3 Breast Augmentation Cases

“Morning! So, today, as I said, we have three breast augmentations and we’re going to talk about all the variables with this operation. So, one of the best things about plastic surgery beverly hills is that there really is no one way to do any of the operations we do. That can also be a challenge sometimes.”

“For those of you who are looking at plastic surgery, it can be confusing when you see one doctor do something one way and another doctor do something another way. Even as a young surgeon coming out of training, it was sometimes confusing, thinking, ‘Well, I see someone doing it this way and someone doing it that way – what’s the right way?’”

“The truth and the final answer is basically looking at things supported by data and research, also by the experience of a surgeon. Bottom line is this: there are a lot of ways to do the same thing. The most important thing is the results.”

“We’ll talk about it more, but, basically, it compels you to look at the quality of your surgeon’s results, talk to your surgeon, understand why they are doing things.”

BREAST AUGMENTATION PROCEDURE #1

“We’re putting on some nipple shields to protect the wound from the bacteria on the nipple.”

“So I use an incision. Typically, it is about 3 1/2 centimeters, so just over an inch.”

“An interesting thing I noticed over my career is that patients with different ethnicities have sort of similar muscle patterns. So, as an example, I’ve found that patients from southeast Asia have more attachments of this pectoral muscle to the actual ribs.”

“So, we put the sizer in on the other side. I put this implant in under the muscle, like I do with most of my patients. I have a lot of thin patients, so they typically need more coverage in the upper pole of their breasts. The muscle provides that extra contour to make them look better.”

“As usual, clear irrigation going in and nice clear irrigation coming out.”

“No touch technique: implants going out…”

“So, the incision is just over an inch, less than an inch and a quarter.”

“I’m hiding some birth marks, but this is how she looked before. And, here she is, after these new beautiful implants. Absolutely gorgeous.”

BREAST AUGMENTATION #2

“Hi, so this is our second patient. You can see her breasts have a little bit of droop, a little bit of asymmetry. We talked about doing a lift. She doesn’t want one right now and I think it’s reasonable. We’re going to put in a nice high profile implant. We’re going to balance out her gorgeous arms. There’s not a lot of difference in the volume of the breasts, so I may not do significantly asymmetrically sized implants, but we’ll see in the OR.”

“So I do our standard markings here. This is just to determine the boundaries of the breast.”

“So, we’ll talk about incisions on this case. There are different types. There’s around the areola, under the breast, through the belly button, and in the arm pit.”

“An interesting thing you’ll notice is this is where I marked the bottom of the breast, but I always make the incision down below that, because the implant drops the breast. Now, knowing where to put this incision so it’s exactly in the crease of the new breast is a bit of an art and it’s a secret I have and I’m not sharing.”

“So, a big question is always what type of incision should we use? And there are a lot of different approaches.There’s a lot of different answers. I believe in using the below the breast or inframammary incision and there’s a lot of good reasons why it’s actually beneficial. What I tell my patients is this: think about what the breast does. It makes milk and, through the milk ducts, it delivers the milk to the outside world. So, because there’s that connection with the outside world, some of the bacteria from the outside naturally gets into the breast through the milk ducts. It’s totally normal. So, if you think about it, if you make an incision around the areola, then you have to go through the breast tissue in order to get to that pocket for the implant. So, because there’s bacteria in the breast tissue, as the implant goes through some bacteria may get on the implant. So, the thought is that some of that bacteria can actually stimulate the body to attack. The body sees it as foreign and goes after it. That attack can lead to what is called capsular contracture or scarring around the breast implant.”

“So, capsular contracture – you’ve seen some patients who have tight, tight, really rock hard looking breast implants. That is all scarring and it is a known complication. So, long story short, we’ve seen that there’s an increase in the incidents of capsular contracture for patients who have had the incision around the areola than those below the breast. So, a lot of plastic surgeons feel that the bacteria and the information are responsible for this. That’s why we’re so crazy about preventing bacteria and information in the pockets. So, that’s one of the reasons why I don’t put anything other than sterile instruments in the pocket. That includes gauze pads, which the thought is that there is all this cotton flying off and that stuff can stay in there and cause inflammation.”

“So, we’re putting in some long acting pain medicine into the muscle and the pocket.”

“Okay, so, again, here she is before – beautiful – and here she is now – gorgeous shape, nicely filled out. She is going to love it.”

BREAST AUGMENTATION #3

“So, our third patient for the day – we’re lucky today – she also has great shape and a little bit of droop. She asked that I give her more robust augmentation and I think that’s going to work great for her to help balance out her beautiful frame.”

“She really represents one of my most important principles: look at this incredible tiny waist, but it just goes straight up here. What we’re going to do is fill out the upper portion of her chest and really accentuate the hourglass figure.”

“So, unfortunately, there was a little bit of an issue with the patient’s aftercare after the procedure, so we’ve all decided it would be easier to delay. We’re actually going to do the operation on Tuesday morning, so we’ll show it then and go over all of the good stuff.”

“Some interesting details are second patient found me on Snapchat and flew in from the east coast to have her procedure done by me. Funny enough, one of the reasons she came to me was actually because of my incisions. She knows that I prefer going under the breast and also saw a lot of my post-op photos on Instagram. I have a couple of very specific photos showing how well the inframammary incision can heal, so take a look!”

“So, despite canceling the last case, today was really fun. I really enjoy getting all of the questions about the procedure. I certainly invite you to throw in as many as you want to me. I’m always happy to answer and to incorporate them into my snaps. I especially wanted to shout out a young student that was chatting with me from West Virginia. She had some great questions and helped me today.”