Is plastic surgery a right choice for you?

As I said earlier, there is a price you pay for plastic surgery.  The price is scar, time off work and exercise, healing, getting someone to watch your kids for a week so you can do this, and the risks of surgery.  What price are you willing to pay? How much are you bothered? How easy is it to fix?

Some people scar well.  For these women, when they have a scar, it will start as a red scar, then turn purple, and then fade away into nothingness.  I have seen some of my patients come back, and I can’t find their scar.  I know where it is, but it faded away.  They pay a lower price than someone who may hyperpigment  (fancy way of saying scar turns darker, black, or brown) or keloid (fancy term for a condition where you form an elevated, itchy, ropey scar).

Some surgeries have small scars and potentially large changes.  Breast augmentation, eyelifts, and liposuction tend to have big changes with small scars.   Small price.  But now let’s say you come in, you were a 34D prior to kids and now you are more like a B, and your breasts droop.  Hmmmm. Tougher choice.  Breast lift with an implant is a bigger surgery, more scar, more potential for sensory change, etc etc.  What price are you willing to pay?  Would you rather have a small scar and the ideal sized breast implant for you, but still be a little droopy? Would you rather go to a larger volume breast implant if it meant you could be perkier and avoid doing a lift? How much larger? If you think, “no way! If I am going to go through surgery and get a breast implant, I want them to look perky and fantastic. I need the breasts up!”, then you might need a breast augmentation with a lift, with the larger length of surgery, recovery, and scar it entails.

Most of my photos I show are women 6 to 8 weeks after surgery.  I am reprimanded for it a lot.  Why do you show red scars? Why don’t you show scars when they are farther out? Why don’t you put underwear on your tummy tuck patients so we don’t see the scar?

I have photos of patients a year out with beautiful scars.  Most have beautiful scars. I don’t think that is helpful. You will see the scar the photos hide under the underwear. Anyone can look at a photo of a wrinkled, strech marked, hanging belly and think “of course they should do a tummy tuck.”  But you, the patient, will need to do the surgery.   You will feel the changes. You will see the scar while you heal.

So, find an honest surgeon.  I don’t candy coat.  I show my large surgery scars on purpose when they are new. Red. Raw. Visible.  New.  I discuss the risks and complications in detail.  When you do surgery there are elements we can’t control as plastic surgeons.  How will you heal? How will you scar?  When we say there is a 1% chance of something, will you be that person?  Education can be scary.  When choosing to do elective cosmetic surgery, you need to know what you are choosing.  I do hundreds of surgeries a year.  For these women, the “price” of surgery was worth it.  Only you can make the decision of what is right for you.

Implants come in all shapes and sizes just like we women do.

It gets confusing when you surf the internet and see photos of websites and patients.  How do you choose?  This is a place where your surgeon really will guide you.  Every surgeon has their method of choosing an implant for a patient.  This includes size, profile (width, projection), and type of implant. 

I see many women come in confused by what implant to get.  There is so much information out there, and you cannot become an expert by reading.  You can pick a surgeon who is right for you.  I repeat myself often on this point, but the two most important decisions when you decide to do breast augmentation: find a board certified plastic surgeon (by the Board of Plastic Surgery), and like the aesthetic

What does “the aesthetic” mean? Look at the photos. Do they look pretty to you? Do you like the shape? Do you want to look natural or augmented?  Every doctor has what in their mind’s eye looks like a “pretty breast.”  You and your plastic surgeon should have the same eye.  At my practice in Palo Alto, and throughout the Bay Area, most patients seek what I would call a natural look.  They want it to look like nothing was done, these are the breasts they were born with.

Major categories of implants:

  • fill:    gel / silicone  or saline
  • profile:    low, medium, or high
  • shape:  round or anatomic / shaped
  • shell:   smooth or textured
  • volume

Profile has to do with the width and projection for a given volume.  In general, the low profile implants are flatter and wider than the high profile implants.  I have some patients who think to have a natural result you must have a low profile implant.  This is not true.  The profile of the implant varies depending on the patient: how broad are they? how much natural breast tissue do they have?  how big are they going? If you look at my photos, you will see all three profiles of breast implant. 

In general, if you are between two profiles, the lower profile implant will give more of a salt of the earth natural look, the higher profile a little more perky look.  Width is important.  If you go with too narrow of a breast implant, you will look fake and have a wider gulley between your breasts.  If you pick too wide of an implant, you will be fuller into your armpit, a particular problem if you are a tennis player or golfer.

My general rule of thumb is to have the patient pick volume first, profile then follows.  If you are at an extreme: a very small size or very large size, then your breast implant width may not be ideal.  This is something I review with patients during their consultation.

If you have further questions, please email me through my website: http://laurengreenbergmd.com

My typical patient never thought they would have a plastic surgeon.

I am a plastic surgeon in Palo Alto, California.  When I started my practice, I thought most breast augmentation patients would be 25 year olds who want to look good in a bikini.

I was wrong.

I have done hundreds of breast augmentations, and my biggest patient population is women after children.  The mommy makeover. After baby tune up.  Call it what you will.   My patients are educated, assured.  They have great self esteem. They are in shape and take pride in having a healthy body. They are not being pushed by a husband.  They do not want hootchie mama breasts; in fact, they don’t want anyone to know they have done a thing.  They are surprised they are in my office.  They never thought they would do plastic surgery.  They think no one they know would do this. (Though most of my patients come from a 10 mile radius, so they likely have a friend with breast implants.)

Breast feeding and pregnancy take a larger toll on us than it did our mothers.  We tend to have our children later; we are having multiple children; and we breastfeed.  Here in Northern California support for breastfeeding is everywhere.  My mother had three kids.  She started at age 24 and was done by 28.  Her whole generation was one who thought formula and “science” was better for the baby than breastfeeding.  Her post baby breasts fared better than mine .

A typical story, ” I was fine with what I had.  I wasn’t large, but I was happy.  Then I had kids. ____(insert number) And I breastfed for ________ months. (insert number)  And now I have nothing left / my bikini rides up / I have to wear a push up bra or padding everywhere / I can’t put on a swimsuit / my breasts look like they are on the cover of National Geographic / I can’t stand to see my breasts.”

You never want to feel like you are common.  I love the uniqueness of my patients.  I love the strength of women.  But there are trends we women fall into after having kids.  Most of us are in a fog for the first couple years after children.  And you don’t really know what is going to look like what.  Most of us had more time with our pre baby bodies.  It is hard to go through pregnancy and watch your body change.  The generation of baby boomer women caused an increase in accepatance of plastic surgery.  So you get done with kids, you are 40 and vital, and you think, why do I have to accept my breasts will look like this?

I see patients usually 2 -3 years after their last baby.  It is at this point you are out of the fog, you have worked out and had time pass, and you can finally assess what your post baby body will look like.  I always feel like I should hand out those iconic flags they stuck on the moon.  This is MY body.  I am not a milk truck.  A jungle gym.  A baby carrier.  I am a woman.  I am ME.  And my patients reclaim their body and sexuality again.

Breast implants are not for everyone.  There are risks, some patients are better candidates than others, some really need a lift, you have to accept you will outlive your first pair of implants… But for the right women, an implant can reconstruct the breast.  Implants can be small or large and be made to look natural at either volume.  Every doctor has an aesthetic.  Look at photos to see if you and your doctor will click.  Look for a doctor who is a true plastic surgeon, Board Certified by the Board of Plastic Surgery.

I will have more posts later on breast implant nuance: profiles of implant, gel or saline, in front or behind the muscle, biplanar or total muscle coverage. It is too much for this post.  Please email me with questions.

www.laurengreenbergmd.com