Michael A. Bogdan, M.D., FACS
How long should you wait after breastfeeding to get a breast augmentation?
While breastfeeding, your breasts will be enlarged with milk. For some period of time after stopping breastfeeding, your breasts will involute (shrink). You want to be certain that the breast has stopped shrinking before considering augmentation, otherwise your breasts will not be as full as desired after surgery. It is reasonable to consider augmentation somewhere between 3 to 6 months after finishing breastfeeding. The actual time will depend on how much your body changes and the preference of your surgeon.
I have saggy breasts and I'm only 21. I'm considering a breast lift or a breast augmentation. Which one would be better?
To answer in simple terms: it makes sense to treat the problem. If you have saggy breasts, then a lift is most appropriate to raise them "up." If you have small breasts, then implants can make them bigger. If you have saggy breasts and choose implants, you will end up with larger saggy breasts. This is a choice that some women lean toward, mainly because they want to do "something" with their breasts, but are averse to the scars that are necessary to perform a lift procedure. (A lift has more visible scars than an augmentation.) If these women later decide to perform a lift, the procedure has a higher risk profile than if they had first proceeded with a lift and later chose implants to add volume. Continue to educate yourself by looking at before and after pictures of both breast lifts and augmentations (pay attention to the relationship of the nipple to the infra-mammary fold on the side view photographs). See if you can find patients who have the same amount of sag as you do, and decide which post-operative appearance you like best. After you have formed your opinion, consult with an ASAPS member surgeon to discuss your options and get their input.
Would like to learn more about the types of breast implants-silicone vs. saline and the cost.
Here is a brief answer: Saline and Silicone implants can both be used for primary breast augmentation. They are mechanically different, and neither is perfect. As with any surgery, you have to weigh the pros and cons of specific choices, and decide which option is best for you. Here are some points: Similarities
- Both implants add volume to the breast and are available in a number of shapes, sizes, and textures
- Both implants have a silicone elastomer shell. Since the shell is flexible, it has the possibility of developing fatigue cracks and leaking sometime during the life of the implant
- Surgical risks (bleeding, infection, scar, deflation, capsular contracture) are present with both implants
- Cost less, tend to be easier to "feel" in thin patients, have more issues with visible rippling, and wall defects are easy to identify (the saline is absorbed by the body, and the breast deflates)
- Cost more, are thought to feel more like breast tissue, and have less rippling issues
- The FDA reserves the use of silicone implants for women age 22 and older, and recommends surveillance MRIs to check for wall ruptures (as there is no other reliable test). The MRI is an out of pocket expense, which means these implants have a "maintenance cost" of roughly $500-$600/year.
Prices for implants vary regionally across the US, so you will need to check with the physicians that you are considering. A great resource to learn more about the implants is:
Can you have a tummy tuck and hysterectomy performed at the same time?
If you are of good health and the hysterectomy is being performed for non-cancerous indications, it might be appropriate to combine it with an abdominoplasty operation. The best way to approach the situation is to discuss your goals with your gynecologist as well as an ASAPS member surgeon who performs abdominoplasty operations. Combined operations do require coordination between both doctors, so they can discuss the plans and make certain the procedure can be performed safely. In some cases, it is not appropriate to combine the operations, but it is still beneficial to coordinate the plan before proceeding the the hysterectomy. In these cases, it is worth discussing the type of scar to be utilized such that your gynecologist will have full exposure for the hysterectomy, and can later be fully removed in a follow-up tummy tuck. (Generally, an open hysterectomy scar can be fully removed with a tummy tuck, but some laparoscopic hysterectomy approaches will leave “tell tale” scars that will not be removed by the tummy tuck.)
I have what I think is called pixie ear, my earlobes are attached to my cheek/jaw, and I would like to know what is involved to give me a normal shaped earlobe.
A “Pixie Ear” is present when the earlobe is not clearly defined and seems to originate from the angle of the jawline. It can occur naturally as a normal variant, but is more commonly seen as an untoward result of a face lift procedure. This can occur if the surgeon did not accurately predict how much contracture (shrinkage) would occur with the cheek skin, and set the earlobe position low. It can be directly corrected by releasing the earlobe, closing the defect where it was attached, and then repositioning the earlobe in a higher position. This repair results in a visible scar running down from the ear, and is not optimum. The best repair is performed by advancing the cheek skin towards the ear, and securing the earlobe in the correct position. This repair is effectively a facelift, so it can only be performed if enough skin laxity is present. In most patients with congenital pixie ears, there is enough skin laxity to proceed with a facelift. However, if the pixie ear is the result of a recent facelift, it is unlikely that enough skin laxity is present to allow for a repeat procedure and some time (5 years or so) will need to pass before a revision can be entertained. The best way to assess your situation is to consult with an ASAPS member surgeon who performs facelift procedures and discuss your goals.