Webinar 6: All About Breasts

Board-Certified Plastic Surgeon, Dr. Kevin Tehrani is here to answer everything you need to know about plastic surgery and more in his latest segment called

#TehraniTalks – During Quarantine. There are so many surgical breast procedures that can be done these days to enhance your figure and give you confidence. So, which one is right for you? Check out this webinar where Dr. Tehrani addresses each procedure, plus receive a special discount for webinar reviewers only!



Transcript:

(00:00): All right, everyone. Welcome to all the graph rests webinar. We’re going to talk about all of that. This something that as a menu, you know, whether you, to us, I’m a board certified plastic surgeon. I do a lot of mommy being corporates as well as breast consultation lifts including breast reconstruction. So majority of my practice is breast related. So we’re going to talk about the different operations. Very few nonsurgical things, but as we go through it and we’ll talk about some of that as well, but you know, we’ll talk rests surgical procedures.

(00:47): So breast augmentation in general have to do with implants. But that doesn’t mean that’s the only thing I do. I do breast augmentation through the belly button called the Tubo trend. Umbilical breast allocation. A tablet is a procedure called that trans abdominal breast augmentation with implants placed through the abdominal incision. When we do a tummy tuck, Werner nominal, classy. We can also do fat injection to the breast to enhance the volume. We’ll talk about that. Which patients are good candidates for that. Now all of that could be in conjunction with or standing Ramon procedure like a breast lift where we basically lift the breast or a breast reconstruction or a breast reduction. Now remember we talk about adverse reduction. We talked about a an elevate lift and reduction the same time and and reconstructed seizures as well.

(01:45): So breast augmentation really applies to enhancement of breast tissue removed for people that feel that their breasts are smaller than ideal. But that’s not only about size and some patients it’s an issue of symmetry or a or size on one side where we only augment one side. We only lift one side to, to even the breast out. Also to correct some misshapen breast, either congenitally or after pregnancy. And changes that can happen because of weight loss, weight gain or changes in body habitus. And of course pregnancy and breastfeeding. The different incisions that we could use to put implants in. Those incisions are most commonly in the inframammary folds, in the fold of the breast peri Arriola or around the areola to put the implant in a small incision through the axilla or the armpit or the newest and best proceeding method, which is through the belly button and the for a umbilical, the different types of implants.

(03:05): They’re silicone implants, same in implants. And within this silicone variety we have textured well or a smooth round implant. So in general now in the U S the majority of the implants that are placed are smooth round implants. So this is the silicone variety, which is yields more natural which is a nicer implant Caucasian, very little breast tissue and a Salen implant, which is a smooth, round, sane and implants basically sterile saltwater. It doesn’t feel as natural to the touch, but for patients that are, that need a small amount of volume enhancement and say for example, they want to go forward with a B cup to a C cup, it may very well be a good option as the future feel of the breasts not going to be there. And of course, their texture shape, the plan to have a shape of a, a kind of a teardrop, and we’ll talk about those and who’s a good candidate for those.

(04:04): And that’s very rarely done. Nowadays we’ll talk about why placement of implants are either behind the muscle and in front of the muscle. And whenever we be talking about placing the implant behind onto the muscle, the risks were some benefits of doing that book. For the most part, even the patients that have implants placed under the muscle, it’s always partially under the muscle. And we can see the lower part of the implant is actually not under the muscle only the top part, whereas somebody has a lot of breast tissue. Placing the implant over the muscle could be very well-suited and we’ll tolerate it.

(04:46): So primary breast augmentation is in somebody who’s never had any breast surgery before, so that’s in patients that have had pregnancies or not and can be done with with different scores that we talked about. This happens to be a patient that had 300 CC a silicone implants. They do a small little incision in her full liver breast and she went from an eight cup to a full C small D cup at 380 CCS is about two cup sizes bigger than she had before, which is an eight cup as you gets. See, she also had some asymmetry with the fold on the right breast being dramatically higher and not as well defined. Yeah, create a new folder for her and make her a more, a lot more symmetrical than other, a patient a that 305 CC silicone implants went from an eight cup with C cup.

(05:43): Again, a, a old incision here in the natural fold over breast depending on the patient’s anatomy. Some patients actually have better anatomy to put this car into Ariola. And some patients have good anatomy if they have it nice, full like she did with it camouflage in the fold or better yet if they are a good sailing candidate for them, black into the belly button. And we’ll talk about which patients are best suited for that. Other patients that have something inherent anatomical considerations like this lady had what’s called the tuberous deformity. You can see the lower part of her breasts are, are Hiter and almost like a Snoopy. A deformity is another word for it. And well those patients, the shaped implants are how much nicer implants in terms of getting an actual result would that the top of the breast booking over the round or, or, well, Mmm. Fake look on the top part of the grip.

(06:51): Another patient that had 300 ADCC silicone implants, she has, can see, she had a very nice fold in the bottom of breast. We were able to utilize. The scars are basically not seen as I could see, she was quite a symmetric. She’s a bit lopsided. The, the nipples a little bit higher on one side versus the other, whereas internally without any clots on the outside, we’re able to even those that for her and give her a much better shape and before size for her after surgery. Okay. So this is a patient that did not have any shape to her breasts, basically a double a, a Cub, her future presses and majority to implant that for the patient. Like this definitely needs a silicone implant, not as safe, but because the feel of the implant becomes a significant issue. And you would have to have a silicone for the best deal. You can see she’s older. She went from an eight cups to if foods you small D cup Victoria’s secret, which runs much smaller, will be a D cup for her. And I’m very happy with the results. A little Valentine.

(08:06): Yeah.

(08:08): So these are the patients that have what’s called the tuberous deforming. So the tuberous deformity that is a patient that would need to have implants either placed under the muscle or if it’s placed over the muscle, which we act to be able to do for this lady is to do a lot of scoring and management of the actual tissue itself. So releasing these lined on the inside of the breast is critical to have this patient have a really nice resolve after a breath. Alimentation natural wood that this new deformity that she had before her.

(08:44): Okay, now we’re going a bit bigger. We’re going to 520 CC implants. In general sizing is something that’s very patient directed and something that patients want and we’re very big part of a discussion about what goes into having their salt on the patient is to try outside there would do three D imaging to really discuss the size and what patients are going to look like after surgery. And really show them what size safety we can get them to to the decides that they want. Sometimes the number sounds a lot scarier than the look. And as you can see, 520 CC, sometimes people think, Oh my God, I’m going to be humongous implant. But in somebody who’s taller as wider shoulders, that 520 CCS could be a fool. What’s going on here? A again, camouflage scar. You never see the scar and feeling well, very happy with the result. Again, 530 CC implants, one comment, a cup to a D cup, almost a double B cup. And happy with the results. Scars are never seen even with their arms elevated, you barely see that scar. We use what’s called the Keller funnel, which uses a small little incision about an inch, a little bit longer than an inch to put in the much larger electric 535 CC implant.

(10:08): Now I’m going to talk about trends on bullet breath orientation. This is typically done for patients that are carvers. They don’t want to have any scars showing either personal reasons, if they’re not feeling well or if they don’t want anybody besides the plastic surgeon or, or themselves and their loved ones to know that had breast augmentation. So the implants are placed through the inside of the buddy one underneath the skin, out a patient, that’s all we, that they thought that they implant goes inside the organ, the combat goes through the breath and it’s not like that. And we’re able to put the implant in under the skin, under the muscle or over the muscle. Majority of tuba patients. I put the implant under the muscle so it looks and feels very natural. And she only had a 300 CC assessed silicone here, but 300 CC implant through the belly button.

(10:58): The drawback of the trends are local breath competitions. You have to use Satan. I cannot put this silicone implant through the belly button, so a, you would have to put it. So the saving implant with the belly button rolled up and then when inflated in the operating room. The other big advantage of in implants is the fact that as you can see in her, she was quite asymmetrical beforehand. And I can adjust the volume of the same, you know, plan to a certain extent and be able to give the as much symmetry to the breast after, after the procedure.

(11:41): Okay. So unlike Truvada has to be a Satan implant at Tava, which is a trend abdominal, this allocation is done on a patient that I’m already doing it. Tell him I’m doing a tummy tuck or a mini tummy tuck. There was an incision there. And then from there I can the abdominal wall and be able to put the implant into those nominal wall without any additional incisions on the breast. Again, for somebody who is Scarborough is not, does one to have as far as this is a very T, patients were able to use less than 300, 270 CCS in her case was a salient implant for Tablo. You can even use a silicone implant through the abdominal wall with Keller funnel on and without any breast scars.

(12:33): There’s also the option of doing fat transfer. Now fat transfer is great for patients. We a moderate increase in their volume for patients who already had breast augmentation, the one that have the implant out. Like this lady we’ll talk about or for patients who’ve had breast augmentation and they just want a small amount of a finesse and being able to get the breast is just ever perfectly improved, especially in the cleavage area. So for those patients, fat transfer to do a really good option. So in this lady, she had breast augmentation in the before picture. We actually took her implant out on the same day that we took our implants out. We were able to do that last word for breath better than them before as advocacy. She has a bit more kookiness to her breasts beforehand. And with fat grafting, I was able to selectively add fat in the, in the parts, the lower her Arriola to be able to give her some more projection in that area and given the illusion of a lift and it’s not a true lift or lifts, which we’ll talk about, you actually need additional scars to to do that.

(13:49): And in her case, we were able to give her a really nice result with just taking them plants out and replacing with fat. Now, one of the issues with fat transfer is how much of that fat takes in patients that have never had any breast surgery. That number is something about 40 to 50% of the fact that we’ll take. Whereas the patients who have had breast orientations have already had beads pension, so that takes maybe as high as 60 to 80, which was the case in her after one session of a background. I don’t like to do I have that from the patients that have had the history of breast cancer. And that has to do with detection of breast cancer on mammography. Rarely less than 10% of the time. Some of the fat that’s injected into the breasts on a mammogram may mimic of breast cancer or microcalcifications can mimic breast cancer. It is not breast cancer but can mimic it. But for that, we don’t like to do that on patients who have a history just for the sake of them needing to have unnecessarily breast biopsies to prove that the fat that’s put there is not breast cancer, which it is. So it doesn’t turn into it. But for lack of detection issues, I don’t let them do it on patients who had it.

(15:14): In terms of timeline of breast augmentation healing after surgery within the first week, there was some swelling, bruising, some grogginess after the procedure within the first week. And most patients with breast augmentation or breast lift are able to kind of get back to the normalcy of things and work. By by week four, especially if there are not placed under the muscle they can actually start doing some cardio exercise and by three months to have the final results bikini ready in the first two to three weeks after surgery. Next thing we’re going to talk about this breast lift. So mastopexy, which is the Latin name for a breast lift is a procedure where we actually lifts up the breast and Ariola tissue whenever we talk about a breast lift is not only about the breast tissue coming off the bat, the areola coming up and the the remainder of the tissue that’s built around it like, like as this way.

(16:17): So she never had any augmentation, not with an implant, just home breast tissue that’s been lifted up enough, much higher position. The different types of breast seizures. There is the the anchor or the inverted T scar, which is the most aggressive in terms of how much elevation you get. Then the less invasive is a lollipop or a vertical lift donut lift, which is this card just around the areola and the Crescent lift, which is a scar just above donut and Crescent of something that we do very commonly. Usually at the same time, the traditional or the anchor lift or inverted T technique is the one that has the most amount of ability for somebody who has the most droopiness. I’m able to lift up the breadth and most make the Arriola smaller. You end up with a scar that heals nicely and overtime up to the two years of scars heal and develop to be better and continue to improve. And there we have a comparison scar regimen, which we’ll talk about to manage this cars, but the shape is what you really getting with the, with the Bressler. Now obviously we can talk about adding volume and adding implants, but the lift itself is what brings shape to the breast.

(17:38): The lobby populates with somebody like this lady who doesn’t need as much of a lift as to see the left side is a bit lower than the right side. These are typically patients that will feel even better than what you see here in terms of a scar shaped is excellent. Scars will fade over time. This is a Fremont picture and if you look, this lady to your downline, this far will be barely visible and at the same time within the confines of this implant, may or may not put in an implant with the confines of the scar putting them okay in periarteriolar or the donut lift is one where you get the least amount of elevation and a, it’s for somebody who needs it. As you can see, she was just ever so slightly droopy and wants to have a perfect location over nipples with this card just around the areola to a camouflage, the position of breast tissue to the area of skin and healed nicely through the same incision. We put an implant. This is particularly a good operation for somebody who’s getting an Aflac. If you’re not getting an implant and this operation is not a good operation for you because you’ll end up not providing a nice shape to the breast. Cause this lift is not the breast shaping lift. It’s more the, the implant to shape the breast. But with this he’s just really addressing the areola position.

(19:09): The Crescent lift is similar to the periarterial lip in that the scar goes around and at the same time sometimes movie the breasts or skin that the top of the areola to make it look like the Crescent, like she has at the same time breast augmentation, which again is a good option for somebody who’s having breast validity with an Aflac. Now we’re going to talk about breast reduction. So breast reduction is a conglomerate of something that is symptomatic, improving, meaning patients that have back pain patients have issues with a bra strap as well as back upper back a and also pendulous breasts that cause the bottom part of the breast and be moist and become a, an issue with self breast examination with working out an overall heaviness to the rep. So breast lift is as part of a breast reductions.

(20:14): Whenever we do a breast reduction, begin the breast rip lift at the same time to put the breast much higher. And I typically actually attach the breast, the breast muscle or the pic throughout the muscle or long lasting move on. So this is a lady that was a double V almost an econ before surgery. How are you all were larger than ideal? We’re able to do aggressive reduction for her and bring you from that to the secret and much nicer scar and a much lighter in. I’m more fit this. A young lady incisions of breast lift and breast reduction are basically identical. The anchor and lollipop are the most two most common ones that we do. Donut and Crescent are very rarely done for major reductions because the majority of that being done for shaping and not necessarily for reduction of breast tissue.

(21:13): But those can be done as well in terms of less lift them reduction timeline, the downtime, especially if there is not a lot of muscle work done and actually be very similar to this obligation that within a week or two of downtime of taking off from work, as long as something strangeness is not going on up from the first four weeks up to a month you’re not doing anything strenuous and be able to get back to the normalcy. Final results are back three months. Final look of this far as this years class and we’ll talk about how far, okay.

(21:54): So there is one procedure that a lot of people don’t think about. I think it’s a really powerful procedure for patients that are either asymmetric or they want to see row scars and that’s do breast liposuction. It’s not a true reduction in terms of scarring. But it can give you the look of a reduced breast and actually a bit of elevation internally with having a light. So this is a young patient who is who has never, hasn’t had a pregnancy, but she was quite asymmetric. Her left breast was happy with and and her right side is what was really bothering them. So we’re able to do a ultrasonic liposuction where on the inside of a breast we actually emulsify the fat, move the fat and also get, provide some skin tightening with skin tightening methods like RFA or radiofrequency similar to things that we use for liposuction on women or elsewhere in the body and body tight and remove beyond to tighten the envelope of the skin to give her a result like this where she, she looks great and she’s elevated.

(23:01): She’s very happy about the results. And the best part about this is there Ruby tiny little liposuction scars and you don’t see any meetings going on as far as, and that’s that’s something that’s really nice about life is that part of a breast reduction, you always do an areola reduction. It’s very rare that patients need a breast reduction and the areola does not need to be addressed in very commonly. The areola similar to the rest of the breast is much larger than an ideal. I would see the two penises taken care of by elevation and the areola is made smaller by basically removing the extra areola in the tissues around and without overall need for grafting or skiing, rapping or anything like that. Just repositioning of the Dario. So higher position and much smaller Ariel either at the same time, but most commonly not at the same time. Some patients have nipple lesion that needs to be addressed at the same time of breast augmentation or, or breast reduction and that could be done at the same time with different types of flaps would basically scars that heal in perceptively in. You never see those cars and make those cars not be noticeable and not the nipples be as large as some patients don’t like.

(24:32): So breast talk would not be completed unless we talk about breast reconstruction. And whenever we talk about breast reconstruction, I like to think of it as aesthetic breast reconstruction. So breast reconstruction is something that’s dear to my heart and something I really enjoy doing. As patients that undergo mastectomy I’m kind of the person that they look to to have some sort of normalcy and, and, and be happy about that outcome of what otherwise seems to be a really difficult time in their cancer operation. So whether or not it’s being done at the same time as breast cancer surgery, which is ideal or delayed, which means after they’ve done the breast cancer surgery, now they’re doing breast reconstruction is basically making two new risks. Now that’s done with your own breast tissue, which is called a tram flap or deep flap.

(25:24): The different platforms, nominal skin side, skin, back skin or with what’s called a tissue expander and implants where we’re putting expanders to expand the skin and then put in the final implant. And in addition to adding fat to provide additional law so this is a patient, is that breast cancer has the, her breasts are, are flat. We’re able to put implants in her, make ya at least the one area that happened or on the other side, she ended up not wanting to have any aerial or tattooing, which is something that would complete the, the right side for her, but overall had breast shape and size that makes her feel more comfortable about her. Her body an inch.

(26:12): Again patients that have had breast cancer in the past have performing needs to their breath and we able to address those and removing scars and adding volume and changing implants to provide additional shape and confidence for our breast cancer survivors. Sometimes it’s about asymmetry and patients that have significant will need to have different operations on different sites. So this is a patient that had significant symmetry issues left side being tremendously larger and droopier. So she needed a lift on the left side were able to do and on the right side were able to do a, an implant through her belly button. And so she had 840 CCS on the right side to match and 180 CC implant on the left. And the remainder of the tissue on the left side is basically home breast tissue that’s, that’s been basically camouflage around the implant and sculpted around her and find to give her the much more symmetric resulted.

(27:29): So in terms of breast augmentation, statistically, a lot of patients that have breast augmentation, especially ones that are had breast implants or breast lift and implants at the same time in their lifetime, I’ll go on to have the back 25, 50% of those patients will have at least another operation to address it either after pregnancies, but are other issues, size issues or the physicality of what the implant looks like? Not, for example, this patient is that a breast augmentation for many years and she was happy for quite a few years. Some pregnancies actually addressed the top part of her breath and she didn’t want it. She didn’t look as that perky as you used to. And for those patients an implant exchange and a pocket change where we can actually address the pocket itself to be able to having the pocket, we position the implants to a much higher position and give her some more. Cleveland on the top, make things look a lot better. For her on the top, it’s what we’re able to do for and making the book a lot more natural. That’s typically done with the inheritance incision, but with an incision that was in the Ariola, which was the case with her, I can reuse that incision or do another incident in the fold. I like to use the same incision they had on this behalf to do an additional incision that keep the same incision of the patient.

(28:59): So this is a three D consultation tool that I use called Vectron. I’m going to play play this video to show you guys what that process is like in terms of we a three D consultation. This is a pre covert video. Now we’ll be done with masks, but still needs to be done. I think the critical part of the consultation process. Cool.

(29:42): Please. Okay. Should be two days. Yeah, no sir. I have a lot more problem because we haven’t, that’s a good sign. Basic. No.

(33:09): I want to talk about texture and implants in a bit. Down the the end of the talk about what we need. We’ve them, one of the things that I want to talk about his scar, Reggie. So do we call it the scarring? Even with the best of closures, the patient’s ability to heal there is the scar that needs to be treated so we can maximize the look of this car. And there’s a range of what we use starting from topicals, like [inaudible] or lasers and silicone cheating. But the most important thing is the first two months episodes. We, we need to see you either virtually or in person and be able to manage that part because that’s the time that it’s critical for us to introduce scar regiments and get things to look best and eventually scars heal, shape remains. And that’s why whenever there was a chance between shape versus scar, what we’d want to do, the breast lift or the shaping procedure, even though there may be more scarring, we want to minimize the after effects of a shape, which don’t go away, but scars will go in.

(34:24): Now we’re going to talk about some of our real patients, but the real results that allowed us to show them on Instagram. So this is the lady who just only and only had fat injections to grasp natural breast volume. She went from an eight cup to almost a C cup with liposuction and she’s very happy with the results. Not only upper breast, but of course the liposuction areas which removed will also give you a better console, which is a nice positive of a fat transfer is a procedure called a composite breast augmentation where not only do breasts use smaller implants, typically [inaudible] and then I prefer around that or more natural shape so that we don’t have to go to silicone implant without any visible scar.

(35:19): So breast lift on a lady advocate, see what you can see in her. A cleavage is not an implant is just all home breast issue that’s been elevated regardless of size. And we can provide a really nice shape to the breast that looks natural and makes him feel good about the outlook in life and the way they feel about their body, which is what it’s all about. Breast augmentation. That doesn’t have to be a haven’t done. Look, it’s under the muscle. It looks very natural. It looks very helpful for patients. And these are patients that want to share their happy results with us on Instagram and elsewhere.

(36:03): Okay.

(36:05): The patient that was seen in the office shortly after surgery, silicone implants under the muscle of 360 CCS. Nice cleavage and very happy with the results. Same silicone implants, these four, 10 implants and it’s all a patient. It can still be a full C cup under the muscle. And whenever we go to larger sizes, I like to use a high profile of the plants to not make the implant school or to the outside. And that’s part of the the discussion that we’ll have doing consultation either virtually or in person when we do three D imaging. So that the implants based with fits within the confines of your anatomical landmarks, which is critical with breast elevation.

(36:52): 410 CC silicone implants under the muscle through a tummy tuck scar, no visible scar on her breast, very happy. Whenever we talk about a scar at Virgin when patients are not are carvers that don’t want any scarring use. The options that we talked about who the umbilicus, who would the tummy tuck scar to avoid any breast scars? 415 CC silicone implants under the muscle. Very natural, nice cleavage. Even if she wasn’t wearing a bra, will look like a very natural breaths and very happy with the results. Yeah. Thank you for joining us. I’d like to find out if there are any questions that are there that you’d like to ask now. I’m going to open this up for Jackie to ask the question.

(37:46): Okay. Thank you Dr. Ryan. So we did have some questions who wrote in prior to the webinar and also if you guys have any questions right now that you’d like for dr Terrani to answer, feel free to write them in the chat and then we’ll ask him them. So we got a couple of good questions that were written in. So I’ll just, I’ll just go ahead and read them to you. So first question, what is the ideal BMI for someone trying to get a breast reduction?

(38:16): BMI is not the best way to actually address that condition. You don’t want somebody with a BMI of 45 or above to do this. Especially if you want to get insurance coverage for it, most insurance companies would want you to be pretty closer to 35 or lower than 35 to 40. But it’s more about the symptoms and whether or not you’ve actually tried weight loss to win up to get to a lower level. So there is none an ideal BMI for a breast reduction. It’s best to have a initially a virtual consultation where we take a look at, you take a look at your height weight, and actually calculate your BMI and make those recommendations based on how much breast volume do I think you need to have. And whether or not a lower BMI than ever gets there is a special a scale called the Schnorr scale that the insurance companies go by and we go by. That allows us to determine that. So it’s, it’s very individual. It’s not a blanket BMI that will apply to patients with breast reduction.

(39:23): Got it. Okay. Next question. What’s the best way to prep the body or skin for surgery?

(39:31): Your skin itself, as long as it’s not been exposed to the sun cannot be prepped by the way you cannot be prepped by the way you or even sleep or do something with it or even topicals will really help breast tissue. The only chap to that is fat grafting where if I’m doing fat grafting to the breast, occasionally ask patients to do breast expansion. The special machine where you actually most muscles like your breath before only breasts for expansion before surgery. But in general it’s not like you have creams or anything before surgery to address that. Having said that, your body needs a lot of protein after surgery for healing purposes. So it’s important to have a good protein intake around the time of surgery, especially after. So a lean protein after it is very helpful.

(40:24): Okay. Good to know. So someone wrote, I’m curious about the extent of visible scarring for breast lift and a fat transfer.

(40:36): So that’s a, a very good question and very common one in that patient. Obviously a worried about scarring, which is the majority of what we were talking about with trying to minimize the look of this card and camouflage the vocation of this call. Depending on the type of lift that you need and the type of steam quality that you have that may be necessary and you may need to have a scoring. Those are the discussions we need to have. Trying to minimize it. You may be one that patient and that could be a range that could benefit on eight in liposuction lifting type of procedure. Would that be external as far as I’m kind of show you what you will look like with that versus if you actually had a full shaping procedure with scars even though you look great. Minimize the extent of this card dizzy with creams and laser cream at the afterwards.

(41:24): So it’s a gamut of risk and benefits that we’ll really need to individualize and talk to you about that. One. One other thing that I meant to talk about before, what didn’t get to was was silicone implants and those are specifically textured silicone implant. Now I’ll rescind. This is back in 2019 go with the bat of textures on implant by a company called again, makes it kind of a texture of implant called the forts 10 device. It’s not this one. This was made by CSRs. It’s not going to be called. And that’s because of the specific kind of an association with a lymphoma type cancer, which occurs in patients who had that particular kind of an implant so that the implant was recalled and we removed those implants for patients who have the issues. I personally never had those patients and I didn’t use that implant.

(42:20): But particularly patients who have had that implant. I recommend seeking can plastic surgeon or coming for consultation to making sure that they don’t have some of the signs and symptoms that could present itself as that very rare type of lymphoma, which is curable if it becomes hard early. But having said that, these implants are made to stay in place with people to have this kind of a no shape to the breast. And the reason we use them very rarely is because of that association and unless you absolutely need it, we don’t want to take that cancer risk. And even though it’s not been associated with this particular implant with the old implant that we’re off the market right now, we want to make sure that the patient will stay state for that.

(43:09): Okay, that’s good to know. So next question, I’ve had my implants for 18 years. Do I need to replace them? Implants. There is a little bit of a myth out there that every 10 years you need an implant screwed up or, or something of the story. And I think that is more of a myth and probably started because originally the implant manufacturers had a 10 year warranty. Maybe that’s why they people think they need to change it every 10 years. Unless you have a problem, you do not need to change. Not the question is what the problems are. If there is a problem, the most common reason to change your implants is actually I don’t like the way it looks. So that is not an implant problem. That could be a pregnancy problem and could be positional problem, aging problem. So those are the reasons you want to change it.

(43:59): But if you have implants perfect and just because it’s been more than 10 years, you want to change them. Absolutely don’t need to change him. Having said that, with saving implants, if you have a ration your breast and find Moodle and you’re going to know you have it with silicone implants, but should be the new generation to live on implants, these implants are so well-made that they don’t, they don’t leak anymore. So even if we cut them and you may have a rupture, it may be considered a silent rupture, which means staying there but it’s not going anywhere. So then you may not know that you have a rupture. So they need surveillance. So even though you don’t need to change your implant three years from surgery and every two years after that, you would need to get an MRI. And we offer that to our patients here to come to the office, get an ultrasound, and then subsequently get an MRI to make sure that there was no rupture of that. So it needs to be surveilled, but unless there’s a problem not teaching.

(44:55): Okay. Thank you. So next question. This patient wants to know how when you are making the Arriola smaller after that, can they still breastfeed?

(45:10): So yes, the short answer to that question now the Crescent type of in reduction, but we actually say cap rest issue has a little bit of an increased chance of inability to breastfeed. But in general, 80% of the time you’d be able to breastfeed as you did before, sir, before surgery or if you haven’t breastfed at all, we’ll be able to do that after a 20% that you will not be able to. And there’s also less than 1% chance that you have sensation loss. One of the nipples after you know, breast reduction or breast lift which needs to be considered as well. So the vast majority will be able to have sensation and have breast feeding at the,

(45:53): Okay. So let’s read what some people wrote in the chat. Can fat transfer, leave the breast?

(46:04): Yes. I typically like to use this fact that doesn’t leave your body, which is what people want to usually have to move anyway. That’s typically the tough areas of the body. Your waistline or whatever other part that is the size for diagnosis. Those fat cells have fewer insulin receptors, which means even if you lost weight after surgery in the new place, that will remember where they’re from. So unless there is more than 15 to 20% of your body by weight loss or gain, that will not affect the area that will work. So the ideal thing for a patient before fat grafting to do is to be at the weight that they’re done at. So I don’t want them to lose or gain weight after the procedure. Now within five to 10 pounds, that’s probably okay. More than 10 to 20 pounds, it’s going to affect the area that now inherently about 40% of what I inject goes away. So that’s within the first three months of certain people. What stays after the three months is there permanently unless you have that weight.

(47:08): Okay, cool. So next question. How do you prevent capsular contracture?

(47:17): Yeah, biggest complication in breaths augmentation surgery is Capitol first off capsule is a, a tissue you own tissue wraps around the implant every time it’s placed inside the patient’s body. So regardless of what kind of implant was saving silicone smoothed round, your body will wrap it around with a capsule. In my practice, less than 5% of the time that capsule become art just called capsular contraction. So there are a lot of things to minimize that. And that’s Superstore technique as the body before surgery and after surgery there a medication called singular, which is a treatment for capsular contracture actually to treat all patients for that for two months to take a pill a day, which is something you take at night and it really doesn’t have any side effects. And to minimize my capsule, if you do have capsular contracture, then will have to do a nonsurgical treatment called Aspen ultrasound. Minimize the, the capsule non-surgically, or you may need surgery to have the capsule either leased or replaced with a new implant. Thank you.

(48:31): So this person said, Hey, I’m all the way from Barbados, so hello. And she said that what determines if you can do a breast lift through the Naval? Can that be done?

(48:46): So the idea of the Naval surgery is that we’ll put implants in with that scar on the brain. If you’re doing a breast lift, you would have to put this card in the breaths and kind of doesn’t make sense to put the implant in through the belly button and then put scarves on the breast. Anyway, since I’m already making fun, having said that, if somebody has a small amount of lift, I could put the implant in through the belly button over the muscle and internally lift the breast without any external scars. And that’s a very small subset of patients that have the right anatomy for it. So even though you were in Barbados, we should do a virtual consult. So I could see if they’re a candidate for that.

(49:31): Awesome. She saw, she saw you do that on Instagram,

(49:35): Correct. How patients are good, a good candidate for that.

(49:39): Cool. So next question. Do you suggest massages after breast surgery to reduce scar tissue and do we provide that?

(49:51): Lymphatic massage or breasts are not really necessary after breast augmentation. There was an implant massage that be asked patients to do massage the own implants that will pay to have the patients to do, but for patients that have breast reductions with breast lift, we do have the fatty massage therapist in both offices that provide those services after the lockdown report. But in general for augmentation, it’s a cell phone, well, breast lift and, and, and reductions. It’s something that we can provide patients to them in the off.

(50:30): Okay. Next question. What are your thoughts on breast implant illness?

(50:36): Breast implant illness is not a medical diagnosis that we know about. Doesn’t mean that it doesn’t exist, but we don’t have a medical diagnosis for it. So unfortunately we know little medically about precedent planning or what some of you that may not know what that is. In general, it’s a combination, combination of symptoms like the entire some fogginess of thinking about things for occasional headaches, nonspecific symptoms that could be related to breastfeeding. I taking care of some patients that would, that presumptive diagnosis, even though it’s not a medical diagnosis and the majority after removal of the implants have not and the one and that if you have we’re actually in the process of starting a study where I’m able to have the patients and actually test the implant shell or or antibiotic or allergy testing before surgery.

(51:40): The idea of this is whether or not there’s an element of a placebo or mind over matter that’s involved with left breast and platinum and whether or not if patients will have a much better result after birth orientation, they knew preoperatively that they’re not allergic well, they don’t have any issues with it. So hopefully that mind over matter element is removed and hopefully we can find answers to breath and finalists. So it’s, it’s a moving target and it’s a dynamic world in terms of present illness. I don’t believe that it’s something that affects the majority of patients. It’s a very, very minor number of patients that are potentially affected and need to do more studies to make sure if it is a real diagnosis. But for now we don’t have that diagnosis and I recommend each patient to actually go in understanding what those risks are.

(52:32): And like I said, the vast majority of patients don’t have that. In my view. All of my patients I’ve ever had it, the ones that have actually operated on have been patients that have had it longstanding elsewhere. And I’m about to remove the implants and hope of being able to help them along. Correction, I do have one patient that I had breast implants elsewhere. I exchanged our implants and then she started developing some symptoms and after, and we’re about to actually in the future we moved from implants to be able to hopefully remove those symptoms from her.

(53:09): Okay. Thank you. That was good answer. It was interesting. So I think one of the last questions is do you inject more fat into the breast to compensate for the potential loss?

(53:20): Yes. because I know I’m going to remove do the baths. What do you do? 50% of the volume that’s added. I over inject. For example, if I want 200 CCS to remain, I’m injecting cools 500, 400 to 500 CC knowing within the first three months, then I’m going to lose youngest. So what’s remaining is 200. So in general there’s an over injection, which means when you wake up it’s not the look that you’re going to have. And over time it will go down by three months would be definable.

(53:53): Okay. Thank you. I think that’s it for the questions. I mean the only other questions that came through were asking about scheduling surgery. Are we doing that right now? If you want to address that?

(54:07): We, we are scheduling. Yeah. In late July and August, everybody wants to have surgery right now. Having said that, if things open up or sound like it may happen in the next week or two we’re able to kind of create and take care of our backlog of patients that have been waiting to have surgeries done. And some patients have been nice enough to postpone their surgeries to actually after the fall, which Gates, if there are openings, we can accommodate, move patients fast digitally during this time when there is downtime.

(54:42): Okay. Thank you. And for anyone who wants, who’s interested in a virtual consultation, we can do that right now if you had to our website, but also send you the link in the chat and if you mentioned this webinar, you’ll get $50 off of your consult fee. So we hope to see you next time. Thank you guys.

(55:00): Thank you everyone.