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Real Patient Questions Answered by Dr. Ghaderi
- 25+ Years Experience, 18 Patient Choice Awards
- Board-Certified Plastic Surgeon in St. Charles, IL
- Trusted, Personalized Plastic Surgery Care in the Chicago Suburbs
Real Patient Questions, Answered
BY DR. GHADERI
The questions below are real questions patients have asked online, answered by Dr. Bahram Ghaderi, MD, FACS, a plastic surgeon certified by the American Board of Plastic Surgery in St. Charles, IL. To respect everyone’s privacy, we’ve removed all names and identifying details. They reflect the thoughts, concerns and curiosity of patients just like you.
Every patient is different, so these answers are general information, not a diagnosis. For advice about your own situation, schedule a consultation with Dr. Ghaderi.
Choosing a Surgeon
Patient question: I have two consultations for breast reduction scheduled for next month. I have large breasts (40J) and know breast reduction would be beneficial. Insurance won’t cover it, so I’ll pay out of pocket. Surgeon 1 is certified by the American Board of Plastic Surgery and has only a few pictures on his website, but they’re all of patients with smaller breasts than mine. Surgeon 2 is certified by the American Board of Cosmetic Surgery and the American Board of Surgery; he also has multiple pictures of his work on his website with patients who look similar in size to me. What is the difference between these certifications? Should one be considered over the other for a breast reduction on larger breasts?
Dr. Ghaderi: First off, it is great that you are paying attention to the type of certifications your surgeons have. The size of your breast does not determine the skill level of the surgeon. But there is a difference between a surgeon who is certified by the American Board of Plastic Surgery (ABPS) and one certified by the American Board of Cosmetic Surgery (ABCS). Surgeons certified by the ABPS have completed specialized plastic surgery training, usually 3 years beyond their other surgical training. A typical ABPS-certified surgeon has 6 to 8 years of training after medical school. They have passed comprehensive exams in both cosmetic and reconstructive procedures. The ABPS is the only board recognized nationally as the standard bearer for appropriate training, credentials and continued education.
For a breast reduction, a surgeon certified by the American Board of Plastic Surgery would be ideal, since that certification reflects extensive formal training in plastic surgery. Of course, meet with an ABPS-certified plastic surgeon you feel comfortable with.
Breast Augmentation
Patient question: I am planning my first breast augmentation and feel stuck between the techniques my preferred surgeon offers. The Preserve breast augmentation (a Motiva surgical kit marketed as “tissue sparing”) sounds promising and could theoretically avoid general anesthesia. However, the surgeon has far more experience with the traditional method, over the muscle, and has only done about 100 Preserve cases. They didn’t seem convinced it is any easier to recover from. Should I weigh the surgeon’s experience more heavily than the technique?
Dr. Ghaderi: I can understand how overwhelming it can be researching your options for breast augmentation. The Preserve method is a newer approach, and less is known about its long-term results and side effects. For some patients, “a new method” might be appealing, but for most it does not necessarily provide an advantage. The traditional approach to breast augmentation has provided great results, with more predictability. Recovery is generally quick (2 to 3 days before going back to work and driving), with limited discomfort.
Most patients having breast augmentation may not have enough tissue coverage to have their implants placed above the muscle, which rules out the Preserve method, since it uses above-the-muscle placement only. Once you have a surgeon you trust, I would suggest following their recommendations rather than choosing a method that may or may not be beneficial.
Patient question: I am 37 and breastfed all 4 of my children for almost 9 years total. I am now 2 years out from that and my breasts are totally deflated. I am in great shape and work out 5+ days a week. I don’t think I need a lift, but my skin quality is not what it used to be. I love the idea of subfascial placement, but I want these to age well, and I have very little tissue to hide the implant. I’m only interested in a smaller implant, around 180 to 275cc. I don’t love the idea of under the muscle because of how I work out, but if there is a long-term advantage, I will do it.
Dr. Ghaderi: There are pros and cons to both above-the-muscle (subglandular or subfascial) and below-the-muscle (submuscular) implant placement. Patients who choose above-the-muscle placement are usually concerned about animation deformity, which is the implant’s shape changing when the chest muscle contracts. Heavy weightlifters tend to want implants placed above the muscle so heavy chest exercises don’t affect the implant. Implants placed below the muscle have a more natural look, better mammogram readings and a lower risk of capsular contracture.
Ideally, you should be evaluated in person by a reputable board-certified plastic surgeon who can recommend the best option for you. Be careful of fads that come and go, and stick to proven methods that have had success for decades. If you have thin tissue, visible rippling, which happens more with above-the-muscle placement, will negatively affect the look you want to achieve.
Patient question: I’m 25 and really want this surgery, but I keep debating whether it’s worth doing now or waiting until I’ve had all my kids. I don’t have kids yet but want at least 3, starting in 1 to 2 years.
Dr. Ghaderi: Many women have breast augmentation before having kids. The pros are that implants do not affect getting pregnant, so if you want larger breasts now and kids later, you do not have to wait to have surgery. Implants can provide fullness that is sometimes lost during pregnancy and breastfeeding, and many women can breastfeed after augmentation. The cons are that the breasts go through a lot of changes during pregnancy, so their shape and volume may change afterward, and that change may call for additional surgery, such as a breast lift. Meeting with your board-certified plastic surgeon will help you compare the pros and cons for your goals.
Patient question: How many weeks do you typically tell flight attendants to wait before returning to work? Job duties include closing overhead bins, pushing and pulling large carts, lifting 50 to 70 lb bags into overhead bins and reaching over seats. Procedure is a primary breast augmentation, dual plane, with nipple/areola correction, using implants around 400 to 450cc.
Dr. Ghaderi: I have many patients who are flight attendants and undergo breast augmentation. Typically, it is recommended that flight attendants not fly for about two weeks after surgery. There is a lifting restriction of no more than 5 to 10 lb for the first week, which increases weekly from there, so that may determine when you can go back to work. Individual recovery varies, and your surgeon will recommend when it is best to return to work.
Patient question: I’m looking to go quite large, as large as I can go honestly. I don’t mind some sagging and am not opposed to a lift in the future.
Dr. Ghaderi: Yes, you can have a large implant placed without needing a breast lift. The size of the implant will depend on the measurements your surgeon takes at your consultation and how large an implant is safe for your frame. A larger implant may cause your breasts to sag because of its heavier weight, but that is not a given. A breast lift can always be considered down the road.
Breast Reduction and Lift
Patient question: I am currently a DD and would prefer to be a C cup, but I want fullness in the upper breast and don’t want to rely on a bra for cleavage. I don’t want the deflated upper-pole look I see in many reductions, and I don’t want them sitting too high or looking obviously implanted. Many consults have told me that a lift with implants defeats the purpose. I am a healthy 49-year-old.
Dr. Ghaderi: Yes, the look you want is possible. It may take two surgeries to get exactly the look you want, but if you are patient, the results are great. The first surgery would be a breast reduction and lift, which makes the breasts smaller, reduces sagging and creates a good foundation. Once the breasts have healed, the second surgery places a small implant, which gives you the upper-pole fullness you mentioned. This staged approach can give you a lifted breast that still has upper-pole fullness. A board-certified plastic surgeon can tell you if you are a good candidate.
Patient question: How effective is a liposuction-only breast reduction?
Dr. Ghaderi: In some patients (generally older patients with more fat in the breast), yes, a breast reduction can be done using only liposuction. Liposuction limits the amount of fat that can be removed and does not address sagging. A traditional breast reduction is a better option for removing larger amounts of breast tissue and fat and lifting the breasts. It is best to be evaluated by a board-certified plastic surgeon to determine which method is right for you.
Implant Removal and Revision
Patient question: I’m having my implants removed 4 weeks after augmentation because I feel it was a mistake and want my breasts back. I’m 33, have never had kids, and my skin quality was good before surgery. I went from a 34A to 350cc textured implants under the muscle. Will a capsule have formed that needs to be removed with the implant, and will my skin bounce back?
Dr. Ghaderi: I am sorry to hear you regret your decision to get implants. It’s important that you feel comfortable and confident with your results, so I understand wanting them removed. It is normal for a capsule to start forming around the implants at one month after surgery. You are still recovering, so the capsule is not as established as it is in someone who has had implants for years. In many cases, the implants can be removed without removing the capsule. Your surgeon can evaluate at the time of surgery whether you need any capsule work.
Patient question: I’m 74 and have had silicone implants for 40 years. I just found out they are ruptured but still inside the capsule. Where do I go from here?
Dr. Ghaderi: The next step is to meet with a board-certified plastic surgeon for a consultation. They will evaluate you and determine the best surgical plan, depending on your overall health and ability to undergo surgery, possibly with general anesthesia. They can discuss removing or replacing the implants and whether any scar tissue or capsule needs to be removed. If a rupture is suspected because of symptoms, an MRI may be recommended to confirm the implants have in fact ruptured.
Body Contouring
Patient question: Is it possible to get a tummy tuck that just removes excess skin and fat without work on the abdominal muscles? I’ve also heard that after fat is removed from the belly, you gain weight in other areas because the fat just goes elsewhere. Is that true?
Dr. Ghaderi: Yes, a tummy tuck can remove excess skin without tightening the abdominal muscles. Not everyone needs muscle repair. If your abdominal muscles aren’t separated, meaning your abdomen doesn’t look rounded or bulge forward, you may not need a tummy tuck with muscle repair. The best way to know is to be evaluated by a board-certified plastic surgeon.
Removing fat and skin with a tummy tuck does not make fat go to other areas of the body. That fat and skin is removed permanently. But if you gain weight after surgery, you can gain it in other areas of the body as well as your abdomen.
Patient question: Can a breast enhancement and an arm lift be done at the same time?
Dr. Ghaderi: Yes, a breast enhancement procedure can often be done at the same time as an arm lift. We do this commonly, since these are common areas of concern for patients after significant weight loss. Combining both procedures treats two areas with one surgery and one recovery. At your consultation, a board-certified plastic surgeon can evaluate whether this combination is safe and right for you.
Patient question: I’ve lost a considerable amount of weight and will likely need 2 to 3 surgeries, starting with an extended tummy tuck. Since I’ll already have downtime from exercising, could I have the arm lift (brachioplasty) 2 weeks or a month after the tummy tuck, or is that a recipe for disaster?
Dr. Ghaderi: Consider what each recovery involves. Tummy tuck recovery requires a lot of arm mobility, such as getting in and out of bed, while an arm lift limits the use of your arms. It is best to wait at least 3 months between the two procedures so you have plenty of time to recover from one before starting the other, with minimal setbacks. If you are also considering breast surgery, an arm lift is a good combination with a breast enhancement, lift or reduction to save on recovery time for your overall body contouring journey. Your surgeon will determine the best timing for both procedures.
Eyelid Surgery
Patient question: I’ve been thinking about upper eyelid surgery, but I wonder whether it will be enough to open my eyes. I have obvious extra skin on my eyelashes, and a lower-set brow doesn’t bother me as long as my eyes aren’t covered by skin. Can I do well with just eyelid surgery, which is faster and less costly?
Dr. Ghaderi: Yes, upper eyelid surgery will definitely open your eyes. The result of eyelid surgery is a more alert and rested appearance, which sounds like what you want. Meet with a board-certified plastic surgeon to be sure a brow lift is not needed. Many times, an upper eyelid lift alone will accomplish your goal.