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.
A flak jacket is good protection for breast implants! Just don’t forget your post-operative sports bra.
Seattle Plastic Surgeon just loves a woman in uniform.
Western Washington is home to several military bases so it is no surprise that as a Seattle plastic surgeon, I see quite a few soldiers (female and male) who are interested in having a variety of procedures. The military has excellent plastic surgeons who are fully capable of doing just about any operation but the wait for a purely elective procedure is so long, a lot of military folks will seek care outside. Also, there is a bit more privacy on the civilian side.
These fine men and women in uniform usually are great patients because they are in excellent shape and because they are really, really good at following pre-operative and post-operative instructions. And (this is what I really love) they often refer to me as ma’am, as in “Ma’am, when can I wear my flak jacket and do a 10 mile march with a full pack?” I find that a nice change from “Hey, doc, when can a get back to my kite board?”
Thanks for reading! Seattle Plastic Surgeon, Lisa Lynn Sowder, M.D.
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”.
Breast enhancement with your own fat? Well, maybe.
Fat transfer to the breast: Seattle Plastic Surgeon adds her two cents worth.
One of the hot topics at the annual meeting of the American Society for Aesthetic Plastic Surgery(ASAPS) in Boston which I attended last week was fat grafting to the breast. This procedure has a very interesting history. Back when the earth was cooling and I was training to become a plastic surgeon (1983-1991), fat injections were considered fringe surgery and fat injections to the breast were for all practical purposes panned by the American Society of Plastic Surgeons (ASPS) and ASAPS. Fat injections to the breast were considered ineffective and dangerous. Well, that was then and this is now.
Fat grafting is now a well established procedure that has been used for facial rejuvenation, hand rejuvenation, the treatment of liposuction divots, buttock enlargement and a few other indications. Much of the early work done with fat grafting was performed by Dr. Richard Ellenbogen in L.A. and Dr. Sydney Coleman in New York and these two doctors were subject to ridicule and disbelief for several years. I remember in 1993, when I took my plastic surgery board exams, the correct answer to any question about fat grafting was that it didn’t work. That is not the correct answer any more.
Fat grafting to the breast started with surgeons, myself included, using fat around the periphery of a reconstructed breast. For example, if there were contour defects at the edges of a breast reconstructed with an implant, some fat would be used to smooth that area out. Then we started using it for patients who had thin areas anound the breast following cosmetic breast augmentation.
Now we are using fat injected into the breast itself for breast enhancement. After taking several instructional classes on this topic in Boston, I am convinced that this is an appropriate and safe procedure for a very select group of patients.
Fat injection, at least currently, will not acheive the same volume of enlargement that implants can. Most fat injected breasts go up only one cup size. That eliminates a lot of ladies wanting to go a lot larger. One of the doctors who spoke in Boston (and who has the most experience with cosmetic fat transfer to the breast) still uses implants in 90% of the patients who present to him for breast enhancement and uses fat in only 10%.
For the best results in patients with very tight breasts and chest tissue, it is necessary for the patient to undergo breast expansion to stretch the breast and skin and to increase the breast vascularity prior to the fat transfer. This is done using a gigantic breast pump called the Brava System.
They should have called it the Brave System because it takes a brave lady to strap one of these babies on and then go out grocery shopping. The plastic surgeons who have the best results in thin, tight patients with fat grafting have their patients wear the Brava 10 hours a day for about 4 weeks. This is no small task. This Brava requirement also eliminates some patients wanting fat grafting. The experts (and who am I to question them?) tell these patients who want fat grafting “no Brava, no breasts”.
For patients who have experienced breast atrophy following breast feeding or weight loss, the tissues are loose and this preoperative stretching is not as important. These patients will likely do okay without the Brava.
My week in Boston at the ASAPS meeting really opened my mind to this new way to enhance the breast and I am looking forward to offering this procedure to selected patients. But remember, if you are “tight” – “no Brava, no breasts”.
Seattle Plastic Surgeon discusses the FDA’s recommendations for MRI following breast impant surgery.
About 4 years ago, breast implants were once again on the market after extensive review by the FDA. One of the stipulations was that women would need to get an MRI three years after implantation and every two years thereafter. These MRI exams are intended to fine “silent ruptures” meaning a breast implant that looks and feels fine but has in fact ruptured. I often get this question: “Do I really need to have all those MRI’s if I have silicone gel implants?”
Answer: “No one is going to show up at your door and haul you off to the MRI suite. Undergoing the MRI recommendations is a decision every patient will have to make for herself.”
Here is an article written by Dr. Thomas Wiender, a Houston plastic surgeon to help each patient make her decision. I cannot improve on his writing so this is an exact copy of his article:
MRI Recommendation After Silicone Gel Breast Augmentation
The FDA has recommended an MRI of the breasts at three years post-op and every two years after. You are currently at one of these postoperative time frames.
Most silicone gel implant ruptures are silent. In other words, there are no symptoms.
MRI is not 100 percent accurate. Some intact implants will appear ruptured, and some ruptured implants will appear intact. This is not a fault of the radiologist or the MRI – this is the limitation of the technology.
Over many years of research, there is no indication that a ruptured implant will cause any disease.
If an MRI indicates a ruptured implant but at surgery it is found to be intact, for Allergan implants, the manufacturer’s full warranty still applies. For Mentor implants, the manufacturer will provide the implant replacement but no financial assistance.
You must understand that because of the limits of MRI technology, you may have surgery for an implant that is found to be intact, but you will still have undergone the possible risks and complications of surgery.
In most countries outside of the United States, the equivalent of the FDA does not recommend routine follow-up MRI.
The cost of the MRI is your responsibility. You insurance company and the implant manufacturer will not pay for this.*
The decision to proceed with a postoperative MRI must be made by you, the patient, based on the above information and the information provided to you prior to surgery in the manufacturer/FDA brochure.
* First Hill Imaging in Seattle charges $1,955 for a breast MRI to look for implant rupture. If the patient pays cash up front, the fee is $1,271. I obtained this information in early 2010. Their fees are subject to change.
Seattle Plastic Surgeon discusses the longevity of breast implants.
I get the “have my breast implants expired?” question a lot. I tell my patients who are considering breast implants that they will likely get 10, 15 or maybe even 20 years out of their implants. This is based on the low leakage and rupture rates of the current generation of implants and the fact that a woman’s body can go through a lot of changes in 10, 15 or 20 years. I am as likely to do an implant removal and/or replacement for naturally occuring changes in a woman’s body and/or life circumstances as I am to do the surgery for an implant leak or rupture. Here are a couple of examples:
Very lovely and sweet 20 something wants her implants out because she has become a Buddhist nun and the implants don’t fit her spiritual identity. I took her implants out and her breasts returned to a similar shape and size that she had before breast augmentation.
Vibrant, slender and healthy 65 year old grandmother whose implants have stayed perky but her breasts have sagged giving her an odd shape and she feels silly having implants “at her age”. I took her implants out and did a breast lift. Her breasts are small but with a nice shape.
Healthy but heavier postmenopausal lady who was “flat” 20 years ago when she had breast augmentation but is now 30 pounds heavier and way bustier than she ever wanted to be. I took her implants out and did a small breast reduction and lift. Her chest went from matronly back to full and voluptuous.
I sometimes see women in my office who have implants 20+ years old and are doing fine. There is no reason to remove these implants unless there is a good reason to do so.
My next blog will be devoted to the FDA’s recommendation of frequent MRI exams to monitor silicone gel implants.
Seattle 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.
@lisalynnsowder
