Question #1:
>Dear Dr.
>In reviewing your chosen photographs showing women you believe
to have had reasonably good implant jobs, I wanted to scream!! The reason
so many women look like they have cantaloupes stuck on their breast wall
is because the surgeon is not concerned with aesthetics. I am attaching
a photo showing a properly augmented woman. Notice the implants do not
look unnatural; they have the right amount of cleavage and appear
to be correctly proportioned.
>
>Now, my question: how do I make sure to find someone who really cares
about the aesthetics and isn't just interested in performing as many surgeries
per day as he/she can? What are the guarantees that you won't end up looking
like your section one models (Pamela Sue comes to mind, so does every woman
in any x-rated video I've ever seen)?
>
>Thanks for your willingness to be candid!
An Answer:
The only point of your diatribe here is that beauty is in the eye of
the beholder. The sample picture that you'd sent shows only one thing:
your impression of a "properly augmented woman." The problem (in all seriousness)
is that the ultimate goals are a matter of opinion. The picture you'd sent
shows a small augmentation result. We do not know how far out from the
surgery she is. We do have the luxury of a pre-operative photo. We do not
know how her result will fare with time. How will she look in ten years?
The bottom line is that each surgeon/patient has his/her own idea of
a good result. Honestly, patients that are displeased with surgical results
overwhelmingly complain that their breasts are too small. I've seen very few
patients who complained that their surgeons had made them too large. Patients
should consider this fact. Also, pictures that patients provide as goals
help resolve the "target" size and shape issues. A last point: there are
no guarantees in plastic surgery. Anyone providing you one is suspect.
Be certain your conversation with your surgeon covers points you consider
important.
Thanks for your question,
John Di Saia, M.D.
Question #2:
>Hello:
>Actually I have two questions. My knowledge of breast augmentation
is very limited. I understand that mammography is still effective--especially
when the implant is placed under the pectoral muscle. However, I was wondering
if there is any impact on one's ability to breast feed?
>
>My second question has to do with some additional studies. Have there
been any attitudinal assessments of husbands and boyfriends of women who
have had the procedure. I really want the procedure for myself, but I don't
want to risk "turning off" my husband with these changes.
>
>Thanks much.
An Answer:
You present a fair set of questions. Unfortunately, they do not have simple (or definitive) answers. Nevertheless...
On the subject of mammography and breast cancer, saline implants are less obstructive to visualization than are silicone implants. Also, as you indicated, placement of the implant behind the Pectoralis muscle hinders mammographic examination less. There are still some investigators that claim that implants may reduce the effectiveness of mammography. This is a far less universally held opinion now however.
On breast-feeding, implants themselves do not directly affect the process of milk production. The surgery however involves a limited dissection of the breast. Scarring can potentially block some ducts leading to a reduction in the quantity of milk produced. Some ducts may not be able to empty well. There could be breast swelling or discomfort. These are problems reported in the journals with an uncommon frequency to which a number could not easily be placed. I have never seen a patient with the problem.
With regards to a person's reaction to the implants, this is a personal
question. I would be foolhardy if I were to suggest that all men (or women
for that matter) feel breast implants are attractive. On resolving this
issue, you are better off discussing it with the people concerned.
Thanks for your Questions,
John Di Saia, M.D.
Question #3:
(Editor's Note: This question I borrowed from a chat room. It is a little
modified and abbreviated.)
I have been contemplating the option of getting a breast reduction.
What are the pros and cons of doing this kind of procedure? Is it safe,
any precautions and tips if I do decided to go through with it? Will I
regret it?
An Answer:
With regards to breast reduction, patient satisfaction tends to relate
to the age of the patient and the actual reason (cosmetic versus symptoms)
that patients seek surgery. Younger patients with lesser symptoms (like
back pain and deep bra furrows) seeking reduction for cosmetic reasons
tend to be less satisfied as the procedure leaves scars (which are of course
variable). Older patients tend to have more symptoms and/or are better
equipped to handle the scarring (probably both).
John Di Saia, M.D.
Question #4:
In regards to breast augmentation surgery, is there any body of information
that tracks loss or gain of sensitivity, especially in the nipple area
after breast augmentation surgery?
Are nipples affected in any way as to size, shape, response to stimulation,
blood flow (engorgement) or other factors that affect arousal and sensation?
An Answer:
With regards to the loss of sensation at the nipple/areola, all patients acutely note a change in their sensation post-operatively. Fortunately, only about 15% note a permanent change as sensation is regained. This change and subsequent return are similar regardless of the surgical approach used. Nerves maintaining nipple/areolar sensation mostly come from the side and less so from the mid-chest.
On the subject of engorgement or size/shape, there is no data to suggest
that these items change appreciably following simple augmentation surgery.
Thanks for the question,
John Di Saia, M.D.
Question #5:
>I have two questions and I would greatly appreciate your response. Does a plastic surgeon require specialized training in order to perform the endoscopic transaxillary breast augmentation? As this is a relatively new procedure, and many surgeons still rely on the old traditional methods, how does one know for certain that a particular surgeon is skilled in performing the endoscopic transaxillary breast augmentation? My second question is whether the transaxillary breast augmention is always under the muscle? I would prefer to have this method. Thank you in advance for your time.
An Answer:
This is not really all that new a procedure. Since endoscopic equipment has become available some surgeons have been trying to use it in breast augmentation surgery. This technique is really a modification of the more standard trans-axillary procedure.
With this being said I am not really a fan of the procedure although I took a course in endoscopic surgery following training that included this procedure. There are several reasons:
(1) This approach requires specialized equipment that would further increase my overhead.
(2) If I were to need to adjust the result for any reason, I would need to make another incision on the breast. This technique as I had mentioned is based upon the trans-axillary, a technique that next to the trans-umbilical (through the belly button) has the highest rate of revision surgery.
(3) I am not in general happy with the shape of the breast that the trans-axillary approach provides.
(4) I am very happy (as are my patients) with the shape and reliability of my current technique.
Thanks for the question,
John Di Saia, M.D.
Question #6:
>A friend of mine had silicone implants 5 years ago. Her doctor instructed
her to take antibiotics every time she went to the dentist; even for such
simple procedures as cleanings. Her understanding for the antibiotics is
that it prevents infection from settling around the implants. I have never
heard of this before. Is the taking of antibiotics for this reason a common
practice?
>Thanks for the informative web page!
An Answer:
This is unusual. I know of no other plastic surgeons that advise prophylaxis
for patients just for their breast implants. There is no data of which
I am aware indicating this is effective. Are you sure this individual does
not have perhaps a heart defect or some other reason to be on antibiotics
prior to procedures (dental cleaning, etc)? Has she had implant infection
before that may make her surgeon overly cautious?
Thanks for the question,
John Di Saia, M.D.
Question #7:
>Hello, my name is Clarita, This is my first time on the internet and
I would like to know more about Breast Implants. I am thinking of getting
surgery and I am not sure whether I should go with Silicone or Saline Solution
Implants.
>
>Also, I would like to know the web site addresses of different implant
manufacturers and/or suppliers, as I have to order them according to my
doctor's instruction.
>
>Of particular interest is a French company known as "Amoena" which
is the brand my Doctor has recommended and I would like to know how reliable
they are.
>
>I live in Medellin Colombia, the city of eternal spring.
An Answer:
Interesting. In the United States, mostly saline breast implants have been available after the silicone version was removed from the market in 1990. It was just recently re-approved for augmentation with restrictions. The allegations for which they were removed have not been well supported by research, but local reactions and an increased contracture rate still make me lean toward saline implants given the choice. The silicone implants do give a more natural feeling result (assuming you don't get a firm contracture). With regards to brands, I am not aware of the brand of which you speak.
In the United States, the implants are not ordered by the patient. The surgeon supplies them in the operating room. Some breast implant manufacturers have web sites. The only ones I have seen are those of Mentor and Inamed (now part of Allergan) medical.
Thanks for your question and good luck,
John Di Saia, M.D.
Question #8:
>Hi,
>I am interested in breast augmentation as I have breast fed three
children and have lost all breast fat. I have gone from a happy B to a
very unhappy A. I am looking to enhance what I have to a large B. Would
this seem feasible without looking like the skin has been stretched too
far? (I really wouldn't want that "bubble" look on my chest) A question
that hasn't been approached in your column.
An Answer:
Regarding "bubble chest," the good news is that after a few children,
your chest skin has probably become more lax. It would be less likely for
you to take on the appearance of tension that you describe. In fact, depending
upon exactly how lax the skin has become, the question of the need for
mastopexy or "Breast lift" comes into play. Make sure you discuss these
items with your surgeon fully.
Thanks for the question,
John Di Saia, M.D.
Question #9:
>I have read most everything on the web about this "uplifting" procedure. I have two questions: 1) I heard once about a lift procedure that was developed somewhere in Europe which involved incisions in the armpit, rather than on the breast itself. Have you heard of it? Do you have any information?
>(2) How do I know if I'm a candidate for the modified version which
is just reducing the areola and surrounding area? >
>Thank you for your help.
An Answer:
Breast lift is literally re-positioning of the nipple-areolar complex.
As such it seems quite logical that incisions upon the breast would be
necessary. To answer your first question, I do not know of a method involving
incisions in the armpit. The modified version using a circumareolar incision
can be used when only mild preoperative breast ptosis (droop) is present.
The patient should be advised however that this form of breast lift results
in a less than attractive wrinkling around the areola. This does improve
over the first year post-operatively, but for many patients this is a long
time. Of course, the traditional breast lift involves several incisions and
the potential for severe scarring. Another method for very
mild droop in patients seeking augmentation is to use a larger breast
implant. There is naturally a limit here and a potential for a recurrence
of the ptosis. Without seeing you, it is not possible for me to tell you
where you lie along this series of options. A consultation with a qualified
plastic surgeon would help.
Thanks for the question,
John Di Saia, M.D.
Question #10:
>Good Morning Doctor!!
>
>I would like to find out what risks, if any, are involved with receiving
Breast Implants and having diabetes??? Would this cause my diabetes to
become out of control, or would it be a safe thing.
>
>Please advise at your earliest convenience...
An Answer:
Relative to your diabetes, I am unaware of any specific risks. The risk
that does come to mind is infection. Diabetics are more prone to infections
than other people. With this said however, I know of no study that clinically
showed this in the case of breast implants. We do not change our approach
or keep such a patient on long term antibiotics, as no one has shown this
to be necessary or efficacious.
With regards to specifically your diabetes, you may wish to ask your
internist or endocrinologist if he or she knows any different.
Thanks for the question,
John Di Saia, M.D.