Dr. Chen is a very skilled professional and her staff are beyond friendly and helpful. I remember making my first phone call and I had all these questions that took up 30 minutes and was never rushed off the phone.Then when I came in for consultation, I was there for probably 2-3 hours just asking questions and talking about why I want them out. Dr. Chen listened and addressed every question. Between the time of my consultation and surgery, Andrea (practice manager) was in contact with me at all times. She’s the sweetest person to work with, always on top of things and so knowledgeable. Dr. Chen took out my implants fully intact with the capsules. The nurse and anesthesiologist were lovely. The nurse comforted me at surgery day and checked up on me the following day.
Dr. Chen is as amazing doctor and human. She spent so much time with me at each appointment and was very reassuring, patient, and sincere. Dr. Chen is very passionate about women’s health and clearly views each patient as an individual. Her entire office staff has been extremely helpful, genuine and prompt. I am very happy that I chose Dr. Chen for my surgical procedure and have the confidence in her skills as an amazing surgeon.
I'll try to keep this short....ish. In 2005, at 41 years old, I had a right breast mastectomy with delayed implant reconstruction. Though I wanted a double mastectomy, every doctor I had dissuaded me and I acquiesced. The result was, I thought, ok. Meaning I wasn't completely miserable over it. By January of 2016 gravity had taken it's toll on my natural breast so I went to a doctor on Long Island. He was recommendation by a friend who'd had prophylactic double mastectomies with implant reconstruction by him. I researched him and he had glowing reviews by both patients and several news publication rankings. My main concern was the dissimilarity between the breasts. He suggested a lift of the natural breast with a small implant and a change from round implant to anatomical implant for the reconstructed breast. He told me he was ordering in excess of 30 implants so that during surgery he could decide which combination would give the best match possible. Surgery was performed and NOW I was absolutely miserable. Before all this I was a 34B; after the initial reconstruction I was a 34C; now 36DD and even more asymmetrical. I was mortified and told him so, through my tears and his response was "Tell me what you don't like about it." (I guess my next step should be to review him on here, which I will so be on the lookout for a scathing review of Dr. Lyle Leipziger.) Fast forward to July 2016 and a 3 hour long, thoroughly enjoyable and promising consultation with Dr. Chen. Her manner was warm, caring and upbeat. I felt like I was chatting with an old friend. Dr. Chen explained my options, including implant reconstruction, in detail. In fact at times she apologized for going on and getting too technical but I found her fascinating and she made the information surprisingly easy to understand. When I hesitantly asked about removing the left breast as well, I was expecting to be met with the same reluctance other doctors exhibited toward this idea, but Dr. Chen was in complete agreement with the plan. I opted for autologous reconstruction of both breasts using the PAP flap and DIEP flap methods. It has been 3 rather lengthy procedures but I am thoroughly thrilled with my new, soft, warm, comfortable, 34B breasts....not to mention the by-product improvements in my abdomen and legs. Dr. Chen made herself available to me any time I had a question or a concern. I cannot stress enough how compassionate Dr. Chen was throughout all of this. She doesn't just utter trite niceties, this is genuine concern for the patient's wants, needs and wellbeing. There is no mistaking her authenticity. On top of all that, Dr. Chen is a brilliant artist in her field. I am so grateful to have stumbled upon her, for she has a rather limited online presence. I could probably go on and on but I'll end it here and say that if you are in need of reconstruction or any plastic surgery of the body, you owe it to yourself to at least experience a consultation with Dr. Chen, no matter where you reside. PHOTOS TO FOLLOW
Most plastic surgeons will have you try on different sized implants under a bra to help you choose an implant size. So you should do this to start. I also ask people to find photos of their ideal breasts in someone with a similar body habitus. I go over these photos with the patient and then put them up on the operating room wall so that I can compare the appearance with how the patient’s breasts look with sizers when I sit her up on the table. At the end of the day, you need to find a plastic surgeon who really listens and pays attention to what you want to have the best chance of getting what you want.
The best imaging to show silicone implant rupture is a breast MRI. If an MRI is not possible, an ultrasound may also show an obvious rupture or even a mammogram. That said, no radiologic imaging is perfect. You could get a breast MRI that did not show a rupture and still have a rupture. Alternatively, the breast MRI could show a rupture and then there could be no rupture when the implant is removed. At the end of the day, the only way to know with 100% certainty whether or not you have a rupture is by surgically removing the implant. Incidentally, silicone implant ruptures are usually either silent or present with pain due to the irritation of the silicone to the surrounding tissues. Also, unlike saline implant ruptures, in which the breast deflates, silicone implant ruptures can actually make the breast bigger due to the inflammation that it can cause to the surrounding breast tissue. Your hard left breast sounds like capsular contracture. Many insurance companies cover implant removal for painful capsular contracture.
Yes, you can have your implants out without putting new ones in. It will likely require more than one surgery to look acceptable, however. 575 cc implants are large, and the implants have stretched out your skin and compressed what breast tissue you have. Pregnancy has also stretched out your skin. Your best way forward is to remove your implants with complete en bloc capsulectomies at the first surgery. The removal of the entire implant capsule will allow your stretched out skin to contract as much as possible and your remaining breast tissue to decompress. Your breasts will look completely deflated, mutilated, and deformed after the first surgery, but the appearance will improve over the subsequent weeks and months as your skin shrinks and your breast tissue fluffs back to their natural state. After several months or even a year, you can reevaluate the appearance of your breasts. At that time, you can undergo bilateral breast lifts (mastopexies) and possibly fat grafting to improve the appearance of your breasts. The breast lifts will remove the excess skin so that your breasts are less droopy. And it is necessary to wait as long as possible for the second surgery to give the remaining breast tissue a chance to decompress. Otherwise, if you try to do everything in one surgery, you will essentially be trying to create breasts with skin only, and you will be throwing away any compressed breast tissue that you cannot get back. Although it’s hard to live with deflated breasts for the transitional time, it will ultimately give you the best result. You can also do fat grafting at the second stage once you know what you’re working with. You may have to undergo more than one round of fat grafting to get the breast size and shape you want.
If you were a small A cup before implants and a D cup with them, then your skin has stretched a fair amount and your breast tissue is compressed. In addition, if it was 23 years ago, and you are the same weight that you were when your implants were placed, you may not have a lot of additional breast tissue. Your best result would likely be a staged procedure. First, remove your breast implants and allow your skin to contract and your breast tissue to decompress (I.e., "fluff"). You breasts may look deformed, empty, and droopy for at least part fo this time. I would wait 6 months to a year to see how much your skin contracts and how much breast tissue you have to work with. Once things have healed, then you can undergo bilateral breast lifts with or without fat grafting - I would re-evaluate at that time. If you try to do everything at once, your breast skin will be very stretched out and your breast tissue will be very thin - it will be difficult if not impossible to create attractive breast mounds with basically thinned out and stretched out skin. You will also have permanent scars with this effort to create breasts from thin skin. Fat graft does not take as well in an inflammatory environment, so that may not be helpful either - not to mention all of this is pretty hard on the body. Although it is hard to live with breasts that don't look great for several months, I think you will ultimately have a better result if you do this. Of course, if on physical examination it seems that you actually have more breast tissue than a small A cup or you have gained 20-30 pounds in the intervening 23 years, then it may be possible to do everything in one surgery and have a reasonable result. The important thing is to think of the best long-term result and not sabotage yourself by trying for a quick fix that may make it difficult to have a nice result in the long term.
415 cc implants are large, but your breasts are not very ptotic. If you can handle it psychologically, I think you should have implant removal with complete en bloc capsulectomies and no additional procedures. I would wait 6 months to a year to see how much of your skin contracts and your breast tissue decompresses. You breasts may look funky for the first few weeks or even months, but it will get better over time and you may not need any additional procedures to look good. If you do a lift upfront, you will have permanent scars that you cannot eliminate. Even worse, your skin will be maximally stretched out and your tissue maximally compressed so you don't actually really know what you're working with, and once skin and tissue is cut and rearranged it can't be put back. And if you end up wanting fat grafting, you will have better fat graft take when your tissue are less inflamed. At the end of the day, your body usually heals and restores itself without any additional procedures, and you lose nothing except a transitional period of letting your breasts go back to their natural state. Removal alone is also a much easier recovery for you.
