Dr. Kaplan on Instagram Live with New Beauty

This is huge and you don’t want to miss it! The award winning, widely read self-care and cosmetic “bible,” ie NewBeauty Magazine will be interviewing Dr. Kaplan on Instagram Live! Sarah Eggenberger, editor-at-large of NewBeauty and Dr. Kaplan will discuss all things breast augmentation.

Dr. Kaplan is thankful to Breast Implants by Mentor for making this possible behind the scenes. So where will you be on Tuesday, November 10th at 9am PST? The same place you always are – looking at your phone! Just make sure you’re tuned to @newbeauty or @breastimplantsbymentor on Instagram Live for the details on breast augmentation.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Dr. Kaplan joining NewBeauty on Instagram Live! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Textured breast implants

First, this doesn’t apply to all implants. It doesn’t apply to saline or silicone implants with a  smooth surface. This doesn’t apply to textured implants by Mentor or Sientra. This is only in regards to textured breast implants specifically made by Allergan.

So what’s the problem?

Allergan textured breast implants are associated with anaplastic large cell lymphoma (ALCL). It’s not your typical breast cancer. In fact, ALCL can occur anywhere in the body. But when it comes to textured implants, the scar tissue around the implant can turn into ALCL.

A patient would be suspicious if one breast all of a sudden grew larger because of an accumulation of fluid around the implant. If that happens, tell your doctor. They’ll remove some of that fluid and send it to the lab for diagnosis. The treatment is to remove the scar tissue that contains the lymphoma from around the breast.

With quick diagnosis, the patient can be cured with removal of this scar tissue.

Why texturing in the first place?

Textured implants help keep an implant in position within the breast. This is less important with a textured round implant because if it spins in the breast pocket, it’s still a round implant and is still in a good position. But a shaped or tear drop implant that spins can create a “sideways” boob. Texturing helps the implant from spinning. To completely avoid the issue, your best bet is to get a round smooth implant since you can’t get shaped or tear drop implants that are smooth.

What if I have textured implants?

If you’re not having symptoms, you don’t have to do anything. Even the FDA is not recommending patients remove their textured implants without symptoms. But again, if you do have symptoms, a cure is likely with removal of the implant and the surrounding scar tissue.

Video regarding textured breast implants and the risk of ALCL

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Allergan removes textured breast implants from market [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Breast asymmetry correction is one of the most complex breast procedures around. The complexity is due to the myriad of ways to fix the asymmetry. It’s not just a matter of size, but also of shape. And then you have to get the nipple in a symmetrical position!

Video of breast asymmetry correction

As the video shows, there are many steps to correcting breast asymmetry. First you must identify the problem. Is it only a size discrepancy or a ptotic (droop) issue. Based on the discrepancy, the surgical plan will proceed from there.

The key to success is ensuring a cohesive plan preoperatively. Having a range of breast implants available to improve size symmetry is important. But you may also need to use different techniques for the breast lift to improve symmetry between the nipple position.

This means a “donut” lift to reduce the size of one areola to match the other. It may mean a “lollipop” lift to shift the areola northward. Or it may mean a more extensive “anchor” lift to shorten the distance between the nipple to the inframammary fold. Again, there are many variables and steps to achieving success. Experience matters.

And while experience is key, obviously cost is a realistic matter to take into account. To check pricing on this procedure from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Breast asymmetry correction with implants and lift [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Check out those breasts! Seriously though, who would’ve thought an implant exchange from 370cc to 560cc (an increase of almost 200cc!) would still look so good and so tasteful? There are several ways to philosophize on this particular patient’s case.

Is an implant exchange in your future?

When I first look at these results, I definitely think her breasts looked fine in the preop photos with 370cc silicone implants. But when compared to the ‘after’ photos with 560cc silicone implants, it makes the 370cc implants look small, even though no one would ever believe that, in isolation, 370cc implants are considered small.

But simply by comparison, the larger implants make them seem small. At the same time, how do the 560cc implants look so appropriate on the same smallish frame? We’ll address this more later. And why didn’t the original doctor place larger implants in the first place?

The answer is, stress relaxation. A patient whose breasts look like they do in the photo above with 370cc silicone implants in place, probably had little to no breast tissue before her original operation. So it was probably a struggle just to get 370cc implants in position with the skin envelope so small and tight.

Fast forward a few years, and the breast skin envelope has been stressed with the 370cc implants. That stress on the skin, makes the tight skin relax and acclimate to the implants. That way, when the patient decided to get larger implants more recently, the skin has already been stretched (in a good way), to allow for the much larger 560cc implants. Thus allowing the “new” breasts to appear more natural than going straight from no breast tissue to 560cc implants.

Implant exchange in breast reconstruction (non cosmetic)

This isn’t just a phenomenon with cosmetic breast augmentation. This also happens when a patient has a mastectomy for breast cancer. Since the breast and most of the breast skin has been removed, a full size implant can’t be placed right off the bat. The surgeon has to put a tissue expander in place first to stretch the skin over several months. Stress relaxation is in play here as well. Once the skin has been adequately stretched, a permanent implant is inserted during an implant exchange procedure. The only difference in the case above is that it’s for purely cosmetic reasons.

But that still doesn’t completely answer the question, how does 560cc implants look so good on a patient’s small frame? When the patient first asked for these larger implants, I was concerned they would be too big. After speaking with the patient, she clearly understood the risks and had reasonable expectations. I’m glad I listened to her because she was right and she looks great! In the end, you can’t always know if a larger implant will be too big. Simply tell the patient that you can only put in the biggest implant that will still allow for closure of the incision. And review the risks and benefits and hope the patient remembers that preop conversation in the postop period!

To check pricing on a breast augmentation or implant exchange from a doctor near you, click here or here, respectively.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post What a difference an implant exchange makes! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Reasons to change your breast implants

YES – You have saline implants and want to switch to silicone for a more natural feel (but you don’t have to)
YES – Capsular contracture caused the implant to deform
YES – You feel pain
YES – Your implant has moved or turned
YES – Rupture
YES – You want a different size

Reasons you don’t need to change your breast implants

NO – Because it’s been 10 years and someone told you that you need to change them every 10 years. The reason people believe this is because one study said that 20% of breast implants have a problem at the 10-year mark…but that means that 80% are fine. So you don’t automatically need to change them.
NO – Because they look fine
NO – You’re still happy with them

Video Removing saline implants

To check the cost of breast augmentation or breast augmentation revision from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Do I Need to Change My Breast Implants? [Video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

What is ‘bottoming out’ in breast augmentation?

In an ideal situation, a breast implant sits behind the breasts in perfect symmetry. However, if the fold under the breast, the inframammary fold, is disturbed, the implant can bottom out. The fold is usually very adherent to the chest wall.

Bottoming out can occur if the fold is inadvertently released from the chest wall. This can occur if the implants are too large and put too much pressure on the fold, such that it pulls away from the chest wall. And sometimes the fold must be lowered to accommodate a larger implant. If that’s done, the fold will bottom out if the fold is not affixed back to the chest wall with a suture.

If bottoming out occurs, a new pocket for the implant must be created. However, two things are important when doing this. First, the implant should remain under the muscle so the implant continues to be camouflaged and look as natural as possible. Secondly, the pocket needs to be strong to minimize a recurrence of bottoming out.

That’s where the neosubpectoral pocket technique comes in. This is a confusing concept so the video below will help. But essentially, the physician uses the naturally occurring scar tissue around the implant (the capsule), to help make the new pocket. A new pocket is made between the muscle and the capsule and the implant is placed here. That way, the implant is still under the muscle and on top of the capsule.

The alternative, is to use sutures to tighten the pocket and eliminate the bottoming out. However, a new pocket made with this technique has a high chance of failing because the sutures can pull through.

Video: How to treat bottoming out of the breast

To check pricing on a breast augmentation revision, click here.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Bottoming out…in breast augmentation first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

What makes silicone implant ruptures less common now?

As the name suggests, these high-strength silicone gel implants have a thick, gummy bear-like consistency. The sticky, but highly cohesive gel is contained in either a smooth or textured outer shell. They also more closely resemble the feel of natural breasts. They retain their soft, “squishy” feel even after breast implantation surgery.

The semi-solid form of these implants means that they retain their shape even when they are cut into pieces, just like gummy bear candies. Depending gone when and where pressure is applied on the implant, they take on different shapes. However, after you stop applying pressure, the implant returns to it’s original shape. This means that the likelihood of the implant to wrinkle, ripple or fold is decreased. Additionally, unlike saline or old silicone implants, gummy bear implants are less likely to leak outside of the shell.

Video: See it here! When your silicone implant ruptures!

Check the price of breast augmentation from Dr. Kaplan by clicking here.

Click here for the original blog post written by @japsiecam for BuildMyBod.

Thanks to @japsiecam for writing this article!

The post What happens when your silicone implant ruptures? [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Don’t submerge in water

While every surgeon is different (and you should check with your surgeon before believing everything you read on the internet!), submerging your fresh breast aug incisions in water is not a good idea. If you’re bathing in a bath tub or hot tub, just think of all of the filth that collects in the water. All of those bacteria are then in contact with your brand new incisions.

While we don’t recommend submerging in water, we definitely recommend letting soap and water run over the incisions in the shower. This will keep the incisions so fresh and so clean. I know everyone thinks incisions should be kept dry and while there’s nothing wrong with dry, not showering or cleaning the incisions leaves behind sweaty, grimy skin. That can’t be good either.

Check with your doctor but we recommend waiting 6 weeks before submerging your incisions in water. That’s not an arbitrary number. That’s how long it takes for the collagen in your incisions to heal and mature.

The 6-week rule also goes for wearing underwire. While we understand you want to show of your new babies, please wait on the push up bra or underwire. The underwire could theoretically put undue pressure on the incisions so just wait. The implants will naturally ride high initially so you don’t even need the push up bra.

And do we really need to tell you not to use any tobacco products before or after your surgery?! The nicotine can affect the blood vessels bringing oxygen, white blood cells and fibroblasts to your new incisions. All of these blood borne cells help with the healing process. So if there’s nicotine on board, the blood vessels constrict and bring less of those helpful cells to the area, increasing the risk of infection.

If you want to know about smoking other things and whether it’s ok before surgery, you can read more here. Lastly, for a nice summary of what you should and should not do, watch this funny video produced by our office staff!

Postop Breast Recommendations

Bottom line: be a good, compliant patient!

To check pricing on breast augmentation from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post Postop Breast Surgery Do’s and Don’ts [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Getting surgery and want to hide your scars? Whether you’re getting surgery for medically necessary or cosmetic reasons, here are a few ways you can better hide your scar. Keep in mind that it’s ok to ask your surgeon about hiding scars but  don’t demand it. While you may be most worried about scars, they’re worried about ensuring the best access to perform your surgery in the safest manner possible.

Hiding your surgical scars

Are you scheduling thyroid surgery? It may be the time to also get a neck lift. The horizontal incision your surgeon uses to remove the thyroid is a little lower than the typical incision your plastic surgeon uses for a neck lift but it’s close enough! This way, when you return to work, you can tell everyone you had thyroid surgery, but you don’t have to tell them about the neck lift. They’ll just think you lost weight and look more refreshed!

For an arm lift (like the patient above), ensure your surgeon places the scar on the inside of the arm. This is certainly more common but it wasn’t long ago that the incision was placed on the back of the arm. The biggest issue with the back of the arm is that anyone walking behind you can see the scar. Whereas with a scar on the inside of the arm, people walking towards you or behind you can’t see a thing.

No matter what type of breast augmentation you receive, your surgeon can hide the scar in 1) the armpit, 2) the fold under the breast or 3) along the edge of the areola. All of these are great options. Which you choose depends on these variables here.

And finally, if you’re getting liposuction, these very small incisions are very easy to hide. Your surgeon can hide the incisions within a C-section scar and or scar resulting from a cyst or mole removal. If the surgeon still has access to the areas that are necessary to do a great job, moving the incision over by a few inches can better hide your scar and provide a great result. That’s a win-win!

To check pricing on medically necessary or cosmetic procedures from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post Clever ways to hide your surgical scars first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

What’s the purpose of postop garments

It’s not clear why postop garments became such an integral part of cosmetic procedures. There’s not a peer-reviewed, multi-center, high quality study showing the effectiveness of using postop garments. Nothing similar to a drug trial with and without postop garments.

However, many surgeons use them. Here are some possible reasons.

After a breast augmentation, with fresh incisions under the breast, your surgeon may worry you’ll wear a bra with underwire. This could cause irritation to the incision, possibly risking it to open. To avoid this problem, your surgeon may recommend a special postop bra because they are usually soft, without much structure. And certainly don’t have underwire. Therefore, your surgeon knows exactly what you’re wearing after surgery and can rest easy it’s not a bra that will place undue stress on “their work.”

In the case of a tummy tuck or liposuction, the patient is often sore and the potential for fluid to collect under the skin is high. With swelling, the skin stretches, causing pain fibers to fire, putting the patient in more pain. To alleviate some of this pain, the garment can reduce the amount of swelling, theoretically reducing skin stretch and therefore pain.

While there’s no proof of these benefits in a large study, many patients like the garment and the “sense of security” it provides after surgery. It’s also interesting to see how many patients are reluctant to embrace the idea of a postop garment before the operation but come to appreciate its benefits after surgery.

Click on the links to check pricing on the procedures that often require a postop garment. Breast augmentation, tummy tuck, liposuction.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post Postop garments first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

It’s a totally reasonable thing to do. Patients, when going in to see their plastic surgeon, bring “wish pics.” That is, a photo of someone (doesn’t have to be famous), that’s had the operation and the results they’re looking for. But reasonable intent can translate into unreasonable expectations.

What’s wrong with wish pics?

Patients bring in their wish pics all the time. It’s definitely helpful to see where they are and where they’re trying to go. This exercise also provides insight as to their expectations and self-image. Some patients have reasonable expectations. Whereas others have an inaccurate self-image preop and an inaccurate appreciation of what’s possible.

Wish pics therefore give an opportunity to have a frank and honest discussion. Sometimes they’ll bring in photos of celebrities that are of a different ethnicity and body shape that is physically impossible to emulate. However, I recently noticed an unexpected pitfall, especially in the case of breast augmentation –  they bring photos of clothed patients.

In some cases, when patients see themselves in the mirror, they view themselves naked. Then they look at a photo of someone else with a breast augmentation and say, “I want to look like that!” But the person in the photo is clothed, which covers up issues of asymmetry, stretch marks, lack of cleavage and other natural imperfections.

So you have to prepare the patient that they can’t conflate how good the breasts look in the photos and how they will look naked. In other words, don’t focus on how “perfect” the breasts look clothed. They may not look that perfect postop when looking in the mirror without clothes on.

One classic example is a patient wanting the cleavage present in a photo of a clothed person. It’s unclear if that cleavage is due to a push-up bra (which wouldn’t be utilized when naked) or if it’s au natural.

Don’t put the breasts on a pedestal

It’s also important that the patient doesn’t “put the breast on a pedestal!” Patients need to be reassured that everyone, even those in the photos, have imperfections when naked.

To discuss further with Dr. Kaplan and to check his pricing, click here.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post Pitfalls of breast aug wish pics! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.