You too, for some $$$, can hang one of these on your wall. No qualification necessary. Just $$$. You can send an email to daniel@americastopbreastsurgeons.com to arrange for payment.
Yet another bogus TOP DOC award I could hang on my wall but won’t.
Here is the cut and paste of an email I received today from one Daniel Singh.
“You Have Been Nominated – Join the Top Breast Surgeons in America
Please reply back to this email and we will have detailed information sent to you regarding this exciting opportunity to showcase your practice as one of the Best of the Best in Breast augmentation and reconstruction.
AmericasTopBreastSurgeons.com is not a credentialing organization. It is not a surgery association. It is nothing but a website to promote their bogus awards that are sold to doctors to display in their offices to impress unsuspecting patients. Do I seem cranky today? I am because this kind of nonsense makes me cranky. Check out this blog for more of Cranky Dr. Sowder.
Thanks for reading! Dr. Lisa Lynn Sowder
Seattle Plastic Surgeon blabbers on and on (again) about her favorite operation.
One reason that breast lift a.k.a mastopexy is my very favorite operation is the variety of breast lift techniques that can treat many different issues with breast shape. Breast lift can do many things to improve the appearance of the breast. Obviously, breast lift can lift the breast but it can also improve the position and/or size of the nipples and areolas and can even lower the actual breast mound in relation to the nipples.
As usual (especially in plastic surgery), a picture is worth a bajillion words.
Let’s take a look at this patient. The top photo illustrates a few issues with her chest. Her nipples and areolas are a little too large and too low. The fold under her breast is too high. She has fullness of the upper lateral area near her arm pits and an indentation in the middle lateral area of her breasts.
A breast lift can address all of those issues. The nipple and areola diameter is decreased and they are raised just a bit. The actual breast mound is pulled down and the breast fold is lowered. This gives the breasts a nicer shape. And, as icing on the cake, the indentation is filled in to make a smoother transition from her arm pit area to her breast mound.
All of this is done without disrupting the blood supply or nerve supply to the nipple and areola. This patient can expect normal nipple sensation. She should not, however, expect to be able to breast feed. The breast tissue has undergone a lot of rearrangement which will likely interfere with the production of milk.
The scars around the areolas and the vertical scars will fade with time. These scars are a trade off for her nicer shape and will not interfere with normal lingerie or swimwear or even a bustier!
Seattle Plastic Surgeon and seamstress thinks of plastic surgery while shopping for fabric.
In April I attended the annual meeting of the American Society for Aesthetic Plastic Surgery (ASAPS) in San Francisco. I sat in on many presentations, took a couple of workshops and spent lots of time comparing notes with colleagues. As per usual, I learned a lot and have tweeked a few of my procedures based on new found knowledge.
But I have to admit, I did skip a session on practice management so I could check out Britex Fabrix, a legendary four story fabric store a stone’s throw from the meeting venue.
This store had everything from fine Italian cotton the weight of tissue paper to the newest neoprene prints to a bajillion buttons and trims. And of course their collection of feather boas was amazing. I could have spent a week there.
Every floor had a full length mirror or two so customers could see the whole effect of holding a length of fabric and assessing the drape, the texture, the pattern, the color and this, of course, reminded me of plastic surgery.
A full length mirror is essential in any plastic surgery exam room because so much of the surgery we do is about balance and harmony. This is especially true with breast and body contouring. Changes made in one area can influence how another area will look. For example, larger breasts can make the waistline and hipline seem smaller. A tummy tuck can leave a patient with a flat tummy but may make her generous hips more noticeable. Even facial surgery comes into play. A face lift may really benefit a lady who has taken great care of her body over the years. Conversely, a really heavy lady may actually look odd after aggressive neck liposuction.
So fear not that full length mirror in my office. It’s useful for both the patient and the plastic surgeon to see the whole picture.
Thanks for reading and next time you are in San Francisco, check out Britex Fabrix. Dr. Lisa Lyn Sowder
Breast implants vs. fat transfer for breast enlargement. Seattle Plastic Surgeon compares the two operations.
I have been doing fat transfer to the breast for about three years now. When I started practice in 1991, fat transfer to the breast was dismissed as ineffective. And indeed it was because the technique did not lend itself to long term viability of the fat. These days, thanks to fat transfer pioneers like Dr. Sydney Coleman and Dr. Richard Ellenbogen, we know how to harvest, handle and inject the fat in such a way that most of the fat survives in its new location. Fat transfer has become an important addition to my breast enhancement practice. Based on my experience, here are the main differences between breast implants and fat transfer for breast enhancement.
For most patients, there is a clear choice between these procedures but a few patients are really torn about which way to go. In consultation, I provide as much information as I can about each procedure and make sure that patients understand the limitations of fat transfer and also the long term consequences of having breast 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 22 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 in the operating room every day except for Christmas Eve, 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.
Seattle Plastic Surgeon reassures her patients that breast implants usually do not interfere with athletic endeavors.
Hey girfriend! Where’s your sportsbra?
Many of my breast implants patients are very physically active and the effect of breast implants on athletic performance is a common question.
Except for the world class athlete, breast implants won’t likely interfere with even vigorous sporting activities like waterskiing, snow boarding, rock climbing, kick boxing, barrel racing, Zumba, parkour, rowing, dog agility, lacrosse, roller derby, etc.
I do warn warn patients that their upper body strength may be a little diminished with sub-pectoral implants but that they won’t likely notice the difference once they are healed.
Also, once a patient with implants starts doing upper body exercise, their implants may feel weird for a few weeks but that they will get used to it. I also warn them that they will definitely need a good exercise bra to protect their investment and they may be getting a little more attention at the gym or the roller derby track.
Seattle Plastic Surgeon knows a lot about shoes and breast implants.
You won’t want to wear them if they don’t fit.
Can you imagine buying an expensive pair of shoes that just don’t fit? Maybe they are too small and you have to cram your little piggies into a too tight toe box or maybe they are too big and slip and slide everytime you take a step. Crazy, huh? Size really matters when it comes to shoes and who cares about the number on the inside of the shoe as long as it fits. Right?
Well, it’s the same with breast implants. Sometimes patients get really, really hung up on numbers. For example, a patient will come in saying “I want a Style 20, 650 cc implant that will get me into a 32 DDD bra”. Whoa, and that’s before I have even examined her!
If she is a slender woman with a narrow chest, that implant is going to have too large a diameter and it’s going to give her the dreaded unaboob a.k.a. synmastia, or it’s going to end up spilling into her armpit. On the other hand, if she is a larger woman with a really, really broad chest, that implant is not going to give her the medial fullness to create a nice cleavage or the lateral fullness to balance her hips. If she has a moderately broad chest and a breast diameter of around 15 cm (about 6 inches), that implant will probably fit her pretty well. But it is my job to examine her, measure her and guide her towards an implant that fits her. A little bit like Goldilocks and the Three Bears, huh?
The other number I’d like my patients to forget about is bra size. Repeat after me “bra size doesn’t matter as long as my implants enhance my figure“. As all ladies know, bra sizes are all over the place and there is precious little standardization. Take a look in any women’s lingerie drawer and she likely has 2 or 3 or even 4 different sizes. I tell patients the best way to deal with bra size is to get professionally measured, buy bras that fit well and, if they don’t like the size, cut out the tag!
SOOOOOOOOOOOOOOOO – keep an open mind about what size of implant will be right for you and trust me (I am a doctor) to use an implant that will fit your body and then, after surgery, keep and open mind about what size bra will be right for you and trust the bra lady (especially if she has a little gray hair and reading glasses) to get you into the right bra.
Seattle Plastic Surgeon offers unsolicited advice on determining if your health insurance will cover a procedure.
The first step is to read you health insurance policy.
“Will my insurance cover this?” I hear that question a lot, especially with the Affordable Care Act becoming law. I even had a patient ask if Obama Care would pay for her breast lift! Wouldn’t that be sweet?
Here are some tips on determining if your health insurance will cover a certain procedure or treatment:
1. Read your health care manual. Often the answer will be there. If you don’t have a manual, obtain one from your employer or the insurance company. If the manual says something like “no breast surgery is covered unless it is related to breast cancer”, insurance will not cover procedures like breast reduction or breast implant removal. It’s right there in black and white.
2. Call your insurance company and talk to someone in customer (that would be you) service. You may get the run around or a phone tree from hell, but you should eventually be able to reach someone who can give you some answers. Remember that you are their customer and you should expect good service.
3. If you are getting what you feel is an unfair answer, talk with your benefits manager or even your state insurance commissioner. Insurance companies are happy to collect their premiums but can be downright prickly about money going the other way. Sometimes they need a little prodding.
4. Have your doctor’s office call. Sometimes the insurance companies have a problem with plain English and do not understand a questions such as, “My breasts are ginormous and are killing my back and I’ve maxxed out my physical therapy budget and industrial strength bras don’t help. Is breast reduction a covered procedure?” The person in preauthorization may only understand “611.1, 724.5, 781.9 and 19318-50”. Your doctor’s office can provide those numbers.
And remember – just because insurance does not cover a procedure or treatment, that does not mean you cannot have said procedure or treatment done. It’s just that you will have to pay for it.
Thanks for reading and let’s hope this Obama Care thing works out! Dr. Lisa Lynn Sowder
Seattle Plastic surgeon blogs about one of her pet peeves – Big breast implants and a Benelli (circumareolar or donut) lift done to avoid a full breast lift.
Big implants and a Benelli lift. IMO it’s just not a good look. A full lift and smaller implants would have served this patient better.
I do alot of breast revision surgery and I see at least one patient a month who had the operation shown on the left who is unhappy with their result. And it is almost always the case that the patient did not want the scar from a full breast lift to treat significant sagging. So she and her surgeon agreed on a large implant to take up some of the slack breast skin and a Benelli (a.k.a. circumareolar a.k.a. donut) lift to lift and reduce the diameter of the nipple and remove some excess breast skin.
The Benelli lift always flattens the area around the nipple as is seen in this case. Occasionally flattening is indicated if a patient has a tuberous deformity. And if the Benelli is expected to lift just a little and tighten just a little, the results can be very pleasing. Problems occur when surgeons and their patients ask too much of this technique.
With breast and body surgery, shape and contour is more important that length of scars. A long scar almost always will fade and smooth out but a weird contour will not change over time.
Seattle Plastic Surgeon explains what causes a double bubble deformity in the implanted breast.
The implant rides high and the breast falls over the lower edge of the implant creating the weird shape of the “double bubble”.
I saw two patients this week with the so-called double bubble. Both of these ladies had implants that were over 10 years old and both had experienced some sagging in their natural breasts.
The double bubble occurs when time and gravity result in the natural breast drooping and falling below the bottom border of the breast implant. Breast implants tend to stay put over time because they are held in place by the implant pocket and the resultant scar capsule that forms around them. Or, in some cases, the scar capsule starts to thicken causing a so-called capsular contracture and the implant can be displaced up which can result in an early or really bad double bubble.
Treatment depends on how much the double bubble bothers the patient, how bad the double bubble is, the age and condition of the implants and the condition of the patient’s breasts. Usually treatment will consist of doing a breast lift to get the breast back up into a better position relative to the implant. If the implant has developed a tight capsular contracture, removal of the old implant and capsule and replacement with a new implant may be necessary.
Sometimes ladies in middle age develop the double bubble and don’t really want to do anything surgical. It can be “fixed” with a good bra. And sometimes ladies in middle age decide that their implant days have come to an end and opt to have the implants out and a breast lift. These ladies are often relieved to be implant free and often just love their smaller and perky breasts.
So, with the double bubble and many other things related to plastic surgery, the main culprit of is time and gravity, which keeps me in business.
@lisalynnsowder
