In general breast implants have no impact on a woman’s ability to breast feed. The exception is when breast implants are part of a larger breast procedure such as a breast lift and breast implants, or breast reconstruction. These complex surgeries often require relocating the nipple, which can disrupt the milk ducts and limit the ability to breastfeed. But, straightforward breast augmentation (regardless of the location of the implant or the placement of the incision) does not interfere with the ability to produce milk or transport milk through the milk ducts.

Rupture of a breast implant is rare, but does happen. The leaking of saline (salt-water) or silicone will not contaminate the breast milk and harm the baby. Also, breastfeeding does not increase the risk for implant rupture.

It is true that there are women out there who have had breast implants placed and now find themselves unable to breastfeed. Most likely the women would have had difficulty breastfeeding, regardless of the breast implants. Women with small breasts may have difficulty producing enough milk to successfully breastfeed. Many women who choose to have breast augmentation do so because they have small breasts and desire an increase in breast volume. Therefore, there is a statistical increase in the number of women with breast implants who report difficulty breastfeeding – but as described above, this is unrelated to the implants.

As with everything, there are a few exceptions. If your breast augmentation surgery damaged the nerves of the nipple and areola, your ability to breast feed may be compromised. This is because nipple sensation is required to stimulate milk release.

Overall, breast implants surgery, when done correctly by a board certified plastic surgeon in new york city, is extremely safe and should have not interfere with breastfeeding or place you or your child in harms way.

Are these “mini” procedures better than their alternatives? This is difficult to answer because it is impossible to define “better.” Yes, the scars are shorter and the recovery is faster. There is generally less bruising, swelling, and pain (although pain is subjective and not related to the length of the scar) after your plastic surgery.

The problem is that these “mini” procedures are just that….mini. They are a smaller version of the traditional procedures that they have evolved from. Oftentimes, there is less “internal work” performed. For example, a “mini facelift” does improve the mid face and cheeks, but does not allow for significant correction of the aging jawline and neck. For the person who only needs midface correction, this is a great option. However, many of my patients require rejuvenation of the lower face and neck as well, making a “mini facelift” suboptimal. A “mini tummy tuck” will improve the area of the abdomen beneath the belly button. There is a shorter scar as compared to a traditional tummy tuck and the recovery is faster; however, there is no improvement of the area above the belly button which is an area that bothers most people. A “mini brachioplasty” limits the scar to the armpit and eliminates the sometimes unsightly scar of a traditional brachioplasty that extends from the armpit down to the elbow. Eliminating this scar also eliminates the ability to remove excess skin in all directions, reducing the amount of improvement that can be achieved.

For the lucky few, a “mini” procedure may be exactly what they need – a person with early signs of aging and only mild skin excess. But for the majority of people, the decision for a traditional versus a “mini” procedure is an evaluation of cost and benefit. Is the shorter scar and more rapid recovery worth the small sacrifice in cosmetic surgery results? I commonly ask my patients “would you be willing to accept a 20% less improvement in results, in exchange for a recovery that is half as long?” If the answer is “yes”, then a “mini” procedure is a viable option. If the answer is “no”, then a traditional approach is more appropriate.

Many plastic surgeons in new york have marketed these “mini” procedures as a way to make themselves stand out in a competitive marketplace – myself included. I believe there is a role for these procedures but, it is important to be honest about the results these procedures offer. I never tell my patients that these “mini” procedures are better. Rather, I explain that the smaller, less invasive procedure offers a more rapid recovery and potentially less pain, there may be some sacrifice in terms of overall results. Many of my patients do accept this sacrifice and elect for the “mini” procedure. In fact, I perform more of these “mini” procedures then their traditional counterparts and my patients have been happy.

It is indisputable that larger incisions lead to longer scars and more potential for post-operative bruising, swelling, and pain. But larger incisions allow for better visualization and more “internal work” , often resulting in a better overall cosmetic outcome.

I tell my patients that in general, the more they are willing to accept in terms of scars, the better contour I can create. So, at least in terms of plastic surgery, size DOES matter.

The internal support of the breast is composed of a network of dense collagen fibers termed “Coopers Ligaments.” This internal bra is responsible for maintaining the shape of the breast, independent of the quality of the overlying skin. As you age, the support structure naturally weakens. The weight of the breast also places strain on the ligaments, thereby “stretching” them over time. This is why it is rare to have naturally large, “perky” breasts. While there is no known way to “strengthen” Coopers Ligaments, wearing a well supporting external bra, especially during exercise, may delay the normal weakening that occurs as you age.

The actual composition of the breast is also important. The breast is composed of a combination of breast tissue and fat. The ratio between the two varies dramatically among women. Women who have heavy, dense breasts may have a breast tissue to breast fat ratio of 2:1. Women with soft, less dense breast have twice as much fat as breast tissue. This ratio between breast tissue and breast fat is very significant in how the breast changes and what breast contouring procedures you may require.

Breasts with a majority of dense breast tissue may be more likely to droop over time. This is because the weight of the breasts causes weakening of the internal support of the breast. As you age, the breast will continue to droop, making a breast lift necessary.

Breast tissue will also change with hormonal changes. So, dense breasts may be more likely to enlarge during pregnancy and breastfeeding. After the hormonal surge of pregnancy is over, the breast tissue may shrink in a process called “post-partum involution”. Correction may require a breast augmentation with implants and sometimes a simultaneous lift.

Breasts with a majority of fat are lighter and less likely to droop. However, the fat in the breast is extremely sensitive to changes in your body weight. Gaining weight may cause your breasts to enlarge and this often does not regress if you are to lose the weight in the future. This may make a breast reduction necessary.

Breast fat is also not as sensitive to the hormonal changes of pregnancy, so enlargement and involution from pregnancy hormonal changes is unlikely. However, weight gain that often accompanies pregnancy may result in enlargement of the breasts. Conversely, weight loss can cause loss of fat in the breast, and make the breast “deflate”. Correction of this may require a breast enlargement with implants.

So, breasts size and shape will changes throughout your life. Understanding the internal support of your breasts, and the ratio of breast tissue to breast fat will help you anticipate these changes. Fortunately, breast contouring has evolved so that there is a procedure for virtually every complaint. New techniques allow for shorter incisions that are more easily hidden, and a more rapid recovery from surgery. Also, implant technology has evolved so that modern implants look and feel more natural, and are more durable then earlier generations of breast implants.

If you are interested in learning more about a breast procedure, contact my office to schedule a consultation.

As a society, we tend to focus on the bad outcomes, because this is what sells the magazines. Moreover, “regular” people probably derive some sort of pleasure (albeit twisted) in famous celebrities who always seem to get whatever they want, being the victims of “bad plastic surgery.”

But, the real truth is that there is excellent plastic surgery being performed everyday on celebrities and non-celebrities. Modern techniques for surgery allow for smaller incisions that are better hidden, more rapid recoveries, and more “natural” results. Gone are the days of dramatic surgical changes and barely recognizable post-surgical faces.

Facelifting technique has seen the greatest advancement. The facelifts of the 1980’s with the windswept look, overtight skin, and upturned mouth reminiscent of “The Joker” are no more. Plastic surgeons now “lift” and “reposition” the deep structures of the face (the fat pads and muscles), and very little is done to the skin. In fact, after the underlying structures are repositioned into a youthful position, the skin is simply “redraped” and not pulled tight. You would be surprised at how little skin is actually removed during a facelift when it is done correctly.

I will share a little trick that I do with every one of my pre-operative facelift patients in consultation. To show what you will look like with a very well done (and natural) facelift, lay on your back and look at yourself in a handheld mirror. Impressive, right? This allows gravity to show you where everything should be.

Additionally, non-surgical treatments have evolved as well. Chemical peels should no longer result in that obvious shiney, over-smooth, waxy skin. Injectable fillers can be done conservatively so that they restore volume and fill lines, without making someone look like they have been over-inflated. Botox and Dysport can soften lines and do not have to completely prevent movement. That “frozen look” that people fear is a result of a bad injector, not the injection! Believe it or not, it is possible to eliminate lines on your forehead AND be able to lift your eyebrows!

My point is that there are excellent plastic surgeons that perform surgeries and injections that rejuvenate and improve, without making you look ridiculous and “overdone”. My patients obviously want to look different (ie. better) but they don’t want people to know exactly what they had done. They want someone to ask if they got their hair colored or lost weight, when the truth is that they had their eyes or face done.

Finding the right surgeon is the key. So, as long as there remain bad plastic surgeons (or non-plastic surgeons trying to act like plastic surgeons), the Weeklies will continue to have lots of content for the “bad plastic surgery” section. Nobody wants to read about the good results.

If you are interesed in seeing before and after photos of plastic surgery procedures performed by me, visit his photo gallery, or contact my office to schedule a consultation.

Recently, I came across a new device to be used in breast augmentation. It is called the Keller Funnel, developed by a Texas Plastic Surgeon. The device resembles a pastry bag. A silicone breast implant is placed inside this bag and essentially squeezed into the surgical opening in the breast.

While very simplistic in its actual design, the concept is exceptional. It allows for a truly “no touch” implant technique. This device allows the surgeon to place the implant, without having it come in contact with his hands or the patient’s skin. This reduces potential bacterial contamination, reduces infection risk, and more importantly, may reduce capsular contracture. Capsular contracture is the development of abnormal scar tissue around the implant, resulting in an implant that looks distorted and feels hard. No one knows why capsular contracture develops in some people, but a leading theory is that a small amount of bacteria on the implant may lead to the development of this abnormal internal scar tissue. It may also be the result of the talc commonly found on a surgeon’s glove. The “no touch” technique is an important concept and until this funnel, was only possible through very large incisions.

In addition, a large amount of pressure is needed to force a large silicone implant through a small incision. This immense force may contribute to a weakened shell and a delayed rupture of the implant years later. The rupture rate has been estimated to be as high as 7% over the first 10 years. The breast funnel allows insertion of the implant with much less force, thereby potentially reducing the incidence of implant rupture.

Lastly, using the breast funnel, I am able to place the implants through a significantly smaller incision. This shorter incision means a shorter scar, and a happier patient. I have reduced the length of my incisions 1 cm.

I am still among a small group of plastic surgeons who have incorporated the breast funnel into their practice. Since I began using it, my incisions are smaller, my operating time has decreased, and my patients have been extremely pleased. In terms of the potentially reduced rate of implant rupture and capsular contracture, only time will tell. The funnel is now a routine part of my breast augmentation procedure and the reason why patients choose me as the surgeon when there are hundreds of other surgeons nearby to chose from.

To learn more about breast augmenation, contact my New York City office to schedule a consultation.

• People are beginning to plan for the summer: This is the time of year when summer vacation plans are made and people begin to dream about long days on the beach or by the pool. With warm weather comes bathing suits and more revealing clothes. This idea usually motivates people to improve their body. Gyms get busier, and so do plastic surgeon offices. Because it takes several months for the body to completely heal after any cosmetic procedure, I recommend that breast and body contouring be done during this time of year, to ensure the best possible results for the warm summer months.

 

• Recovering from surgery in the cooler months is more comfortable: Routine post-operative care usually involves dressings, bandages, and tight compression garments worn under clothes. In cooler months, this is more comfortable. By the time the warm months come around, it will not be necessary to wear all these extra layers. While I do perform a lot of plastic surgery during warm months, my patients are aware that perspiration may cause some irritation to healing incisions.

 

• A good time of year to dedicate to yourself: The hustle and bustle of the winter holiday season is now over, and people tend to have less social and family commitments this time of year. This makes it a perfect opportunity to dedicate some time to yourself and your recovery.

 

• Anticipated Tax refunds: As we enter tax season, many people are anticipating a tax return. Even a small amount of tax refund may make a huge difference in paying for your plastic surgery. Also, there are many different finance options now available for plastic surgery, and your anticipated tax refund may make financing a good option. Many companies have 0% options for a variable amount of time. Many of my patients are signing up for 3-6 months 0% financing, knowing that the tax refund can be applied to partially or totally pay for the surgery.

 

• Plastic Surgery Discounts: While many surgeons only try to improve business during slow times, many (like myself) see a great opportunity to increase business during this very busy season through special pricing. You will be surprised to find very good discounts for surgical procedures this time of year.

As we enter plastic surgery “busy season”, this may be a good time to look into making the improvements in your body that you have always thought about. The timing is right, contact New York City Plastic Surgeon Dr. Schulman for a consultation.

First, let me dispel the myth that ten plastic surgery procedures cannot be performed in one operation. While I will admit that this is a lot, you must keep in mind the complexity of each procedure. 

From what I understand, her procedures included things like a revision of her nasal tip, fat injections to her cheeks, breast implant exchange, liposuction, etc.  These may seem like complicated procedures to the general public, but as a board certified plastic surgeon I know that these are relatively small, quick procedures.  Each procedures carries minimal anesthetic risk or risk of major port-operative complications – especially when performed on a young and healthy person.  While the media likes to focus on the seemingly large number of procedures, the complexity of each and the required anesthetic time is most important.

To give an example, facial rejuvenation surgery in my practice often includes a facelift, necklift, upper blepharoplasty, lower blepharoplasty, browlift, and chemical peel.  This is common combination of six procedures performed widely by qualified plastic surgeons.  The actual operating time of all these procedures may be less than performing one breast reconstruction.

The point is that the most important thing is the total length of the surgery, not the number of procedures. I have no personal knowledge about how long Heidi’s surgery lasted, and if it was an exceedingly long surgery (in excess of 6 hours), than one may argue that it was “too much” – but the fact that ten procedures were done should not be the sole reason for the uproar.

Many people also point out that Heidi is only 23 years old.  Her young age and good health make her a good surgical candidate for an elective surgery (or ten). She has an extremely low risk of complications.  Also the fact that she is so young does not place her at risk for future complications. Yes, as she ages, it is likely that some of her surgery will need to be redone as her body changes. Her surgeries only affect her appearance, not the function of her body or her overall health.

The real issue is whether or not these surgeries should have been performed at all.  The fact that she desires such radical changes in her appearance at such a young age does raise suspicion about her mental state. Body Dysmorphic Disorder (BDD) is a serious condition that involves a person’s intense dislike of the appearance of his or her own body.  In order to truly have BDD, the person must have the perception of a problem, in the absence of a real problem.

For example, if someone has a crooked nose with a large hump, it is understandable that they may be unhappy with their nose and desire surgery.  However, if a person has no obvious deformity, yet they cannot stand they way the nose looks in the mirror and perceive a crooked, humped nose that is not there, then this is a sign of possible BDD.  Plastic surgeons are always on the lookout for these patients because these patients will never be satisfied with the outcome of a surgery, no matter how successful the operation.  They will always perceive a deformity.

I do not mean to imply that Heidi Montag suffers from BDD.  In fact, it is more likely that she simply has a strong idea about how she wants to appear and happens to have the resources and connections to make it a reality.

My personal opinion is that her surgery was a bit excessive in that it dramatically changed her appearance to the point where she looks like a different person. But, as a plastic surgeon that routinely performs cosmetic surgery, I understand that cosmetic surgery is a matter of taste.  It is our job to perform surgery in a safe and ethical manner, without imposing our own sense of taste on our patients.

Sometimes, though, a surgeon needs to say “no” and not be affected by fame or money. Fortunately for my sense of well-being (and unfortunately for my wallet), I say “no” very often in my practice.  I just seem to sleep better at night.

Here are a few guidelines to help you choose your implant size.

1. Determine your personal preference of size – This is done by looking at magazines and photographs in order to determine “how big” you want to be.  You should find 3 photographs: “just right”, “too big”, and “too small.”  You should bring these photographs with you so that your surgeon will have a sense of what you are looking for.

2. As implants get larger, they also get wider – This concept is important in choosing a size implant that fits your body. If you are very small framed, then large implants may be too close to each other in the center or may protrude off the side of your chest.  Your doctor will measure the width of your chest to determine you “base diameter.” This will help him guide you towards a size that fits your body shape and size.  Breast implants are now available in several different shapes such as low projection and high projection. This gives you added ability to have an implant that fits your body.

3. You may not be able to be as large as want – It is not possible to make a big jump in breast size in all women. This is because there may not be enough tissue (breast and skin) to allow for a very large increase in size. Your doctor will examine you to be sure, but size increases of more than 2 full cup sizes may not be safe.  If you are an A cup, and desire to be a DD, this may not be possible in a single operation. You may have to increase to a full C, than a few years later (after your tissue has stretched out) have the implants increased in size to a DD.

4. Small volume differences may not be noticeable – Most people only notice volume changes of at least 50 cc’s, so if you cannot decide between a 330 cc implant and a 350 cc implant, so not stress because the difference will be difficult to tell once they are placed. When trying different sizes, you should increase and decrease by 50 cc volumes

5. Larger implants are heavier – As an implant gets larger, it also gets heavier. This means that very large implants may result in shoulder and back pain, similar to the complaints of women requesting breast reduction surgery.  Also, heavier implants may increase the likelihood of future breast sagging, or ptosis.

6. Take your time – You should not feel rushed or pressured into choosing your implant size. Your surgeon should allow you time to “try on” the implants and examine yourself in clothing.  It is best to try them with a simple, non-padded, non-push-up bra, and a tight t-shirt.  This will give you the best idea about your post-operative result.  Many surgeons will also allow you to borrow the sample implants so that you can see how you feel about the size of the implants over a few days. I routinely tell my patients to wear the implants for a few days, go out to dinner, visit friends, or wear them to work – this is the best way to determine how you feel about the size.

    

So, implant size is a combination of personal preference and your body’s shape and size. You should have an idea of what size breasts you ultimately want to have, and your doctor should be able to tell you if that size is safe for you.  Many Plastic Surgeons now have the ability to use computer simulations to show you what you will look like with different size implants.  This may be helpful, but there is nothing better than wearing the implants for a few days.

1. Permanent Lip Implants – A large number of men and women request fuller lips.  This has traditionally been done using temporary injectable fillers such as Restylane and Juvaderm. In good hands the results are excellent, but temporary.  The cost varies by geographic region and the specific filler chosen, but starts around $700.  With  patients returning on average of every 6 months (sometimes sooner), it will cost you approximately $1400 per year and $4200 over three years.  Now there is a permanent solution – PermaLip. These are soft silicone, permanent lip implants.  With a cost of $1800 per implant, the cost savings is enormous.  I have had excellent results with this safe and permanent solution for those who desire fuller lips.  The demand was high for this at the end of 2009 and I have no doubt that the popularity will only increase.  On a personal note, this makes me very happy given that I am one of only a few plastic surgeons experienced with this procedure.
2. Earlobe Rejuvenation – Long, thin, sagging earlobes are a tell-tale sign of a person’s age and often neglected. I have noticed in my own practice that earlobes age just like the rest of our face and body.  This is why I offer my patients options for earlobe rejuvenation. This may include “plumping” them with fillers, or shortening them by removing excess skin in a simple in-office procedure.  I anticipate that this inexpensive, simple procedure will continue to gain demand in 2010.
3. Adjustable Breast Implants – Selecting an implant size can be a source of tremendous anxiety for the patient. In fact, the most common reason for re-operation after breast augmentation is to change the size of the implant.  Also, many women have pre-existing breast asymmetry, making implant selection difficult because different size implants are required. Post-operative adjustable saline implants can solve this problem by allowing a physician to change the size of the implant through a tiny access port beneath the skin.  While this is not designed for increasing or decreasing your breast size based on your outfit, it is designed to allow the patient to take their time in deciding the final volume of the implants. It is common for breast implants to appear “too large” immediately after surgery when they are swollen and in a high position. After the swelling goes down in several weeks and months, it is common for the patient to complain that they are now “too small.” Now more saline can be added to the implants resulting in the desired size.  The access ports can then be removed with a simple in-office procedure.
4. Belly button enhancement – Another procedure gaining popularity in my practice is belly button surgery. Men and women come to me and complain about the appearance of their belly button. They may feel that it is “too large” or that they what the “outie” made into an “innie.”  Also, the belly button may have been distorted because of a hernia.  Belly Button Rejuvenation can improve the appearance of your belly button with a short in-office procedure using local anesthesia.  Last year I was quoted in the New York Daily News in reference to Victoria Secret Supermodel Karolina Kurkova’s (lack of a) belly button. After that, belly button revisional surgery has become one of the most requested procedures that I performed in 2009 and from the looks of my upcoming schedule over the next few months, this trend will continue.

Only time will tell if my predictions for 2010 come true. I am certain that they will be among the hottest procedures in my practice during the upcoming year, but national trends are difficult to predict.  I look forward to my December 2010 blog entry when I reflect on my predictions.