Peri-Areolar
Advantages: well-hidden incision
Disadvantagous: not possible if areolas are very small, possible disruption of milk ducts which can lead to infection and interference with breast feeding, more technically challenging for the surgeon, higher capsular contracture rate than some other approaches, risk for decreased nipple sensation.

Inframammary
Advantages: well hidden incision, technically easier approach for surgeon, no disruption of milk ducts or breast tissue so virtually no risk for interference with breast feeding, lowest risk of infection and capsular contracture
Disadvantages: scar can be visible on underside of breast.

Trans-Axillary
Advantages: hidden scar, no disruption of ilk ducts or breast gland so virtually no risk for interference with breast feeding.
Disadvantages: challenging approach for the plastic surgeon and usually requires use of endoscopic camera equipment, highest risk for infection and capsular contracture, scar may be irritated when shaving underarms, high rate of implant malposition.

As you can see, there are several different approaches for placement of breast implants. Your surgeon will be able to discuss which approach is best for you. It will depend on your preference, type of implant selected, implant size selected, and your body shape and size.

To learn more about breast implants and breast augmentation, or to schedule your consultation with Dr. Schulman, contact us or call 212-289-1851.

For a very long time, Plastic Surgeons told patients something like this – “capsular contracture is abnormal scar tissue that some people’s body makes. There is no way of knowing if it will happen and really depends on your body”. This was a great way to not take any responsibility for this dreaded complication that can occur in around 7% of women. My opinion is that this is an inaccurate way of portraying CC and is nothing more than a cop-out so that the surgeon does not have to take responsibility if CC develops. It also totally disregards current scientific evidence.

CC is an inflammatory response to some stimulus. This may be a small amount of bacteria and infection, blood from poor control of bleeding during surgery, powder from surgical gloves, or even lint from operating room towels. Basically, anything that irritates the body during breast implant insertion can make CC more likely. In fact, many of us believe that 80% of CC is the direct result of these causes, which means that 80% of the cases of CC should be avoidable. This leaves the other 20% to the mysterious “some-people’s-body-makes-bad-scar-tissue” theory.

There are some very specific techniques that some surgeons employ during surgery to minimize the chance of developing CC – “no-touch” technique, Keller Funnel, triple antibiotic implant irrigation, avoiding towels with lint, and using powder-free surgical gloves. I think that the data will eventually show a dramatic reduction in CC rates among those surgeons using these techniques. The bottom line is that is your surgeon tells you that CC is something that happens and cannot be predicted or prevented, then he/she clearly is not using these advanced breast implant insertion techniques.

To learn more about Breast Implant Augmentation with Dr. Schulman using the latest techniques to reduce complications, contact us or call 212-289-1851.

The mother tends to persuade a smaller sized breast implant. Perhaps this is the mother’s maternal instinct to “protect” and she feels that large breast implants will portray an image that is not “daughterly”. I have watched many battles occur in my office between mother and daughter about implant size.

On the contrary, the husband tends to recommend larger implants. This is probably due to man’s attraction to large breasts. Husbands can at times attempt to mold their wives into their ideal image, and if that husband is a “breast-man”, than he will suggest larger implants. It can be quite interesting when I see a woman alone in consultation and we select a small-moderate sized implant, but when she returns with her husband, she is suddenly trying on large sized implants.

Implant size is a matter of personal taste. You need to choose and implant size that you will be happy with. Of course, the person who helps you in the decision process may have a different opinion about which implant size is best, but you need to ultimately make your own decision.

To learn more about breast implant augmentation in New York City with Dr. Schulman, contact me or call 212-289-1851.

Certainly, the women who have very large asymmetries (such as a C cup on one side and a small B cup on the other) come to my office aware of the difference. However, most women with smaller differences seem surprised when I point them out. I find it hard to believe that a woman had never noticed that her left nipple is 1 inch higher than the right, or that her left fold is 2 inches lower than the other side. It amazes each time, but I have come to expect it. These asymmetries are pointed out by using a large mirror and also taking pre-operative photographs.

Pointing out the asymmetries serves a few different purposes. First it protects me. If breasts are asymmetric before surgery, then they will remain asymmetric after surgery (hopefully less asymmetric, but asymmetric nonetheless). After cosmetic breast surgery, women will stare all day long at their breasts and I can guarantee that the asymmetry that was not obvious to them before surgery will be painfully obvious to them after surgery. Pointing it out beforehand helps to establish realistic expectations about the results.

Second, it helps me and my patient get on the same page regarding the surgical plan. If I need to raise a fold or lower a nipple, I want them to understand the specific surgical techniques involved so that they can appreciate the complexities of the scheduled surgery. In some cases, I need to perform a totally different operation on the left and right breast. For example, sometimes one side needs a lift, while the other does not. Also, sometimes I place different size implants in order to account for volume asymmetries. If different operations are needed on each breast, my patients must understand that this may result in different scars and different recoveries.

So breast asymmetries are almost a given. Cosmetic breast surgery is designed to minimize the difference, but achieving 100% symmetry is impossible and my patients need to understand this.

To learn more about cosmetic breast surgery such as breast augmentation, breast lift, and breast reductions, Contact me or call 212-289-1851.

So, how do you avoid becoming one of those “I wish I went bigger” with my breast impants? It is all about proper selection of the implant size. This means an in-depth discussion with your surgeon about your expectations. You should bring a photograph to demonstrate what you want to look like. This is important because I have had several women who have come to me saying things like “I want to be natural looking” or “I just want to be fuller, but I don’t want people to notice”. This all sounds reasonable until they whip out a picture of Pamela Anderson to show me what they want! Clearly in this case there is a disconnect between what they want and what they say. Do you want to be BIG, do you want to be just a little fuller? These are things you should be clear about before you even arrive for your first consultation.

Next, your plastic surgeon should give you implants to try on. You should see how you look and feel with the new look. Sometimes, your surgeon will even let you take the implants home for a few days so that you can “test drive” your new breasts. Trying on the implants is a million times better than any expensive imaging program that your surgeon may use.

Also important is to understand how the implant will look after it is “inside”. Breast implants tend to look slightly smaller after they are inserted during surgery. I notice that the implants look about 10% smaller. This means that if you like the way a 350 cc implant looks when you try it on, it may appear more like a 325 cc implant after surgery. In this case, you should consider having a 375 cc implant placed.

So, as you can see, a good discussion between you and your surgeon about implant size should prevent you from being unhappy with your size. Breast Augmentations are a major component of my practice, and I pay particular attention to sizing the implant so that my patients are happy afterwards. During our first visit, we discuss the surgery, the risks, and implant size. There is a lot to think about so I do not make anybody commit to the implant size. If there is any doubt about size, my patients will return again specifically to discuss implant size and not be distracted by all the other details about surgery that we go over. I also allow my patients to return as many times as they want to try on implants before surgery.

To date, I have had no woman return for reoperation purely because she thinks she is “too small” after her breast augmentation.

To learn more about breast augmentation with Dr. Schulman, including his Rapid-Recovery Breast Augmentation using the Keller Funnel, contact us by calling 212-289-1851.

My Rapid-Recovery technique involves four specific components:
1. Long-acting local anesthetics injected into pain nerves of the breast
2. Injection of Botox into the pectoralis muscle
3. Insertion of the breast implant using a Keller Funnel
4. Post-operative application of LED lights to reduce bruising and swelling

My breast augmentations are performed under general anesthesia – you are completely asleep. However, I also inject long-acting local anesthetics into the nerves of the breast. The medicine is specifically injected into the sensory nerves of the breast. The result is less pain during the first 8 hours after the surgery which is usually when most patients are most uncomfortable. This prevents the buildup of severe pain that can make a recovery difficult.

The majority of breast implants are placed under the pectoralis muscle. When implants are placed under the muscle, it requires that the surgeon cut the pectoralis muscles in order to place the implant. During the months after the surgery, this cut pectoralis muscle can have painful spasms. This can result in pain that can persist for weeks and months after surgery. Also, the implant can stretch the muscle, causing pain. More importantly, the implants commonly remain “high” for several months after surgery because they are being held by the pectoralis muscle and need to “drop” into a natural position. This often takes up to 6 months after plastic surgery. The solution for all these things is Botox! I inject Botox into the pectoralis muscle at the time of surgery. This causes paralysis of the muscle for 4 months, decreasing painful spasms as the muscle heals and allows the breast implant to drop into the desired position in just a few weeks instead of 6 months.

Next, I use a special device for insertion of the breast implant. This device, called a Keller Funnel, allows non-traumatic insertion of the implant through a very small incision. Less trauma and a smaller incision equals less pain.

The final component of the “Rapid-Recovery” Breast Augmentation in New York City is the use of LED lights. LED, or Light Emitting Diodes, are colored lights. Studies have shown the red and blue rays of light can decrease inflammation and bruising. My patients are given these hand-held lights to take home and apply it to the breasts several times a day. The use of these lights reduces the bruising, swelling, and pain.

Using this technique, I find that my patients have less pain, less bruising, less swelling, and a faster final result.

Contact Dr. Schulman’s practice of plastic surgery in New York City to schedule a free consultation and learn more about Dr. Schulman’s Rapid-Recovery Breast Augmentation.

So why the need for this adjustable implant? There are 3 situations in which I would use these adjustable implants in my breast practice:

1. To account for pre-operative differences in the shape and volume of the breasts. Breast asymmetry is very common and can make it difficult to choose the appropriately sized breast implants. A post-operative adjustable implant allows the surgeon to make small adjustments in the breast volume for months after the surgery, allowing better matching between asymmetric breasts.

2. To correct breast deformities such as Tuberous Breasts. Tuberous Breast Deformity is a fairly common condition characterized by an underdeveloped breast that is constricted at its base. Correction of this deformity involves placing a breast implant to increase the size (this is often only on one breast) and to correct the constricted base of the breast. Unfortunately, this cannot be done simply by placing a breast implant. You actually need to stretch the base of the breast. A post operative adjustable breast implant allows the gradual expansion of the base of the breast to improve the shape and size.

3. To help women choose a breast size that they are happy with. The most common reason for breast implant reoperation is for a change in size. Some reports find that 25% of women ultimately undergo reoperation simply to increase/decrease the size of the implant. A post operative adjustable implant allows the surgeon to place the implant to the desired volume and then over the next several months, small adjustments can be made until the woman is certain of the size.

While this may make these implants sound like the best thing since sliced bread, there are some drawbacks.

• The implants are only saline, which have a tendency to be more visible, more palpable, show rippling and be more “unnatural” than their silicone cousins.
• Adjusting the volume of the implant involves a visit to the doctor and a needle in the skin, which can cause pain and does carry some risk of infection.
• The fill port is palpable under the skin and may feel like a marble.
• Removal of the fill port involves a small office procedure.
• The range of each implant is limited (usually about 75cc in each direction) so you still need a basic idea of what size range you would like.

In my practice, 80% of the breast implants that I place today are silicone because I feel that these are the most natural appearing (and feeling) implants. I do occasionally use adjustable implants though for the situations that I outlined above. In the right circumstance, these implants are a powerful weapon in the field of breast surgery, especially in cases of marked breast asymmetry or congenital deformities. Please feel free to Contact my office if you have any questions about adjustable breast implants or if you would like to schedule a consultation.

Breast implants, to the highest degree, are the most studied medical device in the history of medicine. The FDA along with plastic surgery societies such as the American Society for Aesthetic Plastic Surgery and the American Society of Plastic Surgeons are committed to providing and maintaining the safety and satisfaction of the patient.

Facts:

Anaplastic Large Cell Lymphoma (ALCL) is an extremely rare form of blood cancer – 1 out of every 500,000 women in the US are diagnosed and according to the National Cancer Institute, ALCL in the breast tissue is found in 3 out of every 100 million women nationwide without breast implants. Nearly, 10 million women have breast implants and 34 unique cases world wide of ALCL in women with breast implants have been placed.

Breast implants are still FDA approved and the FDA along with plastic surgery governing societies feel breast implants remain safe and effective for women who are in good physical and mental health. Women with breast implants don’t need to change their medical care and should continue to follow normal routine – self exam and mammography when appropriate. If changes to your breasts are detected contact your plastic surgeon.

The FDA, the American Society for Aesthetic Plastic Surgery, along with health care professionals and manufactures will continue to monitor breast implants to ensure the patient remains educated and safe.

For more information regarding FDA reports please visit: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm241090.htm

If you have any questions, please feel free to contact my office and I would be happy to speak with you regarding your concerns.

This machine can detect any form of implant in the body, including surgical implants of the hip, wrist and even breast implants. Not to worry though, the security officer who is in front of you, watching over while you are examined will not see the x-ray image. The security officer who views the “x-ray” image of your body is in a remote location. The person examining your “x-ray” will be told when to initiate the process by the security officer in front of you over a hand-held transceiver. The security officer in a remote location will see an image on the screen which only shows outlines of the body and objects in and on the body. Additionally the image comes up fuzzy making facial features unrecognizable.

According to a poll done by CBS News 4 out of 5 Americans are all for the extra security measures and feel safer in the airport as well as in the air, but what percent of those people have undergone plastic surgery. Some people are stating that this is an invasion of privacy. People who want their plastic surgery kept secret feel this outs them. This is completely agreeable, but remember the person that is looking at your x-ray cannot recognize your face. They are looking for weapons and dangerous material that could endanger people’s lives. If they see something odd they will radio to the security officer in front of you and ask them to perform a pad down.

Some people choose to divulge their implant or implants before the scan while others will reveal it at the pat down, or not at all. Whether you inform TSA you have an implant or not, it will not keep you from boarding your flight.

To learn more about the advanced body image scanners, or breast implants contact Dr. Schulman’s office for more details.

Just as frequently though, patients request not to look like well known celebrities. This list of celebrity “don’t-wanna-be” changes a few times a year, but here is a list of the most common celebrity no-nos and tips to avoid looking like them.

1.   Madonna’s cheeks – Clearly she has had injectable fillers in her cheeks, but because her cheeks seem to be growing, almost magically, I suspect she has had fat placed in there as well. Fat transfer involves removing fat from one part of the body and placing it in another. The fat that is transferred is a living cell and should theoretically live forever. While this sounds like a great procedure, the problem is that the fat can sometimes take on a life of its own. For example, the fat will still retain the characteristics and behavior of the place it is taken from. So, if fat is taken from a place that easily increases or decreases with weight changes (such as the abdomen), it will also increase or decrease in the face. The result can be mysteriously growing cheeks. While I can’t say for sure that Madonna has had fat transfer to her cheeks, I can say that her cheeks appear too round and too full for her face, a look that my patients specifically want to avoid. Carefully placed filler can give a natural and predictable result.

2.   Lisa Rinna’s Lips – Lisa Rinna has long been know for her full and oddly shaped upper lip. We in the cosmetic world have known all along that this is a tell-tale sign of silicone injections gone bad. But she has adamantly denied having anything injected into her lips for years and years. Finally, she admitted this year to permanent silicone injections and underwent surgery to remove the silicone. Regardless of what was injected, Her lips exhibit the classic characteristics that my patients want to avoid – overly full, asymmetrical, and abnormally shaped. The ideal lip should be fuller in the middle, and less full at the corners. A “pouty” look is also considered very attractive. Stick with temporary fillers like Restylane and Juvaderm for a natural look – and besides, if you don’t like it, it will go away in about 6 months unlike silicone which is forever.

3.  Tara Reid’s abdomen – Tara Reid’s abdomen is the perfect example of what can happen when liposuction is too aggressive. As I always say, with liposuction, it is not what you remove, but what you leave behind. If I were to remove every bit of fat during a liposuction procedure, only a thin layer of skin will remain, resulting in lumps, bumps, and contour irregularities. Careful liposuction with small instruments can help minimize the chance of having an abdomen that looks like hers.

4.  Tori Spelling’s breasts – You may be shocked to hear this, but Tori Spelling has breast implants. And these implants show some serious problems. They are widely spaced and the implants themselves show visible edges and rippling. Some of these problems are likely the result of saline implants placed above the muscle in a woman who is extremely thin. To reduce the likelihood of “spelling breasts”, my patients opt for silicone implants that look and feel more natural and have less chance of having visible edges or rippling. Also, placing the implants under the muscle will add another layer of tissue, camouflaging the implant even more.

5.  Michael Jackson’s Nose – His nose is perhaps the most infamous example of what can go wrong with a rhinoplasty….or seven. Michael Jackson had undergone multiple nose surgeries. Each subsequent surgery can damage the blood supply to the bone and cartilage. This injury to the supporting structure of the nose can cause “collapse” as seen in the later pictures of Michael. I should also mention that Latoya and Janet also likely had multiple nasal surgeries and are exhibiting early signs of structural collapse. Almost all my rhinoplasty patients jokingly tell me in consultation that they don’t want to look like Michael Jackson. The way to avoid this is to not have dramatic changes made and to avoid multiple nasal surgeries.

If you have any other questions, concerns or would like to schedule a consultation with Dr. Schulman please feel free to contact us.