Size Matters But Its About So Much More Than The cc's: How to Pick a Breast Implant w/ Dr. Jason Pozner

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Welcome to another episode of
Park Avenue Plastic Surgery Class,

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the podcast where we explore controversies
and breaking issues in plastic

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surgery. I'm your cohost Doreen Wu.

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I'm excited to be here with Dr.
Lawrence Bass Park Avenue plastic

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surgeon, educator, and
technology innovator.

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Also joining us today as our
guest expert is Dr. Jason Pozner,

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a plastic surgeon in Boca Raton, Florida.

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The title of today's
episode is "size matters,

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but it's about so much more than the CCs:

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how to pick a breast implant."
When you think of plastic surgery,

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breast implants are definitely one of
those iconic things. It sounds really fun,

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but what should people think about and
how should they pick the right implant.

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For most people, it is
a lot of fun Doreen,

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but there are important things to know.

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So you understand what you're getting
into implants are devices and will

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eventually wear out.

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So I tell patients if
you want bigger breasts,

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but you never want to think about the
implants. Again, this is not a good idea.

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If you want bigger breasts and
you can accept that in the future,

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there's likely to be more surgery.
When the implants wear out,

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then you can have a lot of fun with it.

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I think that single issue,

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heavily colors how to think
about implant selection.

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The first big choice
is about implant fill,

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which can be saline or silicone
gel note that the shell of the

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implant is solid silicone. In any case
and solid silicone is used in many,

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many medical devices.

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Currently 90% of implants
placed in the United States are

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silicone gel fill.

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I'd like to introduce my
colleague, Dr. Jason Pozner,

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who I've known for many years
and taught many courses with Dr.

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Pozner is really an expert in
complex aesthetic breast surgery

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and breast revisional surgery,

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as well as on innovations in
technology across plastic surgery.

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So I've asked Dr. Pozner to join
us today to share his expertise in

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the area of advanced
breast aesthetic surgery.

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Dr. Pozner what's your approach?

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What type of implants are you
mostly using silicone gel saline

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and why?

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Okay, well, first of
all, thank you, Larry,

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for inviting me on this podcast
and Doreen for having me as well.

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So hopefully that can be somewhat
entertaining and educational. Um,

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I mainly use Silicon implants,

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I would say over 99% of our implants
placed over the last five years have

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been Silicon gel implants once
in a great while I would use

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a saline implant,

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but only because of certain FDA
guidelines suggesting that for women

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under 22, a saline implant
was the one that approved.

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And silicone was only approved for
women who are 22 and older. Um,

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this is probably not the, the, uh, venue
to get into why that rule came about,

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but, um,

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I still have placed plenty of Silicon
implants on younger on younger women.

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Um, there's different brands of
Silicon implants on the market. Um,

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I'm currently using Allergan
brand and natural implants,

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but during the years I've used probably
much every other kind of implant from

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different manufacturers. I like the
shell wall on the Allergan implants.

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I like the cohesively of the gel.

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And I'm sure we'll be getting into that
a little bit as time goes by in this

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podcast.

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Yeah, that sounds great. A beautiful,
soft breast is always an essential goal.

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What do you think Dr. Bass?

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So my approach is a little
different and in my practice,

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probably about 90% of the
implants I place are saline fill

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in.

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The reason for that is there's less
surveillance required obtaining

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ultrasounds or MRIs to determine if
the implant has remained intact is

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not necessary with saline implants.

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It's easy to know when the implant
fails. Usually within the space of a day,

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the contour will be lost and it's
obvious that the implant has deflated.

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Uh,

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it's easier to treat when it fails to
just remove the shell because the saline

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doesn't have to be addressed
explicitly the way silicone gel does.

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And you have more treatment
options when it fails.

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You can leave the shell in place.

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You can take the shell out
under local anesthesia,

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or you can replace the implant.

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So there's more flexibility and
more flexibility with timing.

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And that's important as patients age,
because you know, when you're 70 or 80,

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you may not want to address the implant
immediately or may not be able to.

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And it just gives you flexibility
in how you approach things.

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Uh, Larry, can I interject also, yeah,

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one of the other things with
saline implants, and again,

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I use rarely use them at this point is
occasionally somebody with a rupture on

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one side, doesn't have the
time to do a revision surgery.

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So sometimes we'll just percutaneously
puncture the good side and let them both

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deflate and wait a while, take out their
implants. So that's another option,

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somewhat advantage to saline Implants,

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you certainly cannot puncture your
silicone implants and drain them.

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Absolutely. And you know,

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I had a circumstance like that in the
last year where someone had a saline that

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was not placed by me, that failed. Uh,

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she was in the process of selling her
business and on a lot of travel and road

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show to get the business on the market.

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We removed the failed implant
under local anesthesia

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and removed the non failed implant.

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And then she circled back in about six
months after her business affairs were

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taken care of and addressed
getting re augmented.

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So there's a lot of flexibility with
that. Another thing that I really,

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really love about the saline implants
is the ability to tinker small

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assymetry. Since most
women have some asymmetry,

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you can put the same size implant that
has the approximately the same base

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diameter. The base diameter will
vary in minor ways based on fill,

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but it's going to be pretty
much the same base diameter,

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and then fill one to the lower end of the
range and the other one on the smaller

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breast to the higher end of the range
and deal with small asymmetries,

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bringing people a little
bit closer to symmetry.

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If there's a big as asymmetry, you
just pick a different implant, right?

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Yeah. So, you know, in the silicone
world, the lower number implants,

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the less volume implants that go up in
small increments, like 25 CC differences,

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which is not very much.

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So that allows us to tinker by perhaps
choosing a 300 or a one side and a 325

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on the, on the smaller side. But as they
get larger in number the differences,

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get up to like 50 CC difference.

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So you can't tinker as much
as you can with the saline.

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I'll totally give you that point. Larry.

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Yeah.

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And I worry that the base diameter
starts to become significantly different.

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A small difference in base
diameter won't show externally,

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especially if the patient has a moderate
amount of baseline breast tissue,

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but, uh, but potentially you're,

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you're inducing an asymmetry at the
same time. You're taking one away.

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Uh, if you go to different size implants
and that's a necessary evil for,

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for women who have big
asymmetries in breast size,

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we just pick different size implants.

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And that's how we treat a
unilateral hypoplasia or Hypomastia

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Anyway. Um,

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there are some downsides though,

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because we have to tell
both sides of the story.

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You're more likely to see
the edge of an implant,

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especially in a very slim patient.

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And you can always feel the edge of
both silicone and saline implants.

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And you're also with a saline
probably more likely to see rippling.

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So those are some of the downsides,
but I, I think at the end of the day,

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um,

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that the theoretical firmness
of the saline compared to
the silicone is hard for

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most patients to appreciate. And if
there's even mild capsular contracture,

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which is not a rare event,

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then that advantage to the
silicone gel goes away. Um.

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But I will bet you that
if you had a saline,

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a patient with saline in one
side and silicone and another,

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you can tell the difference.
The, to me, the saline,

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the silicone size is a little bit more
natural feeling and a little bit more

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like a natural breast. But I
agree with you in many patients,

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especially with a lot of breast tissue,

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you won't be able to tell the
difference, but in the thin patients,

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those saline, I, my experience has
been a lot of rippling in the thin.

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Patients. Yeah, that's a great point.

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And that's the patient
that I'll recommend.

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Silicone gel is the super
slim patient, the marathoner,

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the patient with very little
baseline breast tissue.

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They're really going to be better off
with a silicone gel and get a more natural

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result,

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but a patient with moderate breast
tissue in my hands I'm often headed

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towards the saline unless the patient
feels strongly. They want the gel.

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Okay.

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I see the virtue in both approaches, but
we're not done picking an implant yet.

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What are some other things to consider
when choosing the right implant size?

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So we started to allude to
this in our recent discussion,

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Jason and I,

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the important considerations are how
much baseline breast tissue there is,

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what the desired final size is
and the heightened shape of your

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frame as an individual.

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One of the things I don't like to see is
looking at thumbnails on the internet,

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that list out different implants.

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I don't think that's a very useful way
to figure the right implant for you

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since the size and style of implant are
only two factors amongst all of these

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that we just listed. Also,

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it's very hard to look at a thumbnail on,

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on your computer screen or your tablet
and even worse on your cell phone,

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because you don't know how
big that patient is, how tall,

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how heavy it's very hard to assess
how much their body habitous

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and yours are a match in deciding
what the implant looks like.

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I mean, Larry many patients come in
and say, I want 3 25 CC implants,

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because that's what my friend has.

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And I like her breasts and this often
leads to a whole discussion I'm sure which

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we're going to have in the
next few minutes about,

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you're not the same as your friend.

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She has four kids and she's six
feet tall and you're five feet tall.

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Yeah. And, and so that's
really important and we,

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we have to have these conversations
every week over and over,

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um.

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For 20 something years each.

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Yeah. And, and so, uh, so it's,
it's a little frustrating,

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but the place I think the internet
helps you is you can look and

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see how different breasts
look and say, gee,

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that's something I think
is really beautiful.

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Those are breasts that I aspire to.

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And then your surgeon has the same
picture in their mind that you have in

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your mind.

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So they can then advise you what's the
best way you can get to that end point.

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Yeah. I, I agree a hundred
percent. I mean, I,

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I often have the patients bring in photos
that we look at together because it

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gets you in their head.

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Are you looking for a mild improvement
or you're looking for a larger size and

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you know, a lot of times
they'll tell you why.

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I just want to be a B cup and they
show you pictures of double DS.

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So I think really need to be the
visual aspect really helps right.

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Giving the patient what they
want, if it's within their.

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Limits. I think, you know,

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when you walk into the operating room
and the picture in your mind is the same

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as the picture in the patient's mind,

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you're most likely to get the result that
the patient is going to love and they

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can say it to you in words,

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but they may not be picturing
or meaning the same thing.

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So what are the ways you help the patient,

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Dr. Pozner pick the right
implant for shape and size?

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Sure. Well, you know, the,

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the first thing is we need to talk about
is the shape of the patient that we're

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putting the implants in, you know,
and that's why we do measurements.

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So when a patient comes in
for an in person examination,

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we measure them and we measure their
with the chest. We measure their,

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where their nipple placement is how
tight their fold is the distance from the

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nipple to their fold.

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So various measurements that we look at
that help us figure out what a potential

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size a patient could be. For
example, if you're really narrow,

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there's no way you could put
a really wide implant in you,

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which just doesn't won't fit.

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And we have to be able to fit it in to
be able to close up and get a good long

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term result.

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And there's also the data that suggests
that overly large implants tend to fail

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and not breaking the implant itself,

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but they help stretch the
tissues out and fail the breasts.

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So you need to pick the proper
size for the patient within reason,

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but there is a little variation in what
you can place in those patients based

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upon their height and width.

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So that's the first thing we do is
measure the patient in our office.

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We have a vector which is a 3d camera,

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and that allows us to get volumetric
analysis of the patients and see their

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00:13:35,111 --> 00:13:39,590
native volume. And it gives
you a visual on a computer, um,

230
00:13:39,591 --> 00:13:43,670
what you might look like with different
size implants. So we use that method.

231
00:13:44,370 --> 00:13:45,540
As I mentioned earlier,

232
00:13:46,000 --> 00:13:50,860
we get photos from the patient and
then we have specific sizers that are,

233
00:13:51,460 --> 00:13:56,420
um, given to us by the implant companies
that are basically these little foam or

234
00:13:56,421 --> 00:14:00,620
little sort of fluid filled, uh,

235
00:14:00,930 --> 00:14:02,890
devices that you put over the breast.

236
00:14:03,630 --> 00:14:07,410
And then we put clothes on the patient
and we look at what they look like with

237
00:14:07,411 --> 00:14:09,570
different size sizers in place.

238
00:14:10,230 --> 00:14:14,490
And then the last thing is we give the
patient what's called the rice test.

239
00:14:14,590 --> 00:14:15,423
We give them,

240
00:14:15,450 --> 00:14:19,410
everyone has a pre-printed information
sheet where we tell them to get uncooked

241
00:14:19,411 --> 00:14:19,790
rice,

242
00:14:19,790 --> 00:14:24,660
put it in panty hose and try on clothes
at home and let us know the volume of

243
00:14:24,661 --> 00:14:28,900
that rice. And each one of these methods
is not going to give us the answer,

244
00:14:29,400 --> 00:14:33,740
but the culmination of multiple
efforts to figure out what they want,

245
00:14:34,030 --> 00:14:36,100
helps us to get to where we want to be.

246
00:14:36,920 --> 00:14:40,890
You know, it's, it's interesting because
I use very much the same approach.

247
00:14:41,010 --> 00:14:41,890
I mean we have the,

248
00:14:41,910 --> 00:14:46,570
the vector so we can image people in
3d and I think that's great and you can

249
00:14:46,571 --> 00:14:49,330
rotate the image and patients
love to look at that,

250
00:14:49,950 --> 00:14:54,360
but I think how they look in clothes,
especially I'm in the Northeast,

251
00:14:54,410 --> 00:14:57,840
we're about to talk about Northeast
versus Florida preferences,

252
00:14:58,820 --> 00:15:02,680
but how the patient looks in clothes
is really what they're gunning for.

253
00:15:02,900 --> 00:15:07,040
And so I like them to, to
try with a size or, and come,

254
00:15:07,140 --> 00:15:10,150
how do they look into sweater
or how do they look in a blouse?

255
00:15:10,290 --> 00:15:12,430
And is that the look they want?

256
00:15:13,810 --> 00:15:18,070
And that doesn't mean that that size or
is the size implant they ought to get.

257
00:15:18,210 --> 00:15:22,910
It gives me again the picture of what
they're aiming at the same as what they're

258
00:15:23,070 --> 00:15:23,270
picturing.

259
00:15:23,270 --> 00:15:28,210
And it also depends what they're
wearing because I find when

260
00:15:28,640 --> 00:15:31,640
someone comes in to try on implants
and a dress, it's terrible,

261
00:15:31,920 --> 00:15:35,440
you can't get a shape, a look at their
body. And I always tell the patients,

262
00:15:36,000 --> 00:15:38,240
don't look at your breasts, look
at your shape, look at your butt,

263
00:15:38,400 --> 00:15:40,960
look at your hips, look at your
waist and see how you flow.

264
00:15:41,640 --> 00:15:44,240
These implants have to look as part
of your body. You're a sculptor,

265
00:15:44,520 --> 00:15:48,430
creating a Michelangelo. You're trying
to create a sculpture. So with this,

266
00:15:48,630 --> 00:15:51,950
you need to look at the whole picture
and not just focus on the breath.

267
00:15:52,230 --> 00:15:55,230
So we prefer if you're coming
into size in my office,

268
00:15:55,430 --> 00:15:58,710
I like like yoga pants or low rider jeans.

269
00:15:59,390 --> 00:16:02,870
I find high wasted jeans or
high waisted, uh, clothes, um,

270
00:16:03,710 --> 00:16:06,500
obliterate sort of the waist. And
you can't really see the flow.

271
00:16:07,060 --> 00:16:11,140
And I tell 'em to go home and try on
different this rice test with heels and

272
00:16:11,620 --> 00:16:14,060
flats and different clothes. So
that's all part of our process.

273
00:16:14,060 --> 00:16:17,920
Dr. Bass.

274
00:16:18,060 --> 00:16:21,960
You alluded to the regional differences
between the Northeast and Florida.

275
00:16:22,550 --> 00:16:25,920
What do you see as preferences in size
and look where you are Dr. Pozner?

276
00:16:25,920 --> 00:16:28,350
Okay. It it's pretty
obvious, right. You know,

277
00:16:28,351 --> 00:16:32,150
we have beaches and low cut clothes
and golf clothes and all that stuff.

278
00:16:32,210 --> 00:16:35,350
So they're bigger in Florida and they're
bigger in Texas and they're bigger in

279
00:16:35,351 --> 00:16:39,550
California, but you know, in general,
many of Larry's patients, um,

280
00:16:39,770 --> 00:16:42,030
Dr. Bass's patients in
New York are, you know,

281
00:16:42,031 --> 00:16:46,260
professional women attorneys who
probably don't want to be too large.

282
00:16:46,400 --> 00:16:50,140
And you know, in Florida we have a
slightly, at least for my practices,

283
00:16:50,141 --> 00:16:53,420
it's a slightly older population,
but if I will bet you,

284
00:16:53,440 --> 00:16:57,300
and if we looked at all the breast
implants, Dr. Bass, I have placed,

285
00:16:57,440 --> 00:17:02,220
I'm probably, uh, half a cup to a cup
size larger than him across the board.

286
00:17:02,240 --> 00:17:04,370
In average. What do you think Larry?

287
00:17:05,080 --> 00:17:10,010
Yeah, so I think that's
right on most people,

288
00:17:11,130 --> 00:17:12,770
I mean the real question first is,

289
00:17:12,870 --> 00:17:17,130
is someone looking for augmentation
or are they trying to restore after

290
00:17:17,131 --> 00:17:21,650
breastfeeding childbearing, just get
back to the size that they used to be.

291
00:17:21,900 --> 00:17:26,520
That's obviously going to be a different
calculation in most people's mind,

292
00:17:27,380 --> 00:17:28,880
but in New York again,

293
00:17:28,881 --> 00:17:32,640
because we're not a beach community
10 months out of the year,

294
00:17:32,790 --> 00:17:37,120
there's more focus on the look
and close than bathing suit. Um,

295
00:17:37,900 --> 00:17:42,070
and that's just how it is on
park avenue in New York city. Um,

296
00:17:42,970 --> 00:17:45,030
my average implant size, I mean,

297
00:17:45,031 --> 00:17:49,110
most of the patients want to be
a big B cup or a small C cup.

298
00:17:49,180 --> 00:17:53,880
That's the most common in
my practice in the New York

299
00:17:53,950 --> 00:17:54,783
area.

300
00:17:55,140 --> 00:18:00,120
And my most commonly used implant is a 272

301
00:18:00,780 --> 00:18:05,680
CCS. Uh, and one size up or
down from there, usually up is,

302
00:18:06,380 --> 00:18:07,140
is, uh,

303
00:18:07,140 --> 00:18:11,750
one or two sizes is probably
represents about 80% of the implants.

304
00:18:11,790 --> 00:18:12,190
I use.

305
00:18:12,190 --> 00:18:16,630
That's funny because you know, in my,
my patients all say the same thing,

306
00:18:16,710 --> 00:18:19,470
I want to be a full C,
maybe a small D full C.

307
00:18:19,570 --> 00:18:22,470
So I'm one cup size bigger than you are.

308
00:18:22,730 --> 00:18:26,740
And I would say my average size is
probably high three is low fours.

309
00:18:27,770 --> 00:18:29,660
Yeah. And you know, part
of the reason for that,

310
00:18:29,661 --> 00:18:34,260
and I point this out to patients is
there's horrible grade inflation in

311
00:18:34,450 --> 00:18:37,940
brassieres, you know, there's a
technical definition of cup size,

312
00:18:38,430 --> 00:18:43,260
every brassiere manufacturer ignores
it and has their own custom definition.

313
00:18:44,080 --> 00:18:46,530
So that's a great point. You
know, they come in and they say,

314
00:18:46,570 --> 00:18:50,650
I bought a brassiere, that's a D cup and
you were supposed to make me a C cup.

315
00:18:51,000 --> 00:18:52,930
Well, it's not really a D cup.

316
00:18:53,590 --> 00:18:58,090
And a Victoria's Secret D might be
a Maidenform B cup. So, you know,

317
00:18:58,091 --> 00:18:59,330
there's wide variation.

318
00:19:00,300 --> 00:19:03,390
Yeah. So that's, that's something
important to keep in mind. See.

319
00:19:03,460 --> 00:19:06,260
We've learned stuff over
the last 25 years, just a.

320
00:19:06,260 --> 00:19:07,460
Bit. So let me,

321
00:19:07,520 --> 00:19:12,140
let me switch gears a little bit
and talk about other variations in

322
00:19:12,890 --> 00:19:16,900
implant style, uh, and
form stable implants.

323
00:19:17,120 --> 00:19:20,860
So Dr. Pozner alluded to this
at the beginning of the episode,

324
00:19:20,930 --> 00:19:24,930
that that some of the
silicone gel is firmer

325
00:19:25,750 --> 00:19:28,970
and gives a more defined
shape to the implant.

326
00:19:29,030 --> 00:19:31,490
So this is what a form stable implant is.

327
00:19:31,510 --> 00:19:35,450
And one of the nicknames for these
implants is gummy bear implants,

328
00:19:35,451 --> 00:19:40,090
which most people have proudly heard
of. So I'm curious to hear Dr. Pozner,

329
00:19:40,091 --> 00:19:44,680
what role do you think these have in
aesthetic breast surgery compared to

330
00:19:44,681 --> 00:19:46,160
reconstructive breast surgery?

331
00:19:47,500 --> 00:19:51,440
So, you know, first point is the
implants that I use by Allergan.

332
00:19:51,441 --> 00:19:55,200
Most of the time they come in
different, uh, cohesive levels.

333
00:19:55,940 --> 00:19:59,830
So they have really three different
levels and it well depends on which level

334
00:19:59,930 --> 00:20:02,590
you choose the softness and
how they sit up on the chest.

335
00:20:03,090 --> 00:20:04,510
So we we'll use different ones.

336
00:20:04,511 --> 00:20:08,430
So that's part of the consultation that
we go into and talk about these cohesive

337
00:20:08,570 --> 00:20:11,990
levels. I I've done pretty much,

338
00:20:12,290 --> 00:20:16,710
no form stable implants or very few
form stable implants in my life.

339
00:20:16,830 --> 00:20:19,860
I could probably count on two
hands, how many I've placed.

340
00:20:20,060 --> 00:20:24,740
I was never a fan of them because they
didn't give the look that most of the

341
00:20:24,741 --> 00:20:27,180
people in Florida were
looking to achieve. They,

342
00:20:27,210 --> 00:20:30,180
most of the patients here wanted
a little fuller upper pole,

343
00:20:30,680 --> 00:20:35,260
and then they give you a sort of a more
full bottom pole and less full upper

344
00:20:35,261 --> 00:20:36,094
pole.

345
00:20:36,790 --> 00:20:41,650
But when push came to shove and we had
all the problems with texturing implants,

346
00:20:42,530 --> 00:20:42,970
um, I,

347
00:20:42,970 --> 00:20:47,240
I didn't have to replace any of my
implants that I had placed because were

348
00:20:47,241 --> 00:20:49,640
textured anatomic implants. So, um,

349
00:20:49,710 --> 00:20:53,640
most of the surgeons in this country
have gone to these smooth walled implants

350
00:20:53,641 --> 00:20:58,560
that are around, are not using
the form stable anatomic implants.

351
00:20:58,800 --> 00:21:00,480
I mean, when I learned to put those,

352
00:21:00,540 --> 00:21:04,640
it was in Sweden where they had very
tall women who wanted to be B cups.

353
00:21:04,641 --> 00:21:09,350
So in that particular patient, it
seems to play a role, but again,

354
00:21:09,490 --> 00:21:10,120
in Florida,

355
00:21:10,120 --> 00:21:13,910
where most of my bathing soup patients
are looking for upper pole fullness.

356
00:21:14,370 --> 00:21:17,670
It doesn't really give you that doesn't
achieve that with those form stable

357
00:21:17,710 --> 00:21:19,550
implants to, to my satisfaction.

358
00:21:19,690 --> 00:21:24,500
And, and all the form stable implants
are textured in some fashion or another

359
00:21:24,690 --> 00:21:26,140
even micro texturing.

360
00:21:27,480 --> 00:21:30,770
Because otherwise they could
potentially rotate. You know,

361
00:21:30,771 --> 00:21:35,730
wh when you make a pocket or the
space to place the implant, the form,

362
00:21:35,910 --> 00:21:37,650
the anatomic implants,

363
00:21:37,651 --> 00:21:40,810
you make a relatively narrow
tunnel so that it doesn't rotate.

364
00:21:40,880 --> 00:21:43,320
Whereas we make a little bit bigger
space for the smoother, rounder

365
00:21:45,320 --> 00:21:47,200
implants and move around
a little bit more,

366
00:21:47,220 --> 00:21:49,840
but that's just some
technical technical work.

367
00:21:50,900 --> 00:21:54,920
So I'm not a fan of forms of anatomic
implants or form stable implants.

368
00:21:55,750 --> 00:21:56,610
Before we close.

369
00:21:56,810 --> 00:22:00,770
I wanted to pick both of your brains on
the latest trends in breast augmentation

370
00:22:00,771 --> 00:22:01,604
right now.

371
00:22:01,740 --> 00:22:05,040
And what innovations you predict are
coming in the foreseeable future.

372
00:22:05,041 --> 00:22:07,560
Dr. Pozner, do you want
to take this first?

373
00:22:08,340 --> 00:22:09,173
You know, you know,

374
00:22:09,320 --> 00:22:13,520
I think that we we're at a time now
where there's been a lot of data,

375
00:22:13,540 --> 00:22:17,280
that's accumulated over a number of
years about the safety of these implants.

376
00:22:17,560 --> 00:22:21,390
I can tell you they're safe. Um,
the patients are happy with them.

377
00:22:21,410 --> 00:22:26,150
The generation implants we're using
now is far superior to what was used 40

378
00:22:26,200 --> 00:22:31,190
years ago, the patients have access to
lots of educational material on the web.

379
00:22:31,670 --> 00:22:35,510
I think the difference is the implants
are improved and the patients come in way

380
00:22:35,511 --> 00:22:39,220
better educated than they had in the
past. Most people know what they want,

381
00:22:39,221 --> 00:22:43,300
they've done their homework, um,
spoken to their friends. So, um,

382
00:22:43,600 --> 00:22:46,980
my consultations now usually are
pretty smooth because the patients are

383
00:22:46,981 --> 00:22:49,940
relatively educated. So the
implants are a little bit better,

384
00:22:50,160 --> 00:22:51,460
but the patients are a lot better.

385
00:22:52,090 --> 00:22:54,940
Yeah, I think, I think
that's important. Uh,

386
00:22:55,090 --> 00:23:00,010
information is power and there's
been a lot of effort to get

387
00:23:00,030 --> 00:23:01,450
the information to,

388
00:23:02,270 --> 00:23:06,410
to assimilate the information or produce
the information through clinical study

389
00:23:06,411 --> 00:23:10,250
and then to get the information
to patients. Um, we,

390
00:23:10,350 --> 00:23:13,330
we never know what's coming
next in implants. It's,

391
00:23:13,331 --> 00:23:17,960
it's hard to know what will be developed
and what will be approved by FDA,

392
00:23:18,140 --> 00:23:22,920
but people have talked about putting
chips in implants to help sense if the

393
00:23:22,921 --> 00:23:24,880
implant has failed. Uh,

394
00:23:25,180 --> 00:23:29,640
the improvements in high resolution
ultrasound have made it a lot

395
00:23:29,820 --> 00:23:33,320
easier to monitor implants
without having to go to an MRI.

396
00:23:33,850 --> 00:23:38,670
Those are some recent
developments. Um, another one is,

397
00:23:38,930 --> 00:23:42,270
is something called ideal implant. Uh,

398
00:23:42,740 --> 00:23:44,750
this is an implant that's saline,

399
00:23:45,100 --> 00:23:49,640
but the saline shifts through
baffles in the implant

400
00:23:50,100 --> 00:23:53,320
so that it gives a softer
feel to the implant.

401
00:23:53,510 --> 00:23:56,720
It's supposed to resemble more closely,

402
00:23:57,000 --> 00:24:01,600
a silicone gel implant with
again, the, the safety and,

403
00:24:02,120 --> 00:24:06,390
uh, replaceability advantages
of the sailing. Uh,

404
00:24:06,391 --> 00:24:09,270
ha do you have any experience
with that, Dr. Pozner?

405
00:24:09,610 --> 00:24:12,550
No, I don't. I've seen them at the
shows, but I've never placed one.

406
00:24:12,550 --> 00:24:17,150
And you have a sense how your
population of patients has

407
00:24:17,830 --> 00:24:20,390
received this or they aware
of it, or they interested.

408
00:24:21,450 --> 00:24:22,860
You know, there's so much,

409
00:24:23,000 --> 00:24:27,580
so many patients here in Florida and
across the country have Silicon implants

410
00:24:27,660 --> 00:24:31,140
nowadays that most people coming
in expect to get silicone implants.

411
00:24:31,141 --> 00:24:33,540
They don't want to hear
about anything different. Um,

412
00:24:33,541 --> 00:24:37,300
they want something that's tried and
true and that their friends have.

413
00:24:37,440 --> 00:24:42,130
So I don't go into the alternative,
although I do tell them, you know,

414
00:24:42,190 --> 00:24:43,490
you could have a salient implant,

415
00:24:43,491 --> 00:24:45,650
but I probably haven't placed
one in three years right.

416
00:24:45,650 --> 00:24:47,010
Now. And, you know, I,

417
00:24:47,090 --> 00:24:50,650
I think you brought up the issue
of all the data that's available.

418
00:24:50,920 --> 00:24:52,690
When you have a new implant.

419
00:24:53,550 --> 00:24:56,210
Now it's been placed in many fewer people.

420
00:24:57,120 --> 00:25:00,320
It's been in people for many fewer years.

421
00:25:00,390 --> 00:25:05,080
There's much less information about
the performance of a new implant

422
00:25:05,440 --> 00:25:07,680
compared to an implant that's, you know,

423
00:25:07,681 --> 00:25:12,320
like the current generation of
silicone gel that came on the market in

424
00:25:12,321 --> 00:25:15,520
2003, 2004, uh,

425
00:25:15,521 --> 00:25:19,830
there was 10 years of data when they
came on and now there's even more data.

426
00:25:20,870 --> 00:25:25,830
Uh, and that data lets you benchmark
how the implant's going to behave

427
00:25:26,130 --> 00:25:30,510
and, and really important for
patients to have that predictability.

428
00:25:30,650 --> 00:25:31,630
And that understanding.

429
00:25:32,770 --> 00:25:37,210
This episode has helped me understand
a lot about the factors that go into

430
00:25:37,211 --> 00:25:39,050
implant, selection, and decision making.

431
00:25:39,790 --> 00:25:41,890
But what can you tell me to tie it all up?

432
00:25:42,160 --> 00:25:44,370
What are the most important
things to keep in mind?

433
00:25:45,270 --> 00:25:49,770
So, you know, I'll go back to what I
said at the beginning of the episode,

434
00:25:49,771 --> 00:25:52,250
every implant sooner or
later is going to fail.

435
00:25:52,251 --> 00:25:55,720
Hopefully you're going to be
alive for decades, decades,

436
00:25:56,350 --> 00:25:59,640
many decades after you
place the implant. Uh,

437
00:25:59,740 --> 00:26:03,680
so you have to plan for future
work, but there's no set period.

438
00:26:03,820 --> 00:26:05,560
You run the implants till they break,

439
00:26:05,561 --> 00:26:09,760
or until you need to make a major
aesthetic change because of aging changes.

440
00:26:10,060 --> 00:26:14,240
So you don't change them at a set
time, uh, knowing , uh,

441
00:26:14,241 --> 00:26:19,030
no one ever has baseline symmetry, uh,
but you can get approximate symmetry.

442
00:26:19,031 --> 00:26:22,350
We're trying to create volume symmetry,

443
00:26:22,450 --> 00:26:26,830
but the skin envelope is still not
being changed with breast augmentation.

444
00:26:27,810 --> 00:26:32,020
And so I generally tell patients
not to chase small issues.

445
00:26:32,650 --> 00:26:34,420
Perfect is the enemy of good.

446
00:26:34,800 --> 00:26:37,660
And because we know
future surgery is coming,

447
00:26:38,280 --> 00:26:42,460
that's the time to chase a small issue
at the same time that you do a big

448
00:26:42,461 --> 00:26:45,960
revision after childbearing
or after aging,

449
00:26:45,990 --> 00:26:48,520
when you need a different
size or style implant,

450
00:26:48,521 --> 00:26:51,320
or you need a breast lift
along with the implant.

451
00:26:52,590 --> 00:26:55,730
So Dr. Pozner, what are the big
takeaways from your point of view?

452
00:26:55,990 --> 00:26:59,370
You know, I, I think you covered it
pretty extensively, uh, Larry, that,

453
00:26:59,371 --> 00:27:03,120
you know, there's no set time to
take out these implants. They last,

454
00:27:03,300 --> 00:27:06,720
and you just, you evaluate them
at, at a longer period of time.

455
00:27:06,721 --> 00:27:11,040
Like over 10 years, you see what's
happening with the patients and, um,

456
00:27:11,660 --> 00:27:15,160
you really keep the patients coming in
every year for exams and just make sure

457
00:27:15,161 --> 00:27:19,240
that they're doing okay. But, um,
it, it's a very safe operation.

458
00:27:19,400 --> 00:27:23,070
Patients are very happy with the
results, uh, for the most part.

459
00:27:23,930 --> 00:27:26,670
And I think that we've pretty
covered this pretty well.

460
00:27:26,810 --> 00:27:31,590
And the key is really that you need to
go to someone who does this on a routine

461
00:27:31,600 --> 00:27:34,870
basis. Um, if I was seeking
breast augmentation,

462
00:27:35,070 --> 00:27:36,470
I wouldn't go to a hand surgeon.

463
00:27:36,750 --> 00:27:40,380
I would go to a surgeon that does a lot
of breast augmentation, cuz they have,

464
00:27:40,381 --> 00:27:43,100
there's a lot of little
nuances in this. You know,

465
00:27:43,200 --> 00:27:45,940
I'm at the point as is Dr.
Bass in our careers where,

466
00:27:46,290 --> 00:27:49,700
when we're doing a surgery, we're
looking at a one millimeter,

467
00:27:49,880 --> 00:27:52,380
do I go an extra millimeter
dissection in this or,

468
00:27:52,381 --> 00:27:56,420
or this versus when the people who
don't have a lot of experience with it,

469
00:27:56,421 --> 00:27:58,450
just pop an implant in and call it a day.

470
00:27:58,451 --> 00:28:00,810
There's a lot of little nuances
that come from experience.

471
00:28:01,840 --> 00:28:05,250
Well, thank you Dr. Pozner.
I couldn't agree more. Uh,

472
00:28:05,490 --> 00:28:09,170
I think my patients have a ton
of fun with breast implants. Uh,

473
00:28:09,171 --> 00:28:12,170
they I've gotten roses
and champagne and it,

474
00:28:12,171 --> 00:28:16,880
it is a very safe operation that
people really enjoy the benefits of.

475
00:28:17,800 --> 00:28:21,200
Uh, but I appreciate your joining
us for this episode of park avenue,

476
00:28:21,201 --> 00:28:22,680
plastic surgery class,

477
00:28:22,750 --> 00:28:27,000
because it's really useful to
hear a very experienced expert's

478
00:28:27,710 --> 00:28:30,120
point of view and,

479
00:28:30,540 --> 00:28:33,560
and advice on aesthetic breast surgery.

480
00:28:35,060 --> 00:28:38,110
I'll also add my thanks to
Dr. Pozner for being with us.

481
00:28:38,270 --> 00:28:42,630
I certainly understand a lot more
about the important considerations and

482
00:28:42,830 --> 00:28:45,030
decisions to be made when
choosing a breast implant.

483
00:28:46,150 --> 00:28:49,770
If you think of other exciting trends
or developments in plastic surgery that

484
00:28:49,771 --> 00:28:52,010
you would like us to
discuss in a future episode,

485
00:28:52,230 --> 00:28:56,400
please reach out by email or
Instagram. We'll see you next time.

486
00:28:57,580 --> 00:29:00,430
This is Doreen Wu thanking
you for joining Dr. Bass,

487
00:29:00,570 --> 00:29:04,670
Dr. Pozner and me for this discussion of
breast implants and how to select them.

488
00:29:05,250 --> 00:29:08,950
Be sure to join us next time to hear
about another aspect of this fascinating

489
00:29:08,951 --> 00:29:12,780
field, as always, don't forget
to subscribe to our podcast.

490
00:29:13,080 --> 00:29:16,100
So you don't miss any of the
exciting content that is coming soon.

491
00:29:16,990 --> 00:29:20,980
Thank you for joining us in this episode
of the Park Avenue Plastic Surgery

492
00:29:21,110 --> 00:29:25,620
Class podcast with Dr. Lawrence
Bass Park Avenue plastic surgeon,

493
00:29:26,420 --> 00:29:28,260
educator, and technology innovator.

494
00:29:28,560 --> 00:29:31,170
The commentary in this
podcast represents opinion.

495
00:29:31,171 --> 00:29:33,810
This podcast does not
present medical advice,

496
00:29:34,110 --> 00:29:38,130
but rather general information about
plastic surgery that does not necessarily

497
00:29:38,190 --> 00:29:41,320
relate to the specific conditions
of any individual patient.

498
00:29:41,660 --> 00:29:46,400
No doctor-patient relationship
is established by listening
to or participating

499
00:29:46,540 --> 00:29:47,373
in this podcast,

500
00:29:47,630 --> 00:29:51,680
consult your physician to advise you
about your individual healthcare.

501
00:29:51,940 --> 00:29:53,360
If you enjoyed this episode,

502
00:29:53,540 --> 00:29:57,560
please share it with your friends and
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503
00:29:57,561 --> 00:30:01,590
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504
00:30:01,890 --> 00:30:04,190
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