How long does the drain stay in after breast augmentation surgery?

Posted on June 4, 2013 by Joyce

By Dr. Ted

I never use a drain after breast augmentation surgery. I don’t believe that it’s necessary.

A drain is inserted to remove blood or serous fluid (the body’s thin watery fluid) that can accumulate around a surgical site. The drain is a round tube that resembles a turkey baster. The smaller end is placed inside the body, the bulbous end sticks out of the body. When the bulb is compressed, it creates a suction action and the fluid is removed.

“I love Thanksgiving turkey. It’s the only time in Los Angeles that you see natural breasts.” – Arnold Schwarzenegger

The body can absorb up to about 50 ccs in a 24-hour period, so a drain is needed only if there will be more fluid buildup. During a breast augmentation, my patients consistently lose no more than a teaspoon (about 5 ccs) of blood. After surgery, there is very little fluid accumulation around the implants, so there’s no need for a drain. Likewise, I don’t use drains after breast lift surgery.

With no drains and no stitches on the outside to manage or remove, my patients report that their post-op care is easy. They go home with a Steri-Strip band-aid over their incision. All they have to do is apply ointment on top of the strip each day.

In the United States, there is general agreement among plastic surgeons that drains aren’t needed for these two procedures, although some surgeons believe otherwise. Many European plastic surgeons commonly use drains.

On the other hand, drains are always used for breast reconstruction surgery and frequently used after a breast reduction. In a breast reduction, a large amount of tissue is removed. Flaps of tissue with large surface areas ooze and need to be drained. I remove the drain the next morning following surgery. After breast reconstruction, the drain might stay in place for about a week. It’s usually removed when the drainage is less than 50 ccs in a 24-hour period.

A drain can help prevent a hematoma (large collection of blood) or a seroma (a large collection of fluid). In these situations, the advantages of the drain outweigh the possibility of the drain causing an infection by allowing bacteria from the skin to enter the your body.

Can you add more saline to my implants so I don’t have to have surgery again?

Posted on April 18, 2013 by Joyce

By Dr. Ted

Technically, I could open your incision and add some saline to your breast implants, but it doesn’t make sense. Here’s why: Breast implants come in various sizes, like 325 ccs or 450 ccs, and they can’t be expanded an infinite amount. If implants are over-expanded, they will feel hard, like balloons that have been blown up too much. There might be room for a little bit more saline solution (salt water) – maybe two tablespoons at most – the amount of oil you would add to your pancake mix. This small amount would be barely noticeable. In fact, you could get the same look by wearing your bra one notch tighter.

In 1937, Warner’s introduced its “Alphabet Bra” with A, B, C and D cups. Before too long,
these cup sizes got nicknames: egg cup, tea cup, coffee cup and challenge cup.

Women come to me with the request to “go bigger” often after significant weight loss (about 10 percent or more of their body weight) or after pregnancy, when their breasts may have changed because of hormonal fluctuations and milk production.

In my experience, women want an increase of about one cup size or more, which would be equivalent to anywhere from 150 to 225 ccs, depending on the size of their frame. To accomplish this, they would need larger implants.

By the way, bigger implants aren’t more expensive than smaller ones. Manufacturers don’t charge by the cubic centimeter: They charge one set price for all off-the-shelf saline breast implants, whether they are 200 ccs or 600 ccs, and another set price (about $1,000 higher) for silicone gel implants.

Breast augmentation is easier the second time around, because the pocket around the implant has already been made and has already healed. During surgery, I would place a larger implant through the initial incision, which was made in the crease below the breast where the breast and the chest meet.

Post-operatively, to protect the incision, I ask patients to wear a supportive bra or a sports bra for three weeks. They report significantly less discomfort than the first time around, and women who have surgery on Friday are usually back to work on Monday if they work in an office setting.

The saline implants used during breast augmentation surgery are different from the temporary tissue expanders used during breast reconstruction surgery. These have a tube that runs from the expander to the skin near the outside of the body. Saline can be added over a period of months to gradually stretch the muscle and skin. The expander is then removed and replaced with a permanent implant.

P.S. While saline implants come empty and are filled after they are inserted, silicone gel implants come filled. There’s no way to add silicone to them.

Why did “The Scoop on Breasts” go to Hollywood?

Posted on March 16, 2013 by Joyce

Because it got an offer it couldn’t refuse! GBK Productions of Hollywood invited us to participate in their pre-Oscar luxury lifestyle gift lounge in honor of the 2013 Academy Awards. That meant our book would be part of the “swag bags” and we’d be there to hand it out.

Wayne Knight (Newman)

The event took place in beautifully designed suites in the Sofitel Hotel in West Hollywood on Feb. 22 and 23. Gifts included exotic all-inclusive trips, expensive watches, dazzling jewelry, silk bedding for dogs, Viva Diva wines, gourmet cookies from Cookie Daddy, a $3,000 gift certificate for a ride on a private jet – and our book about breasts.

College age men and women were hired to escort each star from room to room and to carry their very duffle bags that were so big they could hold a body. By the end of the day, the bags were so heavy with gifts that some of the escorts had to drag them down the hall.

CCH Pounder (Law & Order, Avatar)

As each star arrived, their escort would hold up a clipboard with their name and most important roles on the back, so we could see who was coming. We couldn’t help noticing that when people entered our room, their eyes were drawn right to our 6-foot-tall banner displaying our Scoop On Breasts book cover and breasts that were almost 2 feet tall!

We gifted each celebrity with a copy of the book and a $1,000 gift certificate toward cosmetic breast surgery performed by Dr. Ted. (Maybe they can use their jet gift certificate to get to Philadelphia.) We also asked them to autograph our banner.

Most people signed their name around the outside of the sign until Tony Dennison (Major Crimes) broke the ice and autographed the right breast. He noted that it wasn’t the first breast he had ever signed. Next up? Sugar Ray Leonard, who was in attendance to promote his foundation that supports Juvenile diabetes research. He wrote “Be a knockout!” right across the cleavage.

Sugar Ray Leonard

The actors and actresses were friendly, gracious and generous with their time. Some asked serious questions: How long do implants last? Can you breastfeed after you get them? What inspired you to write the book? Others joked a bit and Dr. Ted joked right back. How could he resist telling a joke to Richard Kind, who played cousin Andy on Curb Your Enthusiasm, or to Terry Crews, who made him laugh out loud in White Chicks and The Expendables.

Terry Crews with his wife and the authors

Although we wanted to give the stars the scoop on breasts, many of them already had it. Raphael Sbarge (Once Upon a Time) and Pamela Adlon (Californication) both had roles in the 1997 film Breast Men, which starred David Schwimmer and Chris Cooper as the doctors who created breast implants. The movie was promoted as “Two young doctors with a dream of making it big . . . really big.”

We are certain that Wayne Knight (Newman on Seinfeld) is acquainted with breasts. He might have been hanging out in Jerry’s apartment when Jerry said, “Looking at cleavage is like looking at the sun. You can’t stare at it. It’s too risky. You get a sense of it and then you look away.” And he probably saw a pair or two when he appeared on Nip/Tuck, the show about two Miami plastic surgeons. Evan Handler now plays Charlie Runkle on Californication. He was one of the stars of HBO’s Sex and the City – he was Charlotte’s divorce lawyer and later her husband. We suspect he saw plenty of breasts on that set.

Dr. Ted was tickled to meet Chazz Palminteri, who he loved in Analyze This, and Bruce McGill, the sheriff in My Cousin Vinny. He’s seen both movies so many times that he can recite their lines.

Camilla Luddington
(Grey’s Anatomy)

I was thrilled to meet Newman (he makes me laugh just by looking at him) and Bruce Greenwood, who I had seen two nights earlier starring opposite Denzel Washington in the film Flight. We gave our book to Jayson Blair, a handsome young actor on The New Normal; soon after he tweeted this: “My lady @TheRue has been reading this book for the last hour non stop. It’s brilliant!” TheRue is Rumor Willis, daughter of Bruce Willis and Demi Moore. We love to imagine the book sitting on her coffee table.

Back at home, we turned on the TV and were excited to see some of our new celebrity “friends” on Scandal and Shameless and House of Lies. It was a once in a lifetime opportunity for us. We’ve almost used up our 15 minutes of fame.

How saggy is saggy enough to need a breast lift?

Posted on February 20, 2013 by Joyce

By Dr. Ted

“My husband said, ‘Show me your boobs,’ and I had to pull up my skirt, so it was time to get them done!” – Dolly Parton

Are you wondering if you are a candidate for a breast lift with or without implants? Try this at home:

1) The Pencil Test: Take off your bra and look in the mirror. Place a pencil horizontally along the crease under your breast, where your bra band would rest. Where does the nipple itself – not your areola – rest in relation to the pencil?
a. below
b. at
c. above

2) Put on your bra and take another look in the mirror. When your bra lifts your breasts, are you:
a. satisfied with their size
b. wish they were bigger

At a breast surgery consultation, the doctor will take measurements – without a pencil – to help you determine the right choice for you, but here is some information to get you started.

1a. If your nipple hangs below the pencil, your breasts would be considered moderately to severely ptotic (or droopy) and you would be a candidate for a breast lift, which would raise and reshape the breasts.

1b. If your nipple is at the crease and your breasts are mildly ptotic, it’s a borderline situation.

If you want a more natural look, you could consider breast implants alone. A saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. When the implant fills out the upper portion of the breast, it also fills out the bottom portion, which makes it look like the nipple is located higher on the breast. If you took out a ruler and measured, you would see that the nipple hasn’t moved; it is still in the same place.

If you want your breasts to be higher and perkier, a breast lift might be the better option, because during that surgery, the nipple is moved to a higher position and excess skin is removed.

1c. If your nipple is above the crease, relax. You are probably not a candidate for breast lift surgery. Use some of the money you save for some new, uplifting bras.

Lift and Implants?
2a. If you are satisfied with the size of your breasts, a breast lift alone may be the right procedure for you.

2b. If you want more breast volume, you could consider a breast lift and implants (an augmentation mastopexy).

While some doctors prefer to do two separate operations – the lift first followed a few months later by the augmentation, others perform both procedures at the same time (simultaneous augmentation mastopexy). Having one surgery rather than two reduces the time that you are in the operating room and under anesthesia. It is a safe operation that takes about 3-1/2 hours.

Prefer to take things into your own hands. Some women choose breast lift tape, and others have been known to try duct tape!

Other things to know:
If your breasts are moderately to severely droopy and you get implants, you could develop the appearance of four breasts, with your breast implants up high and your natural breasts down low. Not a good look.

After a lift, your breasts will be the same size as they were before, because only excess, stretched skin is removed during a breast lift; no breast tissue is taken away. You’ll look exactly how you look before surgery when you are wearing a good bra.

I used to have perky breasts. What happened?

Posted on February 17, 2013 by Joyce

By Dr. Ted

No crystal ball can predict how much and how soon your breasts will lose their shape and firmness, but you can blame the following factors for the droop (medically known as ptosis).

When you are pregnant, the developing placenta stimulates the release of hormones, causing your milk glands – and your breasts – to grow and swell. This rapid growth can also cause the skin to stretch. When the milk is gone, your breasts might return to their original size or get bigger, smaller, or droopier.

Although the number of pregnancies and your pre-pregnancy breast size are factors in post-pregnancy sagging, breastfeeding itself is not.

Significant weight gain and loss – yo-yo dieting – can also affect your breasts. When you lose weight, it not only reduces the size of your waist and thighs, but it might also reduce the size of your breasts – sometimes dramatically. If the skin and ligaments don’t retract when some of the fat disappears, you could be left with saggy or empty-looking breasts.

As women age and their hormone levels drop, the lobules (the part of the breast where milk is produced) shrink, and breast volume is lost. In addition, the body’s elastin fibers, which keep the skin from drooping, and collagen fibers, which give tissue strength and flexibility, decrease. Smoking can speed up this process. That’s because the carcinogens in the smoke cause those elastin fibers to break down in the body.

Breasts can start drooping at any age depending on your genes and the elasticity of your skin. That’s why it’s not uncommon for teens to have droopy breasts. Some girls say that they were “born with saggy breasts” or that they “just developed this way.” The rate of droop is largely determined by genetics, although pregnancy and weight changes factor in. And while a bra will keep your breasts from sagging while you are wearing it, there is little evidence that wearing a bra delays or prevents breast droopiness.

Did you ever wonder what your breasts would be like in outer space where there is no gravity? (They’d look like they would if you go swimming braless.) Science fiction writer Arthur C. Clarke did. In his book Rendezvous with Rama, Arthur C. Clarke wrote, “Some women should not be allowed aboard a space ship; weightlessness did things to their breasts that were too damn distracting.”

Did you ever wonder what your breasts would look like in outer space where there is no gravity? They’d look like they would if you go swimming braless.

Gravity gets a bad rap. The pull of gravity on your breasts – or your face – isn’t a significant factor in droopiness. It’s more like the skin isn’t as strong as it once was, and it begins to fall down – like a pair of sweatpants that has lost its elastic.

If you are thinking about having breast lift surgery to perk up your breasts, you’ll need to know your true starting size. Losing 10 percent or more of your body weight could make your breasts smaller, so you should wait until you have reached your dietary goal before you have breast augmentation surgery. To know your post-pregnancy breast size, it’s best to wait at least six months after you have stopped breastfeeding or, if you are not breastfeeding, six months after childbirth. At that point, you’ll be able to see if you want more breast volume or if you are a candidate for a lift.

Next time: Learn how to take the “pencil test” to see if you are a candidate for a lift.

What do bras and shoes have in common?

Posted on February 2, 2013 by Joyce

By Joyce Eisenberg

More than you’d expect. Here’s my list:

1. Women own more of each than they wear.

The average American woman has 19 pairs of shoes in her closet, but she only wears 4 pairs regularly, according to a poll that appeared in ShopSmart magazine. Another 4 or 5 pairs have only been worn once. There are similar statistics about bras. According to Britain’s Daily Mail, the average woman owns 16 bras at any given time but only wears 4-6 of them on a regular basis.

2. Our drawers and our closets are stuffed with shoes and bras that we don’t wear but don’t want to give away – just in case.

These are the shoes that looked great in the store but didn’t quite match the dress you were hoping it would complement, and the bra that was really sexy but made your boobs look bad under your new sweater. These are the shoes that felt okay when you test-drove them around the store for two minutes and the bras that were comfy when you tried them on for a nanosecond. Back at home, in the harsh light of day, they are too uncomfortable to wear. But they’re pretty.

3. Because of traumatic experiences like the aforementioned, women buy comfortable shoes and bras and sexy shoes and bras, and they are rarely one and the same.

Manufacturers understand this, which is why bra companies market ultra-comfortable styles, like the Coobie Bra, a seamless, stretchy, one-size-fits-almost-all bra that’s so comfortable you can sleep in it. They also sell super-sexy models, like Victoria’s Secret’s Bombshell bra that “adds 2 cup sizes for instant hourglass oomph.” Shoes walk the same path. There’s the Blossom, with 5-inch stiletto heels and a rhinestone studded ankle strap, and comfy Ugg boots with their fleece lining.

I haven’t found any bras or shoes that bridge the gap, but a Chicago Tribune reporter tested shoes marketed as “comfortably sexy day and night.” One tester came close to tears cause the shoes hurt so bad; but there were some success stories. I’m sticking with my sensible Aerosoles.

4. If you lose weight, both your cup size and your shoe size can decrease. If you gain weight, the reverse is true.

“I dropped about 40 pounds – three dress sizes,” one woman wrote in an online forum. “Went from a 36DD to a 36D bra. I’m not complaining about that; I just don”t want to go below a C cup. However, some of my shoes are a little too big now, and that does piss me off as I’m an absolute shoe fiend…”

Another women replied, “35 pounds for me was more than a full cup size. Also, I actually had to get a new helmet for horseback riding because the old one got too big. Weird, huh? Didn’t know I had a fat head…”

Breasts, which are made up mostly of fatty tissue, are often the first indicators of weight change. But all parts of the body of capable of storing fat. So if you are dieting, maybe you should squirrel away the money you’re saving on food shopping to use on shoe, bra and helmet shopping when you’ve reached your goal.

5. At the end of the day, women can’t wait to get their bra and their shoes off.

Nuff said.

I’m hoping to get pregnant in the next year. Should I wait to get breast implants?

Posted on January 28, 2013 by Joyce

Written by Dr. Ted

It’s no surprise that this question comes up frequently during consultation. My patients range in age from 18 to 63, but the large majority of them are in their 20s and 30s – prime childbearing years.

The bottom line is this: If you are thinking about having a child in the next year or working on it now, I would suggest that you wait because your post-pregnancy breasts might look quite a bit different from your current pair.

During pregnancy, your breasts will enlarge from hormonal changes and milk production. In fact, many women report that they grew at least a full cup size, sometimes more. Those women who started out smaller often tell me that they liked being bigger and fuller.

“Those early pregnancy breasts are something to behold . . . It’s a fleeting time, those early breasts, but for a couple months, before the tummy catches up, it’s as though you get a free boob job,” wrote Sasha Brown-Worsham in “The Five Stages of Pregnancy Breasts,” which appeared online in The Stir.

Some women who start out with a D cup aren’t so enamored with their new breast size: In an online forum, one mom wrote, “Before pregnancy, I was a solid 36D. I am now 36 DDD (which is equivalent to 36E), and I am only 12 weeks pregnant! I think the 4 pounds I have gained during my 1st trimester have gone straight to my boobs, and I am kind scared to see how big I will be by the end.”

After your pregnancy, your breasts might return to their original size or get smaller, bigger or droopier. There’s no way to predict the future; as Alphamom writes in “Postpartum, Posteverything Boobs,” it depends on a lot. “Genetics. Your age. Your cup size. How long you breastfed. Number of children. Basically, it’s a total freaking wild card.”

You won’t know the outcome until six months after you have stopped breastfeeding or, if you are not breastfeeding, six months after childbirth. In order to choose breast implants that will make you proportional, you need to know your proportions – and your true starting size. See before and after photos.

However, if parenthood is further down the road and you are anxious to enjoy new breasts now, you don’t have to wait. You just have to understand that you might need a revision after your pregnancy.

“At what age were you the happiest with your breasts?”

Posted on January 21, 2013 by Joyce

Ultimo Beauty, best known for its “Miracle Solutions Plunge Bra with silicone gel that can add up to two cup sizes,” recently conducted a study on women’s views on their assets. Results showed that “women are most happy with their breasts in their mid-20s, with 38 percent saying that was when they were most satisfied.”

When they crunched the numbers further, they discovered that “British women rate their boobs most highly when they hit 26.” What’s a 26-year-old look like? Think Lindsay Lohan, Megan Fox or Lady Ga Ga.

When I think back, I remember some things about my 26^th year: my job (I worked at the Jewish Exponent in Philadelphia), my apartment (a townhouse in Roxborough), my husband (that same Dr. Ted who I’m still married to!), and my dog Ginger (a Cairn terrier who looked like Toto in The Wizard of Oz,) but it’s hard to imagine my 26-year-old boobs and how they looked compared with my 24- or 28-year old boobs.

So I brought out an old photo album and searched for my 26-year-old self. I found a picture of me in a bikini on the beach at a Club Med in Guadeloupe, and I looked damn good. I guess I could vote for 26, too.

THE TEEN YEARS
Next, Ultimo found that “a wistful 28 percent of women admitted they thought theirs were best during their teenage years.”

I wouldn’t agree: My breasts didn’t amount to much in my teen years. I was envious of the friend in my middle-school crowd who was the first to develop and wear a bra. If she were British, she would have been one of the 28 percent, I suspect, because when I saw her as an adult, it turned out she was an early starter, rather than a strong finisher.

What changed for me between ages 16 and 26? I gained a little weight, and my breasts, which are made up primarily of fatty tissue, were the beneficiaries. Unfortunately, these days when I gain some weight, it goes straight to my butt or my hips, not to my chest. Not fair.

THE 30s
Finally, Ultimo’s survey revealed, “One in seven (14 percent) claim they were at their best in their 30s.” My breasts were at their peak, so to speak, when I was in my 30s, specifically at ages 32 and 35 when I was pregnant with my son and then my daughter. Thank you, children. However, the size increase was not long-lasting. After I stopped breastfeeding, I returned to my pre-pregnancy size.

What does the future hold? It doesn’t hold up your breasts. “Generally things start heading south after women hit their late 20s,” the survey concluded.

You could consider options, like a breast lift or a good support bra that does the lifting for you – bras with names like “Ultimate Lift” or “Magic Lift.” The survey didn’t talk about what happens to breasts when they turn 65. But we know that they’ll get some good “perks” – like $2 off on a movie ticket and a discounted cup of coffee at McDonald’s. Now that’s something to look forward to.

Will breast implants give me more cleavage?

Posted on January 16, 2013 by Joyce

By Dr. Ted

“Looking at cleavage is like looking at the sun. You can’t stare at it. It’s too risky. You get a sense of it and then you look away.” – Jerry Seinfeld

There’s long been a quest for cleavage. In Europe, as far back as the 1400s, bodices and corsets were designed to push up the breasts. Fast-forward 200 years to the court of Louis XIV of France, where necklines were lowered and cleavage was further exposed. Although it goes into hiding now and then, cleavage has mostly been in style ever since.

When it’s visible, thanks to a low-cut top or a push-up bra, cleavage draws a lot of attention. Scientists conjecture that the attraction is primal: cleavage mimics the cleft between the buttocks, which we hide from view these days by wearing clothing and walking on two legs instead of four, as our ancestors did. As one headline writer put it, cleavage is a “weapon of mass distraction.”

No wonder that women frequently ask me if breast implants will give them more cleavage. In fact they won’t.

Let’s start with the facts: Cleavage, or the intermammary sulcus (the less-sexy anatomical term), is the space between your breasts. It’s defined by where the fatty portion of each breast sits in relationship to the breastbone.

Implants don’t change the space between your breasts. In fact, if a surgeon tries to give you more cleavage by loosening the inside borders – or going beyond the natural limits – of your breasts, you could end up with a symmastia, also known as a uniboob.

What implants can do is give you more breast volume, which will make it easier for you to push your breasts together to accent the hollow between them. Bra manufacturers are happy to help you enhance your cleavage with a variety of bras, including click bras, air-lift bras, and liquid-lift models, which for some reason have gotten the nickname of “chicken cutlets.” But be careful. It turns out that your bra can give you a uniboob, too.

Do you mind that your husband looks at breasts all day?

Posted on January 9, 2013 by Joyce

Some people ask outright. Others just think it.

When my son and daughter were in middle school and their friends heard their dad’s cosmetic breast surgery commercial on the local radio station, their first question would be: “Does your mom mind what your dad does?”

I don’t mind. I’m not a jealous type of person in any way, and I know that my husband is professional and appropriate. I know that a doctor can view a body part as just a body part. Countless breast exams and pap tests have proven that to me.

At work, Ted considers breasts like Stedman’s Medical Dictionary does, as “two large hemispheric projections situated in the subcutaneous tela over the pectoralis major muscle on either side of the chest.” At home, they are more like “like two fawns, twins of a gazelle, that graze among the lilies, as King Solomon wrote in Song of Songs.

Okay, so he’s not that poetic, but he does like breasts, and seeing more than 16,000 of them in his lifetime has not ruined it for him, as some people think.

At work, Ted is objective, which my Webster’s dictionary defines as “neutral, detached, uninvolved, and evenhanded.” Strike “evenhanded.” I’m not so fond of that adjective. At work, breasts are measured from side to side and nipple to crease; skin elasticity is judged, size is evaluated.

At home, Ted is subjective, which the dictionary defines as “personal and emotional.” When people ask him if I mind that he looks at breasts all day, he tells them: “No. Because hers are the ones that speak to me, the ones I come home to.”

And when he comes home, he is not judging and measuring. He is simply appreciating. When I demand, “Look at mine objectively. Do you think my breasts are a little droopy?” he says, “They are perfect just the way they are.” I know that’s his subjective opinion. I like to think it is his professional opinion as well.