Pawel Stachowicz, MD

Even in breast augmentation “less is More”…
I am fascinated that somehow in US the tendency is to achieve “Baywatch” look at all costs…
Number one reason that I see patients needing a re-do surgery in less than 10 years is that the initial implant was just too big “.”
To the point- ask for a sizer and try it in a sports bra (lower profile bit flatter implant sample works best- ask for a shaped implant too), perhaps wear it for a whole day… don’t ask friends, don't even look at the CC’s, start small, just put on your t-shirt or other more fitting clothes and take it for a test drive… look at the mirror once or twice and stay off the internet, do not look at hundreds of “before and after” unless your twin sister is there …

Not likely that you would need a lift

More to the point:
-I am pretty sure that anything half the size would be plenty…
-I routinely review few examples with my patients at time of the consult and show them truly natural breast augmentation results and then casually ask them if they like the look and how big the implants are in their opinion… typical answer is at least 150 to 250+ cc off… so when patient had 200 cc implant they thought it was 400 etc
-as implants get bigger they much quicker get wider and smooth round implants eventually will head in the path of least resistance- into the arm pit. So one of the size determination should be your breast width - in the straight on view- distance where breast starts in the cleavage area to the line that determines “edge of the arm pit” - if the implant fits great. If in doubt go size smaller “.”
-do consider gummy bear Mentor shaped implants- they do best even in breast cancer reconstruction patients. They allow for softer look and nipple position can be bit lower and look great. Added bonus- they are less likely to migrate, less rippling of any implant and definitely less likely to create overly round top aka like Pamela Anderson…
-its great to have a look where strangers don’t ask “who did your surgery?”… but are simply jealous of the appearance
-its easier to buy clothes that fit without busting open and swim suits that don’t need separate tops and bottoms
-even 200 cc with a specific bra can make one look as DDD - but being DDD all the time (during activities, kids care, business meetings, etc) is not fun.
-remember that this surgery should provide results for 15 years or more providing steady weight etc
-when we as surgeons do breast reduction surgeries, we routinely remove 3/4 or a pound or more breast tissue and patients get dramatic improvements in neck, shoulder pain- 500cc is more than 1 pound
-I see patients weekly who come for another opinion being told that they could get 450 or bigger implants… we typically would do 200 or so and 1 year later, after things settled, I often get the message or a card with “thank you for not letting me go bigger and not making me look like a suburban housewife…”
-even though it is an elective surgery that patient pays for - it is surgeon’s responsibility to educate and explain the choices that are reasonable and SAFE - and Yes- surgeons do need to say “NO” at times too- after all, Dr Google is not a plastics surgeon
-I routinely see patients who ask for a specific size implant- I ask how did they arrive to this “number”- frequent answer: “my friend got xxx cc’s and I want to go bigger” - not a good strategy and this definitely will lead to trouble
-implants is not an area to save money on- pick the best ones

Ask questions and second opinions are OK
If something sounds vague or “too good” … slow down
Ask what local hospital the surgeon has privileges at - just in case - even if surgery is done in surgery center
Good luck!

On average after six weeks most patients are of the restrictions.

Nevertheless, one has to be prepared that sometimes things take longer. For example, even a minor wound healing delay (not a long term problem) can be tricky to take care of while on the move.

Travel insurance could be a good idea perhaps just in case.

Traveling before 4 weeks or so I find quite risky. One of the potential issues after any major surgery is clotting in the leg blood vessels, certainly increased by cramped airline seating. Additionally even a minor problem can be frustrating when one has to rely on ER visit away from their surgeon.

My advice to all patients:
-perform your surgery at the location where you can stay sufficient time to recover (it is never “just 1 week”)
-make sure your surgeon has admitting privileges at a local hospital for added safety
-during consultation before surgery ask for a specific ways that you can contact your provider afterwards if there are any urgent questions- for example my patients can text me directly
-planning to recover after major surgery during vacation is a best way to ruin the vacation :)

During any long distance travel: wearing compression socks, getting up and walking frequently, elevating legs if possible and baby aspirin (if there’s no contraindications) would be good preventive steps.

This question brings up an important aspect of traveling for or after elective and cosmetic surgeries in general.
It might be tempting to go to “Miamis” of the world in order to save money…
It is Important to remember that: after care, regular follow up, quick intervention if there is a problem are essential to a good long-term result and safety. I am contacted on a regular basis by patients who had their surgeries performed elsewhere and then traveled back after a week or so. They have questions or may need help and original place doesn’t even answer their phone calls…
Finally, other costs: hotels, tickets, food also add up quickly, often surpassing cost of surgery locally.

No dilemma here - full abdominoplasty is needed here with lipo of the sides 

“Mini” is overly marketed and has indeed minimal Aplication in the real world:)

MEDICAL PART OF THE ANSWER-

 Generally speaking debridement could happen pretty much anytime (based on photo), then most likely even few weeks of Wound Care allowing wound to completely fill-in and heal before in the future scar potentially could be revised -  in other words tissue that will not survive needs to be removed and then the wound needs to heal before any future adjustments or revisions could be made - There’s no inherent emergency but it should be considered in the near future

( antibiotics should only be used if there is indeed documented infection which rarely happens when the wound is cleaned surgically And left open)

THE PRACTICAL SIDE

 This brings us to situation where traveling for elective surgery can be problematic and needs to be carefully arranged and follow up needs to be also figured out with a treating physician AHEAD OF TIME !!!

 If one of my patient needs more than routine  follow up I would treat that patient at no additional charge and if additional surgery is involved only the facility fees would need to be covered -  however when we see patients who obtained their treatment for example abroad or other facility  and the issue occurs a few weeks later and they seek additional care - we would have no choice but to treat them as brand new patients 

 But regardless of the practical limitations- a properly skilled plastic surgeon should be involved in managing this type of the wound-  because this is not going to be a problem that will be solved immediately 

Thank You 

(The choice of surgeon / location of surgery/ who does anesthesia etc - all need to be researched- goes without saying :)

Thin patients , athletic patients I think do much better with shaped (gummy) textured implants. They are more natural and certainly less likely to shift over time with excercice.

Size choice in my opinion is best when  based on breast width- if implant is to big - it will push in to the armpit and that volume is basically “useless” and even shaped implant will create upper part “fake roundness” if to big

Key points:

Talk to the surgeon and not so much to Dr Google- I offer Pre consultation phone calls to give an outline of the process, info on what to bring to consultation (like a stretchy sports bra to try sizers). Consults need to be done by the surgeon - not an assistant. During 1 hour consultation questions can be answered, education can occur, patients can feel more in Controll and reflect on their choices.

In my experience- primary reason for early Re operations is in fact use of the to big of an implant during original surgery, to big of a pocket and activity will eventually push a smooth implant into path of least resistance - the arm pit. Ethical surgeons will advice the patient and they should explain why certain choices are just plain wrong. Somehow we as a nation seem to be obsessed with large implants (Bay Watch comes to mind...)

Cup sizes are relative and create confusion- they are not constant, varying  with overall patient chest size - and let’s face it- completely misused by clothing companies.

Do not focus on CC number - it is unimportant- remember that implant needs to be there for 15 or more years- once to big - it is way more difficult to go smaller... Implant needs to fit “.” Think long term. I would suggest that it’s easier to have augmentation that is not obvious. It’s easier to find clothes that fit, excercice and more. Remember that once there is some volume in the breast then it can be “manipulated” from moderate to voluptuous with bra choice... 

The internet pictures are OK if used for reference but should not be relied on entirely. 3D computer stuff - honestly is not helping as much as we thought - yes there is some potential benefits but many neglect to remind patient that it’s only an approximation...

Make sure- when comparing cost - that hospital, anesthesia, implant and surgeon fees are all included. I have seen many estimates for “amazing price” but for saline implants and then quickly escalate once the best implants are chosen.

With some asymetry possibly different size implants may need to be used on each side

Finally- if you fill unsure after consultation, if you feel rushed or your questions are not answered - do get another opinion !

I hope this helps - I’ll be happy to discuss this further or answer other questions 

Thank you 

Dr S