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

Tan lines and patient satisfaction

November 7th, 2011 — 10:11pm

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder blogs about patient satisfaction. 

I can usually tell when a patient really, really likes the result of their breast or body contouring surgery, at least if they have had any sun lately.  I just take a look at their tan lines!  (Those of you who read this blog regularly know that I am totally anti-tan and I am not advocating any activity that causes tan line nor do I advocate non-tan line nude sunbathing!)

Sometimes I’ll have a patient who is super picky about a very minor imperfection but who has tan lines that tell me he/she is comfortable not wearing much at the beach or pool.   Once I had a tummy tuck patient, well into her 50s, that was upset that her string bikini didn’t cover her bikini line scar.  That is what I call a happy problem!

Hey, thanks for reading and stay away from those tanning beds.  More on that in an upcoming blog.  Dr. Lisa Lynn Sowder

Body Contouring, Breast Contouring, Breast Implants, Breast Lift, Breast Reduction, Mommy Makeover, Plastic Surgery, Skin Care, sun damage, Tummy Tuck

The truth about breast surgery in the obese patient

November 4th, 2011 — 12:01am

Seattle Plastic Surgeon tells it like it is for obese women seeking breast surgery.

A recent article published in The Journal of Plastic & Reconstructive Surgery caught my attention.  This article looked at breast surgery outcomes in  7982 patients (that would be almost 16,ooo breasts!!!!) and divided the patients in obese and non-obese.  Their results were not surprising to me but they may be surprising to you.  The obese patients had a nearly 12 fold increase in postoperative complications when compared to non-obese patients.

Breast reduction is the most common breast operation performed in obese women.  That operation has a nearly 9 fold increase in postoperative complication in obese women compared to the non-obese.

This is not news for those of us who do a lot of reductions.  The sort of problems that obese women tend to have are fluid  collections (seroma), bleeding, delayed healing and infection.  These complications sometimes require a trip back to the operating room and they always require many, many postoperative visits.  Despite a rocky postoperative recovery, many obese women are still glad they had a reduction after everything is healed up.

So what’s the big deal?  All’s well that ends well, right?    Let’s look at this from an few different points of view.  If insurance pays for the reduction, they don’t want to see more bills for a hospital readmission to stop postoperative bleeding or a bajillion office visit bills to treat an infected wound.   And insurance companies are looking more closely at surgical outcomes and costs and using this information to rate surgeons.

If the reduction is private pay, the surgeon is unlikley to bill for increased postoperative visits which can run into 10 – 20 additional visits during recovery.  This can get very time consuming and expensive.

And for the patient it is no picnic having to pack an area along the suture line that either became infected or fell apart.  Post operative complications are just a total bummer all around, especially when the surgery is totally elective.

And here another issue.  Let’s say an obese lady has 5 pounds of breast tissue (which is 99% fat) removed and her weight drifts back up to her preoperative weight which almost always happens.  This means that she has gained 5 pounds of fat.  If that fat is just external fat, say on her hips, it’s not a big health issue but if it is intraabdominal fat a.k.a. belly fat a.k.a. visceral fat, it is a huge health risk.  Her breasts may no longer be killing her neck and back but her belly fat may literally be killing her.

So what am I really trying to say here.  Obese patients need to understand that breast reduction has a high rate of complications and that a reduction may actually make them less healthy if they gain back their weight as belly fat.

So this is a real sticky wicket.  Obese reduction patients are usually helped with back and neck pain with a breast reduction but weight loss would also help those back and neck pain issues.  Non surgical weight loss has no surgical risk and is accompanied by a host of improvements in a patients health.  Think high blood pressure, type 2 diabetes, arthritis, high cholesterol, etc.

So if you are obese and want a breast reduction from me, you will get a little weight loss lecture from me and may get turned down for surgery until you are able to shape up and slim down a little.    You may be willing to accept a high risk for a postoperative complication but I may not be.

Thanks for reading.  And if you have a quick, easy way to lose weight, please let me know.  I’m all ears.

 Dr. Lisa Lynn Sowder

Body Contouring, Breast Contouring, Breast Reduction, Health Care Costs, Obesity, Postoperative Care

Meet your new postoperative best friend

September 23rd, 2011 — 6:51pm

This is your BFF, at least for a couple of weeks.

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder gives a tip for a more comfortable postoperative recovery.

Today I saw a lady for her preoperative visit for her upcoming tummy tuck.  During this visit,  I review the operative plan, do a physical exam, check any necessary lab work, write prescriptions, make sure all the patient’s questions are answered and make sure all of the paperwork is done.

I also use this preoperative visit to discuss recovery with the patient so they really know what to expect.  I’ve been under the knife a time or two myself, so I really know what I’m talking about!

I often will recommend that tummy tuck and breast surgery patients buy a body pillow if they don’t already have one that they used during pregnancy.  The body pillow can be used to make side sleeping more comfortable and safer for those patients who just cannot sleep on their back as recommended after surgery.  They are also useful for keeping that man on his own side of the bed.  When I was expecting, my husband referred to my BFF body pillow as the “Berlin Wall”.

Thanks for reading!  Dr. Lisa Lynn Sowder

Body Contouring, Breast Reduction, Plastic Surgery, Tummy Tuck

Check out this cake.

August 30th, 2011 — 10:32pm

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder blogs about the “Farewell Big Breasts” Cake.

I recently did a breast reduction on this very fun lady and she emailed me this photo of her at her “Big Breast Farewell’ Party.  Her husband and friends had this cake made for her at Safeway.  It is actually two Barbie cakes with the doll top removed and candies placed for the nipples.  Fun, huh?

The first couple of days after surgery, this patient had an amazing case of post surgery euphoria.  I warned her that she would eventually “come down” and sure enough, she did.  Today she was a week post-operative and was sore and tired, bruised and swollen.  I assured her that this was a normal recovery.

In another two weeks, she will be able to be measured for new bras and my guess is that I won’t be able to wipe the smile off her face.

Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Reduction, Plastic Surgery

Happy tears in the exam room.

August 26th, 2011 — 5:10pm

“You mean I’m not the only one?”

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder delivers good news to young women with breast asymmetry.

This past week I have seen three young women with significant breast asymmetry.  It is very typical for these patients to shed happy tears when they discover that 1. they have a fairly common problem and 2. something can be done to improve their symmetry.

Often these patients suffer in silence for years thinking that they are some freak of nature.  I’ve had patients in their 30’s who have not shared their concerns even with their mothers or sisters of bffs.

The treatment of breast asymmetry depends on the patient’s anatomy and wishes.  I’ve used every breast procedure I know (reduction, lift, augmentation, nipple areolar revision and/or repositioning) to treat asymmetry.   Perfect symmetry is never possible and does not occur in nature (or my operating room) but I can usually get the breast to the point where a patient can just put on a regular bra or swimsuit and get on with her day.  And that a beautiful thing!

I just wish this problem would get a little more attention from the popular media so the women out there who think they are the only one can see that they have a lot of company and that their condition can be safely and effectively treated.

Thanks for reading.  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Implants, Breast Reduction, Plastic Surgery

The big price of big bras

July 19th, 2011 — 6:46pm

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder, braves the crowds at Nordstrom’s Anniversary Sale.

Bra shopping can be an exercise in frustration.

Nordstrom’s Anniversary sale is a great time to buy life’s little necessities, like well made bras at a price that doesn’t totally blow one’s clothing budget.  I was recently participating the lingerie department scrum and heard so much grumbling about how hard it was to find bras that comfortably fit the mature and , er, fuller figured woman and how darn expensive these large cup bras were.

Just looking at some of those G cup bras made my back ache and made me wonder if most women who suffer in the fitting room know how much benefit they could obtain from a breast reduction.  I think there is a lot of misunderstanding about breast reductions.  Reductions are often thought of as a purely unloading procedure rather than a nice shaping and lifting procedure.  Also, breast reduction doesn’t get nearly as much media attention as breast imlants do.

I think of breast reduction not as an unloading procedure but  as a mission to find the smaller, perkier breast in the overly large and saggy breast.  It is really about the closest procedure to sculpting that I perform.  Breast reduction is an operation that helps ladies feel and look better and may also make that spent in the fitting room a little less frustrating.

Thanks for reading!  Lisa Lynn Sowder, M.D.

Breast Reduction, Plastic Surgery

“Doctor Sowder, I want breasts like these.”

May 27th, 2011 — 6:27pm
blog surfing the web

“I like these.”

Seattle Plastic Surgeon discusses the limitation of cosmetic breast surgery.

Seattle is a very high tech city and I often have patients requesting breast implants bring in photos they have found on the internet. Internet photos can be very helpful IF the woman on the internet is in the same ball park as the patient in my exam room as far as age, height, weight, breast shape, breast size, nipple position, nipple size, skin elasticity and rib cage anatomy. Finding your breast doppelganger on the internet can be a very, very time consuming task.

Several years ago I had a 50 something lady bring in a Playboy centerfold as her desired look. That consultation required a rather difficult conversation about what plastic surgery can and cannot do and also the fine art of photographic lighting and airbrushing.

So click away on those before and after photos but keep in mind that what you end up with has a lot to do with what you and I start with!

One thing that is easy to find on the Internet are examples of what a patient does not want. Those photos are very, very valuable and help determine if the patient and I are “on the same page”.

Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Implants, Breast Lift, Breast Reduction, Plastic Surgery

How young is too young for breast reduction?

April 11th, 2011 — 8:47pm

The industrial strengh bra, not a great look for a teenager

Seattle Plastic Surgeon Discusses Teenage Breast Reduction


I received an email last week from a mother who was wondering if her 14 year old daughter could possibly be considered for a breast reduction. Her daughter is a dancer and has a really tough time with her large breasts. They cause her discomfort – both physical and mental.

My age spread for breast reduction is 14 – 68 years of age. That’s the biggest age spread for any of the many procedures I perform.

Almost all the teenagers who have had breast reduction were athletes or dancers. They all felt that they had stopped growing and had reached their full breast size. They all were embarrassed about the attention they received from guys because of their breasts.

I’ve been in practice almost 20 years so I’ve had the pleasure of seeing some of my young patients years and years after their surgery and none of them have regretted it for one minute.

There are a couple of downsides to having a reduction at a young age. Women who have had a reduction will not likely be able to breast feed a baby and younger women tend to have more obvious scars than older women. Also, with time and pregnancy, the reduced breast may have a change in size and/or shape over the years. I have done a handful of “re-dos” on women who had reductions decades ago.

The ideal time for a reduction is after a woman is done with childbearing. That being said, I think that certain really, really over endowed young ladies are very well served by this surgery. As with all procedures, it comes down to patient motivation and expectation and a good understanding of the risks and benefits involved. And many young women are emotionally mature enough to make the decision, especially if they have a good and open relationship with their mothers.

Breast Contouring, Breast Reduction, General Health

Plastic surgeons have 100 words for breasts

February 1st, 2011 — 9:38am

breasts_tSeattle Plastic Surgeon Discusses the Wide Variety of Breast Size and Shape.

I saw a patient recently that brought this cartoon to mind. She was requesting breast surgery and knew just what she wanted to look like; like a playboy centerfold. The problem was that she was over 50, a little overweight, and a lot saggy. I had to tell her in the nicest possible way that there was no way I could make her look 20 something, nulliparous (meaning not having given birth), naturally gorgeous and, to top it off, airbrushed! We plastic surgeons call this “deflation of expectations”. I have a jillion before and after photos of patients I have operated on and I arrange them by age and by body mass index. When I see a patient for surgery, I show them examples of patients who resemble them, not some idealized nymph. If I don’t do this little reality check, I can be assured that the patient will be unhappy with their outcome and unhappy with me and behind every unhappy plastic surgery patient is an unhappy plastic surgeon.

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

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