Question #1:
>I am a 34A and want to go to about 34 largeB - small C. The surgeon that I have interviewed with suggested immediately the "below muscle" procedure. I am concerned about the look and feel of this type of placement VS the above the muscle procedure. I would like the breasts to feel as natural as possible. Does this placement make a difference with regard to the feel of the breast. Also I do workout often (as well as strenuous) and was wondering if my developed "pecs" would make the procedure look more artificial. In other words do I have to relax my chest exercises to maintain a natural look after the procedure? I have breastfed one child and am 35 years old. I have lost 25 pounds in 7 months and at 5'4" 120 pounds ( I don't look skinny) I have very little body fat. This of course meant also the loss of breast fats. I was originally 34B Solid. Any help that you could give me would be greatly appreciated.
An Answer:
I would encourage you to go a little larger as dissatisfaction is greater
when the enlargement is less than 2 cup sizes. I also routinely do sub-muscular
surgery for reasons I have explained before. The sub-muscular position
leads to a more natural result as the implant gets more soft tissue coverage.
This is especially the case with the current saline-filled implants. There
is some atrophy of the pectoralis major muscle with the sub-muscular placement.
I have rarely seen this be of functional significance.
Thanks for the question,
John Di Saia, M.D.
Question #2:
My girlfriend had augmentation surgery a few days ago, and we were discussing how bra sizes are actually measured. Somewhere I read that one is to measure underneath the breasts, and add 5 inches to get the major size, then measure over the nipples and subtract from the "underneath" measurement, with a 1 inch difference being an "a" cup, 2 a "b", and so on. She measured herself after surgery, and (aside from the post-op swelling), this technique appears to be grossly wrong. Can you tell me the true formula?
An Answer:
There is no standard of which I am aware. This is one of the reasons
that I ask for patients to bring photographs to consultation. A visible
target is then possible. Bras tend to run small or large depending upon
the production which is variable. An "A" cup in one brand may be equal
to a "B" in another.
Thanks for the question,
John Di Saia, M.D.
Question #3:
>I am a 31 year old woman considering breast augmentation but I have
some concerns. I am a 32A on the left side and not anywhere near on the
right. I have approx. 2 sizes differance between my two breast's. (the
right is almost non-exsistant) Not only do I have the general size differance
but my areola's are two completely differant sizes. Is this something that
can be corrected with this surgery?
>I know that insurance will pay part of the cost of the surgery after
a masectamy or for other reconstructive reasons but is there any possibility
of my insurance paying for part of the cost due to the extreme differance
of size? I had always heard that it was normal to have a difference in
size but this is ridiculous!!!
An Answer:
I am sorry to tell you that I doubt insurance will cover anything here as they will more likely than not consider this cosmetic surgery.
With regards to your surgery, what you will require really depends upon what you want changed.
(1) To change the size of our areolae will requite a formal mastopexy ("breast lift"). At 31 years of age, you may wish to put this off. Scarring is usually worse with more incisions as this procedure will require. If you really want to get the breasts more similar in size and shape, a mastopexy is also reasonable.
(2) If what you really want is to try to get the size of the breasts
close, then a simple augmentation with diferent sized implants will require
less surgery (and will result in less scarring). You may not like the result
however and later may opt for a mastopexy. It is possible to reduce the
discrepancy but not entirely eliminate it (even with mastopexy).
Thanks for the question,
John Di Saia, M.D.
Question #4:
>I have been considering implant for a very long time. I very much appreciate
your informative web page on the subject of plastic surgery. I have just
a few questions.
>1. Is there ever a case in which a woman is too small breasted to
get implants? I am very small (less than AA) and would like to be around
a B cup. Am I expecting too much? I'd hate to pay $4000 for a surgery and
still be small breasted when I'm done.
>Also, it seems to me that many of the bad surgeries had something
to do with the fact that the women were trying to make their breasts too
large. Is this an accurate assumption?
An Answer:
With regards to being too small to begin with......
The leading complaint following surgery is that the breasts are not
large enough. On the other hand, the look of the implants (natural vs supernatural)
is to a large extent determined by the ratio of breast tissue and muscle
to the implant over wich these structures are "spread." A large implant
under little tissue tends to look less natural.
On bad results.......
There is no one reason why any bad result happens. It is true however
that placing really large implants under little tissue tends to look less
than natural. This coupled with the common complaint of "my breasts are
still too small" defines the quandry: "What is big enough?" The answer
is different for each patient.
Thanks for the question,
John Di Saia, M.D.
Question #5:
>Greetings
> I read pretty much everything I could find in your webpage about
tummy tucks and liposuction. What I did not see in your web page was information
about how much of a change a person can expect to see reguarding each.
I have had 3 knee surgeries in the past 3 years and I will never be able
to work out to the degree I will need to reduce my weight. My weight is
not my problem, but the ugly flabby tummy is. I went from a size 9/10 to
a size 16 in a matter of months before I realized that I could not keep
eating like I had been before. Diets work, but they never KEEP the weight
off (and hence my size is never stable) My questions are as follows:
>...How much of a change in the body shape can a person general expect
with either tummy tucks or lipo?
>...Will becoming pregant affect the surgery scars or vice versa?
>...How much body fat is generally taken from a person?
>I would of course LOVE to be a size 9 again, but I know that is probably out of the question. Is it feasable (again I ask in general) for a person to go down from a size 16 to a size 12? (I want to wear my old clothes again!!!)
An Answer:
The questions you ask are widely variable. As I've stated in my liposuction and abdominoplasty sections, neither procedure is technically weight loss. Patients that come to surgery looking for weight loss are more often disappointed. Many patients will lose a few pounds from the surgery (one to five). People seem to think that more can be removed than can be done so safely in one operation. Some of these patients gain some or all of it back.
Pregnancy can of course affect the scars and your shape.
For weight loss, I would recommend that you see a weight loss physician.
For contour changes, surgery can sometimes be helpful.
Thanks for the question,
John Di Saia, M.D.
Question #6:
>One of my closest friends is considering saline implants. She has seen two different doctors who have obviously given her two different opinions. After having two children, she has lost some breast volume and would simply like to regain what she has lost. She is currently between an A and B and would like to be a full B. She wants to have as natural an appearance as possible. She merely wants to reduce that "caved-in" look.
>After consulting with the first doctor, she became convinced that a 210 cc implant would give her the results she wanted. But the second doctor after measuring the width of her thorax and the diameter/circumference of her breast said he would not go below a 270/300 implant. He said the implant needed to cover the entire diameter of the breast and if she were to go any smaller it would look like she had two implants sticking out on top of her breasts as opposed to having a more round, full appearance.
>Both physicians would go through the aerola and place the implant under the pectoral muscle. So my question to you is: does the implant have to be large enough to cover the entire breast diameter? Is it possible to have smaller implants simply to look more full? I understand it depends on the natural shape of the breast but she was thinking that she she doesn't droop she could simply get a smaller implant and have the top part of the breast (down to the areola) filled out. My last question is how much control does the doctor have over which part of the breast gets more filled out??
An Answer:
It is not possible to reliably augment just a portion of a breast. The
implants settle over the first year. They first ride high filling out the
area above the areola. This fullness decreases as the implants settle.
Depending upon how large they were originally and the size of the patient,
remaining upper pole fullness varies. Eventually the majority of the increased
volume rides behind the nipple/areola. Some will remain lateral (toward
the armpit) and some will remain in the area below the areola. The degree
to which this will occur is partly controllable by the surgeon, but the
surgeon cannot guarantee how a patient will heal. One last point: Don't
get caught up in the volume. Many patients come to consultation trying
to figure a volume that they "need." Different patients will wear the same
implant differently. Try bringing a picture instead. Then a visible goal
can be agreed upon.
Thanks for the question,
John Di Saia, M.D.
Question #7:
>Hi, I want to thank you for your candid and non-emotional response to honest questions. Unfortunately there is an awful lot of highly charged negative information on the WEB about breast augmentation. It is refreshing to have an actual exchange of information. I have read through all of your questions and answers and picked up bits and pieces of the answers to my questions but would like some further clarification.
>1. Are there any hard statistics about the incidence of encapsulation
that requires surgery. For example. What % of all implant patients require
surgury for encapsulation? Where does one find objective statistical data
for this?
>2. How long can one expect Saline implants to last? If the answer
is some womens implants last forever and some don't then What % of women
need replacement withing the 1st 5 years, 10 years, 15 years etc.
>3. What are the costs and ramifications of having them removed? Thank
you for your honesty and willingness to put out some effort for the sake
of candid two-way communication.
An Answer:
On encapsulation, breast implant patients do not lend themselves well
to study. Only following the silicone gel implant controversy are we starting
to get good studies. When reading the surgical literature, one sees a number
of varying figures. With this said, many consider the severe encapsulation
rate from 1-4%. Many of these patients will seek capsulotomy. On implant
lifespan, there seems to be a leak rate of about .5-1% a year. A common
figure for leaking is 5% over 15 years. On removal, if the skin over the
implant has stretched prior to removal (happens quickly over the first
few weeks/months), a mastopexy with re-positioning of the nipple and removal
of breast skin may be needed.
Thanks for the question,
John Di Saia, M.D.
Question #8:
>Dear Dr.,
>Thank you very much for your informative pages. The following are
my circumstances:
>I have had four live births, the last two years ago being C-Section. I have had numerous abdominal surgeries: tubal ligation, tuboplasty, numerous surgeries through my naval, and lastly removal of an ectopic pregnancy and my right ovary and fallopian tube. During my pregnancy two years ago or shortly thereafter, I became hypothyroid and it went undiagnosed for almost a year as my weight continued to balloon and my health declined. I have now been taking synthroid for a year and have finally thanks to a low fat, low cholesteral way of eating and power walking at least 4miles a day, been able to reduce my weight from 170 to 145 in the last four weeks and am now hoping to lose 2 to 3 pounds a week to get back to my normal weight of about 125. I have increased my excerise regimen, but I want to know if you think that the only way that I will really redefine my lower abdomen would be with abdominoplasty. After reading your questions and answer series, I don't feel that liposuction alone would help my situation. Could you please give me some feedback. Thank you again for making a lot of my questions clear to me. You were an extra bit of sunshine on my day.
An Answer:
Thank-you for the kind words. Without seeing you, however, I can't make
the kind of determination you seem to seek. Abdominoplasty is one means
to an end. Exercise coupled with a surgical procedure however will often
give better results than the surgery alone. Sometimes patients are able
to get results with which they are pleased with exercise alone. Of course,
I rarely see the latter people in the office.
Thanks for the question,
John Di Saia, M.D.
Question #9:
>I am considering having liposuction done to my abdominal area. I am 25 yrs old but have an abnormally high cholosterol count. My last test showed that it was rather high. I am not tremendously over-weight (about 20 lbs), but my concern is that when I have the fat suctioned from my abdomen that it will increase the fat deposits in other portions of my body. The place I am most concerned about is around my heart. Also will this type of surgery affect my cholestrol count. Will it cause an increase of fat in the blood stream, plaque build-up, etc...?
An Answer:
There is actually some evidence that liposuction of large amounts of
fat can potentially decrease the blood lipids/cholesterol count. This has
been shown in one study in which removal of several liters of fat was performed.
This is not to say necessarily that you will see a reduction in your blood
cholesterol, but you most likely will not see an increase.
Thanks for the question,
John Di Saia, M.D.
Question #10:
>I just wanted to say thank you for the wonderfully informative page! I have considered implants for a very long time (7-8 years!!) and recently decided to research it. I have numerous questions, but I will try to be brief.
>1. From the information that I have read on your page, augmentation does not sound "permanent". By that I mean that the appearance will change not only after the first year, but also over the next 15 years because of possible contracture, leakage, and other variables. I am taking this to mean that as I am 25 now, I could expect to need my implants replaced when I am 40. I am misreading you?
>2. I have nursed two children for six months each and gone through a divorce during which I lost approx. 80lbs due to stress and other factors. I always thought of myself as the ideal candidate for implants because I am 5ft 10in and definitely have room for larger breasts without looking disproportionate. Since losing the weight and then gaining 20lbs back (135lbs now)however, I no longer even fill out my 36B cup, and I have a small amount of the ptosis that you described. Am I still a good candidate?
>3. I have an opportunity to travel to Costa Rica within the next few months, and I thought that it would be the perfect time to have my implants done as then I can combine my vacation with the surgery and not have to take double time off. I have heard that Costa Rica has excellent clinics. Have you heard anything about them? I have located a clinic and requested information on procedures, the surgeon's credentials and so on. One response was that I would need to be there for 5 days, and that my surgery could done under local anesthesia, the incision would be around the nipple area depending on my pigmentation, and that it would not incapacitate me completely so I could still do some sight seeing. I know that every person reacts differently to surgery, but does this sound realistic? One person I spoke with who has had surgery (15 years ago)said that for a week afterward she could not even dress herself or get out of bed or a bathtub without help...is that far-fetched?
>4. This same friend also showed me an area between her breast and under her arm where a bubble has appeared. It is only noticeable when you squeeze the area, but t is apparently rather hard. She developed it when she lifted a heavy box of books 5 years ago and pulled a muscle around her breast area and scar tissue built around one corner of the implant isolating the area. She has seen her surgeon and on the initial visit, he told her it was nothing to worry about, that she could just "pop" it. He squeezed it and she said she heard and felt it pop. Not the implant but just the pocket. However, it kept coming back, and the last time she went to have it popped, her surgeon told her that as her implants were 15yrs old, she was beginning to run a greater risk of them bursting. He said it would be no trouble to replace it if it did burst during one of the popping sessions, because he could just open her up in the office and put in a new one. The result the would be that she would have one new and one 15yr old implant. If all of this trouble comes just from lifting a box of books, is there a chance that lifting one of my children (2yrs and 3yrs) could possibly start me down this road? Also, it was rather scary looking at that "bubble" she had. Is that common? I will say that she states she would still have the surgery in a heart beat even if she had to go through all of the same things.
An Answer:
I wouldn't expect to have the need to replace your implants, but consider that as a possibility. As I have mentioned, statistics are hard to keep on cosmetic surgey patients as they don't naturally lend themselves to long term follow-up unless they have problems. We really don't know exact probablilities on these things. Some studies on silicone gel implants showed a 90% or greater incidence of rupture over twenty years. Other studies on saline filled implants have shown as low as .5 to 2% over 15 years. The real incidence probably lies between these figures. A commonly cited figure is 5% over 15 years. By the way you describe yourself you seem like a good candidate, but again it is difficult to tell without seing you. A consultation with a qualified plastic surgeon should solve this issue.
On the Costa Rica clinics, be careful about choosing a surgeon. I know nothing about them in general, but have heard a few horror stories. Post-operative recuperation is different for every patient, but a few days to a week is average for my patients.
On the "bubble story," it is really impossible for me to comment without
seeing this woman. The "bubble" could be anything from a benign cyst to
a silicone leak. I doubt if it was related to the box of books. This is
probably the situation which brought the area to the patient's attention.
It sounds like she is seeing a surgeon for this problem which is the reasonable
thing to do.
Thanks for the Question,
John Di Saia, M.D.
