“My Breast Implants Are Too Small: How Long To Wait For Redo?”

“I had a BA silicone 450 R went to 500 /500 went to 550 L under, on March 21, I want a redo to go bigger by 100 cc’s , how long should I wait to get a redo, I was thinking maybe July or wait til Nov of this year.”

This is probably one of the most common complaints after Breast Augmentation not related to a complication.  Many patients feel that their Breast Implants are too small right after their surgery.  Personally, I have never felt this way (even after two different breast augmentations with 510 cc saline breast implants) because I had gone rather large and admittedly regretted choosing such a large size (both times!).   Granted, I liked it at first.  When you’re just lying around healing, having noticeable results is like Christmas!  But when you get back to your daily life, finding bras that fit (32F!) and easing back into your activities can be a little “different” with that much mass on your chest.  So be careful what you wish for.   And remember, the larger you go the more stress is applied to your tissues and the faster you will sag without sufficient support (although we all sag eventually).

Now that you’re heard my thoughts from personal experience, I thought I’d share the comments of 4 of our Expert Breast Augmentation Surgeons…

Breast Augmentation Print-Outs, PDF Files Updated

I have updated the Breast Augmentation Print-outs (PDF files) which include:

• Consultation Preparation Tips & Checklists: Are You Ready For Your Breast Implants Consultation?
• Questions To Ask Your Surgeon At Your Breast Augmentation Consultation:  Important Questions to ask your surgeon, including a rating system for the staff, office, bedside manner etc.
• Preparing Your Recovery Area: Tips & Checklists on how to best prepare your recovery area
• Pre-operative Shopping List: Checklists and Suggestions on what to buy before your Breast Augmentation Surgery
• Medications & Supplements To Avoid Before Surgery: A Partial list on Aspirin and Aspirin-like medications.  Also includes prescription medications, herbals, homeopathics and supplements
• What To Do In The Event of An Emergency During Your Breast Augmentation Recovery
• Emotional Preparation Reminder Checklist

BreastImplantsCentral.com Launched

My friend Heather Bakker, you may know her on the forums as “Halo”, and I have started a new breast augmentation website. Heather is having her redo with Dr Horn and thought it would be great to launch a new breast augmentation support website since the old one is gone.  When she asked me to be a part of it I jumped at the chance!  We buckled down and designed a website which we hope is user friendly and informative.  Some of the content is from YTF for now but she and I have been working around the clock to get more detailed, fresh content to help others in their pursuit of breast augmentation. Please help us spread the word and join us on the forum

Heather will also be making a video blog of her entire experience ans well as a traditional journal with photos.  So be sure you stay tuned to see what it is like, from beginng to end, to have breast implants surgery.

 BreastImplantsCentral.com

Are Cosmetic Surgery Contests Unethical

You’ve seen the contests on the Internet, heard them on the radio, seen them in certain clubs: Win Breast Implants!  Apply Within. Free surgery, how great can that be?  All you have to do is agree to be part of the contest, perhaps take a few photos, maybe make a few appearances and interviews. Sounds like an inexpensive way to get a better bustline, yeah? Not in my opinion.  

So why am I so against this obvious opportunity for those who don’t have other means to financially make surgery happen? 

A. how does the awarder know if the awardee is physically and mentally a candidate for plastic surgery? B. In some contests, the patient has no choice over who their surgeon is going to be, not good. C. Some patients are victims of winner’s syndrome, similar to winners on eBay who are willing to pay more, simply to win.  In this case, patients are willing to risk more, simply to win a chance at having surgery.  D. In the event that you have complications, more than likely, you will have to foot the bill. Always include this when considering any procedure.  And lastly, *ugh* sometimes the contest throwers make the contestants do the worst, almost degrading, activities. 

One contest that some may consider mild, yet still similar to clean mud wrestling, was a Halloween contest thrown in Las Vegas.  The contestants had 90 minutes to scurry around a night club looking for Halloween candy.  The five girls holding the most candy at the end of the 90 minute period, went up on stage where others “voted” who should get free boobs. I imagine women fighting over candy they don’t intend to eat, but what is used as currency for raffle tickets for free breasts.  It almost bothers me to think about it.

Howard Stern has also had similar contests.  Heck, he has outright purchased breast implant procedures for women.  Then he parades them in front of his staff and asks outright, on the air, in front of hundreds of thousands of viewers, to strip and let him test drive the new additions.  I think this is what bothers me the most.  Those who know me well, know that I am no fan of this man.  But mention him alongside a breast implant contest and I am all over it like a rabid pitbull.

I personally find breast implant contests disgraceful; my comments are not meant directly at the women but at the men who would stoop so low as to dangle such a carrot in front of their faces.  But, then again I have always saved for my surgeries or gotten them discounted because they would be portrayed on television. So perhaps I am not one to utter a word.  I just would hate for a woman to be made a spectacle of simply so they can get a free surgery.  Surgery is so personal, and to let outsiders in for any reason can make you feel awful, much less be made to jump through hoops to gain a chance at receiving them. But I know, as women, we have all probably done far worse out of either pressure or guilt.

So my question is, is it ethical for men (and the contributing surgeons) to be running these various contests to award breast implants to women? Or do you feel that using your gender and body to get what you want without regret is a good thing?  I am curious as to your thoughts. Perhaps I am just overly sensitive and jaded from past experiences in life.  Perhaps I feel as though I am looking out for other women, when in reality using what God gave you to get what you can out of it is ‘okay’ (even if it means improving what God gave you!).  I am really curious as to how you all feel. Maybe I just have not seen the light, or am I right on the money where being taken advantage of is concerned?  Please let me know…

Micro Breast Implants: The Next Step or A Step Back?

In the techno-world, smaller is better. Our cell phones, our MP3 players, our computers, cameras, nanotechnology in cosmetics and medicine…everything is shrinking and many of us like it that way.  Some may think the next course of action may transcend over into the cosmetic surgery field. Specifically a new invention, Micro Breast Implants (or Microballoons), designed by the same surgeon who brought us the Dr. William A. Brennan Boob Job Giveaway. 

In the micro breast implant procedure, small, textured, translucent silicone implants (US Patent 7169180 ) are implanted into the breast tissue with a special injector through a 5mm incision.  The implants are placed in a pocket like breast implant said to compress together and not migrate.  They are designed to feel more like breast tissue and not like a firm grapefruit (which I happen to like ha!).  I imagine them to resemble little individual, packing bubbles.  Another plus is that the size is said to  be adjustable by simply adding more (or presumably removing some if you’d like to go smaller).  The press release reports that in a poll, 60% of women would prefer these over traditional breast implants.  This new breast augmentation procedure is theorized to look more natural and eliminate the full look of traditionally implanted breasts (which I also like!).

In theory, this sounds like a good idea. So, is this in fact the next generation in breast augmentation, or are we stepping back a little because of not thinking ahead?

• Mammograms: If the implants can only be placed inside the breast tissue, wouldn’t the early detection of breast cancer be hindered more with these implants than with traditional implants?
• Scar Tissue: Although the implants are soft, there are several injectable fillers which rely on micro implant technology and trigger the body’s own collagen production from foreign body reaction to give augmentation.  Wouldn’t the same reaction apply, not so much in augmentation but dense tissue intertwining the implants–ergo more fibrous tissue formation in the breast?
• Capsular Contracture (CC): Would the same reaction apply and how would the end result feel?  Would the treatment of CC be more difficult because of many implants that must be dealt with?
• Contour Irregularities: Although they are reported not to be able to migrate, what if they do?  Coupled with the aforementioned scar tissue, would puckering be possible in the event this occurred? What about the nature of having many small implants inserted into the subglandular position, wouldn’t this not be a good option for patients with thin skin or very little breast tissue? Would it then feel like a breast filled with tapioca pudding?

But this is what clinical trials are for.  These questions can only be answered through the organization and completion of medical trials. Trials which require the implantation of these investigational devices in animals and then in patients like me and you who are willing to be a part of an experiment–a new frontier.  It’s how we advance. Someone has to take one for the team.

Dr. Brennan is said to be the only neurosurgeon in California who practices cosmetic surgery and is a fellow of the F.A.C.S. Dr. Brennan is not certified by the American Board of Plastic Surgery.

For very detailed information on the patent and the breast augmentation system, please visit the below sites:

http://www.patentstorm.us/patents/7169180/description.html

http://www.freepatentsonline.com/7169180.html

Breast Reconstruction After Mastectomy

This subject has been coming up a lot since the announcement of Christina Applegate’s breast cancer diagnosis.  Although it shouldn’t take a celebrity to bring about awareness, it should be something on our minds once a month during our self breast examinations.  According to the U.S. Cancer Statistics Working Group,  in 2004, 186,772 women and 1,815 men were diagnosed with breast cancer. Worse, 40,954 women and 362 men died from breast cancer in 2004.  Breast Cancer Awareness Month is coming up soon so please get into your physician and have a screening performed to be sure.  Even if breast cancer doesn’t run in your family, one day out of your year to go and have a mammogram won’t kill you, but not doing so may.

I have a very good friend, we’ll call her Loretta, who has a history of breast cancer and fibrocystic disease in her family. Loretta lost one breast to breast cancer in 2004.  Just one, not both; she is now in her 60′s and hasn’t had a problem arise in her remaining breast as of yet but she feels it is only a matter of time.  She chose not to have breast reconstruction because she says, “I know who I am. I don’t need breasts. I am at an age where it didn’t matter to me, My [late] husband didn’t mind either.” Although she confided that the external prostheses are heavy and awkward and she now wishes she had had a bilateral mastectomy.  She is proof that there is life after mastectomy regardless whether or not you choose to have breast reconstruction.  Loretta is active, confident, wise–all the attributes I look up to as a woman. 

Loretta, whose mother died from breast cancer, has been a volunteer at We Care Cancer Support Center in the Tri-state area (based in Arizona).  She has helpedso many people get through the bad times after their diagnosis and has supported them during their treatments.  She is a cancer survivor who, she feels, more than likely has another battle ahead of her. She is a huge proponent of breast cancer screening and feels that the best form of prevention is early detection.

But, what if you wish to have breast reconstruction?  Maybe, unlike Loretta, you feel that having breast reconstruction can help you feel “normal” or in some way may distancs you from the fact that you had a mastectomy.  There are treatments available so that you don’t have to be reminded of your breast cancer.

Your Options In Breast Reconstruction

Now that you have beat cancer’s butt, if you choose to have breast reconstruction there are a few options you may not have thought of.  Everyone automatically thinks silicone implants, but there are a few other options, as well as combo-options. 

• Latissimus Dorsi Muscle Pedicle Flap: The Latissimus Dorsi muscle is the large muscle on your back.  Reconstruction using the LD is considered a pedicle flap procedure.  A pedicle is what a flap of skin is referred to when it is still left attached to the body’s blood supply so that the viability of the flap can be maintained.  The opposite is a free flap (see below) when the tissue is removed entirely from the body and then reattached via sutures.  With a pedicle flap, the tissue is still connected via a blood supply and re-situated and reattached in its new position via sutures.  The nipple (if not affected by cancer) is also usually left on a pedicle when possible so that it can be left on the body.  If not, a cosmetic tattoo can match the color and size of the other nipple if applicable.  A hole is often time made in the LD and the muscle is then pulled forward (under the skin) and reattached over where the breast mound once was.  This offers augmentation and creates a small to medium sided breast.  Usually, however, further augmentation with an implant is necessary.  In this case, a tissue expander is utilized to make a pocket and a breast implant is then inserted.  The LD is often used to hide the implant when the pectoral muscles are removed due to cancer. The scars for this procedure are often on the breast, as well as on the back either horizontally, or vertically under the arm.
• Pedicle TRAM Flap:  A Pedicle Tram Flap is a flap using the Transverse Rectus Abdominis Myocutaneous (hence, TRAM).  The TRAM is left on a pedicle, as explained above, to increase the chances of graft viability.  The TRAM flap seems to be the most often used method due to the use of the body’s own fat creating a natural breast feel. The TRAM flap is obtained by creating an almost football shaped incision on your lower abdomen and removing the rectus abdominus muscle, fat and skin, and then removing the skin and inserting the flap under the skin of the breast (where the nipple is normally removed).  The skin is then sutured into place and eventually a “nipple” is colored in using cosmetic tattooing.  The bonus is that essentially, you get a tummy tuck procedure as a bonus. The scars from this procedure are on the breast, as well as a horizontal scar on the lower abdomen as is typical with a tummy tuck.
• Free TRAM Flap Breast Reconstruction: This procedure is similar to the above procedure however the flap is severed from any blood supply and reconnected using microsurgery to a blood supply located in the breast area.
• Gluteal Free Flap Techniques: When a patient does not wish to have a scar on the lower abdomen, or when tissue may not be sufficient in very thin patients,.  Superior Gluteal Artery Perforator (SGAP) flaps and Inferior Gluteal Artery Perforator (IGAP) flaps are the two options in gluteal free flap procedures. In the SGAP procedure, the flap is removed from the middle of the buttock area and is then resituated on the breast mound.  Microsurgery reconnects a blood supply that will increase the chances of graft liability, In the IGAP procedure, the flap is removed from the lower buttocks, placing a scar in the crease of the buttocks.  Either way the procedure creates a scar on both the breast and the buttocks, which is less obvious than the lower abdomen.
• Breast Augmentation Using Breast Implants:  Just as with standard breast augmentation, augmentation can be restored to the breasts using an internal prosthesis.  These prostheses are made from silicone elastomer and filled with either silicone or saline. Often an expander is utilized to create a pocket and the breast implant is inserted at a later date.  Please see http://www.breastimplants4you.com for more information.
• Check with your surgeon for more options which may be available to you

Whatever your choice, whether you choose to reconstruct or not, the important thing is your health. Being cancer free is what matters most! Breasts or no breasts you are a woman and a survivor. No one will ever forget that.  Breast reconstruction is a personal decision that does not define who you are on the inside.  But it an option that is available to you if you so choose.

Smoking & Cosmetic Surgery

There seems to be a lot of talk in the media as of late regarding quitting smoking before having a cosmetic surgery procedure.  This is definitely not old news, so I am not sure of the influx of articles surrounding the subject this week.  It is definitely a serious concern regardless, so rehashing good advice is fine by me.  I used to smoke.  Yep, me!  I started when I was about 14 or 15 and soon moved up to a  pack a day of Marlboro Reds, up until I was 25.  I started looking into breast augmentation at 25 and when I met with my doc, he said quit or no boobies.  So I quit. And OMG it was difficult, so trust me when I say I can empathize with those of you who are trying to quit.  But I guarantee you it will be the best thing you have ever done for yourself.

Why quit? Well other than the fact that it can kill you, make your life miserable in ways you don’t even realize until it is too late (because it can be so gradual), and cause all types of complications later on in life, it ruins your appearance.  So if not for health, do it for vanity–you’re going to look like a leathery, wrinkled, stinky version of yourself if you don’t.  But I am not here to preach, I am here to discuss its effects on your body’s ability to heal after surgery and during surgery while under anesthesia.  many surgeon and anesthesiologists won’t even accept patients who continue to smoke before and after their surgeries.

Anesthesia and Smoking
Unfortunately, newer studies have shown that quitting less than two months beforehand is the minimum.  Below that and you may be increasing your risks while under anesthesia. Smoking effects the oxygen saturation of your hemoglobin by increasing the amount of carbon monoxide attached to it, called carboxyhemoglobin.  When there is more carbon monoxide, there is less room for oxygen.  This, in turn, decreases the amount of oxygen-rich blood your skin receives (and actually increases the amount of oxygen your body requires).  The effect is like a dangerous Catch 22, a smoker requires more oxygen but they actually get less, so a smoker’s heart works overtime. 

Smoking increases mucous secretions in the lungs due to it being an irritant.  This is evident in patients with gurgling, wet coughs–even if present just in the mornings. During gaseous sedation, risks can increase due to smoking’s effects on the lungs.  This is risking your life. That feeling you get from smoking is NOT worth that.

Smoking and Wound Healing

Without essential oxygen your skin is less likely to heal as fast, look as good, and be able to fight infection as it would if it were running optimally. When your skin is injured, it needs increased circulation to help carry away toxins, deliver white blood cells and oxygen, etc.  When your skin can’t get what it needs, cell die off is possible (necrosis), and infections can run rampant without the full armada of your skin’s natural bacteria-fighting process.   

Wounds can heal with less quality scar tissue, causing your incision lines to be more red, ropey, and raised.  Wound edges can heal more slowly causing wound separation.  

So How Long Before Surgery Should You Quit? 

According to new studies, 4 to 8 weeks beforehand is when a true reversal is apparent, with mucous secretions diminishing significantly after the 8 week mark.  Although, as little as 24 hours can greatly reduce your risks in general.  Anything less, can increase your risks dramatically.  Best way to increase your chances of a less risky surgery other than not ever smoking? Stop as soon as you even THINK about having surgery.  Quit today.  I have been there and done it, it took me a while but I finally did it.  You can too.

So How Long Do I Have to Quit For?

This shouldn’t even be a question in your mind.  Now that you’ve made it over the physical withdrawals, why even succumb to the psychological withdrawals.  It’s all  ahead game after this.  You can remain a non-smoker, you just have to not pick that cigarette up in the first place.  It takes months for your body to heal after surgery and days for you to recover from the anesthesia alone.  Being bedridden with lack of movement can put you at risk for clots already after plastic surgery, especially with liposuction, breast reduction and tummy tuck procedures.  Why up that risk with continued smoking?  Do yourself a favor, don’t start up again.

Need more? Further Reading:

• ** implore you to read this one: http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=2149030&pageindex=1
• http://healthlink.mcw.edu/article/1031002485.html

Using the Rice Test for Breast Implant Size

Once you decide to go through breast augmentation surgery, ideally you only want to go through it once, right?  The number one reason for re-operation is dissatisfaction with post-operative breast size, and/or shape.  The options to counter this don’t have to solely ride on expandable implants, or the opinion of your surgeon.  Although as rudimentary as it may seem, trying on your breast size before you get them via the “rice test” is actually quite effective.

I remember when I first heard of this method, it was laughable to me.  n fact even my plastic surgeon laughed outloud when I mentioned it to him.  He scoffed at it until more and more women started coming in with their “rice boobies” and he saw that it was a good tool with which to help convey their desires. 

So how does one make rice boobies anyway?  

What You Will Need:

• A bag of rice or cous cous
• A Pyrex type measuring cup with gradient markings
• a pair of knee high stockings or stockings that you can cut (with no holes or runs!)
• a bra, or a few bras, sized where you would like to see your self as. 
• a few tops such a stretchy camisoles with shelf bras, a sports bra, etc. that you would like to test out your new size in.

How to Measure
There are approximately 270 to 275 cc per cup of raw rice. 1 milliliter (ml) = 1 cc.  So if you think you might like to have 550 cc implants, try two cups of rice.  Place the rice in a stocking and knot off the end securely when you are sure of your end test amount.

Try the rice boobies in your bras, camisoles, bathing suits, etc.  Even try wearing them around for a while to determine how they may interfere or affect your lifestyle.  For instance, if you are a ballerina, a prudent approach to sizing may be a good idea.

My implants were far too large for my lifestyle.  Even know, was I wait for my redo, I can’t imagine having super-large breasts ever again. Before, I had to wear two sports bras, over an underwire bra and even then they bounced like crazy This time I will not make that mistake.  This is why trying them on for size, can be extremely beneficial before you make the commitment.

The End of Capsular Contracture?

The dreaded CC.  When a foreign object is introduced into your body, either purposely or accidentally, a fibrous capsule forms around the object to essentially wall it off from the rest of your body.  Many times, these capsules are tissue thin (my own was after both my implant removal surgeries), but sometimes they become thick and contract causing the patient much agony and distortion of the breast.  CC affects an estimated 5% of patients, and usually occurs recently after breast augmentation surgery.   No one really knows definitively, but CC is believed to be caused by either contamination of the implant or surgical instruments by bacteria before or during surgery, hematoma, seroma, or from radiation therapy either pre- or post-operatively.   Smoking is also believed to be a possible trigger for CC due to the vasoconstriction caused by nicotine, causing less oxygen to the tissue and less than optimal healing conditions after surgery. 

Unfortunately, CC can also occur years after the fact.  Many believe delayed CC is caused by transient anaerobic bacteria, usually released into the blood stream via tiny lacerations in the gums if one has gingivitis, or via bacterial infections introduced through trauma/puncture, and even other types of infections within the body.  CC may also be caused by trauma (without puncture contamination) to the breast area as mentioned above due usually to seroma or hematoma.   I am thankful to have never had an issue, but I felt that the threat loomed above my head every time I went in for a cleaning. 

Due to the recent advances and realizations (trial and error) in medical science, CC has decreased considerably.  Although I do not believe it will be a non-existent possibility, I do feel that the chances can be significantly lowered as we learn more about capsular contracture.   Surgeons are paying particular attention to the sterile handling of the implant itself, sometimes dipped the implants in antibiotics, administering antibiotics and other medications, before, during (intravenously) and afterwards, as well as making every effort to reduce any blood accumulation in the pocket during surgery.

Interestingly, my ex boyfriend had a seroma behind his cheek implant which resulted in fibrous scar tissue and contraction of such which shifted the implant from its intended placement. Even with several revision surgeries, the device never fully maintained its implanted position for very long.

With any luck, CC will be wiped out from the breast augmentation complications list, but somehow I doubt it since our bodies differ so completely from one another. But one can hope, right?

Have You Ever Been Harassed Over Your Decision to Have Cosmetic Surgery?

Whether it is by your friends, your boss, or a perfect stranger.  Has someone been so insensitive that they just had to open their mouth and make an unnecessary comment? Obviously having cosmetic surgery is a very personal and private decision (if you want it to be).  So why is it that some people feel the need to gossip about it?? 

Then again, gossiping behind your back, if not already awful enough, is an entirely different story from harassment IN YOUR FACE.  There was a post on the forum where this girl was unduly harassed for her decision to enhance her body.  This poor girl has been repeatedly badgered by her boss (who happens to be an attorney by the way) about her decision to have breast augmentation.  She did not tell her co-workers before and chose not to tell anyone after.  And what did he do, but march right up to her with a smug look on his face and ask her why, why, why?  Like it is even remotely any of his business; his behavior is unforgivable.   His comments over the next few weeks were shocking to me, especially as an employer and one in the know about sexual harassment suits these days—because that is exactly what he was doing.

These days with all of the hullabaloo about cosmetic surgery, the very public makeovers and even the surgical procedures themselves aired on television, it is becoming more mainstream.  But still, it is a very personal choice and it shouldn’t have to be divulged to anyone you don’t want to share it with.

Have you ever had anyone insist you share with them the details of your surgery, or make snide remarks about your new additions, or lack thereof if you chose a different route, or any surgical change?  I have had some pretty interesting comments by strangers, and some bordering on the verge of you’re-about-to-get-punched-in-the-face but never have I heard of such deliberate harassment by someone practically wishing to get sued.  It would be an open and closed case.  As Ted from Scrubs would say, you should bring cab fare to the courthouse because she is going to be driving your Beamer home, buddy.