Blog — Notes of a Plastic Surgeon

Welcome to my blog. I am a plastic surgeon in Seattle and have been in private practice since 1991. I've seen more than a few interesting faces and cases through my years spent in the exam room, the operating room and the emergency room. And I have an opinion on just about everything relating to plastic surgery (and a lot of unrelated stuff). If you like my blog, let me know. Thanks for reading! Lisa

Category: Breast Lift

Preoperative deflation of saline breast implants.

June 20th, 2013 — 10:33am

Seattle Plastic Surgeon discusses the rationale for purposefully deflating saline breast implants prior to implant removal or replacement.   Check out this recent case of mine.

Blog,   (20121009124134645) 20130607124509392Often it makes a lot of sense to deflate saline implants prior to replacing or removing them.  The case I present here shows a perfect candidate for preoperative deflation.

Her implants are old and the right one has developed a capsular contracture.  She wants the implants out and a breast lift so she won’t be saggy.  In her “before deflation” photo, it is apparent that she has a lot of asymmetry but it’s not apparent if this is just because of the implants.  I can remove the variable of the implants by deflating them.  Of course, this only works with saline implants.

“Immediately after deflation” (this is done in the exam room with a little local anesthesia and a needle and syringe), she looks really, really bad.   But…………………….

As you can see in the “3 weeks after deflation” photo, her skin has retracted a lot.   Absolutely no surgery was done.  This is exactly the same thing that happens to a most women’s abdomens after giving birth.  Immediately after deliver it’s really, really saggy but a few weeks later, not so bad.

She wanted to go ahead with the implant removal and also the breast lift.  She would have looked okay after removal without a lift but she wanted to be nice and perky and as you can see she is!  I do not think I could have achieved this result had I not done the preoperative deflation first.

This was a very, very happy ending for a patient who was terribly worried about how her breasts would look after she parted ways with her implants.

Thanks for reading and thank you to this lovely patient for her trust in me.   Dr. Lisa Lynn Sowder




Breast Implant Removal, Breast Implants, Breast Lift

I’m off to the annual meeting of the Northwest Society of Plastic Surgeons

February 15th, 2013 — 4:14pm

Seattle Plastic Surgeon will present “Breast Implant Removal and Breast Lift in the Middle Aged Patient” at the annual meeting of the Northwest Society of Plastic Surgeons.

cc middle aged woman

Implants? I am so over implants!

Tomorrow I am heading off to my favorite meeting to give a talk on the surgical treatment of women who have either physically or mentally “outgrown” their breast implants.  I see a lot of these ladies in my practice and I have been very happy with the results I obtain with doing a breast lift at the same time as implant removal.  This leaves, of course, a smaller breast but the shape is usually very nice and almost all of my patients are pleasantly surprised at the results.

Thanks for reading!  Dr. Lisa Lynn Sowder

Aging Issues, Breast Implant Removal, Breast Lift

The rolling pin test for breast sagging.

November 1st, 2012 — 4:43pm

Seattle Plastic Surgeon shares a great patient story about sagging breasts.

One thing I just love about being a plastic surgeon is all of the great stories I hear from my patients.  Some of the stuff they tell me is better than anything I could make up.  Here’s one:

Last week I had a patient come in who was interested in breast surgery.   As we were chatting, she told me that she had passed the rolling pin test.  I had certainly heard of the pencil test but not the rolling pin test.  Just to refresh your memory, the pencil test is done by placing a pencil under your breast.  It the pencil stays put when you let go, you just may need the services of a plastic surgeon. 

Will your breasts hold up this rolling pin?

Well, my patient passed the rolling pin test.  Yes, it is true;  her breasts were so saggy and heavy that they could hold up a rolling pin. 

But not for long.  She has signed up for a breast reduction which always includes a breast lift.  I am certain that she will be thrilled with her result but what about her rolling pin?  It probably appreciated the attention.

Thanks for reading!  Dr. Lisa Lynn Sowder


Breast Contouring, Breast Lift, Breast Reduction, Now That's a Little Weird

Sports bra recommendation by an athlete patient.

September 28th, 2012 — 3:56pm

Seattle plastic surgeon’s patient shares her BREST BRA EVER.

I hope she is wearing a good sports bra.

Yesterday I saw one of my patients who had undergone a breast augmentation and was now training for the Seattle Marathon which (what were they thinking?) is held the Saturday after Thanksgiving.   She was in the process of ramping up her mileage but was being careful not to ramp down her chest. 

She had gone from not needing a bra to needing a really good sports bra.  She discovered a great bra at Lululemon.  It’s called the Ta Ta Tamer II and it looks like it would do the trick on the bounciest of bossoms and it’s even nice looking.   No Brunhilda styling with this bra.

I tell all of my breast surgery patients to wear a really good bra when exercising.  It’s all about protecting that investment against the ravages of gravity.  So unless you live in the International Space Station, make sure you’ve got some great support. 

Thanks for reading.  Dr. Lisa Lynn Sowder


Breast Contouring, Breast Implants, Breast Lift, Breast Reduction, Wardrobe Observations

Introducing the Nipple Areolar Complex

August 22nd, 2012 — 10:29am

Seattle Plastic Surgeon reviews nipple anatomy and nomenclature.

The NAC a.k.a the nipple areolar complex.

 I recently saw a patient who wanted a breast lift and also  a “nipple reduction.”  Her actual nipples were quite small and what she really wanted was anareola reduction” which is often part of a breast lift or breast reduction.  

Areola is a very common word in the plastic surgery lexicon but play it in a Scrabble game and it will likely be challenged. 

So…………….. here is a little tutorial this mammary structure, the nipple areolar complex, which defines us as mammals. 

The nipple is in the center of the areola which is usually pinker or darker than the surrounding breast skin.  The nipple contains the milk ducts, which are little tubes that bring milk from the breast gland to the baby.   The areola has little muscles in it which explain how the nipple and areola can contract and relax.  The little bumps on the areola are called Montgomery’s Tubercles  They can be really prominent or almost nonexistent.   I do not know if these little bumps have anything to do with British Field Marshal Montgomery but it’s fun to think about. 

Patients, men included, can have issues with any part of their nipple areolar complex  and usually those issues can be addressed with surgery.

Thanks for reading and isn’t it great being a mammal?  I love it!  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Lift, Breast Reduction, Nipples

600% Increase in Body Lifts in the Past Decade

March 10th, 2012 — 1:12am

Seattle Plastic Surgeon’s hunch confirmed by recent report – body lifting is in demand.

I really, really like doing body contouring procedures on patients after massive weight loss.   There are many, many types of lifts that are done below the neck.  They include:  lower body lift, flank lift, mons lift, brachioplasty (upper arm lift), thigh lift, breast lift, buttock lift and tummy tuck which is sorta kinda a lift. 

These procedures make such a huge difference in both how the patients look and feel.  Many of these patients, despite being at or close to their ideal weight, still feel obese because of all of the excess skin and sags and bags.

It’s a good thing I like doing these procedures because according to the American Society of Plastic Surgeons, these sorts of lifts have increased 600% over the past 10 years.  The reason, of course, is the obesity rates have gone up as thus the incidence of formerly obese patients has gone up.  

 About 1/2 of my massive weight loss patients have had weight loss surgery.  The other half have accomplished their weight loss through huge and profound permanent lifestyle changes usually with the help of a peer support group such as Weight Watchers or Overeaters Anonymous. 

I feel very, very privileged to help these patients finally achieve their personal best after they have suffered so much from their obesity and have worked so very, very hard to improve their health and their appearance.  I say, keep ’em coming! 

Thanks for reading.  Dr. Lisa Lynn Sowder

Body Contouring, Breast Contouring, Breast Lift, Obesity, Tummy Tuck

Tuberous breast deformity

January 26th, 2012 — 11:15pm

Seattle Plastic Surgeon blogs about the psychological burden of tuberous breast deformity.

Tuberous breats - Seattle Plastic Surgeon has a lot of experience.
The tuberous breast is characterized by “puffy” and enlarged areolas, a pointy shape with a constricted breast base. They can come in any size, from extra small to really large. Also, breast asymmetry is very common in patients with tuberous breasts.

I do a lot of breast surgery and I spend a better part of my day looking at breasts.  Just like my patients, breasts come in all shapes and sizes.

One breast issue that I see from time to time is called tuberous breast deformity.  I have also heard it called tubular breast deformity.  This problem does not become apparent until a girl starts developing with puberty.  It is not uncommon for pubertal girls to be very, very modest and embarrassed with their development, even with sisters, friends and mothers.  So many young women with tuberous breasts haven’t shared their problem with anyone and have just managed to choose clothing, bras and swimsuits that hide their tuberous breasts.  I have seen young women in their 20’s and even 30’s with this “secret” and I have seen the psychological damage that tuberous breasts can cause.

Tuberous breasts is a problem that gets very little attention in the popular culture or even the medical culture and often patients with tuberous breasts feel very isolated and think that they are the “only one” with this deformity.  That is until they come in and see me and I can tell them that I see this condition many times a year and that they are, in fact, not alone.

Treatment of this condition is always surgical and treatment varies depending on the severity of the deformity, the size of the breasts and the patient’s desires.  I have never seen a tuberous breast that I could not make a lot better.  Not perfect, but a lot better.

The surgery usually consists of treating the deficient base of the breast with an implant or fat transfer and then addressing the pointy and droopy shape and the puffy areola with some type of breast lift.  In some cases, only a lift is needed to rearrange the breast tissue and reshape the nipple.

My tuberous breat patients are some of my most gratifying patients.  It is so wonderful to see these women actually enjoy shopping for a bra or swim suit.  I have seen some young women go from being very, very shy and self conscience to being confident and happy with their bodies.

I just wish that this problem would get a lot more attention.  Maybe this blog will go viral?  Who knows.  Spread the word and thanks for reading.  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Lift, Nipples

Breast implant removal and breast lift – one of my favorite ways to spend a morning.

January 24th, 2012 — 10:23pm

Seattle Plastic Surgeon warns women of a certain age:  Breast implants that made you look voluptuous 20 years ago may  be making you look matronly today. 

I think she has crossed the line to matronly. Implant removal and a breast lift can take a lot of bulk off the chest and years off the postmenopausal figure.

 Recently I have had several ladies come in with implants that are no longer enhancing their figures.  These ladies are all  several years postmenopausal and even without overall weight gain, have added a cup size or two to their chests.  This is often how weight redistributes after menopause.  Don’t ask me why.  It just happens. 

In these cases, it is often beneficial to remove the breast implants and do a breast lift.  Many, many of these patients have enough breast tissue to leave them with a B, C or even D cup.  And to think that they started out flat chested so many years ago!  Crazy, huh?

Doing implant removal and a lift unloads the chest and makes the torso look much slimmer (much the way a breast reduction does in a lady who carries some extra weight around the middle).  These patients are often just thrilled to look slimmer and have their breast be “the real thing” after having implants for so many years. 

Also, since implants don’t last forever, removing them provides a lot of peace of mind.  Very few ladies over 60 relish having a new set of implants and then thinking about another new set at 80!

Now if I could just figure out a cure for the postmenopausal weight redistribution, I could retire and buy that little island in the Caribbean. 

Oh, never mind.  I love my job and I’m sure I would be bored to death.

Thanks for reading.  Dr. Lisa Lynn Sowder

Aging Issues, Breast Contouring, Breast Implant Removal, Breast Implants, Breast Lift, Plastic Surgery

I promise I won’t drop your nipple on the floor. I couldn’t if I tried!

January 17th, 2012 — 12:40am

Seattle Plastic Surgeon assures her breast lift patients that the nipple never leaves the breast.  It would be impossible to drop it on the floor.

I saw a patient today who was worried about what could happen to her nipple during a breast lift.  She thought we actually removed the nipple from the breast and then sutured it back into a higher position.  This is a very common misunderstanding of how a breast lift works.  Take a look at these illustrations that show how the nipple (actually the nipple areaola complex or NAC) stays attached to the breast tissue.


Preoperative markings for a vertical breast lift.

The outer layer of skin around and below the NAC (nipple areolar complex) is removed.

The breast tissue is loosened up from the overlying skin. The NAC stays attached to the breast tissue.

This is the "Stuff" step in what I call my "Stuff and Tuck" breast lift. The NAC is still happily attached to the breast.

This is the tuck part of the "Stuff and Tuck" Vertical Breast Lift

The incisions are closed and the nipple is inset with stitches. The skin has shifted and the breast tissue has shifted carrying the NAC with it. The NAC has stayed attached to the breast tissue the entire time. Most of the nerves and blood vessels to the NAC are undisturbed.

 So there you have it; the “Stuff and Tuck” Vertical Breast Lift.  So no more worries about the nipple being dropped, thrown away by mistake, mixed up with the other nipple, etc.  It never leaves the breast just like my fingers never leave my hands.  I know these illustrations make it look kind of easy but I don’t advise that you try this procedure at home.

Kudos to Dr. Michael J. Brown of Virginia for these awesome illustrations.  They are the best I have seen.

Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Lift, Nipples, Now That's Cool, Plastic Surgery

Weight loss victories

November 10th, 2011 — 8:29pm
Permanent weight loss – here’s what I’ve learned from my patients

How to lose weight for good according to Dr. Lisa Lynn Sowder’s weight loss patients.

I am a bit of an expert on weight loss, not because I have ever had major weight loss, but because I know so many patients who have and have been able to maintain their weight loss.  These are patients who come to me for body contouring procedures such as abdominoplasty, breast lift, upper arm lift, thigh lift, flank lift, lower body lift and so forth.   


I always ask them how they managed to finally lose the weight and keep it off.   I ask them to go into some detail.  This is not because because I want to write the next “diet bestseller” and buy a small island in Greece (although that would be nice) but because I want to pass on their secrets of success to other patients who struggle.

 About 40% of my weight loss patients have undergone weight loss surgery.  That’s another blog.  The other 60% have done it through life style changes. Here is what that 60% have told me:

  • Without exception, they have all sworn off sweets and refined carbohydrates.
  • Many have embraced a very low carb diet – think Adkins  diet.
  • Almost all have maintained regular aerobic exercise – walking and biking are the most popular with my patients.
  • Many of my patients have been helped with support groups such as Overeaters Anonymous, TOPS, and Weight Watchers.
  • A few of my patients have been helped with nutritional guidance from a physician or nutritionist.
  • I cannot remember a patient who mentioned a prepackaged food or liquid diet system. 

And here are a few patients I will never forget:

  • One gentleman lost 60 pounds when he quit drinking with the help of Alcoholics Anonymous.
  • One lady was able to stay 180 pounds overweight despite her gastric bypass through continuous and careful overeating.  She finally dropped her weight 150 pounds when she addressed her emotional issues with a psychologist and the help of Overeaters Anonymous.
  • One lady lost over 100 pounds by jogging.  She started really, really slow and got faster and faster as she lost weight.   She became addicted to a runners high which I guess is better than most addictions.
  • Several of my patients were able to slim down only after leaving a dysfunctional relationship.
  • One teenager lost 40 pounds just by giving up soda.
  • One lady in her 60’s lost 100 pounds after having bilateral knee replacements.  She had been very, very sendentary and once pain free,  became more active.

So there you have it folks; Dr. Sowder’s  Guide to Slow, Deliberate, Difficult, Soul Searching, Sweating, Hungry but Long Term Weight Loss.    Just think, I could have written that best seller and here I am just giving it away.

Thanks for reading.  Dr. Lisa Lynn Sowder



Body Contouring, Breast Lift, General Health, Obesity, Plastic Surgery, Tummy Tuck

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