A ^Retired Plastic Surgeon's Notebook

Seattle 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”.

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

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

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

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

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

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 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 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

“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