A ^Retired Plastic Surgeon's Notebook

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

Put this on your list for Valentine’s Day.  It won’t end up on your hips and you can wear it in public!

Did ya know why SmartWool socks aren’t itchy?  It’s because the type of wool that is used is very, very fine and flexible compared to normal wool which is thick, stiff and poky.   I don’t itch at all in these sock and I am a very, very itchy gal by nature.   In fact, I am sitting here right now thinking how itchy my boiled wool jacket is.   And you know how that makes me feel?  Well, it rhymes with itchy.

So check out some pink SmartWool socks for Valentines Day.  And no, no, no, I do not get a dime or even a free pair of socks for this blog.

Thanks for reading.  Dr. Lisa Lynn Sowder

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

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

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

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

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder has good news for you and your nipples.

I did a breast lift today on a lady who had waited years and years before having the procedure because she was afraid to have her “nipples cut off” and then “put back on”. This is a rather common misunderstanding about breast lift (and breast reduction) and I want to set the record straight.

Repeat after me:  “Your nipples never leave your breasts”.  The nipples are shifted up into a higher position with breast lifts and reductions but they stay attached to the underlying breast tissue and in most cases, sensation is preserved.

It is only in a rare, gigantic breast reduction that I do a procedure called a “free nipple graft” breast reduction.  In those cases, the nipple has to be raised so much that it is not possible to keep it attached.

Sooooooo, unless you are having a ginormous breast reduction, fear not your nipples falling off.

Thanks for reading!   Dr. Lisa Lynn Sowder

“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

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder finds breast lift and augmentation to be a difficult operation of opposing forces.

I saw a patient yesterday who needs a breast lift and wants an augmentation.  If I just do an augmentation, she will have  weirdly shaped and still saggy breasts and if I just do a lift, she won’t be as large as she desires.  She needs both operations and I was obligated to explain to her how tricky it is to do both an augmentation and a lift at the same time.

This challenge is one of opposing forces.  Placing a breast implant makes the breast tight and we want the tissues to loosen up and stretch some.  Doing a lift makes the breast tight and we want it to stay tight.  The weight and pressure of the implant can make a lift loosen up.  And, to make it even more tricky, every patient reacts a little differently to the forces of the implant and gravity, depending on her breast and skin elasticity and whether or not she spends any time in the International Space Station (no gravity there!).

My revision rate for patients undergoing and augmentation and simultaneous lift is pretty high, about 20%.  In most cases the revision involves re-tightening the lift and this can sometimes be done under just a local anesthetic but some patients need major revision, sometimes using $trattice or another acellular dermal matrix which acts like an internal bra.    Every patient is different.

I must confess that I have no control over a patient’s breast and skin elasticity and certainly have no control over gravity (I wish!)  And I must confess that I do not have a crystal ball to predict which patients will do great and which ones will need a revision.

If anyone out there has a crystal ball for sale (one that really works), let me know.  I’d love to buy one!

Thanks for reading, Dr. Lisa Lynn Sowder

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.

“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