A ^Retired Plastic Surgeon's Notebook

Recently I received this email from a former breast implant illness patient.  I am sharing it with her permission but she has asked me to protect her identity.  I will call her Celeste because I love that name.  I have made no changes except for correcting a few typos.

Celeste:  I read your blog post on breast implant illness and it literally brought tears to my eyes. Tears of joy!!!!  Back up three or four years ago when my life was in shambles – emotionally abusive husband, stressed out to the max at work, sex hormones had crashed, possible thyroid issue…..but yet my family physician said I was fine according to my lab tests. I wasn’t able to see what my ex husband and stress were doing to my body at the time and so I was bound and determined to find an answer. Then I found it – the BII group on Facebook. I had found my answer so I thought. Went through the surgery and wow none of my symptoms got better! It wasn’t until my divorce was final and I was able to relax and started taking a low dose thyroid medicine and got my estrogen back to a normal level that I started to feel normal again. Long story short, I miss my implants like crazy and want them back. I’m soooooo happy to see a plastic surgeon standing behind her beliefs! I totally think it wasn’t my implants at all and more stress and hormone related. I guess I’m going to be the first trial case to see what happens. lol. Thanks for the blog. I really enjoyed it.

Me:  I am very glad you are feeling better after getting your life in order and getting good medical care. Sorry about your implants, though. Have you shared your experience with the Facebook group? I am just curious.

Celeste:  Hahahah.  To spare myself the verbal attacking that would come with it, I have not. All of my friends have implants – a good mixture of saline and silicone, and none of them have issues. I even have one older friend who has had her saline implants for 20+ years to the point one ruptured and still no issues. I don’t want to fight with 18,000+ desperate women who are looking for an answer to their issues when in reality it is probably what you said, the general human condition and life itself. My mom has a lot of allergies and it is possible that my body reacted to my silicone implants (second set), but it took several years for me to feel bad. So, doubtful in my opinion. I had my saline implants for six years with no issues. The issues of general fatigue were once again a result of stress and being on birth control most likely. When I got my silicone implants I went off birth control and my stress was at an all time high. Perfect storm imo. But we shall see what happens. I’m torn on what to get again. I loved how my silicone looked and felt, but still have a slight fear that maybe just maybe it was my body reacting to the silicone (doubtful)……

I’m sure that group has attacked you. It’s like the blind leading the blind and defintely a herd mentality. I can’t bash them too much because three years ago I was one of them – desperate for an answer……and I’m a research scientist, so no dummy either ….. I was just that desperate to feel better.

Me:  Is there any advice you would give women who like their implants but think they have breast implant illness?

Celeste:  Oh geez this is a hard one. There is so much misinformation out there that if it seems pretty far fetched, it probably is.

I lived with my symptoms for years and even had my best friend, who is also my family physician, tell me that I was super stressed and THAT was my problem. The funny thing I have learned about stress in our society is that it starts out small and slow and that becomes the new normal. Then a little more stress gets added on, then that is the new normal. The cycle continues to repeat itself until something or someone stops it. In my case I got my second set of implants (silicone), stopped birth control causing my hormones to crash because I was basically dependent on it, major stress in my marriage, and I was studying for my board exams. And I was the silly one sitting in my doctor’s office telling her that I wasn’t stressed, but yet I couldn’t sleep, felt tired and heavy all the time, my weight was increasing quickly, etc. I went on like this for six years! I’m a little stubborn, ha! Removing my implants helped momentarily because all I could do was sit around and relax. That should’ve been my huge red flag. But nope, I missed it, lol. It wasn’t until just recently that all the pieces started coming together. My hormones are finally at normal levels, my stress is down, my divorce was final two weeks ago. I am finally relaxing and it feels good! I’m still going to the gym and doing strenuous weight lifting and from time to time when I don’t get enough sleep because I’m enjoying life too much and burning the candle at both ends, guess what????? My symptoms start to come back!

For me I’m skeptical that the millions of women that have implants are walking around like zombies (basically what I felt like). I was barely functioning – getting out of bed was difficult, but I didn’t want to lose my job so every morning was a struggle and a pep talk to do it one more day. And what about all the celebrities that have butt implants, chin implants, cheek implants, pec implants (men) – all silicone. I suppose one could argue that those are different than breast implants in chemical consistency, but why aren’t they feeling awful????  I’m more of a believer of an inflammatory response to implants that are too big for the body and overtime the body starts to reject them. My last set were DD and way too big imo. I’m naturally an A, so that is a big difference. And what about all the women in the bikini industry – models and competitors??? They are fine. I’m not saying breast implants are 100% safe, but causing issues almost a decade later is something that I’m not too sure on. My implants came out looking brand new with a thin capsule and no other issues. It is interesting though, the doc that took mine out says he’s seen some stuff that he just can’t explain and the lab can’t identify what it is……so maybe there is truth to it????

With all that being said, I think my biggest piece of advise is know that the mind is very powerful and when you are desperate for an answer, almost anything can be made to fit the given scenario. I wasn’t able to take a step back and evaluate my life and see that the problems I was having were self inflicted. Stress, abuse, lack of sleep, etc. had nothing to do with my implants. After years of living like this, my body was burned out and literally quitting on me. What it needed was lots of TLC! I’m still happy I got my implants removed. That set was too big, but I wish I would’ve swapped them out for a smaller set like my first set of implants. At this point I do miss my implants enough that I’m willing to risk that I’m completely wrong about all this and get implants again……..

So there you have it.  Another side of the breast implant illness conundrum.

Thanks for reading and I would be honored if you followed me on Instagram @breastimplantsanity and @sowdermd.  Dr. Lisa Lynn Sowder

I’ve now been doing fat transfer to the breast for over seven years.  I remain enthusiastic about this procedure in patients with favorable anatomy and realistic expectations.  One FAQ relates to changes in the breast with weight changes.  So here is what I have observed so far in my practice:

Yo-yo is a no-no for fat transfer!

If patients lose weight, the transferred fat shrinks and the patient loses volume in her her breasts.  This also goes for patients who lose fat but maintain their weight.  I have seen this in a couple of patients who did not have a major weight loss but who really leaned out with vigorous exercise.  They both became Crossfitters and both lost a lot of the volume they gained after fat transfer.  One went on to have implants.  The other did not.  I am thinking about adding “do not join Crossfit” to my post-op instructions!

Conversely, if a patient gains weight, the fat that was transferred to the breasts will expand and the breasts will get larger.  I have seen this in a couple of cases.  One case was a middle aged flight attendant who gained about 7 lbs on a cruise (this is why I do not go on cruises!) and became alarmed at how large her breasts became.  I assured her that her breasts would go back to their pre-cruise size when she lost that extra weight and indeed they did.  In another case, a patient gained just a few pounds and rather than going to her saddle bags as it usually did prior to fat transfer, she was delighted to see that it mostly went to her chest!

So whenever we are moving fat around, it’s best to have surgery when you are at a healthy and sustainable weight.  I do not recommend fat transfer in patients who yo-yo.  Significant weight fluctuations make for fluctuating results.

Thanks for reading and did you notice I did not say “ideal” weight?  Sustainable and healthy weight is more important and more obtainable than ideal for most of us who are over 25 years old!

Dr. Lisa Lynn Sowder

I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.

Is there an astrologer in the house?

How are those planet lining up for your day of surgery?

Today I saw a lovely lady who is a great candidate for tummy tuck and fat transfer to the breasts.   She’s done with babies, her youngest is out of diapers and she is ready to reclaim a little bit of her babehood.  She’s also got some help lined up and some time off work available and now all she needs to do is check with her astrologer to make sure planetary alignment is just right!

Back when I was a smarty pants young surgeon, I would have dissed this lady’s belief in astrology but now that I have been around the block a time or two, I recognize that many people believe in things that I don’t and vice versa.  So if I need to tweek my schedule a little bit to get in alignment with her planets, I’ll do my best to do so.

Thanks for reading and by the way, I’m an Aries.  That explains everything, huh?  Dr. Lisa Lynn Sowder

Check out these el cheapo breast enhancers.

Those of you familiar with my web site and this blog know that I really like to emphasize that fat transfer to the breasts is much different than a breast implant procedure.   Fat transfer results in a much more subtle and natural appearing enhancement compared to breast implants.   Here is a great way to determine, in the privacy of your own home,  if you will be happy with fat transfer.

There are a bajillion kinds of breast enhancers (we used to call them falsies when I was in high school) on the market.  I keep the June Tailor Beautiful You enhancers in two sizes in my office to help patients visualize that fat transfer can do.  These enhancers are available at Joanne Fabrics and they are very reasonably priced.  The larger size is pretty representative of the size increase a woman with a little breast laxity and  nice juicy donor sites (hips, tummy, thighs) can expect.  The smaller size is a pretty good idea of what a smaller, slimmer woman with tight breasts can expect.

So if you are thinking about fat transfer to the breasts, buy a pair of enhancers and wear them around for a few days.  And if you come in for a consultation, make sure to bring your enhancers with you.  That will give me a good idea of what sort of volume increase you will be happy with and help me determine if you are a good candidate for fat transfer to the breast.

Thanks for reading!  Dr. Lisa Lynn Sowder

Left to right: Before fat transfer, one year post-op and three years post-op.

Seattle Plastic Surgeon is happy with her long term fat transfer to the breast results.

This week I saw one of my very first fat transfer to the breasts patients.  I was delighted to see her and to get this three year follow-up.  I beg my fat transfer patients to come in once a year but they, like all modern women, are just busy, busy, busy.

This particular patient wanted me to take a look at a little something on her face and I did.   But then I asked her to pose for photos.  As you can see, her fat transfer has held up well.  The left image is before fat transfer, the middle image one year post-op and the right image is three years post-op.  She has had no volume loss.  She has had a teeny, tiny bit of sagging but that’s just gravity for you.

And she told me an interesting story about her breasts.  Over the holidays, she had put on about 5 pounds (sound familiar?), and she says her breasts got quite large.  The fat I transferred to her breasts had come from her hips and normally that was the place she gained weight first but now that fat was in her breasts.   Her hips stayed slim but her chest went a little crazy.  She took off the extra weight over a couple of weeks and her breasts went back to their post-op size.

Her story illustrates why it is so important for body and breast contouring patients to maintain a healthy and stable weight.  I told her if she experiences the same weight gain this holiday season to come on in for photos!

Thanks for reading!  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon explains how different breast implants influence breast shape.

Take a look at these different breast shapes.  It is important to know what type of shape a patient prefers when doing a breast augmentation consultation.  The size and shape and projection of breast implants influences the final shape of the breast.  Other factors include the original size and shape of the breast and whether or not a lift will be done.

The French Breast.  If a woman likes this shape, she may do really well with just some fat transfer to boost her maybe a cup size and fill in the upper part of the breast just a little bit.  The French Breast can impersonate a Could Have Occurred In Nature breast with a well fitted and lightly padded bra.  Oo, la, la.

Let’s Stop Traffic!  This shape will likely require either a medium or high profile round  implant.  These implants give a big boost to the upper pole of the breast.  Some women like this look.  Most men like this look although not all men will admit to it.

Could Have Occurred in Nature.  This shape is likely to be achieved with a medium profile implant.  This provides a nice full slope to the upper breast but not a bulge.  Ladies with this shape of breast can get Let’s Stop Traffic! with a push up bra.

Tennis Anyone?  This sporty shape is most likely achieved with either fat transfer or a low profile implant.  This breast has some medial fullness to get a little cleavage and some lateral fullness to balance the hip but does not have a lot of projection.  This shape may also be achieved with a breast lift or a breast reduction.   This breast shape is preferred by many mature ladies because big, projected breasts make most mature ladies look (gasp) fat.

The French Breast——–Let’s Stop Traffic!———Could Have Occurred In Nature——–Tennis Anyone?

So there you have it, Breast Enhancement 101 on a single blog entry!  When I see patients in consultation, I try to show them lots of examples of my work to get an idea of what they like and to give them an idea of what I can do.

Thanks for reading!  Dr. Lisa Lynn 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.

Thanks for reading and check out my other blogs on fat transfer to the breast.

Dr. Lisa Lynn Sowder

Fat transfer to the breast by Seattle Plastic Surgeon takes time and patience.

Fat transfer to the breast doesn’t seem like it would be a time consuming procedure but it is if done properly.    Here is what’s important and why fat transfer takes time and patience:

Patience – one of my few virtues.

•  The fat must be harvested very gently at a low vacuum.  This is a much slower process than regular liposuction.
• The fat is often harvested from the posterior hip and buttock and lateral thigh area with the patient prone.  This means that a position change is necessary and that also takes time.
• The fat must be handled with great care when it is transferred into injection syringes.  It’s important to have a patient and detail oriented assistant.
• The fat must be injected in small aliquots into the breast, making sure to inject into several different layers.   This tedious technique pays off in the long run because it gives the fat a much better chance of survival compared to injecting big blobs of fat that probably won’t survive.  It has to do with blood supply.  That’s another blog topic.
• The areas of injection vary with the shape of the breast.  When doing an augmentation with an implant, there is very little control of the breast shape but with fat transfer, the shape of the breast can be altered.  This also takes time and multiple visual assessments with the patient sitting up.

Some surgeons do not have the temperament to do procedures as tedious as fat transfer to the breast.  But I do!

Thanks for reading.  Dr. Lisa Lynn Sowder

Fat transfer to the breast is looking like a great operation to this Seattle Pastic Surgeon.

Before (left) and after (right) fat transfer to the breast in a 60 year old jazz vocalist.

Here is yet another satisfied fat transfer to the breast patient.  I slimmed down her muffin top and added some fat to her breasts.  She went up one cup size and also got a bit of a lift, not only in her bustline but also in her spirit!

Her recovery was quick.  She was back to all her normal activities in about 3 weeks.

It has been sooooo rewarding doing this new procedure for the past year and a half and seeing what a difference it can make in selected patients.

Thanks for reading.  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon finds that fat transfer to the breasts allows for subtle improvements in breast shape.

Before fat transfer

After fat transfer

The more cases of fat transfer to the breast I do, the more I appreciate some of the advantages of fat transfer over breast implants.  There are the obvious advantages of no cost or upkeep of implants, no need for anything other than teen tiny incisions and the improvement in the shape of the fat donor sites.

       Another advantage that is nicely shown in these photos, is the ability to subtly improve the shape of the breast.  This is possible because specific areas of the breast can be targeted for injection.  In this case, before fat transfer, the bottom of the breasts was quite square.  After fat transfer, the bottom is more rounded.  Also, the fat filled up the upper part of her breasts.  I think I hit a home run on the right side.  She may be coming back for a little more to get that left side looking as good as the right.

        After 20+ years in practice, it has been so exciting and enjoyable learning this new procedure and being able to offer it to selected patients.

Thanks for reading!  Dr. Lisa Lynn Sowder