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Patient comes in and they're interested in the breast augmentation. One of the key questions is what are we going to do. And I think to answer that; you got to start with the patient. It's a question about what does the patient want. What are their expectations? What do they want to look like? So it's all about communication, making sure that the patient and the surgeon are on the same page. Sometimes patients will come in with photographs, either photographs of their friends, sometimes people that I've operated on. And sometimes they come in with somebody off the internet, whether that's, you know, nasty pages or not so nasty pages, but they pretty much know what they want. Think about it for second.

When most women want to go to a black tie event or charity or even a wedding and they want to really annoy their friends, they know how to do it. They know how to pull off that look in which event. So what we have to do as a plastic surgeon is respect that reality and we have to make that reality, their reality. So, how do we do that? And then we begin by talking about it. What it is that we were really looking for? And then what I do is I go to sizers. In that case, we put the patient into a bra and we give them different implants. We see what looks good in clothing and they can bring their half wardrobe if they really want to. Standing in front of the mirror that's bigger than they are and then they take a look and say, "This is the look that I want."

And once they can bring it down, I want them to push their limits until they look kind of silly and then back it off until you think, "You know what? This is right and this look pretty close." At that point, they're responding to their visual input and assessing what works for them. At that point, then we go and we put them on the computer and I have a three dimensional photographic system that I put them in front of. It's a Velcro system in one location; it's an accessory on the other. So I take a three dimensional photo of them. The computer crunches all the numbers, puts everything together so I can actually turn them in space and so we can view them from any angle you want, from the floor, from the ceiling, from the left, from the right and then we do the augmentation on that image.

So at that point, not only do they get an idea of the volume but they can get a pretty unambiguous view of what their look is going to be. And the key question in that point is, "Does this work for me? Can I see myself looking like that?" And that's really how we try to do that and when I started doing this a number of years ago, I was having patients coming back wanting to be bigger, they want to have different implant. Once I started using these systems, the different types of systems, my revision rate dropped like crazy, close to 1%. So, at most of the time, we spend the time upfront, it's a lot easier than spending the time on the back end with an unhappy patient. There are different types of breast augmentations.

So, we have to take a look at, is this just the first time augmentation. Are we going below the gland? Are we going below the muscle? Is it a secondary augmentation? Is it going to be switching to a different position? Now, the real cracks of these, is what are we doing about the muscle. If we're going under the muscle or if we're doing a lot of work on the muscle, usually recovery takes anywhere from one to two weeks. At the end of two weeks, you're pretty much good to go. Now, that doesn't include working out but working out should begin three to four weeks. By six weeks, pretty much anything that you want but for a very simple type of an operation where we're leaving the patient with the implant in the same location where it was before or when we're going above the muscle, usually about a week and they're pretty good. They just have to be careful.

Breast Augmentation Consult: Patient Communication and Sizing Systems

Dr. Peter Geldner explains the importance of the patient/surgeon communication during the consultation process for a breast augmentation.

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