast augmentation largely targets the fee-for-service customer. These are cosmetic services which are either paid for at the time the treatment is done (Botox) or some time in advance. (Breast Augmentation) With the allure of immediate cash payment comes the inevitable price war and the potential slide into a commodity service. Ads are a plenty for Botox at specific per unit prices and flat low-end fees for breast implant surgery. Dysport, the recent competitor to Botox, has offered incentives if you are unhappy with your Botox results. Breast implant manufacturers have lifelong replacement warranties and even $3500 cash for surgical costs should an implant need to be replaced in the first ten years after surgery.
But unlike most commodity services or pure retail products, these medical procedures do have other intrinsic values. It is obviously important to be able to receive these services with the lowest risk possible and be able to get the desired outcome. The intrinsic value is in the expertise and experience of whom is performing it. Lowest price for medical services is not always the best value. Price alone is not the best barometer to judge whom and where these services should be received.
Competition amongst cosmetic providers has fueled the reduction of services like Botox and breast augmentation into partial commodities. Prices amongst them in any community usually stays within a fairly narrow range as a result. Such competition is not necessarily bad. It keeps all providers sharp and makes sure that their prices, no matter how much intrinsic value they may have, stay within a reasonable range. Be wary, however, of really low prices that are different from the community average. There may be a good reason why they are priced that way and it is not usually for your benefit. You do not want inferior quality medical services when it comes to having something injected or implanted into your body.
Dr. Barry Eppley
When spring just around the corner, this is the time of year when many people start thinking about their body again. Warm weather and less clothing cause some women to think about their ‘curves’. Perhaps to the surprise of some, spring is the peak season when the greatest number of breast augmentation surgeries are done. This is a seasonal trend that is very unique to this type of cosmetic surgery.
When considering breast augmentation, most women today opt for silicone gel breast implants. Since they have become available again for human use in late 2006, they rapidly have become the preferred implant for many breast augmentations. Yet, despite FDA-approval, many patients understandably ask about their safety. Even if one was not old enough to even be aware of what transpired in the early 1990s with the previous generation of silicone breast implants, there remains some lingering concerns that are easy to find on the internet.
Since silicone gel breast implants are FDA-approved, and they would not be available if they were not, that speaks to their safety. But most do not know the extent of information that goes into that type of approval process. And because of their history, silicone gel breast implants have become the single most studied implantable device in the world. As a result, the most common questions that women may have about this type of breast implant has well known answers.
Can breast implants make me sick? In 1997, the Federal government (Department of Health and Human Services) appointed the National Academy of Science to study the likelihood of medical complications after breast implant surgery. After reviewing years of evidence and research concerning silicone gel-filled breast implants, they found that health problems such as connective tissue illnesses, cancer, and other diseases were no more common in women with breast implants than in women who had never had the surgery.
In the 1990s, thousands of women claimed that they had become ill from their implants. Some studies around that time suggested that these health symptoms of women with implants may improve when their implants are removed. We now know conclusively that this is not true. The relationship between autoimmune diseases and breast implants is coincidental…both largely occur in women between the ages of 20 to 50…but one does not lead to the other. The FDA has even gone so far as to conclude that there is link between fibromyalgia and breast implants either.
Will breast implants cause cancer? Reviews of research and medical studies on silicone breast implants show that breast cancer is no more common in women with silicone breast implants than in those without. In fact, for reasons different than one may think, women with breast implants actually have earlier breast cancer detection. This has nothing to do with the implant per se, it is a function of breast awareness. Women with breast implants are more likely to be ‘attuned’ to their breasts and how they feel.
Can I breast feed with breast implants? For the younger women, this is a frequent question. The issue is not whether one can physically do it, but will any harm come to the baby by doing so. The American Academy of Pediatrics concluded in 2001 that having silicone breast implants is not a contraindication to breastfeeding nor does it pose any health risks to the infant. Similarly, epidemiological investigations have not found any increased risk of health problems in children born to women with silicone breast implants.
Dr. Barry Eppley
Enhancing one’s bust size through breast implants today is easier than ever before!….That is certainly the marketing hype and there is a lot of truth to it. But to call the recovery after breast augmentation as….no recovery….or painless… as some advertisements suggest does not quite convey an accurate picture. All surgery induces some pain, swelling, and bruising. Breast augmentation is no different.
Breast augmentation is most commonly done today by placing the implant under your big chest muscle known as the pectoralis. (although there is a recent trend back to above the muscle for some plastic surgeons as silicone gel implants have become available again) By putting the breast implant under the muscle, it is stretched, bruised, and even some fibers are cut. This makes the muscle sore, swollen and difficult to stretch. This also makes the upper arm hard to lift up very far. In essence, breast augmentation makes the muscle stiff and sore. It is not the incision that causes any discomfort, it is the muscle.
While breast augmentation can not be completely pain and recovery free, rebounding from the surgery and getting back to normal activities definitely can be accelerated. This is made possible by doing something to the muscle after surgery…early and aggressive physical therapy. Breast augmentation physical therapy starts the night of surgery and consists of range of motion exercises of the arm. By early stretching of the arm in circles and by raising the arm from one’s side to the level of the shoulder and above, the pectoralis muscle is mobilized. Stretching helps loosen up the injured muscle fibers and prevent restrictive scar formation. The more you move, the quicker you will recover. Just like pulling a leg muscle, the earlier you begin to stretch and use it the quicker you will get over it.
This form of pectoralis physical therapy, combined with anti-inflammatory drugs such as Alleve and Ibuprofen, allows one to get moving very early. While swelling, a little bruising, and some pain can be expected, early physical therapy can lessen its effects to just a few days. Even in the worst-case scenario, one should have a significant recovery by one week after surgery.
One other helpful recovery aid I use in my Indianapolis plastic surgery practice is the ActiPatch anti-inflammtory device. This is a small battery-operated battery device that emits pulsed electromagnetic fields that penetrate the breast tissue and help reduce swelling and inflammation. I have started my patients wearing it for the first 36 hours after surgery. It is easy to wear it inside one’s bra as the loop fits over much of the breast mound.
Rapid recovery breast augmentation is a reality through a combination of early physical therapy, anyi-inflammatory medications, and the ActiPatch device. Significant recovery should now be a matter of days not weeks.
Dr. Barry Eppley
Breast Augmentation continues to be one of the most sought after of all cosmetic procedures. While the idea of making a breast larger is conceptually simple, there are several choices that women have to make. What type of implant (saline vs. silicone), what size implant, what amount of implant projection, and whether to have it placed above or below the muscle are the major decisions. Women are also interested in knowing what the experience was like afterwards. Dr. Eppley discusses breast augmentation in this Doc Chat radio show and interviews several women about their experiences and feelings about having been through the procedure. Listen to this show to hear what actual patients have to say about their breast implants and what the process was like for them!