K (Ryan Gosling) and the very evil Luv (Sylvia Hoeks) stroll among the newly finished small breasted replicants.
My husband and I went to Blade Runner 2049 this past weekend at Seattle’s wonderful Majestic Bay Theater. I am a big fan of the original Blade Runner thus the bar was very, very high for 2049. IMHO, Blade Runner 2049 was too frenetic, too convoluted and the only characters I really cared much about was Rick Deckard (the still handsome and wiley Harrison Ford) and his big ass shaggy mongrel doggie. I shed a tear when the doggie is shown peering out of a shattered building, wagging his tail just a bit, wondering where his human went. I’m tearing up now just remembering that scene.
One thing I found interesting throughout the movie was the relatively smallish breasts of all of the female characters. Hardly any cleavage at all – a real change for Hollywood. K’s (played by a deliciously disheveled Ryan Gosling) made-to-order AI concubine Joi (Anade Armas) and her human side kick, Mariette (Mackenzie Davis) with whom she mind and body melds, were both small chested. The LAPD’s Madame played by the ever wonderful Robin Wright was lean and mean and small chested. The still-under-construction and just “born” female replicants would all measure into an A or B cup bra. Even the gigantic virtual reality pleasure girl with the pastel hair was small breasted. The only bouncing breasts seen in the movie was in the cocktail lounge hologram dancing girls of the distant past. They contrasted nicely with Deckard and K beating the bejesus out of each other.
So maybe this return to a natural sized breast will be the next not-so-big thing for the ever scrutinized female figure?
Thanks for reading and if you haven’t seen the original Bland Runner, you are missing out on a great movie. Follow me on Instagram @sowdermd and @breastimplantsanity. Dr. Lisa Lynn Sowder
This cartoon is by the late, great B. Kliban. His book, “Never Eat Anything Bigger Than Your Head” is a treasure. Get your hands on one if you can. You’ll laugh until you cry.
Portion control is very important for maintaining a healthy weight and it becomes more and more difficult as restaurants, especially fast food restaurants, keep increasing the size of the offerings. There is a Mexican place in Seattle that has a poster of one of its burritos next to a new born baby. They are the same size. So sick in so many ways, huh?
I would like to introduce portion control for breast implants. There is a condition that we plastic surgeon’s call breast greed. Those with breast greed want to go a little larger and then a little larger and then a little larger. This results in the eager to please plastic surgeon putting a too big implant into a too little woman. Supersized implants have an increased chance of having implant problems. Big implants cause thinning of the breast tissue and skin and over-stretching of the pectoralis muscle if they are submuscular. They are more likely to result in the dreaded unaboob or extend into the underarm area. And, in my humble opinion, they look really, really bizarre.
Fortunately I do not get many patients looking for that super top heavy look. Implant patients self select surgeons who feature these jumbo implants on their website or social media accounts. You won’t fine many of those attached to my name.
Thanks for reading and if you want to supersize your chest, don’t come to me! Dr. Lisa Lynn Sowder
Follow me on Instagram @sowdermd and @breastimplantsanity.
This lady initially came in for breast augmentation. She wanted to look a little fuller but was a worried about the impact of larger breasts on her competitive tennis game. After chatting with her and examining her, I came up with the plan of a lift and a nipple reduction. These procedures would give the illusion of fuller breasts without actually increasing the volume.
A small and saggy breast with a long stretched-out nipple looks – I’m gonna say it – a little pathetic. Once the breast skin is tightened up and the nipple shortened, the breast looks almost the way it did before babies, breast feeding, gravity, general aging, etc. And a procedure like this is maintenance free. It should last a lifetime. But remember to wear a bra most of the time when upright. Gravity never sleeps.
Thanks for reading! Dr. Lisa Lynn Sowder
Follow me on Instagram @sowdermd and @breastimplantsanity.
Can’t tell which side is anatomic and which side is round? Neither can I!
I think the anatomic implants vs. round implants smack down may finally be over. As those who read my blog know, I am not a huge fan of anatomic implants although I have tried really, really hard to learn to love them over many, many years. Anatomic implants are presented as the best thing since microwave nachos and those of us who keep going back to round implants are sometimes dismissed as Luddites. Anatomic implants are pushed by industry paid “experts” who make the rounds at meetings and extol the wonder of these more-expensive-and-more-complicated-than-round implants. And patients ask for these anatomic implants being lead to believe that they will look more natural.
A few years ago, evidence started trickling in that anatomic implants actually did not have advantages over round implants in standard breast augmentation in anatomically normal women. There were studies where before and after photos were shown to expert plastic surgeons and they could not tell which patients had which implants. I was present at one of these sessions where a panel of experts did no better than a coin toss. But the study that nobody thought could be done – put an anatomic in one side and a round in the other side on the same patient – has been done! No patient would sign up for having two differently shaped implants used for her augmentation and no institutional review board would approve such a study. But some very clever surgeons did this study in 75 volunteers. Their average age was 39 and their average BMI was 20 (this, by the way, is quite thin). The surgeons took the patients to the OR and put a round implant in one side and a comparably sized anatomic implant in the other side and then took standardized photographs. They then removed the anatomic implant and replaced it with a round implant to match the other side. The standardized photographs were shown to a panel of experts. Even the panel of experts could not tell the round vs. the anatomic when presented with these side by side breast implants!
I really take my hat off to the Drs. Hidalgo and Weinstein for doing this study. It is this sort of research that helps us make decisions based on reality rather than the latest hype from an industry hired gun.
Intraoperative Comparison of Anatomical versus Round Implants in Breast Augmentation: A Randomized Controlled Trial. Hidalgo, David A. M.D.: Weinstein, Andrew L. M.S., Plastic & Reconstructive Surgery: March 2017, Pages 587-596.
MRI is the best test for detecting implant rupture (other than surgery) with a very high accuracy rate, much higher and mammogram, ultra sound or physical exam. I think it is prudent for patients with gel implants, say 10 years old or older to get an MRI to make sure there is not a silent rupture. If a patient has saline implants, there is no possibility of a silent rupture so an MRI would be worthless unless there is another reason for MRI (cancer detection for example). I often have patients who are coming in to have their old gel implants removed regardless if they are intact or ruptured and in those cases I don’t really think an MRI is absolutely necessary. Yes, it is nice for the surgeon to know ahead of time if there is a rupture but honestly, I approach every implant removal as if the implant is ruptured. I try to do an en block resection and have everything ready in the event the implant is ruptured and there is silicone spillage. We have special suction set up for ruptured implants and also some old fashioned surgical lap pads ready for clean up. And even with a rupture, it’s usually not as messy and one might think it would be. Even the messiest cases almost always allow the surgeon to scoop out the gel and then get all of the capsule.
“Just relax. It doesn’t hurt one bit but it is a little noisy.”
In Seattle at Swedish Medical Center, as of 2017, an out-of-pocket MRI to rule out breast implant rupture is about $1300 – $2200. If you pay up front, you get the lower price. The actual procedure requires the patient to lie prone (on the stomach) with the breasts hanging though these little openings in the MRI bed. It’s important to lie really, really still for a good image. MRI does not involve any irradiation so don’t worry about that but it can be kinda noisy with pings and dings. When I had my knee scanned, they gave me earplugs. And after an MRI, please make sure you get the radiologist report. It is more useful than the actual MRI itself. Plastic surgeons are not experts at reading MRI’s although we can usually see an obvious rupture. More subtle things may not be obvious to us.
Thanks for reading and if you are concerned about your oldish gel implants and an MRI will either ease your mind or prod you into action, you should get one! If are ready to bid goodbye to your oldish implants regardless of their status, come on in. I’m here to help!
Thanks for reading! Dr. Lisa Lynn Sowder. Follow me on Instagram @sowdermd and @breastimplantsanity.
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”.
Calcified breast implant capsules can make a breast rock hard.
Calcified breast implant capsule surrounding an 32 year old ruptured silicone gel breast implant.
32 year old ruptured silicone gel breast implant after opening the calcified capsule.
I recently removed 32 year old breast implants from a lovely lady in her mid 60’s. She was embarrassed how the implants felt when she hugged someone. “It’s like having two rocks in my bra.” Here is the reason her breasts felt like rocks.
The photo on the top shows the implant surrounded by the implant capsule. The photo on the bottom shows the implant (which was ruptured) and the capsule after the capsule was opened. The yellow gooey stuff is the implant material. The white structure under the implant is the inside of the capsule. The white stuff is calcium. Yes, calcium – the same stuff that makes your bones nice and hard. The calcium deposits are hard and brittle and can make an encapsulated implant literally rock hard. Nasty capsules such as this are most common in old silicone gel implants but I have also seen cases like this in saline breast implants.
These photos also illustrate another important point with removal of ruptured breast implants. In this case, I was able to remove the ruptured implant and the capsule in one tidy piece and there was no spillage of the silicone into the breast. I love it when I can do this. It is not always possible but I always try. When it is not possible and I have to remove the ruptured implant before removing the entire capsule, there is often some spillage but I do my best to minimize it and clean up any spilled silicone prior to closing the breast.
And yet another important point should be obvious from this photo. Should the capsule be removed along with the implant? YES! It would be crazy to leave that nasty capsule behind. It would shrivel up into a hard mass, be palpable and possibly visible and would look really, really funky on mammogram. I always go after thick and nasty capsules. If removing the capsule puts a vital structure at risk, I may leave some of it behind but I try to get as much out as possible. Removal of the capsule is the hard part of the case but it is worth the effort and time to leave behind a nice, clean breast.
Oh, and one more point. This were really old implants. The implants available currently are much tougher and have thicker gel and are less likely to rupture. The problem illustrated with this case are less likely to occur with the new generation of implants.
Seattle Plastic Surgeon wishes everyone a Very Merry Christmas.
The Christmas season is always super busy in my practice. It seems crazy to have surgery around the holidays but it is the choice of many, many patients. They already have time off of work or school for recovery.
In my 23 years of practice, I have only taken time off around Christmas twice; once to take care of my newborn daughter and once to have surgery myself.
So Merry Christmas to everyone. I’ll be working every day except for Christmas, New Years Eve and New Years! It’s a good thing that I love my work!
Thanks for reading and stay tuned for some upcoming New Year’s Resolutions.
We had a staff meeting to day and our educational topic was earthquake preparedness. Joanne Jordan from Seattle’s Office of Emergency Management gave an excellent presentation that made me feel a little better about living in Washington, the third most earthquake prone state. California and Alaska are the top two. Here are a few things I learned.
Most earthquake injuries are not from people getting squished by a bus flying through the air but rather are related to people running around during the quake and tripping and falling and then walking around in debris in bare feet! Not the stuff of disaster movies, huh? Soooo….. when the big one hits, take a few steps if necessary to get into a safe place and stay put. And keep a pair of sturdy shoes (with a flashlight tucked in) under your bed.
Modern high rises like the Madison Tower where I work are really, really some of the safest places to be in an earthquake. These buildings are made to sway with the energy of an earthquake. You may be in for a wild ride but the building is not going to go down. Soooo… hope that the big one hits while you are at work.
Elevator shafts are super safe structures. So…….if you are stuck in one, stay put and make friends with your co-riders. Bad things happen to people when they try to get out of the elevator without a rescuer who knows the proper way to evacuate.
This in-service really brought back memories of the 2001 Nisqually Earthquake. I was working on the 16th floor of an older medical office building. I could see undulations of the city from my window. I saw it before I felt it and then did I feel it. Later that week, I put together an emergency kit for our family. Yeah, that was 13 years ago. This weekend my project will be to update that rather, er, outdated kit.
For great information about being ready for and earthquake or some other disaster, go to www.seattle.gov/emergency. It is a treasure trove of information.
Thanks for reading and stay safe! Dr. Lisa Lynn Sowder
The ideal breast has a little more fullness below the nipple and above the nipple.
The Ideal Breast
I just read an interesting review of an article published in the Journal of Plastic and Reconstructive Surgery about the ideal breast. Here’s the link.
If you don’t want to read the review, I will summarize. A bajillion individuals which included men and women of various ages and nationalities were asked to rate a series of breasts on their attractiveness. The findings were interesting in that size was not as much of a factor as was the shape and proportion of the breast. And – surprise!- the majority of judges preferred a breast that looked natural which translates into a breast that does not have a bulging upper pole.
I am just glowing after reading this article. I have made it my life’s work to make breasts look like they could have occurred in nature on a really, really, really good day!
After chatting with her and examining her, I came up with the plan of a lift and a nipple reduction. These procedures would give the illusion of fuller breasts without actually increasing the volume.
@lisalynnsowder
