A pproximately 300,000 women undergo some form of breast augmentation each year. While information on these procedures can be found online, the internet and reality TV shows (like Botched) can be misleading and ultimately increase anxiety before you even have your consultation.
Dr. Hall: Welcome to The Trillium Show, where we help you make the changes you want to see in your body, in your mind, and in your life. I’m your host, Dr. Jason Hall.
Dr. Hall: Every year approximately 300,000 women undergo some form of breast augmentation. There’s a ton of information out there on the internet about breast augmentation itself. Some of it’s beneficial and some of it really… isn’t. It’s very easy to go down the rabbit hole of patient horror stories on YouTube or get caught up watching episodes of Botched and thinking that you’re getting good information about breast augmentation procedures.
One of the big problems that I see with a lot of the information out there on breast augmentation is that many of the websites, and unfortunately mine’s included in this to some extent, make it seem that there are tons of decisions that you as the patient need to make in order to have a successful breast augmentation. Do you use a silicone or saline implant? Is the implant smooth or textured? Shaped or round? What profile is it, high profile, moderate plus, ultra high profile? Does your implant go over the muscle? Does it go on to the muscle? Where is the incision? In the breast crease, in the armpit, around the areola?
Quite frankly, none of these decisions are decisions that you need to be responsible for making. And I feel like this does the patient a significant disservice in terms of preparing for and having a successful breast augmentation. Should you understand all of those options? Absolutely. But this is cosmetic surgery, and so the most important thing for you is to get the result that you’re looking for. In the end, that’s why people have cosmetic surgery, in general. So, in this episode, we’re going to go over the main goals of a breast augmentation consultation, and offer some tips at the end to maximize the benefit of your consultation.
So, when we’re talking about the main goals of a breast augmentation consult, there are really four of them. Number one is we want to ensure that both you and your surgeon have the same goals in mind. Number two, that you’re a good candidate for surgery, both physically and psychologically; this is cosmetic surgery after all. Number three is to ensure that you and your surgeon are compatible personalities. If you don’t get along with your surgeon, if you don’t trust your surgeon, if your surgeon doesn’t get along with you or trust that you’re giving he or she accurate information, then online reviews, Facebook reviews, whatever, don’t matter; you need to go somewhere else. And then lastly, we want to ensure that you get the surgical date that best fits your schedule. So, let’s kind of break these down one at a time. So, your first goal is to make sure that you and your surgeon have the same physical goals for your surgery in mind.
Like I said before, I feel like the internet leads patients astray in making them think and feel like they have lots of decisions about how the surgery is performed that are their responsibility. I think this leads to a lot of anxiety and a lot of potential frustration, both before and after the surgical procedure. The most important thing for you as a patient is to determine what look that you’re going for. Really, the only way to do this is by looking through lots of pictures and finding pictures that look like what you ultimately want to look like.
In my practice, I look at the upper pole of the breast. Do you want a really full round upper pole or a more sloping, gradual upper pole that looks—the way I describe it is more natural? My wife and I recently redid a house and I really came to this during the renovation process because we would go through magazines and pull pictures of what we wanted the living room to look like. We had this huge folder of photographs that she’d torn out of magazines and things like that. Each one of them was completely different than the other one.
And when we sat down to look at them, it was, you know, one picture she liked the way that the light fixture looked in front of a fireplace, and another picture she liked the paint color on the wall, and another picture there was a sofa and end table that looked nice together, but all of the pictures are completely different. When I started asking patients to bring in photographs for breast augmentation, I found the same thing. And so now what I tell patients and what I have our coordinator tell patients over the phone is really go through—do your homework, go through and find one photograph that looks as close to what you’re looking to accomplish as possible, and then we can design our surgery, our implant type, implant style, saline or silicone, plan an incision around that result instead of having a patient come in and say, “Oh, I really want a 372 cc, high-profile, over the muscle implant, placed through an incision right here.” It works much better if we know where we’re going and then we can reverse engineer how we’re going to get there. The other analogy other than the house hunting analogy—or house renovation analogy—that I use during the breast augmentation procedure is that the operation itself is very similar to going to the store and trying on a pair of shoes.
When you go to the store, you may know that you wear a size eight in a Nike, but you’re going to try on a pair of Christian Louboutin or whatever it is shoe du jour that you’re looking for. Each brand, each style is going to fit a little bit differently, so while you may wear an eight in one brand, you may wear an eight-and-a-half in another brand, you may wear a seven-and-a-half in a different brand. And the augmentation process with implants is very similar. We stock a ton of different size implants, and when I’m actually doing the procedure, we’ll start with what we measure out based on your chest measurements and breast measurements, and what your ultimate goal is, but then in surgery, when we place that implant, it may look very different than what we were thinking and we have to shift a little bit. And so by not locking in on an exact size before surgery, but locking in on the goal and the result that we want, I’m able to be much more accurate with that surgical planning and not have my hands tied by promising a final implant volume or style in the consultation room. So, that’s where we are in terms of the importance of having a goal in mind.
So, our second goal is to make sure that you’re a good surgical candidate. And this is both from a physical standpoint and from a psychological standpoint. Plastic surgery, at the end, is about safety. Yes the result is vitally important, but if we’re not doing a safe operation—this is an elective surgery—we shouldn’t be there. So, making sure that there are no medical issues that need to be addressed is job one that I have as a surgeon.
Just case in point, a couple of weeks ago, within the span of 30 minutes, we found two breast cancers in patients that ultimately delayed their surgery to get further workup and treatment. The medical part, even though breast augmentation patients are by and large, young, healthy with no medical problems, we still have to do our due diligence as doctors and surgeons to make sure that the surgery is medically safe. Secondly, we have to make sure that you’re a good psychological candidate for surgery, that you have realistic goals and expectations of the surgery. For me, this is a woman who wants breasts that are proportional or roughly proportional to her frame, that her goals are reasonable given the existing breast and soft tissue support that’s there to cover an implant. An example of this is a young mother of three who has breastfed three children and desires an augmentation and brings in a picture of a 19-year-old bikini model who’s obviously never had kids.
We have to have a real discussion about goals and expectations there because the goal that you can reasonably achieve as a mother of three and a goal that you can reasonably achieve as a 19-year-old who’s never been pregnant are very different. The tissue is very different, and that is going to significantly influence the result that we’re going to be able to achieve.
And then lastly, we need to make sure that you have appropriate perioperative support. That’s friends and family who are going to be with you, who are going to help you through the surgery process. Surgery is not like going out and getting your hair done or getting your nails done. It is a major invasive procedure and needs to be taken seriously. You need support—both physical support for the day of surgery when you’re coming out from under anesthesia—and then emotional support as you go through the emotional roller coaster immediately after surgery, which we spend a lot of time talking to with patients during their pre-op evaluation, and is a good topic for another podcast, down the road. So, having that support around the time of surgery from either friends or family is very important.
The third main goal of your consultation is to ensure that you and your surgeon are on the same page. Plastic surgery is as much art as it is science, and you want to make sure that your surgeon, who will ultimately be making a lot of the artistic decisions in the operating room with you asleep, you want to make sure that the two of you see things very similarly. This is where pictures come in. Also, by looking at your surgeon’s before and after pictures on their website, you get a good feel for your surgeon’s artistic eye. The pictures that you see on the website are kind of their default setting; this is where they’re going to aim for when they’re in the operating room and there are little artistic decisions to be made. So, you’ve got to make sure that if you like that their before and after pictures on the website are things that you would look at and say, “Okay, that looks pretty.” If they’re not, you need to move along. Thinking that you’re going to get something that hasn’t even been approximated is not a realistic expectation.
Secondly, here—and this is a part that nobody really talks about—is that you want to make sure that you and your surgeon get along. The surgical process really is about building relationships. Having a good doctor-patient relationship before surgery is crucial; having it after surgery is equally as important. And in the fortunately very rare event that you have a complication, you’re going to be spending a lot of time seeing your surgeon, seeing their office staff; you and your surgeon have to be able to work together and be partners in the journey to get over a complication, should it happen, to end up with a successful outcome. You and your surgeon meshing personally is very important.
Lastly, when you show up for your consultation, you want to make sure that you get the surgical date that you want. With cosmetic surgery, a breast augmentation is a fairly short procedure. Most of them take an hour or less, and so the surgical time isn’t a significant time investment. But you have to budget for time off work, you have to budget for time out of the gym, time off of school if you’re still in school. And so you want to plan that so that when you show up for your consultation, you have an idea of surgery dates that are available that work with your schedule ahead of time.
You also want to be able to plan time off to be able to recover. And this is very important that most patients seem to be caught off guard about recovery time and budgeting that recovery time in. In my practice, what breast augmentation recovery time looks like is two weeks of no exercise and then four more weeks of no arm exercises, no bouncing exercises—so running, things like that. So, you really need to plan for about six weeks out of the gym. And this is important because we want that implant to heal in place before we start stressing it. We want the scar capsule that forms around these implants to start to set up before we start jostling that implant around. This is especially true if we’re talking about using a textured breast implant, which is shaped and is supposed to really, kind of, stick to your body. And that is a topic for a different podcast.
So, in terms of time off from work, that typically—for a straightforward breast augmentation—is a long weekend, maybe. For a lift with implants, you’re talking about a week, week-and-a-half off of work, depending on what we need to do. And so, these are also things that you really want to have in mind, discuss with a patient coordinator over the phone before your consult so you have a good idea of where in that surgeon’s schedule your surgery can fit that also meshes with your schedule. Here’s a little tip for everybody: most busy cosmetic surgeons are typically booked—their surgery schedules are typically full—for a few months from the time you call. So, this is another thing, discuss that with a patient coordinator on the phone before your consultation, so you can plan your consult and plan your schedule around available surgical dates.
So, those are the main goals of the consultation is to, number one, ensure that you and your surgeon have the same physical goals in mind; number two to ensure that you’re a good candidate for surgery, both medically and psychologically; number three, to ensure that you and your surgeon are compatible and get along, and lastly, we want you to make sure that you get the surgery date that best fits with your schedule.
So, here are some tips in terms of consultations and, kind of, how to work the system a little bit to get what you’re looking for. So, on the day that you book your consult, most modern practices have some form of online platform to do complete paperwork. You want to click on the link that you get emailed or sent via text, and fill out that paperwork as soon as possible. Some surgeons—and this is the way we do things in my office—have a waitlist, and preference on that waitlist is given to patients whose paperwork is complete and they’re ready to go. In the event somebody cancels a day before their scheduled consultation or two days before, it’s a lot of hassle to try and call through the list, get somebody who’s not scheduled for a consultation for another month or six weeks to rearrange their schedule, and get their paperwork done and all of that, so preference is given here to patients who have already completed all their paperwork and it’s just a matter of making schedules fit.
So, get that paperwork done early. The other thing that you should be doing, if you haven’t already, is start going through the internet, start going through your surgeon’s before and after pictures, start looking through Instagram, start looking through other online platforms, and narrowing a list of wish pictures down to one or two that you really like so when it comes time to bring that one in, you’re prepared with that.
The third thing to do is to really figure out who—if anybody—needs to be involved with you during the consult process, be that a spouse, a significant other, a best friend, that can be there with you to go through the consult to listen because two pairs of ears are definitely better than one and there are some things that with nerves, and a lot of new things and new people, the consultation is a little bit of a nerve-racking process anyway, you want two sets of ears to hear what’s said so that you don’t miss anything.
And lastly, if you’re over 40, get a mammogram scheduled with your primary care doctor if a potential surgery date would be more than a year from your most recent one. And this is just a safety thing. We want to make sure that we have a good baseline mammogram that we’re not missing anything before surgery. As I said, we’ve had in the last few months, we found two breast cancers in the span of half an hour this way, so it’s very important.
Then on the day of your consultation, you want to make sure you bring some things with you. One—and arguably the most important—is the photo you’ve chosen, your calendar—phone, whatever—with a list of tentative dates, and you want to make sure that you’re ready to pay the scheduling fee to get yourself on the schedule. And lastly, plastic surgery consultations, while they can be nerve-racking, should be fun. This is something that you’re looking forward to, everybody in the office is looking forward to helping you get to where you’re looking to go, and so bring a great attitude; this is exciting. So, I hope you have found this informative.
Like I said, this is a very common part of our practice; breast augmentation is easily the most popular cosmetic procedure in the country, year over year, and so I wanted to put this podcast out to give everybody some background and help make your consultation the most successful it could be.
Dr. Hall: Thanks for listening to The Trillium Show. You can keep up with the latest on the podcast at jhallmd.com. Be sure to follow us on Spotify, Apple Podcasts, or wherever you listen to podcasts. If you want to connect with us on social media, you can find us at@jhallmd on Instagram and Twitter and@DrHallPlasticSurgery on Facebook. Remember, be the change you wish to see in the world.