Symmastia Correction Testimonials

I had suffered from symmastia after I had my first breast augmentation done by a plastic surgeon in Florida. I was happy to learn that Dr. Pousti had experience with symmastia correction and was 100% certain that he was the one I wanted to fix my problem. Dr. Pousti has been great from the moment my husband and I met him. He has been very kind and he informed us in great detail about the procedure. Now, 5 weeks after my operation, I would not be any happier with the results. Not only is the symmastia corrected, but Dr. Pousti was also able to consider my wishes regarding the size and look of my breasts. Dr. Pousti is a great surgeon and I am convinced that everyone who suffers from symmastia cannot find a more qualified and experienced surgeon in the U.S. to correct this problem. I am very thankful to Dr. Pousti and his outstanding staff!! I had my first breast augmentation surgery a little over 2 years ago from another doctor. I knew something was wrong as soon as the bandages were removed. I will never forget that day, I cried the second I saw my new breasts- that didn’t look like breasts at all. My doctor (at the time) told me that it was because my scar tissue had become too tight and it was pushing my breasts towards each other. He suggested a second surgery in which he would fix the problem. Needless to say the second surgery did absolutely nothing to fix the problem; it was nothing but an unnecessary surgery. I knew that something was out of wack, and began to do my own research. I found out about symmastia and knew that it was what I had. I gave my doctor the benefit of the doubt and went back to him one more time. He basically told me that this is just how my body is, and I was going to have to deal. He told me he would perform the same surgery again (if it didn’t help the first time why would it help the second time!!!)

That’s when I began my search for a doctor to fix me! I got extremely lucky and came across Dr. Pousti’s web page while doing further research about symmastia. He is the only doctor in the area I found that specializes in the procedure (and I only saw a few others in the whole country). I made an appointment right away.

I came in for my consult and was blown away by the difference in treatment I received from the very start. The waiting room has a spa feel to it. The girls that work in the office are all amazing and take wonderful care of us patients. Dr. Pousti sat and talked with me longer than my other doctor saw me the whole time I was his patient. He made me feel comfortable, and although it was hard to trust another doctor, Dr. Pousti gained my trust right away. I was told from the beginning that if he felt he couldn’t fix me that he would tell me. Luckily he said I had a great chance of being fixed. Although it wasn’t 100% there is no one else I would have trusted to do a better job.

The difference this surgery has made on my body is amazing. After my first breast augmentation I gained some weight because I was so depressed. I looked even worse because of the way my breasts were placed- almost like a tree trunk. Now, although I still have a little bit of extra weight on me I look curvy- and feel amazing. Thank you so much Dr. Pousti for making me feel like the woman I wanted to feel like over two years ago when I first decided to have this done. The results are amazing, and I would recommend you to all of my friends, family, anyone. And thanks to the girls in the office for making this whole process much more enjoyable than surgery normally would be. I plan on coming back to Dr. Pousti if I ever need anything else done.

Article Contributed by Dr. Tom Pousti, San Diego, CA

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Cohesive Gel Implant Expert: Dr. Steven Teitelbaum

Article courtesy of Dr. Steven Teitelbaum

Many of Dr. Teitelbaum’s patients choose him to be their surgeon specifically because of his expertise with cohesive gel implants (also known as “gummy-bear implants” because the gel has a consistency similar to that of the candy). Widely popular in Europe because of their natural-looking and -feeling results, these implants are now available from just a few surgeons in the United States. Dr. Teitelbaum has been using them in studies since 2000 and is one of the most experienced providers in the country. He is the only surgeon in the state of California who was asked to participate in the clinical trials of all three cohesive implant manufacturers. And because of his extensive, excellent results, some of the same manufacturers have asked him to help develop a curriculum to teach other surgeons how to use them. Dr. Teitelbaum has traveled to places as far away as Asia and Africa to share his techniques with other surgeons.

Cohesive gel implants offer a soft and supple feel with the added benefit of being relatively leak-free due to the nature of the silicone. It is this consistency that allows the implants to maintain the commonly requested teardrop shape. While the edges of the implant blend gradually into the surrounding tissue, the thinner top of the implant slopes gently down to a fuller bottom half, creating the most natural possible breast contour. Plus, clinical studies have demonstrated that cohesive implants have the lowest rate of capsular contracture (hardening of the breasts) and leakage of any implant ever studied.

Dr. Teitelbaum is an enthusiastic supporter of this new technology, and has testified before the U.S. Congress about the safety of silicone implants such as these. However, he always works with each patient to determine exactly what size and type of implant is right for her, and would never automatically recommend cohesive implants. When you come in for your consultation, you and Dr. Teitelbaum can explore if they might be right for you. In the meantime, we encourage you to visit Dr. Teitelbaum’s practice profile to learn more about this exciting new technology and all it has to offer.

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The Laser Bra - Breast Reductions & Breast Lifts

An internal bra created with the patient's own tissue is giving long lasting results to mastopexy (breast lift), breast reduction/lift and breast augmentation/lift surgery patients. A CO2 laser is used to de-epithelialize the patient's own skin and create an internal bra that is then attached to the chest wall, holding up the breast tissue. According to W. Grant Stevens, M.D., This process does not add to surgical time, carries no further risks, and can help create a more aesthetically pleasing shape to the breast. Women who request a breast lift usually have complaints about their breasts being saggy and the nipple being too low. Previously, the way this has been treated is simply to reduce the skin of the breast. Dr. Stevens explained: "Traditionally, the skin that was reduced was discarded, and the remaining skin then fashioned around the breast tissue." Dr. Stevens says that after doing hundreds of these traditional breast lifts with surgery alone, he decided to implement the laser when he saw the incredible way lasers were shrinking the sagging skin on women's faces. He believed lasers could do the same for breasts - thus, he developed an internal laser bra.

The long-term results for a traditional breast lift may sometimes be disappointing, as the breasts tend to "Fall out" when the bulk of the breast drops below the nipple. Hence Dr. Stevens developed The Laser Bra technique called The Stevens Lift. "I was familiar with a mesh that can be used as an internal bra. But this is a foreign body with its associated problems, such as infection, extrusion and palpation," said Dr. Stevens. "I wanted to develop something that used the patient's own tissue and avoid the problems associated with foreign matters."

"With the new technique, the skin otherwise discarded is treated in such a way with the laser, that a bra is fashioned and secured to the chest wall. This "Bra" holds the breast tissue up and in place," explained Dr. Stevens. It is entirely internal and is done with the patient's own tissue. Therefore, there are no added problems with infection or rejection, often seen with foreign bodies."

The surgery is performed under a general anesthetic. Incisions are made horizontally and vertically, as with a traditional breast lift. Excess skin is treated with the laser, fabricating the internal brassiere. This internal bra is then tacked to the chest wall and the entire breast and nipple are lifted. The procedure takes about 2 hours; swelling and discomfort are minimal, with recovery time taking 5-7 days.

Often a breast reduction and breast lift are performed simultaneously to create not only smaller but perkier breasts as well. Utilizing the laser during breast reduction surgery, to reduce the breast tissue as well as create an internal, can be beneficial. The incisions are similar to the breast lift - both horizontal and vertical. However, during surgery the excess fat, tissue and skin are removed from both sides of the breast and the breast is repositioned. "Here is something different from a traditional breast reduction," said Dr. Stevens. "By using the laser, we are also preserving the blood supply that would otherwise potentially be interrupted. The blood supply to the nipple is improved and nipple sensation is preserved." The Laser Bra is utilized to support the reduced breast tissue. For a woman who has developed sagginess and a reduction in her ideal breast size, a simultaneous breast lift and implant can restore lost shape and size. "It is the same process as a laser breast lift. But the effect is much more dramatic, because now the laser bra is not just holding up the breast tissue but is also holding up a breast implant as well," explained Dr. Stevens. With traditional mastopexy augmentation without the laser bra, the implant tends to descend, and fallout can be very noticeable. "There are not extra risks involved in this surgery. In fact, I would argue it possibly minimizes risks because the risk of extrusion, migration and exposure of the implant are diminished since the laser bra creates a new layer of tissue over the implant," said Dr. Stevens.

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Dr. Edward Pechter Voted Best Plastic Surgeon

Dr. Edward Pechter of Valencia, CA was voted the best plastic surgeon in Los Angeles by the readers of the L.A. Daily News. This prestigious award is one of Dr. Pechter's most recent accomplishments. Please be sure to check out the other articles for Dr. Pechter, as well as the before and after photos featured on his profile.

Congratulations Dr. Pechter!  

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Tubular (Tuberous) Breast - Patient Testimonial & Story

I have struggled with the insecurity of having small, misshapen breasts (tubular / constricted breasts) for years. Shopping for clothes was a nightmare and nothing ever fit or looked the way I wanted. I swam competitively for many years and the humiliation of wearing a speedo swimsuit as an AA cup size was almost unbearable. After years of wearing padded bras and praying every night that my boobs would grow I finally decided to explore the option of plastic surgery. I toyed with the idea on and off for about 4 years and finally last December became very serious and started researching plastic surgeons. I didn’t limit my search to just San Diego and ended up visiting with doctors in both northern and southern California.

I am a complete Type A so I had folders and folders of information about the procedure, doctors, testimonials, side effects- everything. I saw quite a few plastic surgeons and was looking for someone special, someone who was not only a top expert in their field but who also had the ability to understand my wants and needs and work with me to achieve them. After meeting Dr. Pousti for the first time, I was positive I had met my match. He is not only a phenomenal surgeon but he is also extremely dedicated to his patients and in touch with their wants and needs. I didn’t feel like just another number as I had in other offices. Given I was not having just a straight forward breast augmentation because of my tuberous breasts, I was anxious and ended up coming in numerous times for long question and answer sessions before even scheduling surgery. When I came into the offices his staff was so friendly and always greeted me by name.

Dr. Pousti was always prepared and willing to spend as much time as I needed to discuss my questions and concerns. He was sensitive to the look and shape I desired and was also honest and realistic with me about what he thought he would be able to achieve. By the time the surgery date came around I had nothing but the utmost confidence and trust in Dr. Pousti and I was not disappointed.

The surgery went smoothly, the recovery was manageable, and the results are beyond my wildest dreams. I try not to be overly emotional but I couldn’t help but tear up the first time I saw my new “additions” because they exceeded all my expectations. I have not had any complications despite such an involved surgery and they look so natural and real that not one person I know had a clue they are not my own because they are so proportionate to my body. I have a confidence I never had before and in large part I owe that to Dr. Pousti. I wholeheartedly recommend Dr. Pousti to anyone even considering any type of plastic surgery as you would be doing yourself a disservice not to choose the best!

I am currently 4 months out and everything has exceeded my expectations. My healing process has been incredible. I was initially very worried about having incisions around the entire areola and was worried about both sensitivity and scarring. After surgery I only had feeling in one nipple and was concerned I wouldn’t gain sensation back in the other side however, about 3 months post-op, I regained full feeling in the other side as well.

In addition, my scars had scared me a little when I first saw them, as they were still quite red and the skin had to re-attach itself after surgery. But despite my first reaction everything has healed really well. My scars started to improve quite quickly after surgery and although they still have some lightening to do they are fairly discreet and blend very well into the natural ridges and texture of the nipple area. I am also so happy I chose to go with silicone implants. They were probably the best choice I ever made. I had gone back and forth about getting silicone since they were just released last year but they have looked and felt so natural from just a few weeks out and only continue to improve with time. Overall, there is nothing I would change. Thanks to Dr. Pousti the surgery results were incredible. My breasts have a round full shape instead of the pointy look they had before. They feel extremely natural and the scars are healing extremely well. I have not regretted having the surgery for even a second!

Article Contributed by Dr. Tom Pousti, San Diego, CA

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Reuters Calls ImplantInfo Web's Clearinghouse for Breast Augmentation Information

Reuters, July 2000

Assets: Beauty and the Implanted Breast - Asset or disaster? By Richard Chang

NEW YORK (Reuters) - Beauty is more than skin deep these days. With surgical implants, women -- and increasingly, men -- seek to enhance their physical assets, with inserts as big as breasts or as small as say, a Viagra bottle.

Image-hungry consumers are remodeling their bodies in droves now that cosmetic surgery is relatively affordable and painless -- or so it seems, anyway. For $3,000 to $5,000, excluding hospital and other related expenses, you can get quick boosts to your bustline, chest, chin, cheeks, calves -- and sexual prowess, of course.

Choosing a new chin or breasts is almost as easy as picking a hair color. Browse through a catalogue at your plastic surgeon's office. If they're not quite right, just have them custom made. Silicone, with a texture like the famous Gumby doll, is the choice material, especially since studies to determine its link to cancer and autoimmune diseases have not been conclusive. But never mind safety questions. Business is booming.

``Implants are here to stay. Women want them,'' said Wendy Lewis, an independent plastic surgery and beauty consultant in New York (http://www.wlbeauty.com). ``In the U.K., it's the No. 1 procedure. In the U.S., it's No. 2 next to liposuction.'' In the United States, more than 132,000 women boosted their bustlines with saline- or silicone-filled sacs in 1998, according to the latest data from the American Society of Plastic Surgeons (http://www.plasticsurgery.org). In 1992, just 32,000 women underwent this procedure.

Chin implants are a distant second in popularity, followed by enhancements of cheeks and buttocks. Figures are not available for pectoral and penile implants for men, or calves for both sexes, though surgeons and consultants say demand is growing.

``There's a tremendous benefit'' from having implants, said Dr. Lu Jean Fang who, having operated on thousands of women over 26 years, is very aware of implant dangers as well. ``It makes the breasts beautiful and sexy, but people need to know the potential risks. If the pleasure they get outweighs their sense of risk, it's a good thing to do because it will make them feel good about themselves, just like a face-lift ''

Nicole Cummings, a 31-year-old mother, grew up with uneven breasts after she had a tumor removed in her teen-age years. Implants finally helped restore her self-esteem, prompting her to create a Web site that has grown -- with sponsorship from plastic surgeons -- into the largest chat room and clearinghouse for information about the procedure (http://www.implantinfo.com). ``It changed my life in a way I can't even express,'' Cummings said. ``I felt really deformed. Now I feel complete. It's reflected in everything I do.''

She bristles at talk that breast enlargement is for glamorpusses. ``Most women with implants are in their late 20s and 30s, who are just not satisfied with the way they look anymore'' because of the effects of pregnancy or aging, she said. ``This is my life, my choice. Let me take charge of my life.''

But countless women claim that their implants triggered life-threatening autoimmune diseases that are too high a price to pay for beauty. Manufacturers and surgeons choose to ignore or downplay these risks out of greed, they say.``There's been a huge cover-up with the dangers. God knows there aren't supposed to be foreign objects in the body,'' said Ilena Rosenthal, director of the Humantics Foundation for Women, a major anti-implant support group (http://www.info-implants.com, http://www.toxic-exposure.com).

Unlike say, a face-lift, breast implant surgery leaves a piece of material in your body that nature regards as an ''invader'' and tries to fight. While many women have no problems with their implants for years, often the surrounding tissue hardens as the autoimmune system forms a thick scar capsule to protect the body from harm. Cancer and other diseases may be a side effect, although the evidence is not conclusive.

Chin, cheek, buttocks, pecs and calf implants are solid and usually stay in place. But breast implants are more liable to move, as they are filled with silicone gel, saline solution or soy oil that may leak.While manufacturers and plastic surgeons stress the safety of implants, British health officials in May warned that women should remove soy implants because the oil can become toxic over time. Inamend Corp., the Santa Barbara, Calif.-based manufacturer, said it has set aside $100 million to cover costs related to the Trilucent implants, which affects 5,000 women in the United Kingdom, 165 in the United States and 20 in Canada.

Also, a recent study by the Food and Drug Administration using magnetic resonance imaging (MRI), showed that 69 percent of women who had their first implants before 1988 had at least one rupture. One-third of another group of women studied had at least one surgery to have an implant removed or replaced.

``This is the information that manufacturers know but they don't want the public to know,'' said Dr. Feng, whose own study confirmed the FDA's findings. ``Many patients are hurt by implants,'' she said. ``For some people the benefits outweigh the risks. They have to make their own personal decision.''

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Correcting Synmastia Through Breast Augmentation Revision Surgery

Synmastia (also known as symmastia) is a condition that occurs when breast implants sit too close to the middle of the patient’s chest. Some women refer to it as ‘breadloafing” and extreme cases can even lead to the “uniboob” look. The problem can be corrected through breast augmentation revision surgery. This presentation by Dr. Steven Teitelbaum, M.D., F.A.C.S. explains in detail how to detect and repair synmastia. The pictures give you visual guidance while the text explains what you are looking at and how the repair is performed.

Dr. Teitelbaum is a plastic surgeon practicing near Los Angeles, California. He has extensive experience with both primary breast augmentation and with breast augmentation revision. He has compiled this presentation from actual cases of synmastia that he has revised recently.

 This variety of patients with synmastia (symmastia) demonstrates the underlying problem: the implant is sitting too far towards the center rather than behind the breast itself. The markings indicate where the implant should sit; correction involves closing off the overly large space so that the implant remains where it looks best
 There are cases in which the breast only crosses the center of the body when it is forcibly pushed over; this is still synmastia (symmastia,) albeit a more mild case.
 Notice how her implants are so close that they are even touching! The implants should not have been allowed to migrate into the area of the hatched red line. The problem can be due to inadvertent overdissection by the surgeon, the shape of the patient’s rib cage, the size of the implants, or weakness of the patient’s tissues.
 In addition to the implant pocket being open too far towards the center, it is often too low in many cases of severe symmastia (synmastia.)
 Laying on her back prior to surgery, it is apparent how the implants come too close to the center and the skin over the breastbone is tented up into the air. The red hatch marks represent the area of her old implant pocket that needs to be closed off.
 Many symmastia (synmastia) patients have somewhat of a depressed breast bone area; gravity can then pull an implant down the slope towards the center.
 This patient has the opposite type of a breast bone: it is protuberant (the medical term for it is “pectus carinatum.”) Note that gravity has pulled this patient’s implants down towards her sides. Correction requires closing off the hatched areas so that the implant just remains within the inner solid line. This can be done with sutures (capsulorraphy), placing a patch of material, or with the newest technique, creation of a new space called a neosubpectoral pocket.
 With correction using the neosubpectoral pocket, the symmastia is totally corrected and looks smooth on the table at the end of the case. Note the wide gap between the new pocket and the line indicating where the old implant used to sit.
 Immediately before and immediately after correction, still in the operating room. The implants now have a normal distance between them and the skin over the breast bone no longer “tents” from the pressure of the implants. It is often important to switch to a smaller implant in order for the symmastia repair to heal and for the problem not to recur. Imagine if the implant in the after photo below were a lot larger; it is easy to visualize how that would stress the repair and if large enough, may cause the skin to tent again over the breast bone.
 Everyone wants cleavage but it must be smooth and even. As in this case, sometimes it is important to leave the breasts just a little wider than ideal in order to be sure that there is ample tissue to prevent recurrence of the problem.
 Symmastia (synmastia) should be judged in a variety of positions. With the arms raised preop in the upper left, the joining of the breasts creates a “uniboob” type of a look which is shown corrected in the upper right photograph. While cleavage is good, note in the lower left how odd it looks when the skin pulls off of the breast bone. This is corrected as shown in the postop in the lower right photo.
 Note how much deeper and more attractive the cleave is on the left. In the middle photos, note the severe extent of the tenting of the skin off of the breast bone. In the upper right, look how far the implant can be moved across the center, but how the implant is restricted to its side in the photo beneath it following repair.
 In this severe case of synmastia (symmastia), the patient literally had a single pocket in which the implants were touching. Not all synmastia repairs turn out this excellent. Sometimes the tissue gets stretched from longstanding synmastia and other times it may have been damaged at the time of the first operation.
 Her underlying problem is that her implants were way too wide for her body and crossed the centerline of her chest. The right was also too low. By raising them, moving them out, and making them a bit smaller, she enjoyed a significant improvement not just to the appearance of her breasts, but to their feel as well.
 When implants are too close to the center, the nipples point out; when they are too low, the nipples point up. It is fascinating to note in symmastia (synmastia) patients how implants in the wrong place can so dramatically change the appearance of the nipples.
 Note in the frontal view how much more even the implants are, and how they are no longer touching in the center. Cleavage is good, but the skin over this patients breastbone pulled away from her body when she would lean forward. Note that in the sideways view, her upper bulge is reduced but not eliminated. This was by the patient’s own choice; had she selected a smaller implant, there would be less of an upper bulge and the nipple would not tip down.
 In severe cases of symmastia with large implants that have been neglected for years, there is often stretch of the skin in the lower inner part of the breast towards the breast bone, leaving the folds that are seen. These could be improved with a lift, but the patient preferred leaving it as it is to having scars of a lift. It is also fascinating to look at the sideways photos and note how the nipple no longer points out to the side when the implant is properly positioned in three dimensions.
 This is another example of a patient with severe, long term stretching of the skin over her lower breast bone. Such folds are usually only seen in thin patients with very large implants who have lived with their symmastia for years. She would need to have a lift if she would like to improve these. Note how an implant sitting too far towards the center doesn’t just distort the center; the breasts in the preop photos are too narrow, they do not fill the width of her chest, and the result makes her whole torso look unbalanced.
 This patient has successful correction of her symmastia, but no doubt some asymmetries still remain. The thinner the patient and the larger the implant, the more likely there is to be some residual deformities. But other than looking straight into a mirror or camera, her shortcomings are not noticeable. Large implants definitely contribute to causing symmastia, and placing large implants back in after correcting symmastia – as in this case, can still lead to implants that look more round than natural.
 It is obvious not just that her implants did not sit symmetrically, but they are simply too big for her body. One of the most frequent causes for problematic outcomes after breast augmentation is selecting implants for which a patient simply does not have the room on her chest for them to be! Any patient considering an augmentation for the first time - as well as getting a revision – would be wise to choose an implant no larger than fits their body.
 This is the same patient as shown in slide 11. Although her symmastia seems subtle when standing, it was actually quite severe and deforming in clothing. By creating symmetrical pockets within which the implants can sit, the breasts become noticeably more attractive for her torso.

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Breast Augmentation Options & Procedures

This article was kindly contributed by: Roger J. Friedman, M.D. and Douglas L. Forman, M.D of The Plastic Surgery Institute of Washington. There are three incisions through which a breast implant can be placed. They include the armpit or transaxillary approach, the edge of the nipple or periareolar and in the fold beneath the breast or inframammary. This may be a personal preference issue of the patient or physician or based on the shape of the breast. If a patient has a distinct fold and a normal size nipple, greater than three centimeters in diameter, she may use any of the three approaches. If the patient has no distinct fold and a normal size nipple the preferable incision is periareolar. If the patient has a small nipple and no distinct fold or wants to completely hide the scar the transaxillary approach is preferable. There are some physicians who offer the trans umbilical approach, through the edge of the navel, but there are some drawbacks to this approach. It is very difficult if possible to place an implant under the muscle from this approach and to our knowledge the manufacturers will not warranty their implants when inserted in this manner.

The inframammary incision is placed just above the fold beneath the breast such that if a patient is wearing a two piece bathing suit and the suit rides up, the scar is not exposed. This approach provides the opportunity to develop the pocket without cutting through the breast tissue as the incision is just at the edge of the breast tissue.

The periareolar incision is placed on the edge of the nipple at the junction of the pigmented skin of the areola and the lighter skin of the breast. From this approach dissection can proceed directly through the breast tissue or tunnel parallel to the skin down to the fold and then under the breast tissue and muscle at the level of the fold. This provides the best approach to release a tubular or constricted inferior pole breast deformity.

The transaxillary approach hides the incision in a natural crease in the armpit. To best develop the pocket, endoscopic techniques are utilized. The only down side to this approach is the fact that if bleeding is encountered at the lowest point in the pocket and it cannot be controlled from the armpit approach, the patient may require an additional incision in the fold. This is extremely rare and has not happened in my personal experience. This approach also takes a little longer than the other 2.

There are 2 alternatives for the location of the pocket for the breast implant, sub pectoral and sub glandular. Some people will use the term, retro pectoral or under the muscle and retro glandular or over the muscle. Personally, we feel that saline implants placed behind the glandular tissue, on top of the muscle, have the potential for more visible rippling. Also the natural slope of the breast maybe more distorted. When placed under the pectoralis major, the pressure of the muscle helps to smooth out the implant helping to minimize the appearance of rippling. Under the muscle the breast has a very natural slope in profile.

There are advantages and disadvantages of both locations. Any one who gets an implant gets a capsule. This is a normal phenomenon. It is your body's way of saying, "this implant is not part of me and builds a wall of scar tissue around it." Five to eight percent of patients develop a capsular contracture. This is when the scar tissue capsule tightens around the implant creating firmness, possibly distortion, possibly discomfort. We feel this is lessened by irrigating the pocket with an antibacterial solution, placing the implant under the pectoralis major muscle and manipulating the implant around the pocket in the post operative period to maintain the pocket larger than the implant. In the sub pectoral position, when the muscle contracts, the implant may move. This is less evident under the breast tissue.

When implants are placed in either pocket, there is some loss of information in mammography as the implant compresses the breast tissue making it appear denser. In the sub glandular position, the breast tissue wraps around the implant and peripheral information is more difficult to obtain. In the sub pectoral position, there is a layer of muscle separating the implant from the breast tissue with the exception of the lowest portion of the implant, near the fold where the implant is in contact with the breast tissue due to the shape and contour of the muscle. Additional views are required for the most information in implant patients. These are called Ecklund or pushback views. The purpose is to pull the breast tissue away from the implant to get a better visualization of the breast tissue. There are 3 companies whose implants I have used. They include: Mentor, McGhan and Pip. All are saline filled. The only difference is the Pip implant, which is a prefilled saline implant as opposed to the other two, which are filled at the time of surgery. Implants may have textured or smooth surfaces. Initially, the implants were smooth. Textured surfaces were then developed with the thought that they would lessen the incidence of capsular contracture. This has not really been proven. What is evident is that patients may appreciate more rippling in the skin surface when textured implants are placed and this may be more noticeable with heavier texturing. Implants may also be round or teardrop. The concern with teardrop implants is that they may shift or rotate. If this happens they then may look distorted especially if only one shifts. Therefore, our preference is smooth round implants. If they rotate, they are always round. Saline implants for lack of a better description are balloons. They have a three- percent failure rate. All implants will eventually fail. The manufacturers warranty the implants. When this occurs, the manufacturer will replace the implant but not cover the hospital costs with the exception of the PIP implant which is now offering money toward hospital costs. First time augmentation patients are only eligible for saline implants. If a patient has had a previous augmentation and are now getting a larger implant or revision, or a patient who is having a breast lift termed, mastopexy, in conjunction with an augmentation, they are then eligible for silicone gel implants. There was a soy bean implant that was being studied but, has recently been taken off the market in Great Britain. The purpose of the consult is for the physician and patient to meet. This sounds quite obvious but, the real question is whether the physician and patient are on the same wavelength. There are several questions the patient must ask herself. Do you as the patient feel the physician has presented the material clearly and confidently, are your questions answered and do you feel this physician can attain your goal and expectations?

Initially, a history is taken with emphasis related to the breasts. The patient is asked what their concerns are regarding their breasts and what their expectation is of the surgery. The procedure, hospital experience, postoperative course and associated risks and complications reviewed. Patient examples are shown and the patient is shown the actual implant alternatives.

The patient is then examined, measurements are taken to assist in assessing symmetry and the breasts are examined to ascertain if there are any masses in the breasts. If any are identified, a mammogram will be ordered and this will be pursued prior to surgery. Photographs are taken and reviewed with the patient.

At this point the patient is placed in a bra consistent with the size she would like to be. Gel implant sizers are then placed inside the bra and the patient placed in a T-shirt to assist in determining the best size. The key is how you look not the cup size. This maneuver helps the patient to better conceptualize but it does not show the change in cleavage that the patient will achieve. There is no way to show this as the sizers are placed on top of the breast and the actual implant is under the tissues.

The procedure can be performed in an office operating room or the hospital. The procedure takes 1.5  to 2 hours. Anesthesia can be either general anesthetic or axillary block with supplemental intravenous sedation. During the operation the patient is positioned with their hands on their hips to minimize distortion of the breasts as can occur if the arms are out to the sides. Once the implants have been placed in the pocket, the patient is brought to an upright sitting position while you are asleep to assess the symmetry, and fold location. At the completion of the procedure, the patients are often given intercostal nerve blocks to minimize their postoperative discomfort. These last approximately eight to ten hours. The DRESSING consists of padding and ace bandages wrapped circumferentially as a "tube top." The patient is then taken to the recovery room where they will spend the next hour and then discharged home. PRESCRIPTIONS are provided for infection prevention (antibiotics), pain control, muscle relaxation, and nausea. The most common complaint is that of pressure. "It feels like you are sitting on my chest." This is because the dressing is intentionally tight and the fact that the implants are placed under the muscle which still thinks it lives on top of the rib cage and is trying to flatten out the implant. This is a muscle spasm. To minimize this sensation, the patient can take a muscle relaxant and as they are lying flat on their back in bed, a folded towel can be placed under each shoulder so that you are sleeping round-shouldered which takes tension off the muscle. This dressing is left in place for two to four days. At that time the dressing is removed and the patient placed into a bra. Our preference is a Warner Bra style 1046 or 1058 or something similar. This bra is comfortable and supportive. It does not have an underwire or a defined cup therefore; it contours to your breast. Patients are asked to wear this bra for the next month during the day only unless they prefer to wear it at night as well. SUTURES are tunneled under the surface of the skin, like a hem, and are absorbable. Therefore they do not require removal. Upper body activity is limited for two weeks. Specifically, you can do what ever you want with your arms as long as your elbows remain by your side. At two weeks, you can start using your arms more freely, gradually returning to your normal level of exercise. Often patients will awaken in the morning feeling very tight. Do not stretch! Get into the shower, the warm water from the shower will allow your muscles to relax. Then stretch gradually. The expectation is that at 2 weeks the patient gradually starts to resume their normal level of activity and are at 100% at 3 to 4 weeks. These are exercises that are initiated approximately one and one half weeks after surgery. The purpose of these exercises is to manipulate the implant around the pocket maintaining the limits of the pocket larger than the implant. This we feel helps to minimize the incidence of capsular contracture. Exercises are performed morning and evening, one time on each side, forever.

The exercises are performed using the left hand for the right breast and vice versa. The exercises are performed in three directions. The little finger is placed in the fold beneath the breast with your hand resting on the breast. Without lifting your hand, the breast is compressed which moves the implant to the upper part of the pocket. The hand then releases and the breast drops down. The hand then reaches around to the outside of the breast and gently pulls the breast toward the center of your chest, the sternal bone. Lastly, pushing from the inside of the breast outward. This moves the implant to the outside limits of the pocket.

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Breast Augmentation vs. Boob Job

Los Angeles plastic surgeon Dr. Grant Stevens suggests breasts that don't look augmented, but rather completely natural, are the ultimate goal for any breast surgeon, Sophie Gordon reports.

An excellent breast augmentation can look natural, feel real and have a natural shape. Plastic surgeon Dr. Grant Stevens, Los Angeles, makes a distinction between successful breast surgery and the obvious "boob job" where it's easy to tell a woman has had surgery

"Part of an excellent breast augmentations the fact that the breasts look as if they could actually occur in nature," he explains. "There should be a question in the viewer's mind as to whether or not these are real or are surgically created."

A good breast augmentation has a natural fullness and gentle sloping off the chest wall. There should be natural cleavage, without webbing between the breasts and a certain amount of perkiness. Dr. Stevens lists five basic considerations that make for a desirable breast augmentation:
which incision to usewhat type of implant to useplacement of the implanttexture of the implantsize of the implantBefore having surgery, you should go over photographic examples of the breasts you want with your surgeon so that you both have a clear, visual understanding of the desired result. "My job is to make the breasts look like the photographs," says Dr. Stevens.

There are 4 choices regarding where to make the incision for a breast implant: underneath the arm, around the nipple, or in the inframammary fold (where the breast meets the chest wall). The 4th is the umbilical incision, but is not as preferred as the others. There are advantages to each incision. "l allow the patient to direct me as to which incision she wishes to have," says Dr. Stevens. "We know that each incision has a certain amount of scarring, but our goal is to have the scar so minimal it's inconspicuous."

Sometimes there are ethnic factors(interms of skin type and color) that might encourage one incision over another. Dr. Stevens refuses to recommend any incision per se but notes that: "Of all the breast augmentations I have performed on nurses, physicians or even my own employees, none have ever asked me to do either the inframammary fold or armpit approach. I find it highly significant that women who have been surrounded by the plastic surgery industry and have seen the most results, have never asked for an incision other than beneath the areola."

The type of implant used has certain limitations in terms of availability. Currently, there is a moratorium on silicone implants; the silicone gel implant has been limited to women who fit into specific inclusion criteria.
"lf there were no moratorium I would be putting in far more silicone gel implants than saline implants," says Dr. Stevens. "The silicone gel implants, in general, feel more like a breast and look more like a breast. However, we can certainly adjust the saline implants and in most cases are able to give the woman a natural-looking breast."

The next question is where to put the implant. It can be placed either on top of or behind the muscle. "l place implants behind the muscle so the implants are partially covered," says Dr. Stevens. "The muscle allows a nice smooth take-off from the chest wall. lf put directly on top of the muscle they can look like a half-grapefruit or rounded balloon the chest."

The fourth criterion in an excellent breast augmentation is the choice of specific implant. Should it be smooth, textured, low profile, high profile or anatomic? It's important that each implant is individualized to achieve the size and shape the patient desires. According to Dr. Stevens, that individualization should dictate the decision.

"It's my feeling that if the surgeon is wedded to only one type of implant then all the breast augmentations will look the same. This is not cookie-cutter surgery. Cookie-cutter breast augmentations are, in my opinion, 'boob jobs'." Finally, although there is a size range from which to choose, the breast implant must be appropriately sized for the individual.

"When a breast augmentation is extremely large compared to the woman's body, in my mind, it falls into the category of a 'boob job' because any one can certainlysp0t it," notes Dr. Stevens. "If you take a little woman and you give her size double-D breasts, most people would agree that this is inappropriate. For a larger woman however, that size may be reasonable.Most0f my patients want to be In the C to D range but certainly some women want to be a large D and some women only desire to be B-cup size."

"Boob jobs" are often hard, round balls on a woman's chest. Beautiful breast augmentations have a natural shape and size. Allowing natural movement, the implanted breasts slope gently off the chest and feel soft to the touch.

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ImplantInfo Serves Up a Fact and Anecdote Combo That'll Knock Your Bra Off

VIRTUAL WOMAN - 07/05/00

ImplantInfo serves up a fact-and-anecdote combo that'll knock your socks off. . . . When it comes to a site for women who want breast implants, nobody does the topic better.

WEB PUTS NEW FACE ON PLASTIC SURGERY

By Sue Levin
Tribune Media Services

Beauty's no longer in the eye of the beholder. Rather, it's in the bank account of the beheld - and the plastic surgeon ain't doing too poorly, either. The American Society of Plastic Surgeons reports an increase from 164,662 surgeries in 1996 to 242,247 in 1998. Yup, business is booming as Boomers celebrate the big Five-O with a trip to the cosmetic surgeon. Ready, wrinkled and able, Boomeisters are plunking down thousands to get a variety of parts lifted. Butts, breasts, faces - if it's got skin, it's probably lift-worthy. Considering a nip and tuck yourself? Proceed with caution and do your homework. Luckily, the Web's got loads of info on the risks and rewards of drinking from the fountain of youth.

DEAR VIRTUAL WOMAN: Could you recommend a site that talks about breast implants? All I hear is negative stuff, and I would like information that is balanced or supportive. - Felice W., Tempe, Ariz.

DEAR FELICE: First hop to www.plasticsurgery.org, brought to you by the American Society of Plastic Surgeons and the Plastic Surgery Educational Foundation. The site is an interesting read, in general, with articles on how plastic surgery began (war appears to have been helpful in moving the science along), information regarding facial deformities and hoards of statistics. For breast implants, head to the top and choose Breast Enlargement on the pull-down menu. This section covers the basics, including implant descriptions, prepping for surgery and recovery. In addition, do a keyword search for "breast implants" on the homepage, and you'll get a group of 80-plus articles to scan - definitely worth the extra keystrokes.

Then there's Nicole's Breast Augmentation and Breast Implant site (www.implantinfo.com).

ImplantInfo serves up a fact-and-anecdote combo that'll knock your socks off. First you've got personal implant stories - even Nicole's, a mother of two who set up the site, after getting implants, to share her pre-op research. There's a killer collection of links on the subject, too. And finally, Nicole uses the Web to do what it does best - she's created a community of women (8,000 a day) who share implant information on the site's discussion boards. When it comes to a site for women who want breast implants, nobody does the topic better than Nicole.

Sue Levin is president of WWWomen Inc. View these links and more at the Virtual Woman Web site: http://virtualwoman.org. ©2000 TRIBUNE MEDIA SERVICES, INC.

Virtual woman is syndicated nationally--currently about 20 different papers have bought the colum. Some names include: The San Diego Tribune, The Sacramento Bee, The Seattle Times, The Arizona Republic, The Asbury Park Press, The Vancouver Province.

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Muscle & Fitness Hers Recommends ImplantInfo.com

Muscle & Fitness Hers Recommends ImplantInfo.com Muscle and Fitness Hers lists ImplantInfo.com along with the FDA and the American Society of Plastic Surgeons as a recommended resource about breast augmentation.

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Breast Augmentation Q&A with Dr. Don Revis- 11/19/2008

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ImplantInfo Welcomes Dr. Mark A. Schusterman and Dr. Patrick Hsu

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Pain-Free Breast Enlargement: Instant Recovery Breast Implant Surgery & A Ski Vacation While You're At It!

If you’ve ever thought that breast enlargement surgery is too expensive, think again. For what you’d pay for the procedure in the largest cities in the U.S. like New York or Los Angeles, you can have the body you’ve always wanted PLUS a great ski or resort vacation. It’s just a matter of flying to another city in the country where the cost is lower. The best part is that you finish your recovery time at a world-class resort and go home with no one ever the wiser that you had surgery while you were away!

In Salt Lake City where I have my practice, we see patients from all over the U.S. and beyond. Our location in the Rocky Mountains makes for a beautiful setting to have your surgery. For the cost of breast augmentation in New York City, you and your partner can enjoy five days in the beautiful Salt Lake Valley on the Wasatch Front of the Rockies. You can have your consultation one day, your surgery the next, your follow-up on the third day, and then spend one or two days recovering at a ski resort or spa. Voila! It’s finished, and you have received “just the right curves” and a little TLC at the same time.

Now, you may be asking if you can truly recover in just one or two days. Yes! With my Pain-Free Instant Recovery Breast Augmentation technique, there’s no need to take the typical one to two weeks. I promise all of my clients that they can begin working at their jobs (as long as it isn’t strenuous work) within two days! In fact, you can be out and enjoying yourself the very same day.

I have spent over a decade mastering this procedure, so it’s something that I take very seriously. Finding a way to give my clients a less brutal way to fulfill their dreams of looking better is what my practice is all about. It’s my passion!
The care and skill provided during surgery.No lying in bed. After a two-hour nap, you are up and about the day of surgery!Stretching without being wrapped like a mummy.Getting back immediately into your daily routine.
There is absolutely no reason why breast enlargement surgery needs to be so hard on the patient! The best results happen when there is less blunt force, less bleeding, less scarring, and, therefore, less pain. But this only occurs when a surgeon knows how to perform the surgery in a way that is clean and quick without sacrificing the most important thing? Your comfort as the patient!

And what about pain medications? Most surgeons prescribe medication for 3 to 7 days, but I have found that it’s rare for my clients to need pain medication other than Ibuprofen after my Pain-Free Instant Recovery Breast Augmentation Procedure. You don’t have to hurt!

We don’t operate like an assembly line, turning out as many patients as possible, and I strongly recommend that you avoid any practice that does. We treat each client as an individual with specific wants and needs. When we consult with a new client, we welcome her to our office as a friend and lead her carefully through the initial consultation, as well as every follow-up appointment. Our surgical facilities are certified by the highest standards set forth for ambulatory surgery.

That’s why so many clients are traveling to Utah to get their surgery and enjoying a beautiful ski vacation in the process?all for no more or sometimes even less than what they’d pay only for surgery in their home cities.

The best evidence I can give someone who is wondering why my procedure is so different is the word of a professional who is familiar with the work. From an operating room nurse: “I’ve seen thousands of procedures, and I chose Dr. Moore. Entering the operating room, this time as a patient, I was confident that I would have the best results possible. I could not have imagined how perfect my surgical experience was, and the augmentation is spectacular. I even joke that there should be a procedure to remove the permanent grin from my husband’s face.” –L. Ellsworth, RN, CNOR

For more information, please visit our site to request our free report. We serve clients from throughout the United States. 

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Allure's Review of Top Breast Augmentation Resources

Allure July 2002 Top Breast Augmentation Resources Allure magazine's July 2001 issue reports on the top internet sites for breast augmentation and includes ImplantInfo.com! We were one of the very few recommended! 

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Breast Enlargement Surgery: 100% Financing Makes It Within Everyone's Reach

Contributed by M. Kirk Moore, M.D., West Jordan, UT & The Genesys Medical Institute 

If you are one of those women who has always wanted a breast enhancement but believed you couldn’t afford it, think again. Many surgeons today will offer you 100% financing, which allows you to pay for your surgery over time. You no longer have to wait until you have saved the money. You can have “just the right curves” today.

It’s sad when women feel they must live with low self-esteem and poor fitting clothes simply because they don’t have the money for the cosmetic surgery they want so badly. But everyone should have the opportunity to feel beautiful. No one need feel insecure about her breast size or shape.

In my practice, we know what a positive, life-long impact breast enlargement can have on women, so it’s important to us to make it affordable for everyone. We offer CareCredit, a financing plan that allows our patients to pay for their procedures in low-interest installments. In this way, you can get what you want when you want it. You don’t have to put it off until it might never happen at all.
No initial paymentLow monthly paymentsNo prepayment penaltyAn easy application process
While paying for your surgery should be pain-free, so should the surgery itself! I offer a unique Pain-Free Instant Recovery Breast Augmentation technique that few are even approaching today. I developed it in order to minimize the discomfort, scarring, and downtime that my patients would experience after surgery. The results have been fantastic, and it has been one of the most rewarding things I have ever accomplished in my practice.

This is why women often travel from across the U.S. to visit my office in Utah. With the opportunity for 100% financing, as well as a pain-free technique that allows them to return to work within two days, the cost of travel is well worth it to them, particularly if you have researched and found your local pricing to be above $5,000 for a breast augmentation for silicone.

If you have felt that having the curves you want is a pipe dream, or you have been afraid of the pain of surgery, you can put those fears to rest and finally have the body you have always wanted. There is no need to put it off. Seeing the lives of my patients change for the better is why I do what I do.

For more information please visit our site and request our free report. We serve clients from throughout the United States.

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ImplantInfo's Support Community Lauded

 Excerpted from Plastic Surgery News June 2001

. . .implantinfo.com . . . offers woman-to-woman wisdom within a “support community.”

Although [the site] also provides reference services, such as how to locate a plastic surgeon, how to check credentials and printable lists of questions to ask your doctor, the biggest draw is the lively conversation among site visitors.

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3-D Simulation of Breast Augmentation Results

Every woman considering breast augmentation shares the same concern: How do I choose an implant that’s the right size for me?

While Dr. Teitelbaum is known for his skill in intuiting exactly what volume will satisfy his patient’s wishes and look most balanced on her body, it’s understandable that you will want to visualize precisely how different options will look on you. It’s for this reason that Dr. Teitelbaum became the first aesthetic surgeon in the country to use the Axis Three digital breast imaging system. He has now used this state-of-the-art technology to help hundreds of satisfied patients get the most accurate possible forecast of how they will look after their procedure.

After taking three-dimensional digital images of the breasts, the Axis Three software then calculates precise measurements and determines the exact volume of the breast tissue present. The system can then be used to simulate what various sizes of implants would look like when placed in your existing frame. Because any size implant can be simulated on your body, the machine presents you with an unprecedented opportunity to determine exactly how it is you wish to look—and to be sure that the surgeon both understands and is able to deliver the results you desire.

Of course, like any simulation, Axis Three can’t give a 100 percent precise prediction of the outcome. But Dr. Teitelbaum has found it to be far and away the most helpful forecasting tool available—and his patients agree. Many say that the digital imaging played a big role in reducing their concerns about their implant size, and gave them more confidence that they would be happy with their outcome.

All surgical consultations with Dr. Teitelbaum include a visual imaging session using the Axis Three at no additional charge.

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Painless Breast Augmentation Surgery: Reduce Recovery Time

Many people have seen breast augmentation surgery on health channels or the Internet and wondered, "Why is it so rough?" or "Can’t they take it a little easier?" ...or even "Do they have to be in such a rush?" The truth is that the best results happen when there is less blunt force, less bleeding, less scarring, and less pain. But this only occurs when a surgeon knows how to perform the surgery cleaner and, most importantly, with the patient’s comfort in mind. How do you find a surgeon like that?

First, the doctor should be credentialed by the American Board of Plastic Surgery, the American Society of Aesthetic Plastic Surgeons, the American Society of Plastic Surgeons. He or she should specialize in Cosmetic Plastic Surgery and have dedicated his or her life to breast augmentation surgery.

Second, the doctor who has a passion for this procedure will give the most effort, the most confidential care, and have the most concern for your safety and well-being. I have spent over a decade mastering the Pain-Free, Instant Recovery Breast Augmentation Procedure. This is not just a surgical procedure to me-it is my life and my passion!

Third, the facilities and service should be nothing short of exceptional. When we consult with a new client, we welcome her to our office as a friend and lead her carefully through the initial consultation, as well as every follow-up appointment. Our surgical facilities are certified by the highest standards set forth for ambulatory surgery.

Fourth, recovery time is typically one to two weeks with MOST cosmetic surgeons, but it doesn’t have to be that way. I promise to have you working at your non-strenuous job within two days! In fact, you can be out and about enjoying yourself with "just the right curves" the very same day-not spending your time recovering from surgery. No one need ever know-unless you tell!

For more information please visit our site to get our free report. We serve clients from throughout the United States.

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Advantages of Submuscular Breast Implant Placement

Unlike other centers, we use sub-muscular placement of implants exclusively, because there are numerous advantages that are supported by study and research: A greater number of breasts are superior in form, position and texture and are a result of using the sub-muscular technique. Mammograms are easier to read with this method. It is more likely that you'll be able to breast feed. Nipple sensation is preserved. With the layer of muscle over the implant, there is less chance of sagging and long-term results are better.

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Getting the Best Results From Your Breast Augmentation

The natural, beautiful results Dr. Teitelbaum is known for are no accident—they are a direct result of the principles that have guided him since he opened his practice in 1995, and have made him one of the country’s premier breast surgeons. Here, he shares his advice for making smart decisions that will yield the best possible outcome.

It’s critical that you select an implant size and shape that fits your breasts. If an implant is too big, the breast looks round, shiny, and bulging on top in the short term. In the long term, the skin will stretch, the tissue will compress and thin, and the breast will sag. If an implant is too small, it will fail to proportionally fill out the breast. There is a narrow range of ideal sizes for each woman’s breast, and your surgeon will help you to understand what is realistic for you.

When considering the choice of incision, the resulting scar isn’t the only factor to consider. The most important thing is that your surgeon uses the incision that allows him to create a pocket into which the implant will sit in the most gentle, accurate, and consistent way. Keep an open mind, and listen to what your surgeon has to say about other relevant issues, such as pain, recovery, accuracy of placement, retention of sensation, and avoiding capsular contracture (hardening of the implants).

If you are thin and can see your breastbone and ribs, don’t expect augmentation to correct a wide gap between your breasts. Some patients and plastic surgeons have the mistaken assumption that larger implants will fill in that space: They will not. Placing an implant under the extremely thin skin close to the sternum will result in fake-looking breasts that could migrate so close together that they form what is commonly referred to as a “uniboob.” (The medical term for this is symmastia.)

All breasts are a little asymmetrical—even after augmentation. Dr. Teitelbaum will do everything he can to make sure both breasts are as even as possible, and can adjust the implant size to correct major asymmetry when necessary. But it’s important to be realistic and accept that a tiny amount of variation will always be present—and almost never be noticeable to anyone but you.

Remember that skin stretches. If your tissue is thin, the implant will be visible no matter what the size. And, just as we have all seen with natural breasts, the larger they are, the more all breasts fall with age. It should come as no surprise that the additional weight of augmented breasts will similarly cause the skin to stretch and sag over time. A good cosmetic surgeon will help you assess what implant will best fit your natural breast pocket as well as examine your skin quality.

Don’t automatically dismiss the idea of a breast lift. If your skin is thinned, sun-damaged, or already stretched, adding additional weight can often cause the breasts to sag more quickly. This seems to be especially common in women who have stretch marks on their breasts, have had babies, or lost a lot of weight. Your surgeon will take measurements of your breast skin under maximal stretch. If the measurements are greater than a certain amount, your surgeon may recommend a breast lift. Heed his or her advice—or do no surgery at all. Proceeding with an augmentation in breasts that really need a lift rarely produces the results desired, and may ultimately just postpone the inevitable and necessitate a lift down the road.

Once you’ve taken the above factors into consideration, weighed your options, and heard what your surgeon recommends, you should find yourself in an excellent position to get the best, most beautiful, and natural-looking breast augmentation results. 

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Breast Augmentation - A Self-Esteem Booster?

Contributed by M. Kirk Moore, MD, of the Genesys Medical Institute in the Salt Lake City, UT area of West Jordan, UT.

Any woman who is dissatisfied with her breasts knows what it’s like to feel insecure about her body. She worries about finding bras that fit properly, she worries about fitting into clothes, and she worries about feeling and looking attractive. That’s why performing breast augmentation is such a rewarding practice and why I’m passionate about helping women to feel better about themselves.

All you have to do is experience it once—the look on a client’s face when she sees how much more proportioned her body has become as a result of the surgery. And often, very little is required to achieve this. After all, it’s about achieving “just the right curves”!

But some women are afraid of breast augmentation because it appears so painful when they see reports about it on television or the Internet. Well, it doesn’t have to be! I have spent over a decade mastering my Pain-Free, Instant Recovery Breast Augmentation Procedure. This is not just a surgical procedure to me—it is my life! That’s why I dedicated so much time to finding a way to give women this satisfaction without so much pain.

As a result of my Instant Recovery procedure, a client not only experiences the joy of beautiful results, but I can give her a chance to enjoy those results immediately. She can go out to dinner the very same day and return to work within two days! No more two-week recovery time.

Another reason that some women shy away from breast augmentation is that they fear the results will be obvious. Again, they don’t have to be. Remember that it’s about “just the right curves.” If you’re considering breast augmentation, you should never feel pressured to get larger implants than you want, and no one needs to know that you had surgery. That’s another benefit of my Instant Recovery procedure. You don’t have to take off a week or two from work post-surgery. You can just take a couple of vacation or personal days, and no one will be the wiser.

There’s no reason why any woman who suffers from low self-esteem as a result of her breast size or shape should continue to suffer. There is now a way to achieve those beautiful curves without pain or a long recovery period.

For more information please our website and request our free report. We serve clients from throughout the United States.

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Improved Technique for Determining Bra Size

Many women express their goals for breast surgery in terms of bra size; yet the traditional method of bra sizing is confusing and inaccurate, with up to 80 percent of women said to be wearing the wrong size bra. In response to this problem, a new system of bra measurement was developed. It is a modified version of a previously reported method of bra sizing that determines cup size by direct breast measurement while now allowing for the fact that cup size varies with band size (e.g., the C cup of a size 36 bra is larger than the C cup of a size 34 bra).

With this system, brassiere band size is still determined by the industry standard of "underbust chest circumference plus 5," but cup size is determined by the relationship of breast width to underbust circumference. Breast width is measured with a tape from the breast mound's origin on the lateral chest wall to its termination in the parasternal area. Small or firm breasts can be measured with a woman upright or supine, and large or ptotic breasts are measured with the subject supine.

The image, Fig. 1. Woman with 500-cc silicone implants. Bust circumference is 36 inches, underbust circumference is 29 inches, breast width is 9.5 inches, bra size by traditional measuring system is 34B,and bra size by new measuring system is 34D. In the top photo, the 34B bra is too small, gapping across the lower sternum and providing inadequate breast coverage. In the bottom photo, the 34D bra fits well.

Breast width and chest wall measurements were studied in relationship to bra fit in more than 1,000 women undergoing breast surgery over a period of 5 years, until a consistent relationship between the two was established. The correlation of breast width and underbust circumference to bra size is shown in the table below. The relationships are most easily understood by examining the "prime" sizes, which are denoted by the asterisks in the table.. For any given underbust circumference, every 1 inch increase or decrease in breast width changes the cup by one size. For example, a woman with a 33-inch underbust and a breast width of 8.5 inches would fit a 38B bra, but if her breast width were 9.5 inches, she would fit a 38C bra.

Conversely, for any given breast width, the cup goes up or down by one size with every alternate step in band size. For example, a woman with a 9-inch breast width and a 3I-inch underbust circumference would wear a 36C bra, but if her underbust circumference were 35 inches, she would wear a 40B bra.

The information in the table was used clinically to help meet patients' breast surgery goals. For example, if a woman with an underbust circumference of 29 inches (34 band size) wished to be a C cup after augmentation or reduction, an attempt was made to enlarge or reduce her breasts to a width of 8.5 inches. Figure 1 on the right demonstrates the difference between the traditional and new methods of bra measurement in a representative patient.

Breast measurements are helpful in breast augmentation and reduction and in quantifying the difference in size in women with asymmetrical breasts, with each I-inch increment corresponding to a cup size. Experience has shown that almost every woman will fit the size bra determined to be right for her by this new system, even if she chooses to wear a bra of a different size for personal reasons.

Chart For Determining Your Breast/Bra SizeBreast
WidthUnder-Bust Circumference* - The asterick denotes "prime" brassiere sizes - *

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No Pain Medication Required 24-Hour Recovery Breast Augmentation

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Firm Support with a Laser: The Laser Bra

Contributed by Dr Grant Stevens, Marina Plastic Surgery Associates, Palos Verdes, CA & Marina del Ray, CA.

Dr. Grant Stevens created the Laser Bra, a procedure for lifting the breast. He discusses how he combines his approach with conventional surgery. 

(This article was reprinted from Body Language International)

As breast surgery is so popular, it is not surprising that accompanying procedures have been developed to improve results or make them last longer. The whole point of the Laser Bra is to create a longer lasting and more permanent lift of the breast when performing a reduction, augmentation mastopexy, or standard breast lift.

In traditional breast-lift surgery, the skin envelope is reduced in size and tightened. This allows the nipple and areola complex to be lifted. Generally speaking, the skin reduction performed results in skin that is excised and discarded. Using the Laser Bra technique, a C02 laser softens the skin and fashions an internal bra. Treating the excised skin makes it soft and pliable, and internal scarring ensures the permanency of the brassier.

The Laser Bra is, basically, an internal bra that elevates the upper chest. The laser creates the bra which is attached to the chest wall with permanent sutures, along with small tabs.

If a patient is undergoing a breast reduction, the Laser Bra will elevate the newly reduced breast. With an augmentation mastopexy, the bra supports the implant and the existing breast, thus avoiding the "ball and sock deformity". One of the greatest attributes of the Laser Bra is greater longevity and lift for cosmetic breast surgeries. What's more, the Laser Bra is created from a patient's own tissue. The Laser Bra cannot be felt by the patient. As it is attached at all times (not a free graft). there is no risk of infection or rejection.

The Laser Bra also makes breast surgery an option for a wider group of women who previously were not candidates. As a result of the increased blood supply provided, smokers, diabetics, hyper-tensives, or people with cardiovascular disease can still have laser breast reduction.

In addition, the blood supply to the nipple and areola (with breast reduction) is so improved that I no longer have to consider performing nipple grafts. This enables a patient to continue to experience nipple sensation and retain the ability to breastfeed. In the past 4 years, I have performed more than 150 Laser Bra procedures. My patients remain incredibly impressed with the longevity of the post-op results and the "perkiness" of the breast.

The procedure generally takes 2 hours; swelling and discomfort are minimal. As lasers are used, blood loss and bruising are reduced. Recovery-time is generally 7-10 days, with the resumption of full activity about three weeks afterward. For those women who have been concerned about achieving a natural appearance of the breast, or the longevity of their post-operative results, the Laser Bra affords a natural, safe, and long-lasting approach to breast surgery.

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Breast Reconstruction - Weighing the Options

The following New York Times article on Breast Reconstruction features Dr. Frank Ferraro, of Ridgewood, NJ. The article was originally published on September 9, 2001

In an era of medical breakthroughs, it is reassuring to learn that breast cancers are being diagnosed in there earliest stages so that, according to the American Cancer Society (ACS), 96 percent of women with such cancers are alive after five years. Another promising trend: advances in reconstructive techniques have made it possible for plastic surgeons to create a breast that more resembles a natural one. "One of the most frequent questions among women facing breast surgery is 'how will I look afterwards'?" said Dr. Frank J. Ferraro Jr., an attending plastic surgeon at Pascack Valley Hospital in Westwood. "They worry about whether their clothes will fit and if they will still feel attractive."

In the past, the majority of women who had mastectomy surgery wore a prosthesis - a breast form made from materials that have the weight and feel of a natural breast - in their bras and bathing suits after surgery. Many women found such a prosthesis inconvenient or uncomfortable and wanted to feel "whole" again; plastic/reconstructive surgeons began to develop techniques to restore the shape and contour of the original breast. According to NIH, today about 75 percent of women who have mastectomies choose postsurgical reconstruction.

"Advances in breast reconstructive surgery mean that almost all women are candidates for the procedure," Dr. Ferraro observed. Cosmetic results also have improved. Although a reconstructed breast isn't a perfect copy of the original, many women - especially those with stage one tumors, the smallest - find that their breast may look almost unchanged. If you are planning to have breast reconstruction surgery, you must find a plastic surgeon skilled in the procedure before the mastectomy surgery so that the plastic surgeon can work with the general surgeon to develop a plan that lends itself to reconstruction. Since this is a demanding technique, it is important to choose a plastic surgeon who is bored certified in this specialty and experienced in breast reconstruction.

Women can choose to have the procedure at the same time as the mastectomy operation or return to the hospital for reconstruction several weeks or months later. The women and her surgeons will discuss what type of procedure is best for her: an artificial implant or a muscle-flap procedure in which the breast is reconstructed with skin, muscle and fat taken from another part of her body. Factors to be considered include the woman's medical history, height, weight and amount of body fat as well as other medical conditions.

Although implants require less extensive surgery and shorter hospital stays, many women now choose muscle flap procedure. Dr. Ferraro, who learned the techniques at Duke University Medical Center in Durham, North Carolina, is a leader in the procedures. "Muscle-flap procedures use tissue from the back or abdomen to either form a breast or create a pocket for an implant. As a result, the breast looks more natural." The flap is made in several ways. In the latissimus dorsi technique, tissue is transferred from the area on the back below the shoulder blade by way of tunnel made under the skin in the underarm area. The blood supply to the muscle is left intact. The muscle and skin create a pocket that an implant fills out to provide a breast shape. The TRAM flap is another variation. The flap comes from the transverse rectus abdominus just below the waistline. The reconstructive surgeon detaches a small piece of skin, muscle and fat and pulls it through a tunnel under the skin between the abdomen and chest. Some women have enough extra fat in the abdomen to create a breast shape without an implant.

One advantage of the TRAM techniques is that some women find that their abdomens look flatter - as though they have had a tummy tuck. Women who have chronic lower back problems often choose other techniques since they may develop weakened abdominal muscle after the procedure and can increase back strain.

A third technique, the free flap, eliminates the tunneling step. A portion of skin, fat and blood vessels is removed from the buttock, thigh or abdomen and move to the breast area. The blood vessels in the flap are sewed to the vessels under the arm at the mastectomy site. Because extensive microsurgery is required to reattach the blood vessels, the free flap is the most technically demanding of the muscle flap procedures. This technique, however, gives superb results.

"Women who smoke or have diabetes may be poor candidates for muscle flap procedures because their blood vessels may have narrowed enough to prevent healing of the flap," Dr. Ferraro noted. "That's why we advise patients to quit smoking and keep their blood sugar as close to normal as possible so that they can benefit from these procedures and have a natural looking breast."

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How to Choose Your Plastic Surgeon

Choosing a plastic surgeon is an important, life-altering decision. It is vital to your safety and the success of your cosmetic surgery that the surgeon you choose has the right qualifications, ample experience, and documented results of his or her work.

Not all surgeons who perform cosmetic surgery are trained equally, and any doctor with a valid medical license—regardless of the length and type of training he or she has—can perform cosmetic surgery.

As the demand for plastic surgery continues to increase each year, this fact becomes more alarming. According to the American Society of Plastic Surgeons (ASPS), the foremost authority on plastic surgery, more than 10.2 million cosmetic plastic surgery procedures were performed in the United States in 2005, up 11 percent from 2004.

It is very important that you choose a qualified and highly experienced plastic surgeon to perform your cosmetic surgery. If there are any complications during surgery, an experienced plastic surgeon will be more adept at handling the situation. In addition, a plastic surgeon that has performed many cosmetic surgeries will have had more time to perfect his or her technique and results.

There are several guidelines to follow in order to ensure that you choose one of the finest plastic surgeons in your area:
You need your plastic surgeon to be certified by the American Board of Plastic Surgery. This certification is an indication that the surgeon has had extra training in the field of aesthetic plastic surgery. This also ensures that the plastic surgeon has earned his or her degree from a reputable medical school and has completed five years of additional residency.Reputable plastic surgeons should have privileges to perform cosmetic surgery procedures at an accredited hospital – not just in the surgery center in their office.Ask your plastic surgeon to show you before-and-after photos of patients who have undergone cosmetic surgery and ask to speak with some of their patients.Good doctors will ensure realistic expectations and take the time to address your concerns. They will encourage you to do your homework, talk to other patients, and make an informed choice.Be skeptical of super saver deals advertised in newspapers and magazines. Most plastic surgeons charge comparable rates and rarely offer "deals." Don't compromise quality care and your safety just to save a few dollars; it may end up costing you more in the long run. An experienced plastic surgeon will be more adept at fixing or addressing any problems that may arise.Of course, one of the most important factors in choosing a plastic surgeon is your personal comfort level with the doctor. You should feel comfortable asking questions about your cosmetic surgery procedure so that you can make an educated final decision regarding your surgery.This article was contributed by Dr. Tom Pousti of San Diego, CA.

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Breast Augmentation with Lowering of the Inframammary Fold

In the operating room with breast implants in position and the infra-mammary fold lowered and therefore producing a larger distance from the areola to the infra-mammary fold.

This procedure can be used for patients with tubular or "constricted” breasts as well to help in achieving the fuller, rounder appearance. Settling of the breast implants may require 3-12 months after surgery.

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Correction of Tubular Breast Deformity

Article Contributed by Dr. Tom Pousti, San Diego, CA

Tubular breasts have a very narrow base and usually a long skin envelope. Sometimes people refer to "tubular breast" shape as the shape similar to "snoopy's nose". In the most severe cases of tubular breast, a breast lift can be done through an incision around the areola, making the breast into a more rounded shape that the patient will be happy with. In many cases however, a lift is not necessary. The patient should be aware that the final result will take months to see and that they will need to be patient.

The surgery is usually done under a light general anesthesia and the procedure takes about two to three hours. The incision is usually confined to around the nipple entirely or beneath the crease, and can be very inconspicuous. The procedure involves making internal incisions to release the tight breast tissues, making a larger space for an implant, rounding out the lower breast crease, and correcting enlarged and protruding areola.

Placing a breast implant underneath the breast and pectoralis muscle, along with making small incisions on the inside of the breast will usually allow this tight skin to spread into a better shape. This process can take a few months but usually results in a very pleasing shape without the telltale scars of a breast lift.

There will be a recovery time of 1-2 weeks just as with breast augmentation surgery for non-tubular breast patients. Bed rest, along with plenty of fluids, is necessary after surgery. Your chest will be sore. Your Surgeon will prescribe appropriate pain management medications. Take your medication regularly and keep your office visits. Usually after a week, you will begin to feel back to normal.

A brassiere and bandeau will be fitted for you during your first week of recovery. These will need to be worn for a month. You will not be able to shower until your sutures are removed. Initially, breast implants will appear to be slightly higher than normal and your breasts will be swollen. Over time, the breast implants will descend to a more natural position.

Steri-strips are placed around the areola (where the incision is made). These steri-strips will fall off on their own

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Symmastia Correction - Revisionary Breast Surgery

Revisionary breast surgery, also known as breast augmentation revision surgery or breast implant revision surgery is commonly performed at Pousti Plastic Surgery. For patients with malposition of the breast implants, it is very important that they have a qualified surgeon performing their revision. Medial displacement of breast implants is known as symmastia. This is commonly referred to as "breadloafing" or "uni-boob". This results from the loss of tissue support along the sternal area, allowing breast implants to move excessively towards the woman’s midline. If the pectoralis muscle that is connected to the sternum and goes across the implant is cut during surgery, then the implant can move toward the middle of the chest. Symmastia may result from overly aggressive attempts to alter chestwall anatomy trying to increase cleavage in patients. This outcome is made worse by use of larger implants in thin patients, and is a problem for implants over or under the muscle, though submuscular implant placement allows the muscle to provide some softening of the transition to the cleavage area from the augmented breast mound.

The degree of medial displacement varies from patient to patient and the reconstructive technique therefore, also varies. Usually, the medial displacement of the breast implants causes the nipple-areola complex to appear off-center on the patient’s breast mound. Often, there are other problems associated with the symmastia including “bottoming out” (inferior displacement of the breast implants), rippling / palpability of breast implants and breast asymmetry.

Correction of symmastia involves careful planning and intra-operative reinforcement of the medial fold of the breasts. Reconstruction usually involves removal of the breast implants and internal suture reinforcement of the involved area. The use of dyes and needles through the skin surface assists the exact placement of permanent sutures. Usually the breast implant capsule that is redundant is removed to allow for two raw surfaces to heal together, presumably lowering the rate of recurrence of the symmastia. Often, it is necessary to “open” the breast implant pocket laterally (outer breast fold) to allow for positioning of the implant centrally behind the breast mound. This maneuver may also decrease the amount of implant pressure against the medial suture line. Use of a smaller breast implant, if possible, may serve the same purpose.

For correction of symmastia, the procedure can take from 2-3 hours depending on how much work is involved. Board Certified Plastic Surgeon, Dr. Pousti takes his time in the operating room to make sure that he does what he can to achieve the best result for the patient.
An incision is made (usually under the areola) to expose the underlying tissue, muscle, and implant.The tissue that surrounds the implant is removed in the area of the planned repair.Tissue is sutured together to hold implant in place (with permanent sutures).The incision is then sutured close.Intra-operatively, sitting the patient upright is imperative to assess the repair and degree of symmetry. Patience is important as multiple trials of suturing may be necessary to achieve satisfactory repair and symmetry.

Post-operatively, the use of tape is used to apply pressure on the previously elevated skin overlying the sternum. Compressive dressings and a pressure bra are also helpful. Bed rest, along with plenty of fluids, is necessary after surgery. Your chest will be sore. Dr. Pousti will prescribe appropriate pain management medications. Take your medication regularly and keep your office visits. Usually after a week, you will begin to feel back to normal.

A brassiere and bandeau will be fitted for you during your first week of recovery. These will need to be worn for a month. You will not be able to shower until your sutures are removed. Initially, breast implants will appear to be slightly higher than normal and your breasts will be swollen. Over time, the breast implants will descend to a more natural position.

The bra that is worn after symmastia repair is referred to as the "thong bra". It is used to stabilize the area after symmastia reconstruction. This will allow the sutured area between the breasts to heal properly without excessive pressure being applied to the area.

Article Contributed by Dr. Tom Pousti, San Diego, CA 

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Breast Implant Cup Size & Expectations of Breast Augmentation Surgery

The following article is an excerpt from Dr. Tebbetts book, The Best Breast 2: Although some methods of defining breast size are popular, they are not as accurate as we might like to believe. First, let’s consider how not to define your desired breast. Cup size is not even a consistent fashion measurement, let alone a medical term that can accurately and consistently define breast size. But it’s probably the most common yardstick women use. Any woman who has ever shopped for bras knows that a B is not a B is not a B. Although the labels say the same size, when you put them on, some fit and some don’t. For the same woman, some B cup bras fit better than her usual C cup and vice a versa. Some B cup bras fit better than other B cup bras. Check your own bra drawer! How many cup sizes do you have?

We frequently hear from patients, I’m sorta a B cup and I want to be a full C cup. Our response is simple. Tell me what a sorta B or a full C cup is! Can you go buy me a bra that is labeled sorta B or full C? If you can’t define it and you can’t buy a bra labeled it, how do you expect a surgeon to create it? And if a surgeon tells you he can create it, what should that tell you about the surgeon?

Cup size is extremely variable and inconsistent from one brand of bra to another. If cup size is inconsistent and you know it from buying your own bras, why would you want to rely on cup size to specify what you want?

You can’t define it because it isn’t a consistent measurement from manufacturer to manufacturer, as much as they’d like you to think it is. If a surgeon guarantees you a cup size, that should tell you something about the surgeon. How can you deliver something that isn’t consistently definable? What about the surgeon who doesn’t even know that bra cup size is not consistent or definable?

How do we use cup size? We have no objection to using cup size as a general guideline, provided you recognize it is only a general guide that can’t be ordered or delivered, and your surgeon doesn’t talk to you about cup size only when defining your desired outcome.

We always ask our patients the following questions: What cup size were you before you were pregnant? Largest during pregnancy? What cup size after pregnancy and nursing if you nursed? What are you now? What would you like to be? If cup size is not a consistent measurement, why do we ask? The answers to these questions give us a clearer understanding of how our patient sees her breasts. During our exam, measurements will precisely define the size of the patient’s skin envelope.

Knowing what a patient thinks she is (by asking the questions) and knowing what she really is (from our measurements) helps us better understand the patient’s perspective and her wishes. But we NEVER define the desired result by cup size alone. Many women don’t buy bras to fit their breasts... a personal revelation from Dr. Tebbetts

During my first several years in plastic surgery, I was baffled by the array of bra types and sizes that patients applied to breasts that all looked very similar and that measured similar in size on exam. One of the more enlightening milestones of my plastic surgery career was the day I realized that women don’t buy bras to fit their breasts. Most women buy bras to push their breast tissue where they think it looks best. Women don’t necessarily buy bras that fit their breasts. They buy bras that the breast will fill. What do I mean?

The width of a breast (from side-to-side, Figure 4-1) increases with increasing cup size. But I was amazed that women who had measurements indicating a D cup width were often telling me they were a B cup. What they really meant was that they were wearing a B cup bra. Then one day I asked a patient to please put her bra on as I observed. The B cup bra did not fit the fold beneath the breast. The breast was wide, more like a D cup width. The bra she had picked was much narrower than the width of the breast. When the patient put it on, she leaned forward and tucked the outside part of the wider breast inward to fill the cup of the smaller and narrower B cup bra. A light went on! Then I understood! She picked the smaller B cup bra because the amount of breast tissue that she had would fill it! When she pushed the outside portion of the breast inward into the bra, it not only filled the bra but bulged at the top of the breast and toward the middle. More cleavage! From that day on, I have been able to put bra cup size in perspective and rely more on measurements to document the size of breasts.

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