• Sizing Up Breast Implants
  
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Talking about a celebrity's plastic surgery keeps many an entertainment magazine and television show in business, and the current poster child for Plastic Surgery Gone Wild is of course Heidi Montag. The ten operations she had in one session last year is certainly ripe material for discussion, but I wanted to comment on the increase in the size of her breast implants during that marathon surgery. Such discussion has to be respectful of the untimely death of her surgeon, Dr. Frank Ryan, in a motor vehicle accident over the summer. Ms. Montag started out with implants that seemed to approximate normalcy, and then went to 700 cc implants, which is about twice the average implant size of what people in this area ask for. She had talked about going to an 800 cc implant, before recently deciding to downsize. According to Life & Style, she is currently shopping for a surgeon in South America.

In spite of what implant size a patient may want, this is not (yet) a do-it-yourself operation. A surgeon has to provide input as to not only what is going to look good, but also discuss the potential problems with an overly large implant, such as thinning of the skin and gravitational ptosis (drooping). During a consultation, I tell patients that implant size may be the first thing on their mind, but it's way down on my list of important things to discuss.

Implant size doesn't change the cost of the surgery or the time it takes to do it. The philosophy that has served me well in over two decades of performing breast augmentation is that I try to make patients as big as they can be, without looking operated on. In practical terms, that means that about the biggest implant I'll use is about 400 cc. If a woman is five feet tall, weighs 95 pounds and is an A cup, and wants to become a D cup, I'll tell her that that is an impossibility. The chest wall simply isn't broad enough to accommodate an implant of that size. About a two cup size increase is what can be expected from breast augmentation. Most patients want to look better in low cut clothing or a bathing suit. Enhancement of one's show business career is fortunately something we don't have to deal with in Central New Jersey.

Another issue that has come up recently is the concept of "awake" breast augmentation, in which the surgery is performed under local anesthesia alone, possibly with a bit of oral sedation added. This movement was started by physicians who not only are not plastic surgeons.....they aren't even surgeons. They are family doctors, internists and emergency physicians who don't have access to operating rooms, hence the reason the surgery is done in an office treatment room.

Plastic surgeons perform a good deal of surgery in their offices, but we have accredited operating suites with board ceftified anesthesiologists providing the anesthesia. It's not that we want to put patients to sleep for surgery....they are simply more comfortable. Performing a breast augmentation with just local anesthesia is absurd.

This ties into the discussion of implant size. The proponents of "awake" breast augmentation claim that one benefit of this procedure is the ability of the'patient to choose their implant size during the surgery, Patients are sat up, get to look in a mirror, and family members and friends are brought into the "operating room" to provide their input. Implant size needs to be discussed with the surgeon in the comfort of a consultation room in advance of the surgery, not while the patient is writhing in pain during a procedure under local anesthesia. I see far too many patients operated on elsewhere who aren't happy with their implant size. That generally results flom too rushed a consultation, or the surgeon not picking up on a patient's completely unrealistic expectations. Patients can expect a different experience at Lawrenceville Plastic Surgery.

Finally, now is the time to deal with skin discoloration. IS Clinical just launched their breakthrough lightening products, White Lightening Serum and White Lightening Complex. They target and treat hyperpigmentation in five ways by providing antioxidant protection, decreasing inflammation, interrupting the communication between melanocytes and keratinocltes, decreasing production ofmelanin, and exfoliating with excessive peeling or irritation. It's the next generation in skin brightening..

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