Dr. Farber:    I’m doing fine, thank you. How are you?

Barry:             Fantastic. Thank you. Scott, why are breast augmentations one of the most popular procedures in the world?

Dr. Farber:    Breast augmentation is a very popular procedure both for young women as well as older women. Breasts are a symbol of femininity and sensuality, but some people feel self-conscious about the size of their breasts. With breast augmentation, you can improve your self-esteem, so they can feel better about themselves. It really is a remarkable procedure.

Barry:             Yeah, okay. Scott, a couple years ago, there was a whole controversy about breast augmentation. In fact, for a couple years there, the silicone implant was disallowed. It really was not allowed to be used. Then, a whole new thinking came on it. What exactly was going on in the past, and what’s going on now that makes it a better procedure?

Dr. Farber:    In the 1990s, it was thought that silicone in the implants was harmful and it could cause a host of autoimmune problems and problems in the patient. Subsequently, the Food and Drug Administration has actually proved that that was not true and that silicone, in fact, is safe. It actually is used today both for reconstructive surgery as well as cosmetic surgery with fantastic results.

Barry:             I’ve had the rare occasion where a person has come to me from Southeast Asia where they’ve had raw silicone injected into their skin, and that’s caused nothing but a mess. What is the difference here, just so that our listeners understand?

Dr. Farber:    Injecting free silicone into the breast, like you said, is never a good idea. It can cause inflammatory reactions in the skin and scar tissue, and it usually ends poorly, requiring removal of the silicone and the inflammatory tissue around that causes it. The difference with breast implant surgery is that the silicone is medical-grade silicone that’s encapsulated in a silicone shell. This implant is placed in the body and is not free to form inflammation in the skin and surrounding tissue.

Barry:             I think also what happened while this moratorium on breast implants was on, I think some things happened in the way breast implants were being implanted. The whole field changed because there were some advances also in putting the breast implants further down, like under the muscle, whereas before, many people were using these breast implants in different planes. Isn’t that right?

Dr. Farber:    Yeah. Today, implants are placed both above and below the muscle, and the indications for putting these implants vary based on tissue thickness, the body habitus of the patient and the aesthetic goals of the patient. And now we can choose the proper position for the implants based on all of these factors, so you’re not pigeonholed into one technique for all different patients.

Barry:             I think part of it is that the breast implant has gotten better, but I also think our knowledge and our understanding of the procedure has gotten a lot better as well.

Dr. Farber:    Absolutely. In patients that require a more natural appearance, where the implant will [Inaudible 00:04:51] or droop with the patient, you can put the implant above the muscle, whereas patients that would like a slightly augmented appearance with a rounded upper pole fullness, generally we put these implants below the muscle.

Barry:             That’s pretty significant. When you’re talking to a person about breast implants, do you explain the different types of implants?

Dr. Farber:    Absolutely. For instance, there are traditional saline-filled implants, where the implants are filled with sterile saline, salt water, versus silicone implants, where it’s a gel type of implant that’s generally softer, more natural-appearing, and gives an overall better set of results. There are newer implants now that actually the gel is more cohesive, and the term in the media, so to speak, is a gummy bear implant, as when you cut it in half, it looks like a gummy bear.

Barry:             Okay. What’s the big benefit of this gummy bear implant versus the others that were out, Scott?

Dr. Farber:    Again, when we have all of these options, we can tailor our specific procedures and implant choices towards the patient to achieve the best aesthetic result. The new cohesive gel implants, or gummy bear implants, are not only form stable implants, so when you cut them, they look like gummy bears, but they’re also anatomically shaped, as opposed to a round implant. What this provides is the ability to give a more natural teardrop appearance to the breast as opposed to a more augmented breast with upper pole fullness.

Another option or facet to these implants is they’re a little more firm, and this is good for breast reconstruction candidates, specifically those who have had radiation, to resist the forces of radiation.

Barry:             What is the youngest age you would consider a breast implant for a person?

Dr. Farber:    I think every case is different. For pure cosmetics, you want to make sure that the patient’s mature enough to understand exactly what she is undergoing. At least in the United States, the rule is you cannot put a silicone implant in a patient under 22 years old, so anyone under 22 requires a saline implant.

Barry:             That’s really good. At least there are some rules and regulations regarding this. There’s a whole controversy over whether cosmetic surgery should be done on adolescents. As you say, a person should be fully formed, and certainly, that maturation does not occur in everybody by the time they’re 16 or 18 years of age.

Dr. Farber:    Absolutely. I think it’s important to take every patient, every procedure on a case-by-case basis.

Barry:             I think, also, people should also be mentally mature as well.

Dr. Farber:    Absolutely. Absolutely. They have to understand both physically and mentally what’s involved. They have to be able to care for themselves after surgery, and it’s not to be taken lightly.

Barry:             No. When a person goes through a breast implant, how much down time can they expect? Let’s suppose we have a person who’s an avid sports enthusiast and they exercise every day. They’re really doing the things they like to do. How much time would you recommend them to stay off exercise if they were going through one of these newer implants?

Dr. Farber:    Generally, I recommend to my patients that they take one week off. Everyone is different, again, but for the most part, a couple days they’re going to be sore. They may not feel like doing their normal activities, but usually by one to two weeks, they’re back to resuming the majority of their activities. With regard to sports and being active, that generally is four to six weeks to really allow the tissue to mature and heal to not cause any damage with the surgery.

Barry:             One of the complications that used to be out there, at least fairly commonly in years gone, by used to be a capsule used to form around the implant, and that caused all sorts of problems. Is that still a common complication?

Dr. Farber:    It’s a complication. What you’re referring to is capsular contracture, and this is essentially when scar tissue forms around the implant. That happens in every single patient that we put an implant in, both for cosmetic and reconstructive purposes. It’s a foreign body, and your body forms a scar in response to having an implant in the body. In the majority of patients, this scar is soft, unnoticeable, and nothing needs to be done.

However, in a select patient population, this scar will become hard and firm and may distort the breast and cause pain. Why this happens is a subject of much debate. We have done lots of different things to decrease the incidence of capsular contracture, such as sterile techniques and changing our gloves and using antibiotic solution, and a lot of these things have dramatically decreased the incidence of capsular contracture.

Barry:             Interesting. Okay. Good technique or excellent technique seems to decrease some of these risks. Is that not right?

Dr. Farber:    I think that one of the paramount philosophies in surgery is that there is no substitute for good technique. The better the technique, the more meticulous the dissection, the more attention that’s paid to detail, the better results you will have.

Barry:             Several years ago, there used to be a technique where these implants used to be put in through the belly button. It used to be called the TUBA, or trans-umbilical breast augmentation. Is that still being done?

Dr. Farber:    Not in my practice. It’s generally, in my hands, not as effective a technique for breast augmentation. I don’t feel it’s as safe, and you really don’t have as much control over the pocket to get the most aesthetically appealing breast.

Barry:             I think there is also the risk of getting infections put in there, in the way that the belly button frequently has a little bit of yeast in it, and that frequently would cause some problems, was it not?

Dr. Farber:    Absolutely. Absolutely.

Barry:             Some of the concepts we had, unfortunately, were not the best concepts. That’s how medicine progresses. We learn something, we do something. Medicine progresses and learns from our mistakes as well as the things that we do right.

Dr. Farber:    Absolutely. Without mistakes from the past, you’ll never learn from the future.

Barry:             Absolutely. This is Dr. Barry Lycka, host of Inside Cosmetic Surgery Today on webtalkradio.net. Today, I’m talking with Dr. Scott Farber from Boca Raton, Florida. We’re really talking about a very, very interesting topic, something called breast augmentation, something that’s being done around the world. It’s the number one cosmetic surgery procedure in most circles. And it’s gone through a lot of changes over the years, so something that everybody should be aware of.

Scott, is it still the trend that people want bigger and bigger breasts, or do people want just nicer, smaller breasts now?

Dr. Farber:    Again, coming from south Florida, there are a lot of different patient aesthetic goals. The augmented upper pole full breast is still desired. People feel that it’s a pretty aesthetic result. However, other patients want a more natural result, a more teardrop look to the breast, less augmented, less upper pole fullness. And because of the different types of implants we have and the different techniques that we have afforded to us, we’re able to really satisfy a host and a wide array of aesthetics.

Barry:             This is going to be a dumb question, but it’s going to be a question that your patients are going to ask you. They’re going to say, “Is it true that I can shop from a catalog and decide exactly what type of breast that I want?”

Dr. Farber:    It’s interesting, because in older days of breast surgery, it was more a gestalt, a feel for what size implant. Now, at least in my practice, it’s more bio-dimensional measurements. We pick an implant and pick a style of implant based on patient’s anatomy. We want a footprint of the implant, essentially a size of the implant that fits a patient’s chest. I always recommend patients bring in pictures of breasts that they like the appearance of to better communicate with me exactly what they are trying to achieve with breast augmentation.

Barry:             Are there options available to patients who do not want a false material or a silicone implant or a saline implant? Are there other options available to patients?

Dr. Farber:    It’s interesting, because some of the newer techniques involve fat grafting. Patients that are not keen on breast augmentation with an implant, there are newer techniques that actually take fat using liposuction techniques from one area of the body and infiltrate the fat into the breast. This was initially taboo, and people were not very comfortable doing this, but it is definitely currying favor in the plastic surgery community.

Barry:             In fact, I’m working on one of those right now with a plastic surgeon from the Stanford area of California, and we’re actually using very small implants of fat into the area and then serially augmenting them so that the procedure gets done, we do it again a month later, we do it again the month later. Getting some fantastic results. Again, it won’t do what an augmentation will do in the fact that, if a person wants double Ds or greater, they’ll never get that with a fat implant. But, if they want a smaller, perkier, natural-looking breast, we’re getting some pretty phenomenal results with this, and I’m very pleased with that.

Dr. Farber:    Absolutely. Fat grafting is [inaudible 00:16:27] technique, and like you said, you’re not going to be able to achieve the increase in size that you would with an implant. However, for modest size gain and to be able to avoid needing an implant, it definitely is exciting.

Barry:             What we’re finding with this is also the lack of downtime is really something phenomenal for a lot of our patients. It’s looking like the average person can get this done on a Thursday or Friday and be back to their full exercise and everything else by Monday, Tuesday. There really isn’t a great deal of downtime, and that’s becoming something really nice for the patients.

Dr. Farber:    They’re not putting an implant underneath the muscle and not manipulating…

Barry:             By not getting into the muscle cavity, it certainly saves a lot of those problems. That’s something nice. Just to keep the heads up for the listeners, because I’ll be covering this with my friend, Dr. Hoffman, from Palo Alto, California, in a few weeks, so I want people to be aware that this is another option for people who are looking for this sort of procedure.

Dr. Farber:    Absolutely.

Barry:             A couple of things as we’re going ahead here. Scott, who is the ideal candidate for a breast augmentation?

Dr. Farber:    Breast augmentation is a wonderful procedure in that it can really improve a person’s appearance, not only appearance, but how they feel about themselves. A woman who has been unhappy with the size of their breasts is really a good candidate for breast augmentation. They should have an adequate skin envelope. They should have appropriate expectations in terms of how they look and how they want to look, and they should be able to plan for future procedures if necessary in the future.

Barry:             Here is the reverse side of that question, Scott. A person walks into your office, and who is the person you do not want to do an implant on?

Dr. Farber:    I think that anyone who has a deficiency of breast volume who desires larger breasts, they may need a skin tailoring operation if it’s someone who has very inelastic skin. But as long as they are understanding of the procedure and what they’re involved in, they have appropriate expectations, they have a need for a volume augmentation, their skin can accept it, and they’re medically healthy enough, it’s really a procedure that’s appropriate for a very large group of patients.

Barry:             Again, I’m going to rehash this because we’ve already said it. It’s a good procedure for people who are medically healthy with realistic expectations and are both physically and mentally mature enough to accept an implant.

Dr. Farber:    That’s pretty much the requirements for any cosmetic procedure.

Barry:             Again, there are a lot of listeners out there that are thinking of this and they’ve heard about this procedure. I think they have to be realistic about these things with every cosmetic procedure that we do. For example, the other day I got a lady in that wanted liposuction. We showed what we could do as far as reshaping her body, but then she asked me, “How am I going to lose the extra 60 pounds?” I said, “Look, this isn’t realistic. Liposuction doesn’t remove 60 pounds of weight. We can reshape your body. It’s not a weight loss technique.” Again, it’s the realistic expectations that have to be met.

Dr. Farber:    Absolutely.

Barry:             Very, very important. I think Scott realizes this. Scott’s been in this business for a long time. He’s done a lot of procedures, but at the same time, the listener has to be prepared for this, has to be prepared to ask questions. I’m going to ask another leading question, Scott. A friend of yours wants a breast implant and doesn’t want to see you. How do they choose the doctor that can do the best job for them?

Dr. Farber:    When choosing the surgeon for breast augmentation, I think the first and foremost is to find a board-certified plastic surgeon. These are doctors or plastic surgeons that have gone through extensive training in plastic and reconstructive surgery and have gone through a lot of tests and evaluations to ensure that they’re providing safe and appropriate care to their patients. Once a board-certified plastic surgeon is found, you need to develop a sense of trust with your doctor. It’s important that you have a good relationship and you trust that he or she is doing for you what you want, and you trust that he or she will be able to provide for you a result that you’ll be happy with.

Barry:             I think the key words here are experience, caring, person that can do the results that you want, but somebody that also pays attention to detail, somebody that really is a conscientious doctor and somebody that you feel comfortable with. You’ve got to feel comfortable with their office from all phases of the game, from the moment you phone their office to the moment you walk into their office.

If you’re treated poorly on the phone to begin with, that’s probably how you’re going to be treated after your procedure, too, if you have a complication, etc. I think it’s very important to have this rapport. I think it’s very important to develop a relationship and feel comfortable about things.

Dr. Farber:    Couldn’t have said it better myself. Developing a rapport with your physician and with your office staff, having someone that’s done this procedure over and over again, feels comfortable with the procedure, and that you trust. Those are really the most important things when choosing a surgeon.

Barry:             These are all fundamental things. We think about them all the time, but for a person going through thinking about a procedure, it’s a scary time for them, Scott. They’re wrapped up in emotion. They’re worried about the horrendo-plasties that have gone in the press. They’re worried about the horror stories that have gone on there. Those are hard things for people to put beside when they go in and see a doctor.

Dr. Farber:    It’s true, but for every one problem, there are 100 happy patients. I think it’s important to realize that breast augmentation is very safe, and it’s done every day, and it’s truly a life-changing procedure for my patients.

Barry:             Let me ask you a question, because this is a question people are always asking and always want to know, what do you do when you face a complication? What do you do when something comes up out of the great unknown and bites your bum, so to speak? How do you address that complication?

Dr. Farber:    I always say it’s not if you have a complication, it’s how you handle the complication. Oftentimes, doctors will try and avoid the situation and not like to deal with that patient if it’s a problem. I am the exact opposite. I want to be there. I want to be the one to fix it, and I’m there the whole step of the way. I hold the patient’s hand, and we get them through it.

Barry:             That’s a good answer. I always tell my patients that in the unlikely event that there’s a complication, I’m in your corner. I’m working with you until we get that resolved, and we’re going to resolve it, and we’re going to get it better. Unfortunately in medicine, crap happens. It’s one of those things that does happen, so when it does happen or if it does happen, it’s very important we address it, take care of it, and make you better.

Dr. Farber:    Absolutely.

Barry:             Those are key words, and I think the listener has to understand that, unfortunately, both Scott and I are not gods. We do have problems that come up in our practice. However, it’s how we deal with them that really matters. If you want a doctor who’s a god, I don’t think you’re going to find it in this day and age. But if you want somebody that’s going to do the best work that they can for you, work at you, and make you better, then it’s very important that you try and follow that through.

Dr. Farber:    Absolutely. Again, these procedures are safe. There are things that happen, but for the most part, they can be overcome, and the end results are usually very positive.

Barry:             Again, the way that both Scott and I deal with complications is, first, we address them, but we try to prevent them in all cases by doing meticulous attention to detail, which is very, very important.

Dr. Farber:    Yeah. Again, I can’t stress enough that by paying attention to detail, by planning three steps ahead, by doing everything the same way every time, and to really put the patient first, usually things go off very smoothly.

Barry:             Today, I saw a patient that told me that they had been following me on the Internet for eight years before they came in. They were so afraid of getting some cosmetic surgery done. These fears are very realistic for patients. It’s something we shouldn’t discount. It’s something we should certainly recognize and certainly should try to lower the barriers to their entry, but the patient that came in today was very pleased when they finally did and got over their apprehensions. I’d like the listener out there to also realize that these fears that you’re having a realistic, but at the same time, please don’t let it scare you away from getting procedures done.

Dr. Farber:    It’s funny, because patients like that—and there are a lot of patients that contemplate cosmetic surgery for a very long time before actually having it—they always, invariably, will say, “I cannot believe I waited so long to have this procedure done. I am so happy right now, and I can’t believe I waited this long to have it done.” At the same time, it’s not something to be rushed into. You have to put a lot of thought, you have to be ready for it, and when that time comes, you’ll be very pleased.

Barry:             Absolutely. Well, Scott, we’re nearing the end here. Are there any final words you’d like to say about breast augmentation?

Dr. Farber:    Again, just to reiterate, breast augmentation is very safe, and it truly is a life-changing procedure. It can improve your self-esteem, and it makes you feel better about yourself both inside and out. It’s something that’s available and FDA approved, and it really is a good procedure.

Barry:             Excellent. Okay, Scott. I always like to give the patients the opportunity to get in touch with my doctors that come on the air. How can they get in touch with you if they’d like to and how can they get to your office?

Dr. Farber:    The best is to visit us on the website, rsi261w1.wpengine.com, and all the information is there.

Barry:                         Excellent. You’re located right in Boca Raton, Florida, itself?

Dr. Farber:    Right in Boca Raton, Florida.

Barry:             Excellent. Excellent. Scott, I’ve got to thank you immensely for coming on the show tonight. I’ve got to thank you for your wealth of information, and I have to thank you for putting yourself on the spot as I hit you with some of those very difficult questions, because they are difficult questions, and at the same time, those are the questions that patients are feeling.

Dr. Farber:    It was my pleasure to be here. Thank you for having me.

Barry:             Thank you, Scott. We’ll talk again.

Dr. Farber:    Have a good night.

Barry:             You too. Bye now. This is Dr. Barry Lycka, host of Inside Cosmetic Surgery Today on webtalkradio.net, your inside source of information on cosmetic surgery. As you’re traveling around in the world and need more information on how to choose a cosmetic doctor, I encourage you to go to amazon.com and check out a little book that I wrote. Dr. Barry Lycka, B-A-R-R-Y L-Y-C-K-A. It’s called, Don’t Choose a Cosmetic Surgeon Without Me.

This book is 180 pages, a wealth of information that tells you what to look for in cosmetic doctors. It tells you who the best are. It tells you the traits to look for, and there’s also a very useful checklist at the end of it that will help you rate doctors and get a better feel for what’s important. Please check that out. That’s Don’t Choose a Cosmetic Surgeon Without Me. It’s available on amazon.com, and it might save you a lot of grief in choosing a cosmetic doctor.

Bye for now. Have a nice day.