Virtual Consultation – The new normal

2020 has brought some major changes to our lives. Whether we like it or not, social distancing, wearing a mask, and avoiding events is going to be with us at least for the near future. The medical field has also felt these new changes. In addition to COVID screening protocols for all patients, visitors, and staff, we have also significantly limited the number of in-person consultations. This has been done to minimize person-to-person contact, and so our part to help keep everyone safe.  This has increased the popularity of “virtual consultations” with over 80% of our new consultations choosing this option.

 

 

 

A virtual consultation means that instead of a new consultation coming to the office to be evaluated for their surgical procedure, they are evaluated in another way that eliminates person-to-person contact. This is also commonly referred to as “tele-medicine” or “tele-health”. This is done over an electronic device such as a phone or computer. There are several platforms that can accomplish this task, such as facetime, zoom, or just the telephone.  During your virtual consultation, you will be evaluated by the medical professional as if you were right in the office. While there are clearly some limitations to these types of evaluations, it can be very accurate and very successful when a skilled provider is combined with a patient who is forthcoming about every detail. Every doctor has a different method of performing these types of visits.

Your virtual consultation with Dr. Schulman:

 

Dr. Schulman has been offering virtual consultations for about 10 years now. This is because many of his patients come from long distances, and virtual consults offered a unique convenience for his out-of-town patients. However, new COVID-related restrictions now make virtual consultations a good option for even local patients. Dr. Schulman has been able to refine his virtual consultation process over the past ten years to make it more efficient and accurate.

 

Read below to learn more about the specific Virtual Consultation process with Dr. Schulman:

 

 

  • Consultation Submission:

 

The initial step is complete an online virtual consultation submission form. This form is found directly on our website and asks for basic information about you, your medical and surgical history, and what procedure you are looking for. It also allows for submission of photographs so that Dr. Schulman can see the areas your are inquiring about. Out website contains instructions about how to properly take photographs and you can use our photo gallery as an example.

 

 

  • Initial Review Process:

 

After your submission is completed, your information and photographs will be personally reviewed by Dr. Schulman. Make sure to provide as much detail as possible, including dates of prior procedures. He will use all this information to determine if the requesting procedure is appropriate and safe.  If you are a candidate for the procedure you are interested in, you will receive and email with more information about the procedure and details about available consultation dates and times.

 

If you are not a candidate for the procedure, you will also be notified by email with a brief reason why. Reasons why you may not be a candidate for the procedure may include that your current weight is about the safe limit, the procedure you are asking for is not the procedure that would give you the best results, you have medical problems or medications that would place you at increased risk for an elective cosmetic procedure.

 

Occasionally, you will be asked for more information. This is most common if you have had prior procedures that may affect the procedure you are inquiring about, and you did not list a date for that procedure. You may also be contacted if your photographs are lacking in quality and it makes it difficult to evaluate, or if you did not include photographs of the body part you are inquiring about. There is also the possibility that it is simply too difficult to evaluate you in this manner and you are better suited to have an in-person consultation. This is more likely if you have a very complicated medical or surgical history, or if the procedure you are asking for is a correction of a previous surgery.

 

 

Because every submission is reviewed by Dr. Schulman, it may 24-48 hours to receive a response. If you do not receive a response, be sure to check your spam folder!

 

 

  • Preparing for your Consultation:

 

After you have been deemed a candidate for your virtual consultation, you will be sent more detailed forms. These are the same forms that you would fill out if you were in our office waiting to be seen in person.  These forms will ask for a more detailed medical and surgical history and will also outline important office policies.

 

You will also be sent information about how to pay for your virtual consultation. The submission process and Dr. Schulman’s initial review and approval are all done complimentary. However, our office does charge a consultation fee for your virtual consultation. A portion of this fee will be credited towards your surgery.

 

  • Your consultation:

 

Dr. Schulman prefers to perform his virtual consultations via telephone. He has found that this is the most reliable method of communication and eliminates normal internet “glitches” that tend to occur. It also allows you more flexibility in terms of where you are during the consultation since you don’t have to worry about proper lighting, a computer, or internet connection.

 

Dr. Schulman will call you at the scheduled time and day of your consultation. He will have already reviewed all your paperwork and your photographs and will also have those in front of him. Dr. Schulman will discuss your goals and what is, or is not, realistic for you. This is the exact process that would be done during in in-person consultation in his office.  You will have the opportunity to ask any questions you wish.

 

 

  • After your consultation:

 

Immediately after speaking with Dr. Schulman, you will be transferred to a surgical coordinator. This coordinator will discuss pricing for the procedure you just discussed with Dr. Schulman, and will let you know what the surgical availabilities are.  The coordinator will also review our booking and scheduling policies with you.

 

  • Pre-Operative appointment:

 

After you book your surgery, you will be offered a “pre-operative appointment”, usually about 3-4 weeks prior to your surgery. This pre-op appointment will be done in-person, so you will have the opportunity to meet with Dr. Schulman in the office. This is an important part of the process, since it allows you and Dr. Schulman to meet each other, and confirm that the virtual recommendations still apply. 

 

Advantages to Virtual Consultations

 

  • Adhere to social distancing recommendations and minimize infectious risk
  • Obtain a consultation sooner than for an in-person consultation
  • Have the consultation from anywhere
  • More flexibility on days and times

 

Dr. Schulman has been performing virtual consultation for ten years, so this new trend is nothing new for him.  There are certainly difficulties with performing virtual consultations, since it is not always possible to determine skin quality and other things from photographs. However, Dr. Schulman is skilled at this process and will let people know if a virtual consult is not for them. Currently, about 80% of new consultations opt for this method. This is a good option for those requesting tummy tucks, mommy makeover, Brazilian butt lifts, liposuction, and breast augmentations.

To start the process of your Virtual Consultation with New York City plastic surgeon, Dr. Matthew Schulman, visit our website.

What you need to know about selecting your Breast Implants

Breast Augmentation surgery is a procedure to increase the size of the breasts by inserting breast implants. Breast Augmentation with breast implants is the most popular procedure performed by Board Certified Plastic Surgeons.  There were over 280,000 breast augmentations performed in the United States during 2019, making it the number one procedure. Breast augmentation procedures have been the most popular cosmetic surgery for many years.  The advancing implant technology, combined with improved surgical techniques that offer a more rapid recovery, are some of the reasons why this procedure continues to be so popular.

 

If you are considering breast augmentation with breast implants, there are some important things to consider. These include: the type of implant, implant size, incision placement, implant placement, and surgeon selection.  Continue reading to learn more about these issues.

 

 

Type of Breast Implants

 

Breast Implants generally fall into the category of SALINE or Silicone.  This refers to the internal contents of the implant. All implants have a thin silicone rubber shell, but some are filled with saline fluid (salt-water) and some are filled with a silicone gel. It is this fill material that classifies it as either saline or silicone. Let’s discuss the differences

 

Saline implants are essentially a water balloon. This means that the can show rippling and wrinkling.  Some women report a sensation of “sloshing” and the implants can feel firmer than natural breast tissue. Silicone gel, however, is more like a slime, so sloshing will not occur and rippling and wrinkling is less common.  Most patients and plastic surgeons would agree that silicone gel filled implants tend to look and feel more like a natural breast.  During your consultation with a board certified plastic surgeon, he or she may recommend one type of implant over another based on your desired appearance, and amount of native breast tissue. You should be sure you are comfortable with whichever type of implant you choose.

 

Implant Size

 

The increase in breast size that you desire will dictate the implant size that you choose.  The larger the implant, the larger your breasts will be after the surgery. This is very obvious. However, when selecting an implant size, you need to consider the amount of breast tissue that you are starting with. For example, placing 300cc breast implants in a woman who has A cup breasts, will give a very different result than placing the same 300cc implants in a woman with a C cup breast. This is why when using online photos to help select you implant size can be misleading. You need to make sure that you focus on their “before” photo as well.

 

The other thing to consider about implant size is what size will fit your body. As implants get larger, they also get wider. This means that a woman with a narrow chest, may not do well with large implants, since they will likely touch in the center (synmastia) or hang off the side of the chest wall (“side-boob”).  Your surgeon will take measurement of your breasts and these measurements will be important in deciding which size breast implants fits you.

 

Additionally, if you have small breasts with tight skin, it will limit the size of the implant that you can get. If an implant stretches your skin, it can give a very unnatural appearance and can cause complications later. This is why your surgeon will do a “pinch test”, to determine how much you skin is able to stretch when the implant is placed.

 

In cases of breast asymmetry, where one breast is larger than the other, it is common to place implants of different volumes. For example, a larger implant can be placed in the smaller breast, and a smaller implant can be placed in the larger breast.

 

 

Incision Placement

 

The choice of incision is important because the incision will determine where the scar will be.  There are several choices for incisions when having breast augmentation with implants. These include: around are areola, within the breast crease, and in the underarm.  Each has advantages and disadvantages.

 

The incision around the areola provides an opportunity for a well concealed scar, since the scar will be along the border of the darker areolar skin. However, if the areola is very small, it may not be possible to use this incision.  Also, if someone is a poor healer and they make thick and raised scars, this would leave a bad scar right in the center of the breast. Some also report that the risk for nipple numbness is increased with this approach.

 

The breast fold incision is a very versatile approach. It provides direct access to the space beneath the breast tissue or beneath the chest muscle.  When the incision heals, the scar is well hidden in the breast fold, although this can be seen when the breast is lifted and sometimes when a bikini top rides up.  The incision can vary in length depending on the size of implants being placed. This is the preferred incision for most plastic surgeons.

 

A third incision option for breast implant placement is the underarm. This is intended to provide the most hidden scar when healed. This approach is more technically difficult and there is a higher incidence of implants being in the incorrect position (malposition).  Proper placement usually requires the use of a small camera to allow the surgeon to see what he/she is doing.  This approach may be impossible for very large implants. Also, some women do find that if the scar becomes slightly raised, it is irritating when they shave their underarms.

 

Implant Placement

 

Implant placement refers to the relationship between the breast implant and the chest muscle. Breast implants can be placed under or over the chest muscle (pectoralis major).  This in independent of implant type, size and incision.

 

When an implant is placed under the chest muscle, the muscle offers an additional layer of covering to the implant. This means that on top of the implant is skin, breast tissue, and muscle. The more hidden the implant is, the more natural it looks. Placing an implant under the muscle, however, does increase the post-operative pain of the procedure and does extend the recovery time and activity restrictions after surgery. For women with very little breast tissue, placing an implant under the muscle is preferred. Also, there are several studies that show that placing an implant below the chest muscle reduces the rate of capsular contracture and infection.

 

When an implant is placed over the muscle, it is in the space between the breast tissue and the chest wall. This mean that the chest muscle is not disrupted during the surgery, so recovery is less painful and there are fewer restrictions.  Because there is less tissue covering the implant, the implant will be more visible. This means that you will see more roundness to the breast which can be perceived as more “unnatural”.  In women with a lot of breast tissue, placing an implant over the muscle may still look very natural.

 

 

 

Choosing your Surgeon

 

When selecting your surgeon for your breast augmentation with implants, you want to make sure you select a Board Certified Plastic Surgeon who is experienced with breast augmentation. You should take a look at the results your surgeon has achieved and make sure you are in agreement with his or her aesthetic. You also want to be sure that your surgeon has experience with the various implant types, sizes, incisions, and implant placements. This will help ensure that he or she can appropriately guide you and allow you to choose the best options for your body and desires. You also want to be sure that your surgeon will allow you adequate time to select your implant size.  I personally think you should avoid any surgeon who tells you that he or she will pick a size for you while you are in the operating room. You also want to find out where your surgeon performs their surgeries – in an office operating room, ambulatory surgery center, or a hospital.

 

Combining your Breast Implants with other procedures

 

It is very common to combine breast augmentation with breast implants together with other procedures such as tummy tuck, liposuction, and Brazilian Butt Lifts.  In some cases, your breasts also require a lift, and a breast lift can be performed as well.  When combining multiple procedures into a single operation, it is commonly referred to as a “Mommy Makeover”.

 

Schedule your Consultation

 

To learn more about breast augmentation surgery with Dr. Matthew Schulman, a board certified plastic surgeon in New York City, contact our office today by phone or through our website.

A Breast Lift Explained

One of the most popular procedures performed by Board Certified Plastic Surgeons is a breast lift.  There were over 120,000 breast lifts performed last year in the United States.  This is a procedure performed by 90% of all Board Certified Plastic Surgeons. The reason for it’s popularity is how powerful it is at transforming the body and erasing years off someone’s appearance. 

 

 

What is a Breast Lift?

 

A breast lift, or mastopexy, is a procedure that lifts the breasts.  It is intended to give a more youthful appearance to the breasts and reverse the sagging and drooping that often comes with aging, pregnancy, and weight loss. A breast lift will:

 

  • Removal of excess breast skin
  • Lifting of sagging breasts
  • Reduction in the size of areolas
  • Creating more symmetry between breasts

 

 

 

 

Who is a Good Candidate for a Breast Lift?

 

Because a breast lift is designed to lift breast tissue and create a more youthful appearance, anyone who feels like there breasts are sagging are a candidate.  Breasts can sag and droop due to a variety of reasons. These include:

 

  • aging
  • pregnancy
  • weight loss
  • removal of breast implants

 

To know if you require a breast lift, you need to look at the position of your nipples. If your nipples are below your breast fold, then this means that you have breast droop, or ptosis, and are a candidate for a breast lift. If you feel like your breasts are droopy, but your nipples are still above your breast fold, than you likely have breast involution and a breast implant may be what you need.

 

 

Preparation for Your Breast Lift

 

The first step is an evaluation by a Board Certified Plastic Surgeon, experienced in a breast lift procedure. During your evaluation, your surgeon will take your medical history and perform a physical examination. He or she will specifically examine your breasts, looking carefully at the amount of excess skin, the quality of that skin, underlying breast tissue, and signs of asymmetry.  Your surgeon will also make sure that there is not a personal or family history of breast problems, such as cancer.

 

Your surgeon will also discuss the required incisions and resulting scars for your breast lift. These incisions will depend on exactly what needs to be done for you and how much your breasts need to be lifted.  Small lifts often only require incisions around the areola, while larger lifts may require incisions around the areolas, down the front of the breast, and underneath (like an anchor). Some may require something in between.  Your surgeon will also discuss whether you also require an adjustment in the volume of your breast, either with an enlargement or a reduction.

 

If you are an appropriate candidate for the procedure, your surgeon will discuss specific details about the anesthesia, recovery, and scars.  He or she will also discuss the risks associated with this breast lift procedure. You will also be sent for medical clearance with your primary medical doctor. This will include a physical examination, bloodwork, and an EKG, along with any other tests required to make sure you are healthy enough to undergo the surgery. If you are over 40 years old, you will be required to have a mammogram as part of your pre-operative medical clearance. 

 

 

Where is the Procedure Performed?

 

A breast lift is a surgical procedure that needs to be performed in an accredited surgery center or hospital. These are regulated facilities with the appropriate safety standards and appropriately trained staff.  The procedure is usually performed on an out-patient basis, meaning, you are able to go home the same day. In situations where other procedures are being done at the same time, you may be required to stay overnight for monitoring.

 

The Surgery

 

  • The Anesthesia

The procedure is performed under intravenous sedation or general anesthesia. This anesthesia is administered by a Board Certified Anesthesiologist and you will be monitored the entire time. You breathing and heart rate will be monitored, as well as your oxygen level. 

 

  • The Incision

A breast lift is performed with a variety of incisions. These incisions are used to remove skin, reshape the internal breast tissue, and move the nipple. The incisions are important because it is the incisions that ultimately determine the scars that will be left. The incisions that you need will depend on exactly what needs to be done and how much lift you require. The typical incisions include:

 

  • Around the areola (circumareolar)
  • Around the areola and down the from (“lollipop”)
  • Around the areola, down the front, in the fold (“Anchor”)

 

Sometimes, a different incision is needed on each breast, since many breasts start out different from each other.  Your surgeon will be able to tell you during your consultation, which incision he or she thinks you will need. Your surgeon can also draw the planned incision on you so you can visualize where the scar will be located and how long it will be.

 

  • Reducing the size of the areola

One of the first things that will be done during your breast lift, is reducing the size of the areola. The areola tends to enlarge with aging, weight loss, pregnancy, and breast droop. Your surgeon will use a template, called a “cookie cutter”, that will mark a perfectly round circle on your original areola. This new shape and size will be smaller and rounder. This will also allow both areolas to be made the same shape and size. After marking the areolas with this “cookie cutter”, your surgeon will use a knife to cut along the marks.

 

  • Removing the Skin

The excess and loose skin of the breast is also marked and removed. By doing this, the breast will be more perky and lifted when things are put back together. Depending on the amount of lift that is needed, skin can be removed from around the areola, down the front of the breast, and along the bottom.

 

  • Reshaping the Internal Breast Tissue

While breast skin needs to be removed and this does play a role in the result, the skin can’t do it all. In fact, the breast skin has already proven that it cannot support the breast tissue, which is why you need the lift. The real key to a beautiful and long-term result from your breast lift is reshaping the internal breast tissue. After the skin is removed, the breast tissue is reshaped using a combination of removal of breast tissue and internal sutures. Your surgeon will basically reshape your breast tissue into the shape of a breast implant.

 

  • Closing the Skin and Raising the Nipple

Next the skin is closed over this newly shaped breast tissue.   The breast will have a rounded shape. The nipple and areola will be slid up to a higher location and closed with sutures.

 

 

 

 

Recovery

 

After a few hours in the recovery room, you will be discharged home. You will have pain medication and antibiotics. This procedure is very well tolerated and the pain is significantly less than with other procedures like a tummy tuck. You will wear a supportive bra, such as a sports bra.   After about a week, most people feel pretty good and you will be cleared to return to normal activities, including work and school.  You will be restricted from heavy exercise for about 3-4 weeks while you are healing.

 

 

Scar management

 

Scars never go away, but they will fade. Special care is taken during your surgery to promote good healing and the best possible scar. However, everyone’s skin is different and creates different scars. Some scars are thin and flat, while others are raised and dark. Your Board Certified Plastic Surgeon should be able to assess your skin before surgery in order to determine the types of scar you are likely to produce. In general, the darker the skin, the higher the possibility of thick and dark scars.  If you have a history of making “bad” scars, be sure to let your surgeon know about that so proper precautions can be made.  There are some things that can be done after the surgery to help your body create better scars These include the early use of silicone scar gels or tapes, and laser treatments.  Your scar will continue to evolve over the next 9-12 months. During this time, you should limit the exposure to the sun since UV rays can make the scar appear more red and irritated.

 

Combining a Breast Lift with Other Procedures

 

It is very common to combine your breast lift with other procedures. Sometimes a breast lift is combined with breast implants if you want your breasts lifted AND larger. Also common is to combine your breast lift with a tummy tuck or liposuction. This is because all these parts are very susceptible to changes associated with aging, weight fluctuations and pregnancies. Combining multiple procedures together is commonly called a Mommy Makeover.

 

If you would like to learn more about lifting your breasts and making them appear more youthful, contact New York City Board Certified Plastic Surgeon, Dr. Matthew Schulman. During your consultation, you can find out if a breast lift is right for you.