yeah we'll see what I do for our audience I ask the stupid questions or
maybe the question that nobody wants to ask questions ... there are no stupid questions
thanks for tuning back in to our second act with Paige and Silke we're
continuing our conversation with board-certified plastic surgeon dr. Adam
Rubinstein in Miami Florida thank you for staying with us dr. Rubinstein
my pleasure it's great to be with you I've seen on our last segment you know
we discussed breast augmentation for women over 50 what is and is impossible
why people are seeking it on this segment let's let's talk about we've
made the decision what you know what do we expect in going through the process
so a woman comes to you how do you counsel her advise her on breast
augmentation after 50 ...well really at any age we have a similar process it's
important that we sit down and talk about what your goals are you might want
to be a certain size a certain shape you may want to just be replacing what has
left you a lot of times there's that that wasting of the breast atrophy that
happens whether it's from childbirth or just from aging and maybe hormone
changes there's two very common requests that we get one is you know doc I just
want to get back to what I was before I had kids and then there's doc I'd really
love to be the way I was when I was pregnant because you know the breasts of
course engorge it gets full and a lot of women like that fuller breast
whichever your goal is it could be neither of those as well important to
get that together with your surgeon so I speak to my patients for a long time
about it we have a process we follow looking at pictures having my patients
pick out pictures but that's the starting point and then the question really
becomes is this just a breast augmentation or are we talking about a
lift because a lift really adds a lot to what needs to be discussed ...well what is
what is involved in a lift you know in terms of scarring and and
and the procedure ...well breast augmentation is a much simpler procedure
you know there's three typical ways to approach a breast augmentation you can
go at the edge of the areola which is a my personal preference I find that the
most discreet and really a scar that's almost invisible there's a scar
underneath the breast that you can use particularly for a woman who has a bit
of a breast to begin with very flat-chested women won't do well with
that because you can't really predict where that's going to be and then
through the underarm which is not bad because there's no scar on the breast
but going through that way is a little more complicated as a higher revision
rate and those scars can be visible you know and in California in Miami when
you're wearing strappy things or strapless things every time you raise
your arm you point through your reach for something you might be showing you
have breast implants so depending upon how that heals it might not be the best
approach when it comes to lifts well that opens the door to lots of different
techniques in the old days a lift used to mean you'd get an anchor shaped scar
you know around the areola vertical line down and then the line underneath the
breast that was an anchor shaped incision and scar line that's what's
most commonly seen but when modern technique there's ways to do it with
much less scarring ...okay well how what then how does this what does the
scarring look like I'm glad you asked I do 60 or 70% of my breast lifts with
a scar that just goes around the areola and that's it and that's a
technique that takes a bigger circle and cinches it down to a smaller circle and
thereby tightens the breast tissue and the only scar you're left with us around
the areola then the next step would be what I call a lollipop scar which is
around the areola and then a vertical line down and that allows us to tighten
in a breast if you had a larger breast and you wanted to tighten it in to make
it a little bit more petite or narrow that would be a way to do it and then
the more you have to lift the more incisions or more scarring you might
have to have so the next step would be a line that runs first down and then
towards the outer part of the breast and then of course for really large breasts
if we're having to lift them there's a lot of hang then we do get to the anchor
shave scars cuz it gives us the most control but I'd say most of the time way
more than half that's my only scar just right around the areola so it basically
involves taking off the nipple that's a I'm glad you mentioned that
because that's a really common misconception my own wife thought that
that's how we did it no it's not how you do it yes that's why I'm asking I really
don't know that's kind of the common perception
you'd think because you see the scar that goes all the way around oh my god
they must have popped it off and sewed it back up yeah
it stays attached the whole time and it's complicated how you manipulate the
tissue but you want that attached because it needs the blood supply if we
were to remove it and then stick it back on number one you wouldn't have normal
sensation and number two it might not survive because that's making it into a
graft instead of having it just always attached to you and having its own blood
supply so in the vast majority of cases we never remove a nipple although people
think it's commonly done ...well and one of the questions I've been asked is you
know do you lose sensation of the nipple when you have a breast lift ...it's a great
great question and actually the breast lift is not the culprit sometimes you
can have a change in sensation when you do a breast augmentation because it has
more to do with how you're making your pocket the nerve first sensation to the
nipple comes out from your back goes around the side of the chest pops them
to the side of the breast and then goes up into the nipple so you can make
incisions all the way around the areola it doesn't affect sensation where it
gets affected is when you're making your pocket for the implant out here on the
side of the breast because there's a bunch of those little branches that are
coming around if they get stretched that can irritate them and actually increase
sensation and if they get cut well obviously that can decrease sensation
but I'd say about 80% of the time or so in my experience it doesn't change and
then 20% of the time where it might go up or down that's typically temporary
and resolves but it can be permanent yeah well see what I do for our audience
I ask the stupid questions maybe the questions nobody wants to ask and
another was interesting site has a conversation with a friend of mine who
is considering breast augmentation and she was telling me that she absolutely
needs a lift and you know and so I'm kind I told her a little bit about what
I thought it involved but she goes well do what you just don't take it and just
lift it ...so that'll be nice yeah I tell patients you know you could because they
sure well can't you just do this yeah yeah you have to walk around with
your hands yeah so I really like the way you explain this I think this will
really be helpful you know and as I said in the last segment you know III had
augmentation I didn't have a lift so I didn't I don't
know about this but there's just so many questions that people don't ask or don't
know don't know to ask that it was one of the reasons I want to do this segment
so you get the best possible results because likely at our age you will need the
lift and you should know or need to know what you're in for what what is the
recovery after a lift I mean an my stuff was it was not painful but it wasn't
pleasant what what what about it if you're just doing a lift and not putting
an implant in then it's not so bad you'll be sore usually one to two weeks
is pretty much the recovery for any procedure we do and at the end of one
week you're comfortable enough at the end of two weeks then you're feeling
pretty good the if you're doing an implant and a
lift which is most often what we need to do you're gonna have a little bit of a
little bit more pain because we get under the muscle and that's what hurts
when you do the implants and you know again you know at one week's time you're
still sore but manageable and at two weeks time you might still be a little
sore but you're almost not even noticing it anymore
so you know that two weeks is usually a good period ...okay so you you just taught
me something else new or something where I had a misconception that is that the
implant which is a simpler surgery is actually more painful because you go
under the muscle did I hear that right ...that is correct and when you release the
muscle you make the pocket under the muscle to accommodate the implant
it's that release of the muscle all along the edge of the the muscle excuse
me that is creating the soreness and without having to manipulate the muscles
you're just doing a lift and working only on breast tissue typically it
doesn't hurt as much... interesting yeah although it's a more complicated
procedure yeah well doctor Rubinstein did I not ask
something that other women asked that would be a good question I know that
there is a concern about cancer and breast implants or breast augmentation
is there any validity to that ...well anytime that you're talking about
women's breasts there's always a concern for cancer and if you're doing surgery
but the truth is that breast implants have never been shown to increase the
incidence of breast cancer that does not increase risk in any way that and it's
been studied many many times there really is no
evidence that it increases risk in fact I once saw a paper that showed that it
decreased risk because it increased the likelihood of detecting a nodule on
self-exam because the implant pushes the breast tissue forward and it's easier to
feel over the implant I don't know if I buy that either either way it shouldn't
increase nor decrease the risk for her breast cancer I think that's a kind of
pre-programmed implants really don't have much of a bearing on it ...yeah and
and detection through mammogram doesn't the implant doesn't hide a tumor
potentially or ...great great question there are special techniques that they
do use special views when you have breast implants but no they can see
the breast just fine with an implant or without obviously but with implants
there's no decreased ability to detect from a mammogram
well dr. Rubinstein we've come to the close of our segment again thank you so
much for this information I know I learned something in this segment so
hopefully we're putting out some good information for our viewers I will link
to all of your information so anybody can get in touch with you directly I
know that you're very good about answering personally the emails so if
anybody is in the Miami area or willing to travel please contact dr. Rubinstein
we will see you next time on another episode of our second act with Paige and
Silke for more information about what's up and new in plastic surgery
my pleasure look forward to our next show
so glad you were able to join us today and I hope you found this information
helpful if you haven't already done so please take one quick second to
subscribe to our channel the buttons right over here and for more information
about living your life to the fullest after 50 please visit our website
2ndact.tv... see you soon
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