So first and foremost if you are reading this and I have kept you waiting, or will keep you waiting, I offer you my sincere apologies. There is more to this blog however. I thought you might find it interesting to know how and why we can get backed up.

—–The cascading arrival time: While we have a good scheduling program all it takes is one late arrival to shift the schedule off kilter by 30 minutes or more. Unfortunately that will happen on average about twice during an office day at anyone of my plastic surgery practices in the Washington DC, Virginia area.

—–The exploding consult: for the average consultation we have a pretty good estimate the time it will take for me to evaluate, explain and go over treatments. However, it is extraordinarily common for a patient to book a consultation about one type of surgery but then also ask about two or three more. At 25- 30 minute per topic the math gets a little scary. Interested in knowing more about that topic, read my past blog “What Goes Together- More Than One Procedure of Plastic Surgery”.

—–The mom /friend phenomena: I love it when a patient brings a friend or family member to the consultation another set of ears and eyes is comforting and helpful. It is extremely common though that the friend or family member becomes the second consult in that room at the same time.

—–I am long winded: yes, it’s true. I love to teach and educate my patients and I don’t want anyone to leave feeling they did not get the best and most informative experience they could. So if one topic becomes 3 or if mom or friend has a question I will always feel compelled to answer it in detail.

I hope this doesn’t scare you off. A busy cosmetic plastic surgery practice is a good thing.

So a few tips: Morning consults are less prone to cascading delays, if you’re interested in many things, or so is your companion, just let us know ahead and we’ll leave more time. Bring a book just in case. Whether it’s breast, body, face, nose, or liposuction I’d love to meet you and I’ll do my best not to keep you waiting.

If you have any more questions about my office or to schedule a consultation please contact me.

These breast implants are not approved for use in the United States and I have never used them in my practice. The concern is only relevant for patients who have had breast augmentation outside the United States.

The only gel breast implants approved for use in the United States are manufactured by American companies and adhere to strict quality and manufacturing requirements.

The FDA requires extensive bio-compatibility testing on all its breast implants as described in their administration’s Summary of Safety and Effectiveness Data. These guidelines have resulted in silicone shells that have been tested and shown to possess excellent strength, resilience and elasticity.

If you have any concerns or questions about what is going on in France please do not hesitate to contact our office. If you had breast augmentation surgery outside the U.S. and would like to remove or replace your gel breast implants just please let us know.

Every month or two, I will see a woman with a double D or more breasts who wants me to do a breast lift and give them gravity defying breasts. Now I can do a breast lift on just about any size breast. The problem is that if I lift a large and heavy breast that breast will go south again quite quickly. Heavy natural breast tissue will always respond to gravity and usually the patient does not want to be smaller (smaller breasts droop less).

So here’s how you create a gravity defying large breast… and please recall I generally do not recommend this to patients, but I hope the concept makes sense. First do an aggressive breast reduction and remove most of the natural breast tissue, the tissue that responds to gravity. Come back a few months later and then put in a large implant. The implant restores the volume and upper fullness and tends to defy gravity more than natural breast tissue.

When I do a breast lift with an implant I will often remove a moderate amount of tissue if the patient agrees for the reasons listed above. If an aggressive reduction is needed at the time of lift and augmentation, it is often safer to stage the two in order to preserve blood supply to the breast.

To make a breast smaller only to make it bigger kind of seems like the death of common sense to me but for some it may be the only option to achieve their goals. This is a very technical and difficult concept to get across for me.

If you want to know what’s right for you, or to set up a consultation then contact me and let’s chat.

The most common reason for men to have enlarged breasts is unknown. While a very few patients will have a hormonal abnormality it is quite rare and does not change the surgical solutions.

Rule of thumb: Gynecomastia surgery should be performed after puberty and is best performed at younger ages when the skin is more elastic and likely to shrink up when the tissue underneath is removed.

Types:
1) Long nipple.—far more common in women than men a long nipple can be easily shortened under a local anesthesia.
2) Puffy areola: some men (and even women) have a normal breast contour but the areola is large or puffy as though it is sitting on top. The tissue under the areola can be removed under a local anesthesia.
3)True Gynecomastia- a firm lump of breast tissue is sitting right under the nipple areola area and is visible. It feels like a small egg. This can be removed from an incision around the bottom edge of the areola and can often be done under local.
4) Pseudogynecomastia (fake Gynecomastia)- here the problem is not the glandular breast tissue. It is that the breast is fatty. This is usually treated by liposuction. I tend to use ultrasonic liposuction as I believe it works better in the dense male breast. I usually do this with patients asleep.
5) Combination- Most Gynecomastia treatment is a combination of number 3 and 4 above and will require a combination of liposuction with direct excision.
6) Droopy breasts- In an older male patient or sometimes in a patient that has lost a lot of weight the skin becomes droopy and will not shrink up when the tissue underneath is removed. In this situation I will recommend excising skin as well as long as the patient is ok with the scars.

If you are considering this type of surgery and would like to be evaluated I have offices in Annapolis, Rockville, Maryland and Mclean, Virginia. Feel Free to contact me.

So why switch to silicone breast implants?

A silicone gel implant is softer than saline, mushier and generally more natural looking. A gel implant softens the transition from the chest wall to the upper portion of the breast.

So who might make the switch?

- If you wanted silicone in the first place but had your breast augmentation surgery back when silicone was not available in Maryland.

- If you are very slender with little breast tissue and wish to look more natural.

- If you have rippling from a saline implant that bothers you. Silicone gel implants can ripple too but they ripple the least.

- If you’re saline breast implants are old and you’ve been considering an exchange anyway.

- If you’ve thought about changing your size.

To find out if switching to silicone is right for you and learn more details just contact us through my web site or e-mail my assistant Pei@washingtonplastics.com for a complimentary consultation at one of my three locations in Annapolis or Rockville, Maryland or in McLean, Virginia.

If you are interested in correction of inverted nipples, breast augmentation, reduction or another type of breast surgery procedure in Maryland or Virginia; contact my practice today to schedule a consultation.

The American society of plastic surgeons and the American society of Aesthetic plastic surgery are working with the FDA in order to follow and better understand this rare condition.

So what does this mean for my patients considering breast enhancement? First and foremost it is important to note that the FDA has not changed the status or availability of breast implants. Patients who have them are not being encouraged to remove them and we continue to use them. I think it is something to be aware of as you make an informed decision. With or without implant I always encourage good self breast examination and mammography.

Because the condition is so rare, it is likely that most plastic surgeons will never see a case of it. There may be more of a risk of being struck by lightning. I always discuss all the risks and benefits of surgery with my patients. This new information will now be included, but it is perhaps the lowest risk of all. For more information the FDA link is: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm240000.htm

For those that have questions or concerns always feel free to contact my office to schedule a time to speak with me. We can talk over the phone or meet in person at one of my offices in Rockville, Maryland; Annapolis, Maryland; or McLean, Virginia.

Natural breasts in the mature woman, or after child bearing, start with a gentle slope off the chest wall and more fullness toward the bottom of the breast. This distinction is important, and I go over this thoroughly in consultation. I think many women expect a breast lift will make them look like they have breast implants. Well they will… but only for a while. In a full breast lift we remove droopy skin from the bottom of the breast and elevate breast tissue. For a time that woman will have dramatic upper breast fullness. In fact we often make the lift tight to accentuate the upper breast. But interestingly, the body is smarter than the doctor.

Over time the tightened skin will relax and over the course of about 6 to 12 months the upper breast fullness will diminish and ultimately the breast will once again look more like the “natural breast” (though much less droopy). If that patient wants to maintain the upper breast fullness she may elect to place a breast implant with the breast lift.

Natural breast or implanted breast? I support whichever one achieves my patients’ goals. Understanding the difference is the key.

If you are interested in learning more about breast augmentation, breast lift or both, contact my office to schedule a consultation at one of my three locations- Rockville, Maryland; Annapolis, Maryland; McLean, Virginia

What to ask during your consultation for breast augmentation:

1. What are your credentials?

*The only board recognized by the American Board of Medical Specialties in the field of plastic surgery is the American Board of Plastic Surgery. Your plastic surgeon should be certified by the American Board of Plastic Surgery as this will ensure he has undergone extensive training and met all standards as deemed by the Board.

2. What plastic surgery societies are you a member of?

*Certain societies such as the American Society for Aesthetic Plastic Surgery and the American Society of Plastic Surgeons only accept applicants after they have received certain certification, training and met their society’s standards.

3. What hospitals are you affiliated with?

*Breast augmentation is an outpatient procedure and can be performed in an accredited surgical facility. However, some individuals prefer to have breast augmentation in a hospital. Additionally, in the unlikely hood of an unforeseen event, it is important to know which hospitals in your plastic surgeon has privileges to operate at.

4. If you have not already done so, ask to view before and after photos of breast augmentation patients.

5. What breast augmentation techniques do you perform and how many have you performed for each technique?

6. What techniques do you provide to improve healing if any?

7. Do you offer techniques that utilize instruments that will provide less trauma to the breasts?

8. What does the recovery process entail following breast implants?

9. What medications or technology do you provide to reduce swelling, inflammation, and speed up recovery if any?

10. I am allergic to ______? Will this have an effect on which breast implant I am able to have and or could I have a reaction due to this allergy?

It is important to disclose your full medical history at time of consultation so your plastic surgeon is able to give you the best advice possible based off your needs.

If you are considering breast enhancement surgery, consult with board certified plastic surgeon Dr. Adam Tattelbaum, contact his office today.

What I do in breast augmentation is attempt to find the best balance of all these opposing forces. Saline breast implants offer some flexibility because I can change the volume. I will often adjust the size of saline implants intra operatively to find the best overall balance of shape versus volume.  When you change the volume of a saline you change its shape.  If the dominant pectoral muscle is thicker than the non dominant I may back off the volume slightly.  If a patient is droopy I may keep the volume to give lift and projection even if the upper pole is fuller.  In some situations I will use a lager breast implant on one side.  The larger implant will have a greater diameter, but may keep a better shape rather than just over filling the same size implant which would make it pointier.  In cases of extreme asymmetry I may use a high profile implant on one side and moderate or low on the other. 

If one breast is higher than the other I may have to drop the fold of the higher breast down so that the upper portion of the implants will be symmetric.  This is a balance and trade off as well.  Often the higher breast will have a higher nipple.  Dropping the fold can make the higher nipple even higher—again a trade off for the goal of overall symmetry.

Silicone gel breast implants look and feel more natural.  The smooth round implants which I prefer are technically not tear drops but when upright they take on a teardrop shape.   To me they are the preferred implant in very slender patients with little breast tissue to cover over the implant.   In patients with droop a saline implant may be preferable. While technically less natural saline implants are fuller in the upper portion and give more breast elevation in the patient with droop.

Each patient, each case is different and augmentation is about finding the best balance. Contact my office today to schedule a consultation to meet with me. Together we can determine the best implant size and type that will meet your needs.