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 Reduction


May 14th, 2017 — 7:00pm

motherhoodSeattle Plastic Surgeon Discusses Mommy Makeover on Mother’s Day

Ah, the joys of motherhood! I can wax eloquently about fat little feet, apple cheeks, wet baby kisses and so on but one of the joys I did not expect was a boost in my Plastic Surgery practice, especially my “mommy makeover” patients. Since becoming a mother myself, I speak “mommy” really well. I know first hand the glorious details of feeding, bathing, changing, and schlepping the baby. I can recite the stages of the toddler, the preschooler, the gradeschooler, the tween, the teenager and currently I am becoming an expert on the joys of being the mother of young adults.  

Being familiar with all that being a mother requires makes me much better at counseling patients about the process and timing of a “mommy makeover”.

“Mommy makeovers” usually combine breast surgery (augmentation and/or lift or reduction) with body surgery (usually abdominoplasty and/or liposuction). Most women are healthy enough to have a combination of procedures during one operative session. It is, however, the first couple of post operative weeks that are the most challenging for the patient.

Mommy is used to taking care of everyone but herself. After surgery the Mommy needs to take of only herself. She needs to be “Queen for a Week or Two” and resist the urge to cook, clean, change, wipe, mop, vacuum, load, unload, fold, etc. And if her youngest weighs over 20 pounds, she may not pick him/her up for at least two weeks if breast surgery was done and for at least six weeks if an abdominoplasty was done. The little one can crawl into Mommy’s lap for a cuddle but NO HEAVY LIFTING for Mommy. This also applies to the dog.

It’s very important to for patients to discuss these issues with their families. I’ve had a few ladies who have underestimated their recovery time, have done too much too soon and have turned what should be a relatively comfortable and relaxing recovery into a very sore and frustrating one.

So, calling all mothers interested in a “mommy makeover”: Plan ahead and get your husband and your children and your friends on board. Make a sign for your bedroom door. “DO NOT DISTURB – MOMMY RECOVERING”.

Body Contouring, Breast Contouring, Breast Implants, Breast Lift, Breast Reduction, Mommy Makeover, Plastic Surgery

What breast shape do you like?

June 5th, 2014 — 2:38pm

Seattle Plastic Surgeon explains how different breast implants influence breast shape.

Take a look at these different breast shapes.  It is important to know what type of shape a patient prefers when doing a breast augmentation consultation.  The size and shape and projection of breast implants influences the final shape of the breast.  Other factors include the original size and shape of the breast and whether or not a lift will be done.

The French Breast.  If a woman likes this shape, she may do really well with just some fat transfer to boost her maybe a cup size and fill in the upper part of the breast just a little bit.  The French Breast can impersonate a Could Have Occurred In Nature breast with a well fitted and lightly padded bra.  Oo, la, la.

Let’s Stop Traffic!  This shape will likely require either a medium or high profile round  implant.  These implants give a big boost to the upper pole of the breast.  Some women like this look.  Most men like this look although not all men will admit to it.

Could Have Occurred in Nature.  This shape is likely to be achieved with a medium profile implant.  This provides a nice full slope to the upper breast but not a bulge.  Ladies with this shape of breast can get Let’s Stop Traffic! with a push up bra.

Tennis Anyone?  This sporty shape is most likely achieved with either fat transfer or a low profile implant.  This breast has some medial fullness to get a little cleavage and some lateral fullness to balance the hip but does not have a lot of projection.  This shape may also be achieved with a breast lift or a breast reduction.   This breast shape is preferred by many mature ladies because big, projected breasts make most mature ladies look (gasp) fat.


breast shapes

The French Breast——–Let’s Stop Traffic!———Could Have Occurred In Nature——–Tennis Anyone?

So there you have it, Breast Enhancement 101 on a single blog entry!  When I see patients in consultation, I try to show them lots of examples of my work to get an idea of what they like and to give them an idea of what I can do.

Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Implants, Breast Lift, Breast Reduction, Fat Transfer to the Breast

Marijuana and gynecomastia. Is there a link?

March 6th, 2014 — 1:13pm

Seattle Plastic Surgeon riffs on the possible link between gynecomastia and marijuana use.

blog pothead

“Gyneco what? Oh, well. Pass the Doritos.”

Okay, full disclosure here.  This is just my theory.  It is based on nothing more than urban myth from my high school days and wishful thinking.

The yearly procedural statistics published by the American society of Plastic Surgeons (ASPS) recently came out and one of the procedures with a significant increase in frequency was the correction of gynecomastia otherwise know as male breast reduction.   This procedure was up 11% between 2012 and 2013.  This got me wondering about an urban myth from my high school days that marijuana use causes gynecomastia.  A little research online did not come up anything really convincing but there are studies that show regular toking decreases testosterone levels in men.

If, in fact, regular marijuana use does cause gynecomastia, I better look into getting some more operating room time.  Seattle was the epicenter for recreational marijuana legalization and in the very near future anyone over 21 will be able to walk into a “Green Boutique” and make a purchase.  Seattle is already the home to about a bajillion medical marijuana shops and from the fragrance I smell when I’m walking in downtown Seattle, there are a lot of people carrying one of those “green cards” in their wallets.  And soon, they won’t even need one for a purchase.

I am really, really hoping that the gynecomastia/marijuana connection is real.  I really like doing gynecomastia surgery and I’ve been telling my seventeen-year-old twin sons about the connection for several years.  I don’t want it to turn out to be just another “dumb thing Mom says to scare us.”

Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Reduction, For Men Only, General Health

Recent breast reduction article makes me wanna holler.

September 4th, 2013 — 1:24pm

Seattle Plastic Surgeon takes umbrage at recent article in the Journal of Aesthetic Surgery.

Illustrations and photos showing three breast reduction techniques.

Illustrations and photos showing three breast reduction techniques. The top technique is a horizontal breast reduction, the middle is a Weis pattern breast reduction and the bottom is a vertical breast reduction.

I came across this article in the August 2013 Aesthetic Surgery Journal.   I must share this article with my readership because I think it presents some astonishing flawed logic about prodedure selection.

Let me walk you through it: Prospective patients were given illustrations of  3 breast reduction techniques emphasizing the scar placement and were also shown early postoperative photos of  the techniques.  Early is important because early on, scars are red and obvious.   Most prospective patients prefered a technique that did not involve a vertical scar from the nipple to the bottom of the breast.  Not a big surprise.  Of course women would prefer to have well hidden scars.

Here’s the kicker:  First of all, almost all these scars will fade within a year of surgery and in many cases be almost invisible across a room. Second of all, take a look at these breast shapes.  The top case shows a really boxy shape that will only get boxier with time.  Yeah, the scars are hidden under the breast but the shape is bizarre.  The middle case has better shape but still a little boxy and again, this will get worse with time and gravity.  The bottom case shows the technique that I almost always use – the vertical breast reduction.  Yes, there is a vertical scar but look at the shape.  The breast is round and contoured the way a breast should be.  And because of where the excess breast tissue is removed and how the resultant breast is shaped, this vertical technique holds up much better over time compared to the other two techniques.

The author of this article thinks the top technique, the horizontal breast reduction,  is a good  technique because patients prefer not to have a vertical scar.  This is such flawed logic because the scars fade and the horizontal technique leaves such a weirdly shaped breast.

In breast and body contouring, it is shape and contour, not scar length or scar position that is the most important.  And we surgeons have a fiduciary duty to educate our patients on the trade offs between scars and shape and contour.  I can’t imaging any patient prefering a result like the top case over the result in the bottom case regardless of the scars.

I feel so much better getting this off my, er, chest.  Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Reduction

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

Fat Necrosis: it looks and sounds worse that it really is.

August 24th, 2012 — 9:52am

Seattle Plastic Surgeon explains fat necrosis.

Fat necrosis often gets much, much better with a little tincture of time and usually does not require reoperation.  It occurs most frequently in overweight patients who have a thick layer of fat.

     Recently I re-operated on an abdominoplasty patient of mine for fat necrosis.  The term, fat necrosis, sounds so awful that I am compelled to blog about this uncommon and totally manageable problem that can occur after any surgery that removes and/or rearranges fat. 

     Fat necrosis occurs when the blood supply to the fat is inadequate.  The fat cells die and as they die they release fatty acids and other chemicals that causes inflammation and swelling and sometimes pain.  Usually fat necrosis presents as a non-tender lump but in my patient’s case, the area was quite painful. 

     Fat necrosis can look a lot like a wound infection to the patient.  Diagnosis is made by evaluating the patient for other signs of infection such as fever or chills and examination of the surgical site.   Fat necrosis has a very doughy texture.   It feels just like bread dough under the skin and is rarely very tender.

    In most cases the lump shrinks over time and ends up as a firm little lump that many patients just ignore,  If it is a bother, the lump can be excised under a local anesthetic through a small incision.  

       The lady I re-operated on had an area of fat necrosis the size of a small plum.  Two days after removal, she felt like a million bucks and is on her road to a quick recovery from this “lump in the road”. 


  Thanks for reading.  Dr. Lisa Lynn Sowder

Body Contouring, Breast Reduction, Obesity, Postoperative Care, Tummy Tuck

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

Ideal Breast Size?

June 13th, 2012 — 3:51pm

Seattle Plastic Surgeon blogs about the highly variable “ideal” breast size.

Yesterday was a great day in the office seeing patients.  It was one of those days where all my post op patients were pleased and all the new patients were good candidates for surgery.  I had two patients, one a post op and one a new patient,  that drove home the fact that there is no single ideal breast size.  What is ideal for one woman may not be for another. 

Patient A was a year out from a breast augmentation.    She was thrilled with her result and was happy with her 34DD bra size.  The breasts looked good with her shoulders, tummy and hip line.  She was all curves.

Patient B also wore a 34 DD bra and was horrified at the size of her breasts.  She wanted a reduction.  Patient B’s breasts looked almost identical to Patient A’s augmented breasts but they did not fit her narrow chest or narrow hips and clearly they made her the recipient of a lot of unwanted attention.  She wanted to go down to a C cup which is where Patient A started.   Too bad they couldn’t have just swapped, huh?

Breast surgery is so individualized.   The entire body must be taken into account as well as the woman’s age, child bearing plans, athletic endeavors, career goals, etc.  This is what keeps my job interesting.

Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Implants, Breast Reduction

Can plastic surgery change your brain? You bettcha!

April 12th, 2012 — 4:49pm

Seattle Plastic Surgeon removes one pound of breast and with it, a bucket load of obsessive thoughts.

Recently a breast reduction patient told me that she felt like a part of her brain had been removed along with some of her excess breast tissue.

As a young woman, she watched in horror as her breasts became larger and larger and then in middle age became saggier and saggier.  Her breasts tormented her every single day of her adult life.  They dictated the sports she played (or didn’t), the clothes she wore (or didn’t), and in some cases, how others (particularly dudes) percieved her.

Finally, she overcame her fear of surgery and came in for a breast reduction.  During her initial consultation I told her that a pair of smaller, shapelier  breasts (that would match her slender build) were lurking inside those big, saggy breasts and it was my job to liberate them.  And indeed, when her surgery day arrived, I did.  It took me three hours to fix something that had tormented her for thirty years.  Despite the usual early postoperative bruising, swelling and discomfort, I could not wipe the smile off her face from the minute she woke up from the anesthetic and took a peak into her postoperative bra.

All of that mental (and physical) effort she had been putting into her breasts was now freed up for something else.    This particular patient’s “something else” is  lessons in the aerial arts –  twisting, turning, and slinking up, on, in and around a large silky ribbon suspended from her ceiling.  Talk about a change and just not a change in her bra size.

Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Reduction, Plastic Surgery, Uncategorized

Back to top