Tag Archives: breast augmentation



If we’re taking bets on a woman who is at least partially clothed, without X-ray vision even a plastic surgeon has to admit, “No.” But that doesn’t mean there’s not some help going on. There’s all kinds of smoke and mirrors out there. The bionic push-up bras aside, I’ve had patients go down two cup sizes in the exam room once they remove the Victoria’s Secret water bags. And even though they’re just meant to try on in the office, I swear that my supply of sample “try-on” breast implants has definitely dwindled down over the past few years.

Don’t even try to decipher the ones you see in magazines. Even the implants are photo-shopped—-here’s a lovely video about that from one of my old posts that I highly recommend 🙂

Of course, there are the obvious ones, like the ninety-five pound woman sporting a DD cup, or the one who looks like she has melons pushing up to her chin.

But those are obvious to everyone. So maybe a better question to ask is:

“Why do some breast jobs look fake and others don’t?”

Even here in Beverly Hills, most women seeking breast augmentation—whether it’s a college graduation present or part of their mommy makeover–want to look “natural,”  “in proportion to their body,” and often have it done so “nobody can tell.”

In my experience, the most important variables involved in achieving a natural-appearing breast augmentation with an implant are:

1)    The size of your breasts to begin with.

Especially the width. As a breast implant size increases, so does the base diameter. Your goal may be a D cup, but if your chest wall is too narrow, the implants will not only stick out on the sides and disrupt your natural anatomy, but this is a set-up for unnatural shape, rippling and implant malposition down the road. When I help a patient choose a breast implant, I recommend keeping the base diameter of the implant at about one centimeter narrower than the base of her breast.

2)     Your skin envelope.

Is there room in there for the size implant that you want, or is it going to be so tight that the implant will never drop? Chances are, if you’ve had children and breast fed there will be plenty of room, but not always. Also, skin in darker and Asian women is usually thicker and has more elasticity, so it doesn’t stretch as much for a big implant.

3)     How much breast tissue do you have now?

Can you pinch at least two centimeters of thickness? If so, if you go with a size-appropriate implant, you probably have enough tissue to camouflage the upper border so there won’t be that obvious ledge. Having your implants placed “under the muscle” or sub-pectoral also helps avoid this problem.

4)     What is the distance from your nipple to your inframammary crease (the fold underneath your breast)? This usually depends on whether you have tuberous breasts or not. If the distance is closer to ten than five centimeters, you are more likely to get a natural, tear-drop shape result with a breast implant, as opposed to a round one.

So–again, keeping it G-rated—with all of the above information, can you tell which of the women below has had breast implants?

The answer is, of course, ALL OF THEM (I mean, come on, this is L.A.)

I grew up in New York where everyone got nose jobs, but I’d never even heard of anyone having a “boob job.” You just started every high school summer promising yourself that this was going to be the year, you were just a late bloomer and somehow you were going to show up at school in September with a C cup. And if it didn’t happen, well…the only option was to learn to live with it and develop your personality. Even in Northern California where I went to college, I remember hearing about one girl on campus who was rumored to have had breast implants and it just seemed so unfathomable to me. I mean, how could her parents let her do that, and where would you go to even do such a thing?

Well, I soon found out. And what I also found out was that unless you’re talking about a twenty-one year old girl with perfect natural C-cup breasts, breast implants actually usually look do better than the real thing.

I remember when my plastic surgery chairman at UCSD took his daughter to a Britney Spears concert (yes, this was a long time ago, before she’d even been married the first time or had any kids). They had really bad seats, and although they’d had to watch the show through binoculars,  he did get a good close-up look at Britney in her risqué costume, and he said that she had breast implants. This was when she was a teenager, long before such an accusation was even hinted at in the media, so I asked him how he could know such a thing without seeing her naked and he said, “Because they look too good.”


So since then whenever someone asks me, “Do you think those are fake?” my expert plastic surgeon’s answer is always:

“If they look too good to be real, then they’re probably not.”



First I have to make it clear that I despise the catch phrase “Mommy Makeover”—I’m only using it because I need the keyword. I feel like it’s a name that a male plastic surgeon somewhere thought up and decided was total genius–and for some reason it has been perpetuated in the media. For me, the term “mommy makeover” is like nails on a chalkboard—it conjures up images of the flat-ass suburban housewives of my mother’s generation, walking around in high-waisted mommy jeans with a kid balanced on one hip.

Regardless, whether you call it a “Mommy Makeover” or “Breast and Body Contouring,” after you “finally do it!” and spend your time and money to have your body sculpted and/or your breasts made bigger/smaller/perkier, and you soldier through the recovery, you need to throw out your “fat” clothes. Because if you don’t, you’re still going to feel fat.

It’s a crucial part of the transformation. If you continue to wear ill-fitting, baggy, saggy clothes, you will continue to see your body the way it was before. Once my patients are six weeks out from a body contouring procedure, they are no longer allowed to troll around in oversized jeans and huge hippie tops and complain that they don’t feel any different (you ladies know who you are.)

And don’t fall into the trap of hanging on to old clothes for emotional reasons–although I myself am guilty as charged. I am the first—and last—to admit to being an emotional clothes hoarder. My sister, who is a major professional stylist and the fashion director of Who What Wear, edits my closet on a quarterly basis, but sometimes…I have to sneak things back in.

So what relics do I have, taking up space, hidden from my fashionista sister?

1)   A pair of Gotcha bikini bottoms from 1989, a time in my life when I actually enjoyed wearing a bathing suit in public:


Now I should probably just have them framed.


2)   A pair of 1997 Miu Miu cork wedge sandals that were so comfortable that I wore them practically every summer day for the next ten years:


I have lost count of how many times I’ve had them refurbished by Levon at the European Shoe Repair in Malibu, and then at Arturo’s Shoe Fixx in Beverly Hills. It’s been nearly fifteen years, and they are no longer wearable in public, but I’m thinking about getting the entire shoe rebuilt around the amazing buckle.

1)   And my favorite: A 1997 Nicole Miller dress that kind of resembled the Partridge family bus:


Screen Shot 2013-06-16 at 11.20.34 PM

There is rarely an article of clothing that I fall in love with at first sight. But the minute I saw pictures of that dress plastered on every bus stop billboard across Manhattan, I became obsessed with finding one.

Apparently, I wasn’t the only girl who felt that way, because the Nicole Miller store only only had one left—fortunately in my size (a true “four” from the time before there was such a thing as a “double zero.”)

I wore that dress every chance I got, everywhere I went, often with my prized Miu Miu sandals.…not that I had many places to go, since I was a general surgery resident at the time. Then came the heartbreaking day in 2004 when I over-wore it at a plastic surgery graduation party in a dive bar, and ripped the hem in half.

“It would make a nice shirt,” my sister suggested. “Besides, it’s not really in style anymore.” But I was resistant. There was too much nostalgia wrapped up in that dress—all of my under-thirty adventures. I couldn’t give up on it. Eventually, the tailor at Colony Cleaners of Malibu managed to salvage enough of it to turn it into a very short mini-dress.

But it was bittersweet to wear it as a mini-dress, especially now that my skin was almost ten years older as well and I really shouldn’t have been leaving the house bare-legged without a spray tan.

I only wore it twice. The second time was on a whim, to a fashion event at the Chateau Marmont in 2007. My sister had gotten me on the “list,” but she was out of town, so I was on my own. So there I was, walking around this fabulous little soiree by myself, ignored by all the truly fabulous fashion people around me, yet reminding myself how fabulous it was to be there at all, at a party at one of the private Chateau Marmont bungalows, when an attractive, elegant red-headed woman pointed at me and said, “That dress!”

I went from feeling completely out-of-place to ecstatic. At least someone here appreciated my truly phenomenal style. I proceeded to fill her in on the dress’ entire history: “Oh my God, don’t you love it? It’s a Nicole Miller! I got it in 1997. It was the dress of the year! It was on every bus stop billboard in Manhattan! It wasn’t always this short. It used to be below the knee but it got ripped and I had to have it shortened—“

The Redhead did not seem to find my story charming. Or entertaining. She simply looked at me like I was a complete moron and said, “I’m Nicole Miller.”

At which point I became completely starstruck and began babbling even faster until she cut me off with: “You’ve had that dress since it was new?” as if even she didn’t approve of keeping such a relic. Then she added, “I like what you’ve…uhhh…done with it.”

I’m sure she was flattered, but in general, you probably shouldn’t wait until you run into the actual designer to question why you’re hanging on to something that’s over a decade old, and no longer in style.

Which, in a roundabout way, brings us back to the point. Once you’ve spent the time and money on a lipo, tummy tuck, breast aug/lift/reduction—and your shapely body has been uncovered–you should only wear clothes that fit you.

In the first few weeks, you may have swelling in areas that will keep even your “fat clothes” from fitting. Do not despair! This is a common early complaint. As I tell all of my patients—your body doesn’t know that you did this on purpose. On a cellular level you may as well have a huge third-degree burn. Your body has to heal itself, and the way it does so is by pouring fluid into the space of injury (this is known as third-spacing fluid.) 

Think of your body like a sponge. For at least the first six weeks, you need to wear your compression garment as much as possible to squeeze all that fluid back into your bloodstream. It’s going to take a while—after two weeks you should really start seeing it go down, but it could take up to three months (and sometimes longer) for the healing to be complete. And often times, even after the three-month mark, you may experience fluctuation of the swelling with activity. Once you can tolerate massage, ultrasound and infra-red treatments, try to get them as often as possible to help decrease swelling and expedite healing. I send my patients to the Brighton Institute in Beverly Hills, but most physical therapy centers or chiropractors in your area should also have the equipment.

I know that as the swelling goes down, the issue becomes wearing a cumbersome, uncomfortable garment under your more form-fitting clothes. Our  Lipo Queen™ by Design Veronique® shapewear can be used as a second-stage garment, and is almost invisible under clothes, even your skinny jeans.


Wait till about six weeks to start shopping. I had to do an intervention on a patient in the office this week—she’s ten days postoperative after a full body lipo and she was just about to order a couture gown in her old size. What was she thinking?!?  I mean, what did she think she paid me for?

But you don’t have to go to Barney’s and spend an outrageous fortune on designer duds crafted by the Olsen Twins. At six weeks just start treating yourself to cute clothes that fit. Go to Old Navy, Target, the Gap. The Gap is really good these days. And I don’t know about you, but those vanity sizes are always good for my demeanor.

For instance:



This woman is three months postoperative from a full body liposculpture in all of these pictures, but in the one where she’s hiding under a big, baggy sweater, you can’t tell.


And here she is in yoga pants, which are always flattering. 🙂

This patient is two weeks postoperative, in a baggy shirt vs. a tight tee:IMG_1408




Even without seeing her face, doesn’t she look younger in the more fitted clothes?

If you’ve finally rid yourself of those stubborn bulges—whether by way of diet and exercise, or a little help from a friend ;)—and you’re wearing clothes that fit the new body that you don’t hate anymore, you will just naturally start living a healthier lifestyle. With more confidence, your sex life could improve. Your workout gear will look cuter and you’ll probably exercise more, get in better shape, and you might find yourself in a productive vicious cycle. Before you know it, you’ll be staving off hypertension and heart disease without even trying!

I rest my case. Meanwhile, although Nicole Miller didn’t seem too enthused about my suggestion to bring back the Partridge Family Bus dress, I haven’t given up hope. I’m still searching the billboards on Sunset Boulevard.

So here’s a shout-out to Nicole Miller and her team: How about a Lipo Queen Limited Edition?!? 😉



Well, now of course. 😉

No, seriously–this advice is not coming from someone who makes a living contouring women’s bodies. This is girlfriend-to-girlfriend chat, from someone who’s had it done herself–about how and when to do it on the down-low. Because if you’ve been thinking about it, pinching those areas you just can’t get rid of at the gym, and years have gone by because there’s always a scheduling conflict, the time window between Halloween and Thanksgiving is as optimal as it’s going to get. It’s like everyone always says, “there’s never a good time to have kids,” except I can pretty much guarantee that having liposuction is much easier.

The deal-breaker for most of us when we want to “get something done” is the down-time. With body contouring, these are the main questions:

For how long am I going to be out of commission?

Fortunately, the thing about lipo is that since there is no muscle work involved in the procedure, (like when you have a breast augmentation, and the muscle has to be lifted to place the implant) and there are no big incisions to protect postoperatively (like with a tummy tuck or breast reduction), you are limited only by your own discomfort. There’s really nothing that you’re going to do that will “ruin” your results. All that’s going to happen if you “overdo” it is that you will get tired, achey, and more swollen. I recommend to my patients to take a week off from “responsibilities”(i.e. work, participation in school activities, social gatherings, strenuous exercising) but it’s not a week in bed. You can do whatever your body allows you to do. That’s not to say that you should do what I did–go Christmas shopping the next day and suddenly realize six hours into it, half a mile from your car in the mall parking lot, that you’re not feeling so great. Because the truth is, after lipo you don’t really feel “sharp” pain. Speaking from my own experience–and most of my patients agree–it just feels like you worked out really, really, really hard. Like you did a million sit-ups or ran a marathon. Just, no matter how good you think you feel, don’t stray too far from your home or mode of transportation.

But how long till I can work out again?!?

I know, I know, telling many of you that you probably won’t be able to work out strenuously for a few weeks strikes fear in your hearts. But guess what? For about a month to six weeks after surgery, your body is in stress mode, and your metabolism is jacked up about one and a half times normal while it’s healing. Your body doesn’t know you did this crazy thing on purpose–on a cellular level you may as well have just been in a car accident or had a sixty percent body surface area third-degree burn. So if you just eat as you usually do, even if you’re not doing five days a week of cardio and pilates, you won’t gain weight. You may actually lose moreYou’ll be the only person who comes back to the office the Monday after Thanksgiving not complaining about how all you did was eat all weekend and you just gained six pounds.

So when am I going to look normal?

Back to this again. 🙂 Even with body contouring procedures that you can hide under your clothes, there are different definitions of “normal.”  (see previous post: How long after having my eyes done will I look “normal” again, and what does that have to do with the CW’s new show, “Emily Owens, MD”?)

Postoperatively, you will need to wear a compression garment (or what many of my patients fondly refer to as “the suit”) to reduce the swelling. For upper body lipo including arms, my patients usually only wear  it for a week or two, as the swelling in that area goes down pretty quickly. For the lower body (muffin top, abdomen, inner/outer thighs, knees) you really should be wearing something for six weeks. Yes, the first one we put you in is pretty industrial-grade but after a couple of weeks you can switch to something thinner and lighter like a Spanx®. Regardless, even the surgical compression garments (we get really cute ones from Design Veronique®, see below) can be easily hidden under clothes:

Just maybe not your skinny jeans the first week out.

So it will be easy to hide your little secret from your extended family over Thanksgiving weekend and your colleagues when you go back to work.

But by the time the Holidays roll around, you’ll be ready to go in your little black cocktail dress ;).

Mila Kunis in an Herve Leger black bandage dress. And if you don’t know about these, you need to.

What about my significant other?

Well, if you’re married, you’re probably going to have to tell your husband. At least, I would hope so.

But if you’re in a relationship and you don’t live together, there are ways around fessing up. I’ve pretty much heard it all, from “I told him the suit is a back brace” to “He’s colorblind and can’t see the incisions.” The “suits” we get for our patients (and we are in the process of designing our own “Lipo Queen” line!) are cute enough that he might even think it’s some kind of planned sexy lingerie (“Look, Honey, open crotch!” ;)) After a couple of weeks, the bruising should be gone and you can intermittently take the garment off. If your partner isn’t colorblind, and he’s not particularly savvy, you might be able to convince him that the tiny incisions were mole removals.

This is how one of my patients handled it:

He said, “What are those?”

I said, “Oh, I had those moles taken off.”

He said, “What moles?”

I said, “Don’t you remember? I had those moles and I told you I had to get them taken off! You never listen to anything I say!”

And you better believe he backed off.

Or you can always use the foolproof back-up, “I had to have a surgery for…you know…it was one of those female things…” and you know he’ll immediately change the subject.

Hope this answered some of your questions! If you have more, ask away!



Between working on the book and doing my day job as a plastic surgeon, I’ve had to take a vacation from blogging for the last couple of weeks…But I was so inspired by this article in the May issue of Plastic and Reconstructive Surgery (Our plastic surgery Bible) that I had to make time to share it with everyone. In layman’s terms 🙂

Most of you who know me are aware that I have been performing autologous fat transfer for breast augmentation (liposuctioning your fat from wherever you want to get rid of it and putting it in your breasts instead of an implant—yes, it’s a dream come true) for over two years and that I think it is an amazing procedure. (See my previous blog, “When fat is your friend.”) My patients have been thrilled with their results and I have had tremendous support from Doctors Lebovic, Schwimer and Goldberg–a very prestigious group of radiologists in town who specialize in breast imaging. So far the fat injections have not interfered with any of my patients’ mammograms.

If you have been seriously researching this procedure for yourself, you have most likely heard of the BRAVA. Developed by Dr. Roger Khouri in Miami, it is an external soft tissue expansion device that looks like a “Madonna Bra.” When you’re wearing it, it literally suctions your breasts out like a giant suction cup would, temporarily enlarging them. The theory is that wearing it before and after the procedure will increase the percentage of fat that “takes.”

Breast augmentation with fat grafting is probably the hottest new topic in plastic surgery, but the multiple variables involved with the technique still leave a lot of unanswered questions:

1)    Does it matter where we take the fat from (ie, is back fat better than thigh fat)?

2)   Does centrifuging it (spinning it down before injection to separate out the blood and fluid) really select out precious fat cells or just destroy them? There are two opposed camps on this topic.

3)   What type of system should we be using to harvest the fat? Hand-held syringes or suction machines with the pressure turned down? Two opposed camps here as well.

4)   What type of system should we be using to inject the fat?

5)   Does Dr. Khouri’s BRAVA thing really work or is it another marketing gimmick?

6)    Is selecting out stem cells with an expensive machine and calling the procedure a “stem cell breast augmentation” necessary for the fat to take? (The plastic surgeons who own the stem cell machines will say it is, but see my blog “What is a ‘stem cell breast augmentation’ or a “stem cell facelift” and is it worth the extra money?)

There have been multiple conflicting reports on this topic without real scientific data. Most of the plastic surgery journal articles are like second grade classroom show-and-tells: “This is what I did, and this is how it looks, Ta Daa!!!” As of yet the only thing that everyone agrees on is that there is no standard way of doing this procedure to give the optimum results.

But at least now we have an answer to question #5:

 According to this new study, yes, wearing the BRAVA seems to increase the fat volume “take” from about 50 to 80 percent.

 There is a strong possibility that this is accurate information. Last summer I was able to compare notes with Dr. Scott Spear on this topic. Since Dr. Spear is the chairman of plastic surgery at Georgetown University and one of the renowned breast surgery experts in the world, I felt validated to learn that my experience and results have been identical to his. We agreed that the most important determinant of success with fat grafting to the breast is the “skin envelope.” So, whether it’s from breastfeeding or age, in this situation, “sagginess” of the breast skin is good news. It gives the transplanted fat more room to live comfortably and survive better. I like the analogy in Dr. Khouri’s paper: when planting crops, the most important thing to a farmer is not the seeds, but what kind of soil he is planting the seeds into. If it’s crappy soil, the seeds won’t do well, no matter what kind of magic potion (ie, stem cells) they are mixed with.

This is why the BRAVA makes sense. It stretches the skin and tissues—and by doing so may also increase blood supply to the area–to allow for a more accommodating “home” for the fat grafts.

Other “pearls” that can be taken away from the results of the article are that:

1)    when done correctly, the fat injections really do not interfere with the reading of mammograms as much as we first thought they would

2)    spinning it down fast in a centrifuge is probably a bad idea.

 So what does this mean?

 In the past, when my patients have asked me about whether or not the BRAVA was worth the extra money (It’s about $800 at cost) I told them that it probably helps, it couldn’t hurt, and that the patients who used it seemed to have more of the fat volume survive, though I couldn’t guarantee it. I do not like “selling” things to people if I can’t justify it. I still can’t guarantee anything, but now at least I can quote this paper, that the patients who wore the BRAVA had about 80% retention of volume as opposed to about 50%.


 The results of this study may make more patients more motivated to wear the BRAVA, but most still won’t be able to do it. Logistically, it is quite difficult.

For one thing it looks like this:


Okay, sorry–I had a picture of someone wearing it here but I guess it got remove by the people that own this blog server for “porn” so I am working on a censored version of it with my IT guy–hopefully it will be up later today. How annoying is that? I mean, really. So you can see the shadow of a woman’s breast underneath it–so what? For now, just imagine big plastic domes that project about ten inches in front of your chest.

So, unless you’re okay with people staring at you for reasons other than being famous or impossibly gorgeous, you can’t wear it in public. Your regular clothes won’t fit over it. And the protocol calls for wearing it ten hours a day for a month before the procedure (with 24 hours a day for the last few days) so unless you work from home, you have to learn to sleep in it. The logistics are even challenging for “stay-at-home” moms, because most of them don’t really “stay-at-home.” You can’t show up to school drop-off wearing a BRAVA unless you have tinted windows, and forget about making the rounds at Whole Foods/Costco/the drycleaners unless you’re okay wearing a tent.

But at least I can assure my patients who are dutifully wearing it in preparation for their surgeries that yes, it does work.

 Again, for all of you BRAVA-wearers out there, here are some inspiring before and afters:


Before, an A cup


One year after BRAVA and fat-grafting, a C cup


Here is the link if you would like to read the full article:


One more thing I would like to add:


In his video discussion of the article, Dr. Spear mentions that we must “respect the donor sites” (the places where the fat is being taken from) and that is EXACTLY what I tell my patients. I often see patients who have been told by someone else that they are candidates for the procedure. But as a surgeon who has performed thousands of liposuctions for over ten years—and someone who understands how a woman wants her body to look—I have turned some of them away because I felt that I could only get the fat out at the expense of causing deformities at the donor sites. MAKE SURE that your plastic surgeon understands that you CARE what your legs/arms/abdomen/back are going to look like after the fat’s been removed (unless, of course you don’t.) And make sure that your doctor is GOOD AT LIPOSUCTION, which is not as easy as it sounds, especially when the patient is thin to begin with.

For example, if someone looks like this to start with:

…she should look like this when you finish:



That’s Christine and Karianne, the nurse practitioners at Ava MD who are helping to keep me looking under forty (it’s crazy how forty sounds so young these days…) Good thing neck Fraxel® is so easy to hide because my office staff surprised me with a new patient when I got back from my treatment. Fortunately I didn’t look too scary:

I do look a little more like E.T. than usual, but it’s easily camouflaged with a scarf or long hair. Besides, I know from the last time that this is as bad as it gets. Besides, Christine says after a few more treatments my skin will be less crepey. A neck lift won’t help someone like me. It’s the thin texture of my skin that’s the problem.

I have seen other post-treatment Fraxel®  patients from Ava’s whose necks definitely look better than mine, so there is still hope. But if the Fraxel doesn’t work…there is this thing called a “Vampire Facelift®” that I am going to check out. It’s the first time I’ve found anything related to vampires remotely interesting (I think I’m the only person I know who didn’t read Twilight or watch Trueblood or The Vampire Diaries.) I’ve heard a few people talking about it—including one of my colleagues–so I decided to look into it. Basically, it’s along the same lines as a Stem Cell Facelift or Breast Augmentation, but without the fat. The reason they’re able to throw the catchy term “vampire” in there is because the procedure involves drawing your own blood, and then injecting it back under your skin. First, it’s spun down to get a layer of “platelet rich plasma” (PRP) which contains growth factors like the ones in stem cells. Since some of these growth factors have been shown to improve wound healing, the thought is that they may also rejuvenate unwounded tissue (ie, make skin look younger.) Again, there is no scientific evidence supporting the use of concentrated growth factors in enhancing cosmetic procedures(see Stem Cell Facelift Post), but I don’t see much downside to it, except the expense, which shouldn’t be outrageous since the physician’s cost for the PRP isolation kit is fairly low  (as a reference for price-shopping, in most neighborhoods, a single vial Vampire Facelift® shouldn’t be $10 G.)

And as far as those two “bands” under my chin that everyone swears “you can’t even see them! I don’t know what you’re talking about!”–well, here they are (in this side view under the chin):

Although they really don’t look this bad in real life—the area under the chin is what gets most noticeably swollen with the Fraxel. Anyway, anatomically, these are the edges of the platysma muscle that sag over time, and they are especially evident in a thin-skinned neck like mine. The first step of treatment is to Botox® them to relax the muscle. This works in most of my patients, though for some reason I can’t get it to work on myself. I’m going to let Christine give it a try, and if she can’t get it to work, I’m going to have a submental plication (a mini-neck lift that involves an incision hidden under the chin, and tightening of the muscles and redraping of the skin. For before and after pictures, check out

Okay, this is getting a little absurd. I really need to get out of here and start thinking about something else besides my neck. Though I know everyone is waiting with bated breath on these Fraxel results so I’ll keep you posted! 🙂



I get this question from every patient I see in consultation for a breast augmentation, and even from those who have come to see me for something else.

“By the way,” they say, “I should talk to you about my breast implants. I need to get them changed out.”

“Do you like the way they look and feel?” I say.

“Yes, they’re great. But I have to switch them out every ten years, right?”

The short answer is: “No, you don’t HAVE to.” So where did this “replace every ten years” myth come from?

My theory:

1) The implant companies used to offer a ten-year warranty on replacing your implants if they ruptured.

They offer this because even if your health insurance kicks in for the capsulectomies (removal of the scar tissue surrounding the implant), they will not cover the replacement implants if the first procedure was done for cosmetic reasons. The only exception here is if the initial augmentation was authorized for reconstruction, such as after a mastectomy in breast cancer, or for a congenital breast deformity such as tuberous breasts or Poland’s Syndrome.

If your implants are ruptured and you are relying on your health insurance to pay for the rest of the breast implant removal surgery, be prepared to have a Breast MRI or mammogram documenting the rupture before you see your plastic surgeon. Most insurance companies will demand proof of implant rupture before they will pre-authorize the removal.

Also, Insurance companies like Anthem and Aetna usually will not pay for removal of saline implants, even if they rupture. And while silicone implants could theoretically last you the rest of your life (although nobody will go on the record saying that), after ten years all bets are off with a saline implant. The shells really do start to weaken after ten years to the point where you could just wake up with one of them deflated and completely flat. Don’t worry—it’s psychologically traumatizing but not dangerous. The implants are filled with sterile physiologic saline that will just absorb back into your body. You should also know that saline implants deflate on their own about one percent per year, so if your implants seem to be getting smaller, that could be why. For instance, if you have implants filled to 500 cc, That’s fifty cc after ten years, which is about half a cup size.

But now, the two main implant companies in the U.S.—Mentor and Allergan—offer “lifetime” warranties on their implants. I’m sure this new company Sientra will do the same to keep up, since these guys always have to be neck-and-neck with their promotional deals. (See the First New Implants FDA-Approved post)

All of Allergan’s Natrelle® silicone implants automatically come with a Confidence Plus® lifetime warranty of the implants including $1200 toward out-of-pocket surgery expenses for whatever your insurance company won’t cover, for the next ten years. And, if you give Allergan an extra $100 within forty-five days of the your first breast augmentation, you are enrolled in the Confidence Plus Premiere® program, which gives you up to $3500 and a free implant for the other side if only one is ruptured for up to ten years.

Mentor® offers a similar program for their Memory Gel® implantsthe Lifetime Product Replacement Warranty–and the comparable upgrade is free.

I realize that if you’ve read this far it’s just because you have implants and you’re trying to figure out what frequent flier plan you’re on. The bottom line is that if you got your implants in 2009 or later, they are lifetime guaranteed, but the extra money is only available for ten years after the first surgery.

See the following links for more information: (for Mentor) (for Allergan.)

2)   The second part of my theory has to do with the typical “timeline” of a breast augmentation. Many women undergo breast augmentation in their early twenties, so by their late thirties-to-forties, after child-bearing and breast-feeding, they have developed capsular contractures, rippling or further sagging and need a lift, or want them bigger/smaller/looking “perkier” again. So they get them switched out because of the way they look, not because they have to.

 Multiple studies have proven that there is no significant association with silicone and autoimmune disorders (see link, Breast implant rupture and connective tissue disease: a review of the literature, Plastic and Reconstructive Surgery Journal, 2007 Dec;120(7 Suppl 1):62S-69S.)

So even if you find out that an implant is ruptured, it is not an emergency. The silicone isn’t going to leak all over your body and cause Lupus or connective tissue disorders. In fact, lots of women are walking around with old ruptured silicone implants and don’t even know it. The only thing that could happen is if the liquid silicone (and now we’re talking the second generation of silicone implants from the seventies and eighties) gets outside the capsule (the shell of scar tissue that your body makes around the breast implant) and into the breast tissue, you could develop hard little nodules called siliconomas. But even these will not hurt you. At the worst they can local inflammation and discomfort.

Siliconomas are rarely an issue anymore, since the third generation of silicone implants have been around for more than a decade—they don’t really leak since they have the consistency of Jell-O® (See my previous New Implants blog)

Okay, I think this is more than enough information for the rest of the week, but I hope it’s been helpful for at least some of you out there.



This is an easy one. I’ll go out on a limb here and say pretty much, yes. Men like breasts, period. Real and fake. All men are “breast men.” They just won’t tell you they are if you don’t have them.

How do I know this? I’ve lost count of how many times I’ve witnessed the following scenario:

A woman comes in to discuss breast augmentation. She’s not asking to look like a stripper. (Though most men find absolutely nothing wrong with that, either.) Generally she’s in her late thirties/early forties, since we’re in Los Angeles she weighs about ten pounds less than the average woman her height in the United States, and exercises about twice as much. She doesn’t even like big breasts. She just feels that hers are starting to make her look old. They’ve deflated and sagged after childbearing and breastfeeding and she wants to replace the volume and regain the youthful shape. She just wants to look like she’s wearing a bra, without wearing a bra.

She’s keeping this first meeting a secret from her husband or significant other because he would “kill her” or “die” himself if he found out she was even considering breast implants. He would never understand. Even though she has to wear painful push-up bras with two inches of padding all of the time just to get back to square one, he thinks her body is perfect the way it is.

So back to this first meeting in my office. She’s wearing a wife-beater and she’s got small Allergan® silicone implant sizers tucked into the try-on bra. Finally, after about half an hour of staring wistfully from all angles at her reflection in my full-length three-way mirror, she hands back the sizers and sighs. Oh, well. She loves how they look but her husband/significant other would never be okay with this. He doesn’t believe in breast implants, like we’re talking about the Easter Bunny. That’s fine, I tell her. I absolutely understand. But we’re here if you change your mind.

Fast forward about a month and now we’re having a second meeting, with the husband/significant other in tow. Her fortieth or forty-fifth or fiftieth birthday is coming up and she’s decided she really wants to do this. Since I am so good at explaining things and making her feel comfortable, she wants me to explain it to her husband, convince him that it’s not really such a crazy idea. Especially since he’s going to fund it.

The husband turns out to be much less opinionated and controlling than the picture she’s painted of him, especially when it comes to a discussion about making her breasts artificially bigger. There she is, standing in front of the mirror again with a pair of 210 cc style 10’s under the wife-beater (my go-to implant for the “natural look”), asking for his opinion. He’s trying to appear uninterested and neutral about the whole thing, staring at my blank white wall, down at the floor, out the window at the view of the side of a brick building. Again he recites his mantra: “This is totally up to her. I don’t think she needs it. She’s beautiful, perfect the way she is.” But when he is finally forced to give an opinion, the tell-all words slip out of his mouth as he tries to keep his expression as objective as possible, “Well, if you’re going to do it, you might as well go a little bigger.”

Together they pick a size and she schedules the procedure. Her husband arrives to get her after the surgery and again he is expressionless and objective, overly focused on how to take care of her that night, when she can take what medication, what position she should be sleeping in. He averts his eyes from her tightly wrapped, newly-enhanced chest.

At the post-op visit when her new rack is unveiled for the first time, I can detect a smile flicker across his face, but he’s trying to keep it under wraps. “They look great, honey,” he says, as objectively as possible, like he’s admiring a new set of dining room chairs.

At her visit a week later she reveals to me with genuine shock in her voice: “He loves them.” And then after a month she tells me how he demands to see them every night when he comes home from work, and that their sex life has improved dramatically.

So is it possible that all of his earlier talk about “hating breast implants” and saying that you’re “perfect the way you are” is just political and safe? I mean, your husband is not stupid enough to agree with you when you say, “My breasts look deflated and old and I need implants, what do you think?” It’s like asking if a pair of jeans makes you look fat. Unless he’s a total fool and wants to sleep outside, he’s never going to tell you, “Yes, your muffin-top looks disgusting. You should change into something loose-fitting.” He does love you the way you are, and he does still find you attractive, but he doesn’t care enough about the little details to get into trouble over them.

I am absolutely not advocating that we all go out and get breast implants (although I know that my husband would be thrilled if I did.) All I’m saying is that if you really  want them, and the reason you’re holding back is because you’re afraid your husband would be horrified at the mention of them, you might be pleasantly surprised. I’ve just never had a patient come back after her breast augmentation and say, “My husband is repulsed. He won’t touch me. He is demanding that I take them out.”

Food for thought! Happy Sunday!