– [Dr. Cohen] So, this was a very interesting case of a general situation that was improved with an implant years ago and no lift. So the patient aged, the right breast became very droopy, and the left breast had a old silicone implant in and which ruptured and migrated upwards because of the encapsulation reaction.
So this operation was involved because we needed to do a lift on the right side, remove the implant and the contracture on the left side, replace the left implant with something nice and modest, which was the patient’s desire, then be able to raise the right breast, and actually augment it as well as lift it to have it match the left side.
So I’m very happy. The patient was extremely reasonable and had very, very realistic expectations. So we’ll see in the coming weeks how it evolves and how it heals, but I think it’s going to be great.
– [Emily] Morning.
– Hey, Emily. How are you?
– Hi. And Jen and…
– What’s your name again? [inaudible].
They’re really nice, they’re great nurses. We have great nurses here.
All right, Jamie.
– [Jamie] Hey. – How are you?
– Fine. How are you?
– Good, thanks.
I was just signing the consent, getting everything ready for the paperwork, which is, of course, important. This is a very interesting case. It’s a revision case. Prior implants from a long time ago with capsular contracture on the one side, and some ptosis, or some droop, with some congenital asymmetry, or some difference to begin with.
So prior to her first surgery, I’m sure she had some congenital asymmetry. This is the case. It’s a revision case, not something that I did originally. It’s something that’s evolved over time.
…today. – [Patient] Breast augmentation and lift on both.
– Right. And so…
– Let’s review your history just a teeny bit because that’s what we usually do before surgery. You had implants how long ago?
– One implant in ’83.
– In ’83.
– When I was about 18.
– Right. And you’ve changed, your body has changed over the years. And what’s happened to the right breast?
– Sagged, it’s…
– And the left breast has done what?
– Well, the implant moved up.
– Right. So they’ve kind of gone in different directions.
– Okay. And your goal today, which is the same as my goal, is what?
– To have two even-looking breasts.
– Exactly. Okay. Soft, and pretty, and natural. Correct?
– Mm-hmm. Yes.
– Nothing overdone, not too much.
– Just the right size.
– How about size? What size bra are you currently?
– What’s funny, the implant is supposedly a C, but then I wear a D-cup. I don’t know why.
– Implants don’t come in A, B, C, D. Maybe when you had it done originally by the original doctor, they may have suggested that, “Well, this is an A. This is a B. This is a C.” Well, that’s really not true because the same implant can be an A, B, C, D on different people. Just depends upon what you have. So it’s addition. It’s what you have, plus the implant gives you some bra cup size that somebody at some place in a mall is now measuring you for. And if you go to a place, you know, two stores down in a mall, they’re going to measure you with something else. The fact that you were a C and now you may be a D is…
– I wear a 36D.
– Yeah. Eh, people age. Sometimes they put on a little bit of weight. Sometimes their bodies change. So that’s not… And then also, too, since you had it done, the sizing has probably changed. So they tend to flatter women more with larger cup sizes because everybody gets excited when they’re told they’re a D cup, and so, that’s kind of the way they do it now.
Yeah, the preoperative markings are important because when patients are on the table, laying down, then everything changes. Then, you know, it’s hard to know where you are in space. If you’ve marked it preoperatively in the standing position, then that’s what they’re going to hopefully look like afterwards.
– I’ve never had, ever. When I grew, it just didn’t grow right. And so now this is an opportunity to have… – Something… – …normal-looking breasts. I’ve never had, ever, normal-looking breasts.
– Yeah. Well, I think you will today. You really…
– I told you, when you’re growing up and you’re a teenager and things are changing, and mine weren’t…just weren’t.
– Yeah. Yeah.
– It was very traumatic.
– I’m sure.
– I’m sure.
– I’m nervous only because it’s exciting, sort of.
– Good, good. It should be. No, it should be. Yeah. And I’m happy for you.
– Now I’ll have something that looks nice.
– Good. I’m going to do a lift and more than likely use an implant. So she’s planned on two implants.
– For sure I’m going to use an implant on the left side, depending upon the look. So I may go back and forth. I think I’m going to start out with the left side first.
– Because I want to take the old implant out, I want to put something in. Get a nice shape. Then I’m going to start to shape the right side and depending upon what it looks like, then we may or may not put an implant in.
– You know what I mean?
– So, it’s…this is one of those interesting cases where we might go back and forth and back and forth. Start one side, kind of leave it temporarily, go to the other side. And so we’re building both so that they look the same.
– That’s right.
– Who’s anesthesia?
– Oh, perfect. He’s great. He’s really, really great.
– All right.
– See ya.
So now we’re just going to get the room ready. Patient has already spoken to anesthesia. I’ve already done the markings. She’s consented, ready to go. She’s very excited, so I’m excited for her, and she’ll be a great model. Although I do tummies, and eyes, and various other body parts, breast surgery… Primary breast surgery and revision breast surgery, are probably the things that I enjoy doing the most, so we get to do that a lot here.
So we have two operating rooms. One here. Just looks just like the hospital. It’s very up-to-date, modern, all the latest equipment. Anesthesia equipment, surgical equipment, endoscopic equipment, that sort of thing. Then we have another operating room right across the way, so sometimes when there are a lot of doctors needing to use the OR at the same time, you know, we have both rooms going, which is really nice. It’s a nice thing. And it’s ours, so we can make the schedule any way we want it and we’re never stuck waiting in line for other people.
In the operating room, we’re always attentive to sterile attire, technique. We give the patients antibiotics before surgery, give them antibiotics after surgery, use relatively little touch when it comes to breast implants. Some people call it no-touch technique. Try not to manipulate the implant very much, want to kind of keep all the germs and anything away from the patient that could potentially create a complication or a problem.
…go in and see if everybody is ready to go. So we have great anesthesia services. All the anesthesiologists come from St. Joe’s and they’re the best. We’ve worked with them for over 12 years and every one of them is really great. Really. They’ve even put me to sleep. Not during surgery, but on days that I wasn’t operating.
So anyway, everything went great. It really, really did. I think she’s going to be really happy, and I think she’s actually going to be pleasantly surprised because she wasn’t asking for the world, but I think we gave her the world.
– [Man] Right.
– It looks really, really nice. There’s one implant on the left side, and I took all the implant out that was ruptured, so…
– It was.
– Remember how we talked about it?
– Again, you know, you have an implant that’s in there for 20-some years, or 30 years, it’s an old-style generation implant, and I could’ve predicted, as I did, that it was ruptured. So we took out the hard capsule, took out the old implant, let that rest, and on the other side I did a lift and put a small implant in, and then adjusted the nipple. So I cleaned up the scar on the left side. We did a new lift on the right side, put implants on both sides, little bit different. More on the left, then less on the right. So it looks really, really nice.
– Yeah, okay.
– So I’ll see you in the recovery room.
– But she did great. She’s already awake, and Dr. Lennox from anesthesia took beautiful care of her.
– All right, good.
– Great. All right.
– Yell if you need anything.
So if you liked this video on breast surgery, share it. Share it with friends. If you have any questions, submit the questions, and we’d love to answer them for you. Look forward to seeing you here at Belcara Health.