Jacksonville Doctors

Breast Reduction from DDD to C, Would This Keep Me Proportionate?

I am 5' 1/2'' (dead in the middle can't round it) and my back is constantly pressured and hurting. I weigh about 148-153. Varies on what I eat. And my breasts are size 38DDD. I feel un-proportional for myself. When judging with my friends, my waist size was actually average. And it looks weird to have my breasts so large. In addition to my back hurting, it strains my neck to help keep them up. MY shoulders are a bit broad, but not extremely. Just wondering if it would look right with a size C.

Hi there-

It sounds like you may be a great candidate for a breast reduction, and I do believe that the average patient with your complaints and goals would be very pleased with the experience and outcome as long as she mad her choices and decisions appropriately.

On the other hand, it is very difficult to use bra size as a means of communicating your goals, or judging the outcome.

A better way would be for you to develop and communicate to your surgeon a goal for your appearance and proportion. I suspect that if you have an appearance and proportion you like, and your discomfort is relieved or improved significantly, that you won't care what letter is on your bra.

Armando Soto, MD

Orlando Plastic Surgeon

Is a Certification From ABCS the same as ABPS For a Mommy Makeover?

I found a Dr that I really like with an American Board of Cosmetic Surgery Certification.. Is that adequate, or does he need to be a member of different societies? He is also a faculty member of the American Academy of Cosmetic Physicians. I'm doing a Mommy Makeover, and only want to do it once!

Hi there-

I think my colleagues have done an excellent job of explaining the critical differences... Here's the bottom line:

I bet if you looked at every single member of the "American Board of Cosmetic Surgery", that you would not find a single one who has Certification by The American Board of Plastic Surgery. 

I bet that if you also looked at every single Diplomate of The American Board of Plastic Surgery, that not a single one claims certification by the american board of cosmetic surgery.

Why do you think?

Because the only reason the american board of cosmetic surgery came into existence is because those doctors who wanted to try to legitimize their entry into the field of cosmetic surgery without the required legitimate credentials (actual completion of plastic surgery training and board certification by an ABMS supervised Board) needed to be able to say they were board certified by someone... and admitting to patients that their board certification was in emergency medicine or family medicine was not going to work if their goal was to attract cosmetic patients.

Allowing yourself to undergo surgery by someone like this puts your safety and happiness at inherent risk.

Armando Soto, MD

Orlando Plastic Surgeon

Now 9 Months PO, Noticed "Bottoming Out" at 4 Mo PO, I Approached my Dr. and He Totally Denies This. What To Do? (photo)

Had BA 4/11, had bottoming out 4 mo PO with stretch marks. I am now 9 mo PO couple months ago had PO visit surgeon denied this, but did not take measure. or allow me to lie down to show him, he insisted on the 550 cc. When I lay down they're at my armpit,even with a bra no cleavage.He blew me off, told me i am just an unhappy person told me to come back 3 mo, I've consulted w/ another Dr. who totally agreed, but don't feel i should have to pay $9k to fix.My next PO visit is March.What to do now?

Hi there-

As all of my colleagues have mentioned, and I am sure you are aware at this point, your breasts were fairly uneven before surgery, and so without a more significant intervention, it would not have been possible for your breasts to be perfectly even after a breast augmentation.

Nor is it reasonable (again, without a more significant intervention)  for you to think that your breasts can be perfectly even with a minor revision at this point, no matter who does the surgery, or how they do it. 

I also hope you take what I have to say in the spirit in which it is intended- I want to help you (and all patients), and sometimes the best help is given by telling someone something other than what would be easiest for them to hear.

Your situation really presents several different points worth learning that I think might help you at this point. I think that both you and your surgeon bear some responsibility for your dissatisfaction at this point:

1. Too often, patients want to believe that unrealistically amazing outcomes are possible through relatively minor interventions.
2. Just as often, it is too easy to find a surgeon willing to let them believe that these unrealistic expectations are possible in order to "close the deal"
3. The outcome of any aesthetic surgery is highly dependent on how carefully the patient follows postoperative instructions. I'm not saying that you didn't follow instructions, just that when patients are initially happy, but then develop adverse changes in their appearance, this is one of the possible causes.
4. After it becomes clear that these expectations are not going to be met, the worst way to approach the problem (if your goal is to most easily and economically achieve a better breast appearance) is to forget that your safety and happiness depend on maintaining a healthy and positive relationship with your surgeon. Becoming accusatory and belligerent will cause a defensive response (as you now well know) and make it harder to get what you want.

It has become unfortunately become very common for patients to think of their plastic surgery like a trip to the McDonald's drive trough window- where you decide what you want, you drive up and give them your money, and you expect to get exactly what you asked for... and have the right to be angry if you don't.

Aesthetic surgery is as much art as it is science, and like all medical interventions, the best experiences and outcomes will depend on the healthy doctor-patient relationship. Mutual respect, honesty, careful communication, realistic expectations, and the understanding that perfect outcomes are not possible and guarantees of outcome are not reasonable are all essential for success.

These are all reasons I so often find myself saying on these pages how very important it is to choose your surgeon carefully, and be a good patient. After all, it is now you- and not your surgeon- who has to live with the outcome you're not happy with and the additional expense of improving it. I think both your disappointment and the need to pursue further surgery with another surgeon might have been prevented...

At this point, I would let your capsules mature (a full 6 months after your last intervention) and do one of two things:

1. Return to your initial surgeon, explain that you realize that no guarantee of outcome could have been expected from the initial procedure and that you understand your initial asymmetry contributed to your postoperative asymmetry. Explain that you nevertheless would like to know more about how to improve the outcome if possible. Approach him in the same way you would approach any other damaged but very important relationship in your life that you would like to repair.
2. Abandon your relationship with your initial surgeon and find another who is willing to take you on. 

Choosing option 1 will require you to swallow your pride, but it is fundamentally the truth, and offers you the possible benefit of feeling good about your plastic surgery experience in the end, not to mention the possibility that your initial surgeon will offer a reduced fee for your revision in the interest of saving your relationship and achieving your happiness.

Choosing option 2 will allow you to avoid the uncomfortable conversation with your initial surgeon, but at the expense of starting over with another surgeon, and having to pay him a lot more money than if you stayed the course with your first surgeon.

Even if you elect to start over with another surgeon, please bear the above in mind- your experience going forward and your relationship with your new surgeon will benefit from it.

Finally, I would say that the one thing you should not do is go online and start trashing your surgeon's reputation. This will not help you get what you want, and may even lead to further problems for you both.

I'm sure he wants you to be happy- be respectful of his training and profession, as well as your relationship, and see if it can be repaired. In the long run, this will (in my opinion) be lead to a better outcome and more positive experience for you.

Good luck!

Armando Soto, MD

Orlando Plastic Surgeon