Posted on February 26, 2010 in Breast, Mommy Makeover / Body post baby, Post Pregnancy Breast, breast reduction
The trend of the week this week: questions to me, the plastic surgeon, about “how can I avoid you?” How can I do what I want without surgery?
I get it.
Surgery is a big deal. It is scars, and surgery with its risks, and recovery, and paying money. So I get it.
So. Back to the question: Can I do a breast reduction without surgery? Breast size is related to a bunch of things. And breast size and composition (breast tissue versus fat) changes over time. Two things come to mind which will reduce your breast size without surgery:
1. Lose weight. Particularly if you are overweight, losing weight will reduce the size of your breast.
2. Breast feeding. It doesnt’ happen for everyone. Some women stay the same size, and some swear they are larger afterwards, but the general trend I see is loss of volume after breast feeding, particularly the longer and more children you have.
But size isn’t everything with the breast.
When women come to me with large breasts they have two issues. 1. size (obvious) 2. droop. The skin is an important factor. One of the issues we have with liposuction of the breast is the younger large breasted women who have good skin tone (who’s skin will shrink if the breast is made smalller) tend to have dense breast tissue with little fat, which is not amenable to liposuction. The older women with the softer, buttery fat who would liposuction easily are droopy, so when you remove the volume, they just droop more.
So, as breasts get smaller, they flatten and droop. I fix this constantly in women in their 40s seeking a mommy makeover. If you want to go smaller AND reshape, lift, and firm up the tissue, you need a surgery. Welcome to my short scar vertical breast lift.
So it is just the size you don’t like? Or do you also not like the bungy jump when you take off your bra? If you want to lift and firm, you need surgery. Sorry.
Posted on February 22, 2010 in Breast, Post Pregnancy Breast, breast augmentation, breast implant, interesting & new
This is the age old question.
How can we make breasts larger without a foreign object? They have tried all sorts of things in the past. The issue with many of them is:
1. Screening of the breast for cancer
2. Injury or hormonal stimulation to the breast- could it cause cancer or make a cancer which is there grow faster?
There are medications which claim to make the breast larger. Be careful of anything hormonally based. Many “herbals” are basic forms of hormones and are as potent as the prescription strength hormones you get.
There is a machine BRAVA that applies suction, causing the tissue to swell and get new blood supply to make the breast larger. It does seem to work, but it requires 11 hours a day for a median period of 18.5 weeks to go up about 100cc. It has been around for over a decade and never got traction in the cosmetic market. Why? To quote a plastic surgical colleague of mine, “The patients hated it. It required a lot of nursing time and assist because it was difficult to use, and the results were not impressive.” But now, BRAVA, the “machine looking for an indication” may have found it. It may help fat survive when transferred to the breast to do breast augmentation using fat.
Fat injections may be a promise in the future. Really thin women don’t have enough fat to harvest, so for them, this will not be an option. For others, it may. I went to a recent meeting (Feb 2010) in Miami with surgeons who are innovative in the field. The main issue still remains, how do you get the fat to survive reliably? How can you make sure it is safe? How much does it impair the ability to screen for breast cancer?
I will continue to blog about fat grafting to the breast, or as some believe, “stem cell breast augmentation.” I am just not sure yet I am ready to do it. My base question always with patients is would I recommend it to a family member? And as of now, I wouldn’t feel comfortable telling them I know it is safe. But with more research, time, and hard scientific data, I believe it may be.
(NOTE: This is a hot topic. Beware of untrained doctors who call themselves “plastic surgeons” who are doing fat grafting to the breast. We do know fat grafting when done poorly has poor survival, causing oil cyts, hard nodules, and calcifications. You can also easily get into the wrong plane and cause a pneumothorax, or the possible risk of fat emboli. This is only a technique which should be done by experienced board certified plastic surgeons. We do breast surgery, from breast reconstruction to lifts/ reductions/ augmentations, and we trained as general surgeons (doing mastectomies, etc) prior to plastic surgery.)
Posted on February 16, 2010 in Uncategorized
I know many people think plastic surgeons are all about changing everything. I am not.
I was saddened by the recent Heidi Montag feature on People magazine. Here is a beautiful young girl who underwent a lot of surgery and procedures to change herself. Overlooking my opinion she aged herself by a decade and looks more masculine, the real issue is why? what motivated her? and why didn’t someone stop her?
I know many of you will read this with a grain of salt. How can a plastic surgeon not be about promoting plastic surgery? But there are different types of surgeons. I don’t like the culture now, where it seems people are becoming distortions and caricatures (just see the women on one of those reality shows, some don’t look human anymore); where everyone calls themselves plastic surgeons when they are not; where plastic surgeons spend more time marketing than taking care of patients and doing what we were trained to do; where people start to think about surgery when they barely hit 20. People are being encouraged to dislike themselves. Is it the old “girls with straight hair want curly hair, and those with curly want straight”? Or is it something different?
I am a plastic surgeon. I do surgery. But I talk women out of surgery. A lot of what I do is more “restoration” than “change.” I like natural. I like subtle. I like people to still look like themselves.
I want you to still be you when you are done.
Be happy with yourself. No surgery or change in your appearance will make you more popular, get a husband, or be more successful. (though it can get your breasts off your waistline and your eyelids out of hanging into your eyes.) Happiness comes from within, and we can’t do surgery for that.
Posted on February 11, 2010 in Breast, Post Pregnancy Breast, breast augmentation, breast implant
Now there is a title which gets your attention.
Nipples aren’t symmetric. Breasts aren’t symmetric. We always aim for them to be close, but as a colleague once said “breasts are sisters, not twins.”
I got an email from a breast augmentation patient saying her nipples are asymmetric. Most are a little. I looked at her preop photos and hers were always asymmetric. She was happy after her surgery at all of her visits, including a couple months out.
But she is sending me an email now, about 2 years after her surgery, saying they are asymmetric. What changed? Why is she now noticing there is a difference?
The most likely culprit for seeing a progressing nipple asymmetry when you have breast implants is a mild capsular contracture on one side (if it happened on both, your nipple position would likely be changing equally). If you notice one breast is softer than the other, you might be forming a mild contracture. When this happens, it often causes the affected breast to become a little rounder in shape, firmer, and it lifts the breast up a little. You may notice your nipple position changes or you look like you have more cleavage in the upper breast on one side than the other.
See your surgeon when you see this. Sometimes there are habits which may make one side age differently than the other. Do you sleep on your tummy? Only on one side? Do you wear good supportive bras? Did you have a child? Did you breastfeed evenly?
You can try nonsurgical ways to loosen it up. Massage, lying on a stack of books, vitamin E, singulair have all been described. I haven’t seen tremendous success with these, but it is worth a shot. We don’t do closed capsulotomies like they did in the old days (turns out you could rupture the implant when you were trying to break open the capsule). So it frequently ends up being a surgery. (ug.)
When to operate? Hmmm. Tough question. If it bothers you. If it is a grade III or IV capsule. If it is painful. If it is visible in clothing. The bad part is we still don’t really know what causes capsular contracture. Bleeding, fluid, infection, gel implants, in front of the muscle placement- all are associated. But then there is dumb (bad) luck. To fix it you can open up the capsule, cut out the capsule, or create a neopocket. The issue is there is no guarantee it won’t recur.
So. See your surgeon. And think- how much does it bother you? are you willing to do the time/expense/recovery of another surgery? how will you feel if it recurs? There is no rush. Remember your nipples were likely never exactly symmetric.
Breasts are like sisters, not twins. (But is nice if the sisters look like they are from the same family.)
Posted on February 4, 2010 in Breast, Mommy Makeover / Body post baby, Post Pregnancy Breast, breast reduction, interesting & new
Ahhh. Marketing.
Do I sound like a broken record or what? I am just so dismayed by all of the hype and spin out there. It seems like everyone is trying to make a catchy new phrase for their surgery which will change the world, defy gravity, have no scars, and no downtime.
Bottom line still is when it sounds “too good to be true” it is.
I recently got an inquiry about the laser bra. Why don’t I do it, it only takes one hour to do, it keeps its lift better, etc etc. In general, good plastic surgery techniques get accepted by the general board certified plastic surgeon population over time. The hype and marketing things do not.
Lasers sound cool. They sound more modern, high tech, and less invasive. But there is a great deal of deception about lasers. When I was in residency and the CO2 laser came out, we all jumped on board. Now 15 years into plastic surgery, with a gazillion different lasers out there, I don’t use lasers at all. There are many types of lasers. Some address redness, some pigment, some promote collagen in the skin, some sandblast off the top layers. The one used in the laser bra is the CO2.
The CO2 laser does tighten the skin. I used to use it for resurfacing facial skin. I stopped using it due to issues with depigmentation, redness, and potential for scar. If you are using it on skin which subsequently is buried, those are not problems. The biggest thing with lasers is the amount of “tightening” is not much. Some people imagine lasers are like putting a wool sweater in the dryer. Oh. If that were only the case. We 40 somethings would jump in and laser every inch of us. But alas, lasers are more like an “iron”- they help remove fine light wrinkles only.
The laser bra involves lasering the top layer of skin, and then using that skin, tacked down to underlying tissue, as an internal “bra.” Sounds fantastic. Who wouldn’t want an internal bra to lift you?
But the laser bra will not “hold” the lift any better over time than traditional surgery. Traditional breast lifts already use the skin as an internal bra- we just deepithelialize it, not laser it. Regardless of what you do, skin stretches. Skin droops. This is deceptive marketing. I am saddened by the claims.
- “The Laser Bra surgeon can keep the breasts lifted in a natural, beautiful position.” Nothing can “keep” breasts lifted. They will droop again over time.
- The time claims of surgery are skewed. Normal breast reductions do NOT take 5 hours- in most hands it takes 2 1/2 to 3 hours.
- Finally, many of the photos involve augmentations. Implants will always help “lift” the breasts and give fullness in the cleavage area- and that has nothing to do with what reduction or lift technique you use.
I have done many different kinds of lifts over the years. The breast is made up of breast tissue and fat. In general
- the more breast tissue, less fat
- the smaller the breast
- the better you support the breast (ie good bras)
- the less you stress the breast (pregnancy, breastfeeding, jogging)
the better and longer your lift will last.
I find in my hands the best lift is the vertical lift. I do a lot of internal suturing. Why? It takes tension off the skin and shapes the breast better. Hmmm. Maybe I should make a catchy new term. “The hammock”? “The cone”? “The anti-gravity-little-scar-secret-special-exclusive-breast reduction-by-Dr. Greenberg” technique?
I think I will stick with being a good surgeon and leave marketing to others. There are many good breast surgeons to choose from. Meet a few. Look at photos. And beware of the gimmicks. When someone sounds like they are selling you a rainbow, they usually are.
Posted on February 1, 2010 in Skin / Nonsurgical, interesting & new, skin fillers
Both products are offering goodies right now.
Juvederm is offering a free Vivite lip plumper ($45 value) when you use a syringe.
Restalyne and Perlane are offering $50 back for every syringe you use.
Woo hoo! Call the office for an appointment. These are great fillers for the tear trough, cheek, nasolabial fold (the parenthesis around your mouth) and your lips (yes,don’t worry, you don’t have to look overplumped and ducky when it is done well.)
