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Daniel J. Casper, MD: In choosing the right size, I have an interesting technique whereby I have my patients obtain a bra which is, best way to say it is, like a grandma bra. It's the cup size that they want to be, the desired size they want to be. With a little trick using twist tie baggies and water, I'm able to size out accurately the size it will require to augment from where they are to what they want to be.
This is in contrast to what a lot of other surgeons do, in which they use a sports bra, and they put an implant in it. The implant just sits on top of the breast and is kind of a rock in a sock phenomena as opposed to the system that I use where the volume situates itself around the breast and fills out a precise measuring cup so I can accurately size what's needed on the right versus what's needed on the left.
It all depends on the visibility of the scar. In most cases I do incisions on the periareolar area, or in the crease, and I try to set these scars right in the crease to make it least visible. Then, it would depend on whether they were palpable, whether you had any degree of firmness. There are a number of things I do in surgery to reduce the firmness.
Then, postoperatively I manage my patients to see if any firmness is developing. If there is, then we institute things like Singulair and Accolate and massage regimen. Most of my patients actually do not have to massage their implants, and they maintain what we call a Baker's Zero, a soft, natural breast. It's related to a number of things. One of the things that contributes to capsular contracture is any blood in the pocket. I am very compulsive about making sure there is no blood in the pocket,multiple triple antibiotic irrigations to make sure there's no blood around the implant. That at least gives you the best shot of reducing your capsular contracture rate to a minimum.
Number one is start with their credentials. They need to be a board-certified plastic surgeon. Secondly, you'd like to see what their results look like, before and after photos. Three, it seems to be the trend nowadays, everybody looks at reviews, and that's, you know, keenly important to see what people feel is about a certain surgeon.
Than, last but not least, go in and meet the surgeon, see how they feel toward the surgeon, and you'll just get sort of a gut feeling or gut response to know who'll be the right surgeon for you.