More Patient Questions Answered – now in print form – continued!
Posted on April 16, 2019
By: Dr. Asaf Yalif
At Y Plastic Surgery we see a lot of patients with a lot of questions! It is always a great pleasure to sit with our patients in consultation and answer all of their questions! Oftentimes patients voice some interesting questions and concerns and we would like to present them to you as well. In this way you should know that you can always ask us anything that is of concern to you. As we say, there are no dumb questions! So for today’s post we present some of Y Plastic Surgery patients’ questions we have fielded in Atlanta and Alpharetta GA.
Can you have a breast lift and not exchange the implants?
Yes, you can. There are several caveats though before saying definitively “yes.” First, are the implants relatively new (less than 10-15 years old)? If the implants have been in place more than 10-15 years the FDA recommends an exchange so that there is less chance of rupture, etc. Second, are you happy with the volume/shape of your current implant? If you are totally happy then that usually begs the question – why are you wanting a lift? If the implant is fine then why is the interface with the breast needing a change? The only way to answer that particular question is with an in person evaluation to evaluate the implant, the skin/breast envelope and where the mismatch is. If we find that we really are satisfied with the shape and position of the implant, and it s fairly new (less than 10 years old) then absolutely we can consider a lift without an exchange.
If you already have an implant can you do an exchange to go up or down in size?
Yes we can. To go up in size is fairly straightforward in most circumstances. Usually we can use the same access incision and simply exchange for the larger implant once we have enlarged the pocket a little bit. The recovery is usually easier for this as well. If on the other hand, we are downsizing the implant then we will also need to make the pocket smaller. Otherwise the implant may move around in the pocket a lot and look asymmetric. In having to adjust the pocket we may also fin d that the breast and skin may be a bit redundant/loose as well. This may necessitate a discussion about doing a breast lift too. I am not trying to be a broken record here , but the short answer is yes we can – the truth is we need to have a discussion and examination to make sure we are comfortable with a plan that may necessitate a lift too.
Why do you massage the breasts after surgery?
The body will create a capsule around any device we place in it. Whether it is a breast implant or plate and screws for a broken bone the body creates a thin layer of tissue to surround/encapsulate the device. Especially with a breast implant we want the capsule to be thin and pliable, almost non-existent. We teach the displacement exercises to allow you, the patient, to gently manipulate the implant and capsule as the capsule is forming. In this way we hope to keep the capsule thin and pliable and allow a more natural feeling capsule to form. Not every plastic surgeon utilizes displacement though so please make sure that whomever your plastic surgeon is that you follow their specific protocol for post-operative management of a breast augmentation with an implant.
How do you decide to go above or below the muscle with an implant?
The are several factors that go into the decision about whether or not we can put a breast implant above or below the pectoralis major muscle. Chief among them is the patients’ soft tissue envelope (skin/breast). If very thin and not able to camouflage the implant, then we routinely recommend below the muscle. In addition, if the implant is larger than 300-400 cc then we will typically recommend below the muscle. There are always gray areas though and depending on texturing of the implant, and projection choices we can usually accommodate a patient’s preference as long as it is within reason. The last thing we want to do is place an implant in a position where it is plainly visible, either through visibility of the edge of the implant or through rippling.
What causes “side boob?”
Side boob is a curious thing. There is natural side boob, and then there is side boob that can happen from implants placed below the muscle. Normally there is a “tail” of breast tissue that goes towards the armpit. This area may grow larger for any number of reasons and become a “side boob.” We can remove this excess with surgery, as in a breast lift or reduction. The side boob that can happen with implants occurs when we go below the muscle but do not fully alter the muscles course and function. If we don’t change how the pectoralis muscle moves, then every time a patient moves the muscle they will inadvertently be pushing the implant towards their side. This leads to a widening of the space between the implants and when a patient lies down the appearance that the implant falls into their armpit. This can be corrected with surgery.
How soon after a baby can you have a mommy makeover?
Timing of surgery after having had a baby is dependent on a number of issues. First is you and your child’s health. Obviously we do not want to do a large procedure that may incapacitate you during the time when your newborn requires a significant amount of your attention. Second is that natural response and elasticity the body will exhibit after having a child. What this means is that if we were to do a tummy tuck at the same time as a c-section we will not be able to “tighten” your skin and muscles nearly as much as if we wait until the swelling of pregnancy has gone away. If addressing your breasts we also want to wait until you’ve finished breast feeding and your milk has stopped. Once the gland atrophies and goes back to a smaller we size w e can make a more accurate determination on whether you might want an augmentation, a lift, or both. So, as a general rule we recommend waiting at least 6 months after finishing breastfeeding before addressing the breast and body components of a mommy makeover.
