Q: I don’t like the size of my breasts, and I have been thinking about getting Breast Augmentation. But I’m nervous about this because I do not want them to look fake. Is there is a way to make them look more natural?
A: Dear Laura:
Loss of breast tissue after massive weight loss is very common. Breast reconstruction including breast implants and a breast lift are common after gastric bypass, LAP-BAND, or Roux-En-Y surgeries. In addition, extreme dieting and exercise can also lead to a significant amount of breast tissue loss. I feel the best way to achieve “natural looking breasts” is to spend a significant amount of time with the patient preoperatively to determine the breast size they wish. My patients, for the most part, want normal, natural looking breasts. Usually this would mean they would be in proportion to the abdomen. Many patients do not know what breast size they want so I often perform an abdominoplasty or tummy tuck first. This establishes the foundation of the body and achieves a flat abdomen, helping the patient to then decide what breast size they want to have. It is very common for my patients to want to be a full C or small D. This is entirely dependent on patient proportions and size and is just a generalization. To make the breast look as natural as possible, I use a silicone implant placed underneath the muscle. I may also need to perform a breast lift or mastopexy. Unnatural results typically happen when the implant size is too large and placed above the muscle. Most of my patients after massive weight loss are wanting a natural look and not artificial or fake looking breasts. Congratulations on your weight loss and good luck on your breast augmentation. I hope this information has helped.
J. Timothy Katzen, MD, FACS
Q: My Menstrual Period is supposed to start several days after my Body Lift. What should I do? Cancel my surgery?
A: Dear Melissa:
Do not worry. I would continue with your scheduled 360 body lift, but let your plastic surgeon know. Sometimes the stress of surgery delays the menstrual cycle or can cause one to skip the cycle entirely for a month or so. Sometimes the stress of surgery also makes the menstrual cycle start earlier. If your menstrual cycle does start, let your plastic surgeon know. In addition, it is very important to use sanitary pads. It is imperative that you do not use tampons during that time because this can cause a very serious condition called toxic shock syndrome. Congratulations on your weight loss surgery. Good luck on your 360 body lift.
J. Timothy Katzen, MD, FACS
Q: I really want to get implants, but I hear they get hard and need to be replaced every few years. Is this true? Is there something I can do to prevent this?
A: Dear Lisa:
Loss of breast tissue after massive weight loss is very common. The majority of the female breast is composed of fat and after Roux-En-Y gastric bypass, gastric sleeve, duodenal switch, or LAP-BAND, there is a significant loss of fat. Included in this fat loss is a significant loss of fat in the breast tissue. In addition, the skin around the breast loses its elasticity and the breast deflates. Since there is a loss of volume in the breast, the volume needs to be replaced. There are a variety of ways to return volume to the breast. This can be achieved with implants, fat transfer, or even tissue transfer. My favorite way of breast reconstruction after massive weight loss is the use of implants. There are two types of implants, silicone and saline, and each have their inherent values. My preference is silicone because I feel they give a more natural result. They are FDA approved and are generally considered to be safe. Typically, I placed these underneath the muscle for the most natural results. There is a misconception that implants need to be removed every few years. This is not true. Most plastic surgeons believe that the implants only need to be changed if there are concerns about the implants. Concerns would be chronic pain, questionable issues on mammogram, or significant scarring around the implant. The scarring around the implant is called a breast capsule and this develops around any implant. The thickness of the capsule depends on genetics, surgical technique, type of implant, and position of the implant among others. To minimize your chances of capsular contracture, a silicone implant should be used and placed underneath the muscle. Ways you can decrease the chances of having the implants replaced would be to do breast massages after surgery. Congratulations on your weight loss journey and good luck on your breast augmentation.
J. Timothy Katzen, MD, FACS
Q: Breast Cancer runs in my family, is it risky for me to get Breast Implants? If not, is there certain type of implant I should get?
A: Dear Christine:
The risk of breast cancer is not increased by getting breast implants. In fact, implants are routinely used for breast reconstruction in patients who have been diagnosed with breast cancer and need breast reconstruction. You and your plastic surgeon need to discuss the risks and benefits of putting implants in with the breast cancer history. Also, it would be very important for you before your breast augmentation to get a routine mammogram as a baseline. The implant type does not matter, but I would suggest putting the implant behind the muscle. The reason I would suggest putting the implant behind the muscle is to allow radiologists in the future to see the breast tissue better. Congratulations on your weight loss journey and good luck on your breast augmentation. I hope this information regarding breast implants and breast cancer is beneficial.