Breast Augmentation: Bigger, Rounder, Better

Breast Augmentation

Nipped and Toxxed: Breast Augmentation - Now Streaming on Spotify, Apple, and Google Playlists

Ashley: Welcome to Nipped and Toxxed we are talking about breast augmentations today. I am Dr. Ashley Robey. I am a quadruple board certified plastic surgeon. And with me is Katie Reichart. 

Katie: Hello, I am a CPCP and a cosmetic tattoo artist. And we're talking about breast augmentations. 

I don't know a ton about breast augmentations. I don't have one. I know people who have had them.

Ashley: Sure. Well, breast augmentations have been classically one of the most popular cosmetic plastic surgeries that is performed in the United States. So a lot of people have had them for sure. 

Katie: Right. 

Ashley: Yeah, so it's one of the more common procedures I do. In general, a breast augmentation is a procedure where you are enhancing the size and or volume of your breasts. So it's mostly women that are interested in this, right. 

Katie: Say, you know, Trans, I guess if you want to enhance your upper area. 

Ashley: Sure. That could be a thing. 

Katie: So how many breast augmentations do you do a week? 

Ashley: I don't know, maybe. Two three. 

Katie: Two or three? Yeah. What are the prerequisite say, someone comes in and says, I want a breast aug. What do they need to be BMI? All that stuff. 

Ashley: The BMI restrictions. I don't feel as strongly about for breast augmentation. Because it's a really small incision and I don't think it is as impactful having extra weight with regards to healing after breast augmentation. But ideally, the person would be at their ideal weight. I think that's true for all things, as far as health is concerned. So being healthy enough to have a surgery. Having realistic expectations and understanding the pros and cons. Those are the main criteria. 

Katie: So as far as where the incisions are. Are, are they all in, always in the same place? Do you do them different areas depending on the outcome or does it depend on the implant? 

Ashley: So the classic incisional options for placing an implant would be either under the breast crease. So that's called the inframammary fold. Or. Usually at the bottom of the areola, but anywhere around the areola. So periareolar, some people will do an armpit. And incision. So transaxillary, and there are some people which I think is quite rare that even do an umbilical incision. 

Katie: That seems strange to pull it up through the abdomen. 

Ashley: Yeah, that's a long slide, right? 

Katie: Are they doing other things when they do that? Like how would you even have an area to pull that through? 

Ashley: Well, you have to make a tunnel.

Katie: Oh, okay. Yeah. So it's not like you're doing it along with liposuction or something like that. 

Ashley: I'm sure you could. 

Katie: Interesting. Yeah. So, When you said areola,. You're talking about around the areolas. 

Ashley: Yes. 

Katie: So you take the areola off or you just. 

Ashley: I just put it in an incision. Yeah. I'm usually like a half circle or less than half a circle of incision at the border. Around the areola. 

Katie: Oh, okay. And as far as does that depend on if it is above the muscle below the muscle? 

Ashley: So usually most surgeons have their preferences. But you can go under the muscle or on top of the muscle for any of those. 

Ashley: So for me, I do prefer the crease or the inframammary fold incision. It has a lower risk of what's called capsular contracture. And we can get into that earlier. That's an unwanted outcome associated with a breast augmentation. 

But besides incisional differences, another big difference that people will want to consider when they're trying to decide what they want to do for their breast augmentation is what kind of implant, right. So. In general Gumby. Yeah. So in general it falls into two broad categories, saline and silicone, right? 

But within each of these categories, there are subdivisions. So for the silicone implants, The gummy cell implants you're referring to. Are the fifth generation more form stable form of silicone implants. So they're a type of silicone. 

Katie: So it was just like a gummy bear. 

Ashley: It's yeah. That's how people. 

It was described like a gummy bear, because just like a gummy bear candy. If you were to cut that implant in half. You still have two well-formed pieces of the gummy bear candy or an implant? Whereas some of the older generation silicone implants, if you were to cut that implant in half, they, you would have extruding Ms. Sticky, gel. 

Katie: Right. So, which one looks more natural? 

Ashley: They look very similar. Okay. Yeah. So it's more about how 

Katie: is it saline like saline solution. 

Ashley: It's saltwater. Yeah. So saline. 

Katie: You know, you would think that it is more like, I dunno, moveable. 

Ashley: Saline is. Going to be 

Katie: It has more of a droop to it. 

Ashley: Not necessarily because you're filling the implant. Full. So think about. Like a water balloon. And not like, just like that, but it's not like once you fill the balloon, like there's parts of the balloon that look droopy, right? So you fill the saline to what's called a nominal fill. So a minimum required amount. So that you don't have that overly, 

Katie: do you have to worry about it popping? 

Ashley: You have to worry about implant failure for any kind of implant. Whether it's salient or silicone. 

Katie: What, if you, I don't know. Jumped in the pool and did a belly flop, would you have to worry about the impact of something like that popping your implants? 

Ashley: That shouldn't be enough to break your implant. 

Katie: Like a car accident or something? 

Ashley: If you like that. And I think if you had a really old implant and it was on the verge of potentially failing. Sure. If you were involved. In a car accident and your airbag deployed your chest, hit the dashboard or steering wheel. Yeah, that could be enough to 

Katie: it wouldn't matter what was in it, saline or gummy or whatever. 

Ashley: No, but certainly in that situation, you're, if it's that much force to your chest, you're thinking about how are my ribs? How are my lungs? So yeah, the breasts would be an afterthought in that scenario. 

Katie: I was just thinking about a water balloon. You know, my kids have a water balloon fight, some like oh boy it's like a water balloon in your body, obviously. It's way more. Durable right. 

Ashley: More technologically sophisticated, for sure. But yeah, so the saline implants, there's the traditional single lumen implant. That all of the companies or not all companies, all the companies that have saline implants usually have those. 

And then there's. An ideal saline implant. So that is the company's name is ideal. That's not me saying it's ideal. The company's name is ideal and they have what's called a baffled shell saline implant. So instead of just a single lumen, meaning an outer lining, all filled with saline, it has layers of shells of. The

Katie: extra protection. 

Ashley: It's just like a layered extra layer. Extra extra layers and it reduces fluid waves. And it tends to be a little more, stable with regards to rippling and that kind of thing. 

Katie: Okay. So as far as textured and non textured, What would be the point in having texture? 

Ashley: So the idea behind textured implants would be that. You have, a reduced risk of capsular contracture. Okay. 

Katie: So encapsulation. 

Ashley: Well, everything's going to get a capsule around it. So the difference is you don't want that capsule or lining to become a thick scar that starts squeezing the implant. 

Katie: Right? So I've seen that in when they like repair breast implant. You know, 

Ashley: Right. So capsular, contracture, we were talking about that just very briefly earlier. That's when so a capsule is the lining of your cells. That would be next to the implant. So anytime you get an implant, your body will have a capsule around it, right? 

Katie: Because it's a foreign entity

Ashley: Right? So we mostly talk about it in terms of breast augmentation, because we're really concerned with a certain feel of a capsule. And if you have a tight capsule, around a metal prosthesis. 

That metal's not going anywhere, but in the case of a soft press implant, it can start to make the implant feel more firm. It can be yeah, can be distorted and, and some more severe cases can even become painful. So capsular contracture would be an unwanted outcome, certainly. Things that can be done to reduce that because no one wants that. So what we were talking about earlier, 

Putting the incision in the breast crease that has a lower risk than. In the armpit or around the areola, putting the implant under the muscle. So that's another decision that people are making to do they want that implant under the muscle or on top of the muscle? So under the muscle, does reduce your risk of capsular contracture. 

Katie: Does that change the way it looks? Because when I think of, you know, the muscle. I'm thinking. Okay, now that is going to, you know, breasts are made of fat. And then muscle's obviously much denser and then an implant under that. 

Ashley: It can change the way it looks. Usually it tends to make things look a little more. 

I would say natural because you get more of a gentle slope transition from above your breasts, where your chest wall is. And the muscle provides kind of like a thicker blanket transitioning from no breast to breast or implants. So instead of having like an abrupt, like blip where you're all of a sudden the implants, they're like an orange on a board kind of look. 

You're seeing more of a smooth transition under the muscle. So the thinner you are. The more likely you are to see that obvious and abrupt transition on your chest wall and you are more likely to see it when it's on top of the muscle, because he's just have less of a blanket of coverage. 

Katie: So, how do you determine, like what size. 

Ashley: So just like you have to get your, before you stop growing right you had to get your feet measured to find the appropriate shoe. Those measure, the same kinds of measurements, although on your chest wall would also be performed. To find out which implants would fit you. So. 

Classically the main measurement that I'm looking for with regards to implant options would be check breast width. So the, footprint, so to speak of where your breast sets, how wide is that? Once you have that measurement. And you have some kind of idea as to how thick their tissue envelope is. Right. 

So someone with a really thick layer of tissue or fat that's going to occupy some of that space. As opposed to someone who's really, really thin that won't occupy as much of that space in the chest wall. So once you have those measurements, then it goes down to looking at what implants are available and picking out the profile. So people. 

That are looking at implants are considering the profile. So profile means how much projection slope. Or projection. How much distance off the chest wall, the implant will go. So if you have. Put like your. I feel like you need some visual aid for this, but if you. 

Katie: Like the profile of your face. Yeah. To the side. Is it kind of like that same thing? Like.

Ashley: Yeah, how, how much it's coming off the chest wall. Sure. So the bigger the profile, the more your chest would stick out away from your chest wall. So we already have a fixed measurement for what your breast width is like, but that's not going to change. Right. 

As you add more volume to that fix width, the only direction really to go is forward. Is out right. You can't really go to the side without starting to get under your armpit. So, yeah, as you add volume, you're going to really increase the projection. So once you know those measurements, you and your surgeon can look at, okay. If I did a low profile, low plause moderate. 

Full extra full. How much volume would that be? Right? 

Yeah. 

Katie: What about somebody who's like, I want, you know, these giant breasts. Sure. Are you, you know, there's obviously a limit to how much your body can take for sure. 

What do you say about that? 

Ashley: So the biggest implants that are available in the United States are 800 ML implants. You can get into just huge, just really big you can overfill. So the saline implants, they come with a film. 

Katie: What's the visual of 800 ML. 

Ashley: Bye. That's at least four cup size bump.

Katie: So like a large grapefruit. 

Ashley: Oh, bigger than that. 

Katie: Or a single serving. Watermelon. 

Ashley: Well, so it's just under a liter, right? 800 MLs. Think. About like a liter of 

Katie: liter of Coke.

Ashley: Sure 

Katie: Per side. 

Ashley: Yes. So you're almost getting two liters. 

okay. And also you have to remember that's the breast augmentation is in addition to what you already have. So. If you already have some breast volume, you're just adding your bad. To it. 

Katie: So 800 N D U is already comes full. I've seen how sometimes they fill them. 

Ashley: The silicone implants are going to be pre-filled. 

Katie: Right 

Ashley: and sealed. So you don't. So there's no free silicone floating around. The saline implants will all come empty and then sterile saline is. Yeah, once it's in the pocket, you have a little fill tube when you fill it. And 

Katie: so what if someone comes in and says, I want 800. What do you say? 

Ashley: Well 

Katie: I thought it was cc's. Not MLS. 

Ashley: Same thing. Okay. One cubic centimeter equals one milliliter. So if you come in and say, I want 800 ML implants. Well first, just like anyone else, you would have to have measurements, right? So you can, your body take it. Can I even fit on you? Now, that's not to say that you couldn't theoretically just accept a way bigger implant. You maybe you're saying I'm. That sounds great. If my breasts goes away off to the side. 

Because I think unless you were your chest was wide enough. The only way to fit that volume on, but to have a lot of side cleavage, right. Where some people would be, I'm assuming if you have 800 CC breasts implants, you kind of want some of that side. Great. Projection. 

Ah, yes. 

But that's a lot of strain on your tissue. And I think about this analogy. Okay. I imagine an 80 year old woman with a cup breasts. I think they're probably not too bad. They're not big there. They're small, but they're probably not too droopy. I imagine this same 80 year old woman with. Triple D breasts, right? 

Katie: To see kids. Did she have. If you breastfeed. 

Ashley: Right. But they're just not, you just know they're not going to be perky. Right. So that same concept. So as you add more and more weight to your tissues, And as more time as a lapsed, the less likely your body will be able to maintain that tissue in a perky position. So I think that's definitely something to take into consideration. There's some kind of happy medium. 

Also the other thing I think about too is Now people get breast reductions for those, for that kind of volume, right. And volumes way smaller than 800 MLs. So people will say, I have. 

Katie: Personal preference. 

Ashley: Yeah. People will complain about chronic neck back shoulder pain because of heavy breasts. Right. 

Interestingly, I. For the breast augmentation population. That's not something I hear as feedback consistently. In other words, I don't have people coming to me saying, oh, this. Yeah. This extra 500 CCS is really killing my back. Right. I just don't hear that. I'm sure there's someone. 

Sure. 

Katie: I think it's different for somebody who's already has big breasts for a long time. And it's like, Hey man, I need to take these down 

Ashley: probably. So I'm sure there's some psychological parts to it, for sure. Right. 

Katie: And as far as, you know, breast lift and implants go. I had a friend who had a lift and implants. And she was actually pretty young. Hadn't had any kids. I was like, oh, Interesting. Like, I wouldn't have even thought that you would've needed a lift.

Ashley: I know a lot of people do. A lot of people think that exact thing, like I shouldn't need a lift because I don't have kids and, or my I'm I'm so young, but I would say that's not the case 

Katie: just depending on what their size. 

Ashley: Well, just, some people just never really have perky breasts. 

Katie: Is it genetic? Like people who sag. 

Ashley: I'm sure it was. I'm sure there's a genetic component to it. Right. Some of it is. Yeah. Some of it is that. 

Katie: You wear bras maybe. 

Ashley: Oh, that too skin elasticity, environmental factors. Also, I think just 

A genetic component to your breast shape, right? Some people just, when, as soon as they hit puberty, they just start off with these droopy conical breasts that were never perky. And the nipple and areolas were never in the center of the mound. 

Katie: That's where you do a breast lift and maybe breasts aug to get them to the right. 

Ashley: Yeah. So anyone. 

Katie: Desirable shape, I guess. 

Ashley: Yeah. So that is part of when I was talking about doing the measurements earlier. One of the measurements I do is called a breast droop or ptosis PTO. S I S so a ptosis measurement will tell you how much below the ideal position on the breast mound. 

Are your nipples. So the bigger that number, the less ideal they are classically, 

Katie: I've heard about the pencil test. 

Ashley: Sure. 

Katie: How you put the pencil. I wonder, and if your pencil can hold, if your boob can hold the pencil, you need a breast lift or where your nipple is in relation to the pencil is that what it is.

Ashley: Yeah. 

Katie: Yeah, does that work?. So I'm going to try it at home. 

Ashley: So the pencil for you would be. Your breast crease. So the ideal nipple location would be at, or just above a point where that breast crease is transposed onto your breasts. So if you've got a pencil, so you put a pencil on your breast crease, and you're seeing that, Hey look. 

My nipple is below this pencil. That suggests that you have breast droop

Katie: and that you would need a lift. 

Ashley: Yeah. Needs a relative term. Right? You cannot need to do anything, but. Like to get the best look, I would say. 

Katie: If you're looking for an aesthetic. You know, And just bringing things back up to where they were. 

Or whatever, just want to add correct something. So as far as do you, do you do under the muscle and over the muscle? 

Ashley: I do. More of my patients select under the muscle, but I do both. 

Katie: And so I mean, what determines. So we talked about you know, projection, we talked about size. What determines otherwise, whether or not you do under, over. 

Ashley: So there are a couple additional things. So we talked a little bit about enough thickness, right? So if you're really thin. And that blanket of tissue above your muscle is so thin then. You're going to see every little fold undulation of your implant. And not that you couldn't do that, but it's usually recommended that you wouldn't just because people don't want to see all those. You don't want your breasts look like it has folds and rippling, meaning being able to see little. Changes in the surface of the breast. 

Katie: It's silicone or 

Ashley: all implants can actually have rippling. Saline implants have a higher risk of rippling than silicone implants. The more. The nature of the material. Of fluid. The more cohesive silicone gel implants would ripple less. 

Then the less cohesive and also the ideal saline implant ripples less than the traditional single lumen saline implant. 

Katie: So it has a lot to do with this, what the skin looks like. 

Ashley: So, yeah. So the thickness of your tissue of your soft tissue envelope, the kind of implant you're selecting. The other thing that people consider when they're trying to decide above or under the muscle would be an animation deformity. 

So when you put implants under the muscle. If you were to, let's say, go to the gym, look in the mirror and do some chest exercises. When you flex your pectoralis ross muscles because the implant is beneath them. You will see the implant move. Oh. So people say describe that as a animation deformity, meaning. 

All of a sudden your breast is positioned higher and different because you're flexing your chest wall. Some people don't like that. 

Katie: Okay. Yeah. I can't flex my chest. 

 I don't know. 

Ashley: Yeah. If you're one of those. People that likes to pop their Peck muscles. 

So the alternative to breast implants for augmentation purposes will be a fat transfer. 

I know we talked about fat transfers a little bit on one of our previous podcasts, but basically you're liposuctioning fat from an area of relative excess. And then adding it to the area of relative deficiency. So whether it's your abdomen or your flanks or wherever you feel like you could borrow fat from, and then you transfer it to the breasts. 

Not every single fat cell survives at somewhere in that 50 to 80% range. And I would say classically with a fat transfer to the breasts, maybe you're getting a cup size bump. So, if you want anything more than one cup size, Then you're talking about more than one surgery, which is fine. 

That's just an extra hurdle to jump through, to get that kind of volume. 

Katie: What about fat transfer to add volume where, you know, say, you know, you've had kids, your, Your boobs are droopy and maybe just taking that fat and plumping them back up. 

Ashley: Sure. You can do that. 

Katie: So that can just help kind of 

Ashley: restore some of that deflated volume 

Katie: through it, you know, bring them back at least two plumper sizes. 

Ashley: Yeah. People do that all the time. 

Katie: So, where do you take the fat when your liposuctioning? We kind of talked about this in liposuction, but 

Ashley: wherever you have extra fat, 

Katie: So just looking, you just look all over and say, Hey, you know, this might be a good spot. 

Ashley: I'll usually ask the patient where they would want to. 

Where they're most concerned about or where they would most like to want to donate the fat from now. 

Katie: What if they don't have any fat. 

Ashley: Well, then that's a problem. 

Katie: Then that's just not gonna work. 

Ashley: Like, you're not, if you don't have enough fat to donate. So you're not a candidate.

Katie: I also think this is a great option for somebody who's scared of implants. 

You know, you hear about people who are just, you know, they just don't want to put foreign things in their body since like, Hey. 

Ashley: I think it was a good, really good alternative. We should talk about those things though. So things that people are scared of the complication, so. 

For a breast augmentation. As the most surgery is a small risk of bleeding, small risk of infection. We're going to add a scar. Your breast can be numb. Usually that gets better. 

Katie: Are you under for this? 

Ashley: Yes,

Katie: For this surgery. Completely knocked out.

Ashley: Most people like to be knocked out, especially if you go onto the muscle. 

I mean. Thing is like what's on the other side of the muscle ribs. Right, right. And what's right under the ribs. 

Katie: You don't want to be even semi awake. You want to be asleep. 

Ashley: I I've done. So I've done some in-office like little tweaks and revisions. It's not like it's hard. It's just not that fun. 

I've done someone under someone who really wanted IV sedation. And we were going to do it on top of the muscle. And I don't think that patient was a really good candidate. She didn't, she didn't even tolerate getting her IV without squirming a bunch. So, yeah. So that failed. But I think, yeah, there's a, I think you could potentially do with the right person. 

A sub fascial or subglandular meaning on top of the muscle and implant pocket under IV sedation. But. Okay. I don't think there's a huge advantage for IV sedation versus a general anesthetic. 

Katie: Talk about more with complications. 

Ashley: Oh. So the implants, none of them are considered to be lifetime devices. 

Katie: Yeah. So how long do you have them in for? 

Ashley: So the rule of thumb is to consider changing. Every 10 years. So every decade that doesn't mean they expire or go bad, 

Katie: but do people really do that? 

Ashley: Hmm. Some people. 

Katie: I always think about people with implants, like what, you know, they get them maybe in their. Twenties thirties. What it's going to be like when they're like 70. 

Ashley: Yeah. 

Katie: And what happens when you die? They still

Ashley: they're still there. 

Katie: They're still there and they just, they just don't go away. 

Ashley: they wouldn't degrade the same way organic material would degrade, right. Yeah, 

Katie: or do they say. 

Ashley: It's a very strange line of questioning. 

Katie: I'm just wondering, didn't you ever wonder, like what happens, you know, Cause it's not like you. I don't know. I feel like in recent years, breast implants have been someone, you know, so popular that now we're getting to the part where people are getting older and having breast implants. 

Ashley: Yeah. So you should consider turning them on every 10 years. That doesn't mean you have to, that doesn't mean they expire. No, one's going to be knocking on your door, telling you a time to change around plants, but you know, they're not gonna last forever. So you should go into breast augmentation surgery with the mindset that, Hey, this isn't the first and last surgery I'm ever going to have my breasts. 

Sure. If you have your implants longer than 10 years. Great. You got more, you were out of that implant, but. The 10-year mark does coincide classically with most of the companies warranties. Okay, so let's say so to be in warranty. Yeah. So if something happens, certain plant in 10 years have not elapsed. 

The implant companies classically will cover the cost of a new implant or implants depending, and a good portion of the associated exchange costs. Okay. If something happens to your implant and 10 years have gone by, they will still cover the cost of the new implant, but then you're responsible for all the exchange costs.

Katie: That's so interesting. 

Ashley: Yeah. So the other thing that I think is interesting too, is with regards to warranties. 

How most companies do warranties from my understanding is that. Let's say you think you have a product that. On average would last 20 years. 

If you made the warranty 20 years, that means half of the people that have the product would be cashing in on the warranty just based on statistics. Okay. Okay. So that wouldn't be very financially optimal, right? So what most companies will do is whatever they think the average. Length of the implant or product. Excuse me. 

Is, they usually make the warranty half. Otherwise just numbers wise and statistically, if they actually thought it was going to last 10 years. Oh man. They would just be like shelling out money, right. And left for these warranties. 

Katie: Do you see this very often at all? 

Ashley: Implant failure. No, I don't, but , not for new implants, but for really old implants. 

Katie: You didn't do. 

Ashley: Yeah, I've been at this point. Cause I haven't been. I'm just kind of around the 10 year mark, right? 

So I don't see a lot of implant failures. I have seen some but they're pretty rare. 

Katie: Right. So it's like, you know, you even just from a doctor's perspective, you're not saying it very often anyway. 

Ashley: Right? I'm not seeing. Half of the people. 

Katie: You have a warranty? I had no idea. 

Ashley: Yeah, it comes, it comes with the implants. So that's. 

Katie: Anything else in the warranty? That's pretty amazing. 

Ashley: I don't think so. 

Katie: Do you like, fill out paperwork, like your car or yeah. Like send it in, then you can get like,

Ashley: I mean, , the patient does all that stuff, but usually it's just, I submit. Tracking data just with serial numbers, serial numbers and patient numbers, basic patient information. So they have in their system that, Hey so-and-so has these one or two, classically two, implants. So if they're trying to get their warranty, like, you know, this is legit. The legit claim, potentially

Katie: exactly what you've done. 

Ashley: The other thing, the other couple of two things that I think come up a lot people. See a lot of it on social media, our one. ALC L so anaplastic, large cell lymphoma. That is a very rare. Cancer that has 

Katie: never heard of this. 

Ashley: Well, you don't do plastic surgery all the time. 

Katie: I mean, even on like plastic surgery websites, 

Ashley: You don't know. So it's a very rare cancer that has been. Associated essentially with just textured implants. And it seems to be one of the one form of texturing. So not all of the textured implants, just one of the companies that did a more of a macro salt loss texturing. They have a higher risk of that. 

Katie: Is that company still in business? 

Ashley: Yeah, they just don't sell the implant anymore. Oh, Yeah. But from, so from the incidence of that, So on the higher end, it's about a 0.03% chance of developing. The ALC L then. Anaplastic large cell lymphoma. Which is not, it's not zero, but then also you think about in the United States, one out of eight women get breast cancer. So that's 12.5%. 

I don't know. I mean, 12 point no one wants additional risks of breast cancer, but going from 12.5 to 12.5, three it doesn't seem hugely significant. Anyways, 

Katie: pretty small in the grand scheme of things. 

Ashley: Yeah. 

Katie: Rupture. And malposition and, and other. 

Ashley: Yeah. So the rupture is means implant failure. Right. Malposition, meaning it's not sitting right where you want it to. So either it's too high. 

Too low or too right. Or too left. All those things could theoretically happen. The other thing that comes up is The breast implant related illness. 

Katie: Yes. I have heard of somebody who had that. 

Ashley: Yeah, so that 

Katie: Does it go away when you get them removed? 

Ashley: Well, it's interesting because so in the United States there was. A period where enough people had proposed this as a problem. Meaning I have implants and I have this right. I have a myriad of classically autoimmune symptoms. So I'm pretty sure my implant caused these symptoms so enough patients. Had proposed that kind of relationship that the United States actually took silicone implants off the market for several years. 

Katie: Interesting. 

Ashley: And they decided to, after reviewing so much data that to reintroduce them back onto the market with a little more. Close follow-up with regards to imaging and such. But I'm patient. So data doesn't support, statistically breast implant related illness. I do see patients that have concerns that they have are, might have that. 

Of the patients that. I have removed implants for that. I would say. Maybe half get better or feel like they're better. Yeah. Okay. Maybe. 

Katie: So it's like their body overcomes, whatever it was. Attacking.

Ashley: Again, it's it's You know, hopefully it's something that. As a scientific community, we can parse out, but right now, 

It's hard to. Give that anyone a definitive diagnosis, cause there's not data to support that. 

Katie: And it could be any number of things. 

Ashley: Sure 

Katie: they just happened to have implants as well. 

Ashley: Yeah. So it's hard. And I, I tell patients about the placebo effect. So if I tell you for example, that. If I gave you this pill, you're gonna feel better. It does this, that, and the other 30% of the time. 

Which is what the placebo effect is, is 30%. It will get better. And you know, the negative placebo effect is a real thing, too. So if you decided that this is what's making me sick and you're just determined it to be so. I'm sure that their negative 30% placebo effect comes into play too. 

So , I don't know. It's the jury is still out with regards to that, but so far. 

Katie: Is there a statistic for that? How many people say that they get that statistically? 

Ashley: No, it's pretty rare, but yeah, I don't have 

Katie: So that's rare as well. 

Ashley: That's rare. 

So. For a breast augmentation. If you feel like your nipple and areola are in a different position. Afterwards. 

It's most likely due to pre-operative asymmetry. And everything gets augmented. So not just volume and size, but some of those asymmetries get augmented to. 

Katie: Exasperated. 

Ashley: Accentuated, You're already a 

little bit over and then adding everything. The thing is just makes it look okay. Yeah. How do you. 

Fix that. You just, well that's so, okay. And that's a lift, right? So you can, you can technically do a lift where you're moving the nipple and areola. Right left. And when I do that regularly, because it's rare to have someone for whom the nipple and areola are perfectly centered on each breast, over the, kind of over the breast Meridian, over the center of the breast mound. 

So usually I'm adjusting that and trying to get them as close as possible as I can. One side for the other. 

Katie: Can you tell that when you've done them, if it's off, it needs to be corrected. 

Ashley: afterwards. 

Katie: Like right when you're in the surgery.

Ashley: During an augmentation? Well, that's why you do measurements beforehand. Right? So I do measurements. 

From the nipple to the midline, pre-op. So I already know what it is. 

Katie: Well, like for someone like that after they've healed, it seems like it's gotten worse. 

Ashley: I don't know. 

Katie: Just wondering. 

Ashley: I'm not sure. I mean I don't know. Usually if there's some, asymmetry pre-op, you're still going to see it post-op. Just with the augmentation and if you're wanting to adjust that. You were asking earlier about, you know, what are some lift options will that would be part of your lift plan? 

Would be to try to move one of the nipple and areola Right or left just depending upon what would be the most symmetric 

Katie: you want to talk about the different types of lifts? Lollipop and 

Ashley: oh, sure. So lifts generally fall into. Two broad categories. So one, I would say it would be the traditional surgical and that's what the vast majority of people and or plastic surgeons would perform. So. 

You're adding some centralized incisions on the breast mound to try to. Reposition than a nipple and areola in a more desirable location. So usually up. Maybe to the right or left just depending on where it is. So the incisions that you could utilize would be one or the smallest lift is called a Benelli lift. So you're basically just doing a little Crescent shaped excision on the top of the areola. And that is good for, I would say. 

Less than a centimeter. Tiny. 

Katie: That doesn't seem like a big change. I mean depends on the breast size. 

Ashley: Sure. That's subtle. The next one would be a circumareolar, a periareolar lifts. So. So an incision that goes all the way around the areola. 

Katie: And down. 

Ashley: Nope, just to circle around the areola. That's good for somewhere in the one to three CM, 

Katie: where you cut the circle bigger than the area. 

Ashley: And you're doing that purse string. Kind of wagon wheel type suture to tighten it down. So that's good for one to three centimeters. Okay. And then you have the lollipop incision. So that has. Kind of like, not a semi-circle, but maybe seven eights of a circle and decision on marking above the nipple and areola where you want it to be. 

And kind of a V like, Almost like a D shaped incision at the bottom. Yeah. At the bottom of that. 

Katie: Are you taking out excess tissue. 

Ashley: So you're. Lifting the nipple and areola up, up into that seven, eight to the circle, and then closing that V into a line. And then you ended up with the lollipop pattern. 

Katie: Do you take tissue out? 

Ashley: Not necessarily. 

Katie: Can you just tighten the skin and leave the tissue. 

Ashley: So. You can do either one. The downside of the lollipop incision is that. If you have any vertical skin asymmetry, or you have vertical skin excess. It would not address that very well. 

Katie: Right. 

Ashley: So that's where the people will talk about a wise pattern. 

Or anchor pattern, incision, 

Katie: anchor pattern. 

Ashley: So in addition to the lollipop part, You would also have an incision that runs along the crease, so that can help when you have more asymmetry or you have a lot of loose skin in the up and down dimension. 

Katie: Okay. Now I had a friend that. Got to lift. And then after the lift, she had the incision around the areola. The borders of her areola. Blended with the rest of her skin. 

Ashley: Hmm. 

Katie: Now what is that called? 

Ashley: Really pale. 

Katie: Her skin is really light. Yes. Yeah. But like it made it so that there wasn't really a distinction between her aerial anymore in her regular skin. It just kind of all blended into one. Kind of muddled. 

Ashley: Was her areola really stretched out. 

Katie: I only saw the after and didn't see the before. 

Ashley: Well, I could see in a scenario that if you were really pale kind of light skin and your areola is really light colored too. And you had some wider scars where it could look like that. Usually, I think the opposite is true where you know, the average person doesn't have a perfectly circle finite border where you can tell like the, this is where the areola ends, right. 

So when you do a lift, you actually do make a perfectly round circle around it. And then you're sewing that into another circle. So it tends to give you more of an abrupt transition between. You know, perfectly round areola, right. That's the end of the areola skin. And then there's the rest of the breast again, so I could see how it could happen, but usually it's more of the opposite. 

Katie: So as far as stitching goes. Can you see this stitch marks? How's the stitching done? 

Ashley: Well, I can't speak to how everyone else does it, but I think most people opt to put sutures under the skin. So that you don't have the, the train track marks where you're seeing them poke hole on both sides of the scar. 

But that just tends to make the scar look wider and less good. 

Katie: Right. You have those little dots, which don't seem natural. So do you have to go and have stitches taken out or do they dissolve. 

Ashley: So all stitches that are under the skin. ideally are dissolvable. Yeah, that makes that I've seen people put permanent. Some people will do a permanent suture in the circumareolar lift, but that's deep enough that you wouldn't have to remove it.

Katie: What about where you see or hear about people getting out internal bra? 

Ashley: Oh sure. 

Katie: What does that mean? 

Ashley: So if you're putting Implants. Well, you can do it either on top of, or below the muscle. So if you're going on top of the muscle, I will use what's called GalaFLEX, which is an absorbable mesh that you essentially are wrapping the implant in. 

And you're fixing that mesh to the chest wall and it allows you to so it in your body in process of absorbing that mesh will lay down its own connective tissues. And it will leave that tissue layer four times stronger than it would have been without a mesh being there. And also, if you're going on top of the muscle, that extra layer will help reduce your risk of capsular contracture. 

If you're going under the muscle. So the pectoralis muscle usually has poor coverage in the lower outer quadrant of your breast. Meaning there's probably not muscle there. Anyway, it's just the way that muscles running from your breast crease up toward the arm bone. That angle will just show you that there's this part that doesn't even have muscle there anyway. So when you're standing up. 

That's where gravity tends to take implants down. And when you're laying on your back, it tends to take the implants to the side. So that lower outer quadrant certainly is a potential weak point. So you can take that same mesh and in a smaller piece, certainly. And so that your breast crease and that lower border of your muscle and provide a full coverage. 

For the implant pocket. So that's like an internal bra. 

Katie: Does that mean? Like you don't need a bra. After that, like you can just go around with 

Ashley: no, I think I actually did advise patients to wear bras not only during the day, but when they're sleeping too. And that goes back to the 

Katie: healing or all the time, 

Ashley: all the time. And it goes back to our same 80 year old lady at breast analogy. Right. 

Think about covers of national geographic, where women have never worn breasts. Right. I'm sorry. Women have never won bras. And you know what their breasts look like. They're deflated, droopy big kind of pancakes. 

Katie: So, I mean, underwire, no underwire or does it matter? Anything that holds them up? 

Ashley: Yeah. I don't think it matters. 

Katie: So can you do an internal bra? If you just do a breast lift? 

Ashley: Mm. I know people describe that, but. 

It's not something that I really employed a lot of. Okay. Yeah.

Katie: Not really necessary? Or well, not a way to put it since there's not a breast implant. 

Ashley: So it, it would depend. So if you were saving a bunch, so for some patients that get a breast lift and they're trying to save all of their breast volume, 

So I think we talked about the auto augmentation type thing before, where you're lifting up the nipple and areola in one little blood supply, and then you're maintaining another area below. That area below you could, you could make a little sling of a internal bra with some mash and help support that extra weight below. 

Katie: So that maybe you don't get the same spot again. 

Ashley: Yeah, it just, it provides additional support. Right. It's just, it's the same thing. It's like, okay. Isn't is a bra helpful? Yeah. Well, you can tell people that never wear a bra versus a woman to do. The same thing, like is having that extra connective tissue better. Sure. Does that mean that you're never going to have a problem? No. it just reduced it. It's kind of risk reduction. 

Katie: I feel like, you know, I had three kids at breastfed, all my kids. I feel like everything was great before that. And then after breastfeeding, that was where it really took a toll. You know, personally now, do you see that a lot? As far as women who have breastfed versus not. 

Ashley: Well, yes, so. One with breastfeeding, your breasts will get really engorged. So they get transiently bigger than they've ever been. And so that stretches out all the connective tissues. Obviously, including your skin. And then you can also get some involutional changes, . So less kind of glandular tissue, more fatty tissue. 

So both of those things can lead to less volume and more skin.

Katie: After the retraction, 

Ashley: right. So less volume. More skin. Is not. That's not a great set up for an awesome looking breast. Yeah. Okay. 

Katie: So Another thing about breastfeeding actually. Can you breastfeed? If you get breast implants. 

Ashley: Yes. So. That is a theoretical risk and it's on most breast augmentation consent forms said there could be lactation or breastfeeding difficulties. For someone who has a breast augmentation and has an incision place in the breast crease. Statistically, I don't think it should really be impactful as far as your ability to breastfeed. Now, that being said, there are people that can't breastfeed and they've never had breast surgery. Like they just have issues breastfeeding, right? 

Once you start doing things like breast lifts and you're cutting into the breast tissue or putting in incisions. Right by the areola, which is where all those all the ducts emptying to nipple are and we had talked about earlier for the breast lift. You are impacting the blood supply too, so certainly. 

If the blood supply was so poor that the tissue didn't heal all that obviously would not be good for breastfeed.

Katie: Does that depend whether or not they're over under the muscle as well. 

Ashley: The ability to breastfeed. 

I think that there. Could certainly be some. You know, so there are some potential impacts. Associated with having implants in. So as you have more pressure applied to the tissue. So whether it's a back pressure from the implant, I could see how you can get some more involutional thinning. So thinning of that tissue. 

Okay, so potentially. 

Katie: So it wouldn't matter either way. Just depends on. Personal, 

Ashley: maybe. I would guess more on top of the muscle. I would guess. But I don't think I have data to support that right. Just a hypothesis. 

Katie: Yeah. 

Ashley: So after breast augmentation, I have patients avoid strenuous activity or exercise for about two weeks. And then I have them not lift more than 15 pounds for six weeks. And when you wake up from a breast augmentation surgery, especially if the implants under the muscle, you're going to notice that. 

That muscle. It's an extreme muscle pull. So if you ever pulled a muscle or strain something It's kind of like that, but to an extreme. So we've pulled the muscle away from the chest wall. And we put an implant in there. So the muscle is tight and spastic. And it's going to force that implant up into an artificially high position on the chest wall. So when people wake up after breast augmentation, . 

They will notice that their implant is really. They're really high. Like as close to their collarbone or clavicle. It's firm. So not that soft. 

Gummy cell implant. They felt in the office and it's kind of boxy. So they get that overly full top. The bottom of the breast is really flat and then it otherwise looks really boxy. So doesn't look great.

Katie: How long does it take to relax. 

Ashley: Different people, different amounts of time. I think by the two week appointment, most people still are pretty boxy and tight. 

By six weeks. I think most people have made some really substantial improvements, but I think the total duration to that settled phase. There's going to be a function of. How much. Muscle bulk, you have some more muscle means it's going to take longer. And then how big your implant is. So a bigger implant is more stretch on the muscle will take longer. 

I think another part that I don't really think about as much as probably I know comes into play is, you know, stress levels and activity levels. I have. I've had some people that have had like really stressful jobs. And I quite certain that they never took any substantial amount of time off to recover from the surgery. And I think that they definitely. 

Katie: Took longer.

Ashley: Yeah. 

Katie: So how long were you off work? 

You have a breast augmentation. 

Ashley: Well, it depends on what kind of work you do. So. If you have,

Katie: if you're at a desk job, 

Ashley: I would say maybe a week. 

Katie: Okay. Yeah. 

What, what is, have you ever heard of these commercials that, that. I haven't heard of in recent years, but it's like, oh, get a breast aug on your lunch break.

You can go to the mall the next day. 

Ashley: that. And then the whole. Lunch lifestyle lunchtime facelift to,

Katie: oh, I don't know. 

Ashley: Like go got a facelift. I don't know. 

Katie: Facelift. Maybe with injectables. 

Ashley: But yeah, liquid facelift. Sure. Yeah. I haven't heard those commercials of recent, but I certainly know the phenomenon that you're talking about. 

There certainly are patients that can do that. So I think that's more of a sales gimmick than, oh, this person has some amazing technique that allows patients to return to work. It's just after lunch. 

Katie: Just getting people in the door or something like that. 

Ashley: Yeah, it sounds appealing, but I don't think they've got some special trick up his sleeve. Things that could help you? 

We're trying to work out earlier. On top of the muscle probably does hurt a little bit less. If you use Exparel which so long acting local anesthetic that lasts about three days, I think that would just mean you have less pain and you probably would be

Katie: What about your diet. 

Ashley: So yeah, certain foods are more inflammatory than others.

Katie: Well what about like collagen? I heard collagen helps. 

Ashley: I think that, I mean, I take collagen supplements. It's going to be hard to have a randomized controlled trial of augmentation patients. One group that takes collagen in their coffee and one that doesn't and be able to say, look, wow, look how much better this group did. But yes. 

In general, I think the healthier the patient, the more nutritional optimization and stress reduction and whatever, all those compliance things, the better they are in that regard. Yeah. 

Katie: So, what about , can you sleep normal on your back? How do you. Yeah. How has recovery at home? Do you have drains? 

Ashley: No drains for breast augmentation. I don't do drains for lifts either. So breast Aug and lifts or lifts or reductions or combinations of those. Yeah. Don't need to. 

Katie: Okay. 

Ashley: You can sleep however you want. After a lift I wouldn't have you sleep on your chest,.

Katie: Right. But like you could sleep flat on your back. 

Ashley: Oh yeah. 

Katie: Okay. You don't have to worry about. I don't know. 

Ashley: No, I mean, I just like, if you have, let's say you sprained your ankle and your foot got swollen. Yeah, elevating the effected area probably reduces some of that postoperative swelling. But yeah, you don't have to 

Katie: do you need painkillers? 

Ashley: Most people do. Yeah. 

Katie: For how long? 

Ashley: Maybe a couple of days. Just two, three days. 

Katie: Tylenol or Aleve. 

Ashley: Usually I give a prescription. So I do prescription pain medicine. So usually hydrocodone. And then I do a prescription Valium or diazepam to help with that muscle tightness. Right. And then I do singular. So we, I know we had talked a little bit about. 

Capsular contracture. Which is that we get that type scar ball around your implant. It can make it look and or feel bad. So Singulair has been associated with reduced risk of that. So I give that to patients. It's an asthma allergy medicine.

Katie: Okay. I was going to say that's like allergies. 

Ashley: So I give that to patients for 30 days after surgery and then usually a handful of days of antibiotics. And then the anti-nausea. 

So a little micro pharmacy of sorts. 

Katie: Seems pretty easy. 

Ashley: Yeah. It's not bad.

Katie: How soon until until you can like be out say you, you know, what about on the lake or something around the pool. 

Ashley: So for the incisions to be totally healed. That will be required to be getting in a pool or a lake. And so I would say about at least 10 days, 

Katie: Okay.

Ashley: but you'd want to have your surgeon take a look at those incisions, especially for 

Katie: And you have a post-op. 

Ashley: Yeah, especially for a lake. I mean, a pool, assuming it's appropriately chlorinated would be less risky. But for You know, a lake or ocean water, that's just teaming with microorganisms. So. 

You want to make sure it's totally, totally. 

Katie: You don't want any incisions opening

Ashley: Yeah. Fortunately for breast augmentation. I would say that I feel like having an infection is super rare. I've only, so in my 

Katie: How big are the incisions 

Ashley: usually about two inches. Okay. So in my career I've only seen two. So one of them was someone who went to gosh, I want to say like Costa Rica or something. I can't remember. Like they went to Costa Rica for their breast augmentation and they came back with just like a bad infection. So I saw them for that. 

And then the other one was someone who Was in the tub, the night of surgery, took a bath. Just soaked in the bath water. Like, what are you doing? Right. So yeah, 

Katie: they just thinking, like, I can't take a shower, so I'm just going to sit in the bath, 

Ashley: I guess I'm just gonna write it off to they weren't thinking because. 

Maybe 

Katie: I could see how you were like, maybe it just won't touch the breast area, but accidentally did or something like that. 

Ashley: Whatever. I don't know wasn't thinking. 

Katie: What's the treatment for that? I. Obviously it's rare, like you said, like, 

Ashley: oh yeah. I mean, if your implant pocket gets infected, you have to remove your implant. 

Katie: Oh, that's no good. 

Ashley: Yeah. 

Katie: That's an extra cost. 

Ashley: Oh yeah. So then let's assuming 

Katie: your fault. Yeah, the person's fault. 

Ashley: Yeah. So classic would be taking the implant out. So you'd have one in. And one out. 

Katie: Oh so then you have to wait. 

Ashley: You got to wait until the infection cleared up 

Katie: and then put one in. 

Ashley: So you can't just like clean it out. Like you'd have to get it removed. Wait, let the infection clear out then have it replaced. 

Katie: And then is there possibility like scar tissue and 

Ashley: yeah, sure. I mean, I, again, I have to tell you I've never actually had that happen, but oh, the person that yeah, the Costa Rica person, yeah. That happened to them. 

Katie: I hadn't even heard of Costa Rica being a destination. It just seems really interesting to me. You know, you hear about Brazil all the time. 

Ashley: Do you? I feel like I hear a lot about the Dominican Republic. People go to the D.R. a lot. 

Katie: And I've heard Brazil is really big on plastic surgery. If you look in the pictures, 

Ashley: Also Miami people. I mean, that's not a different country, but a lot of people will go down to Miami for. And I think we had to touch on this in an earlier podcast, but you don't have to be a plastic surgeon to do plastic surgery. 

Katie: Which is scary. 

Ashley: Yeah. And I was actually just talking to a patient yesterday from Europe and they asked me, why does everyone make a point of saying they're a board certified, so, and such and such in the United States? And I said, because a lot of people do, but they shouldn't. I said, because you don't actually have to be a board certified plastic surgeon to do plastic surgery and , he was totally taken aback. 

 He couldn't believe it.

Katie: Right. It could be a dentist. Yeah. Putting in breast implants. And there are those out there. We just scary, which is why you should do research 

Ashley: so. Yeah, in general, I would say, yeah, make sure you have a legit surgeon and probably stayed in the United States. 

Katie: So I know somebody who went down to Miami to get a breast lift. She's like, Hey, I'm. 

Bodybuilder type person. And she went to a really great surgeon, but she had said there was another surgeon that she looked at. And down there and she said it was like a chop shop. There was just lines of people. Like, they were just churning them through this. This guy was literally just like one after the other. Breast augs all day long. 

Ashley: Yeah, 

Katie: which I don't have none of that. Ideally, but the bedside manner of. 

Ashley: Well, I mean, I think if your consultation is a quick phone call from several states away, And you're meeting the doctor as you get ready to roll back into the, OR it's just a, not a lot of time to have those kinds of, I think, ideal discussions about. 

You know, measurements of your chest and what's an appropriate implant size, and for you to try on sizes, all those things that are part of a regular consultation. I just think you're probably missing a lot of them. 

Katie: I think I'm those people, you know, doing these tons of breast augs down in Miami, you all daily show the pictures of like 20 year old. 

Super hot breast augmentations that don't show the ones of like 40 and 50 year old women. Sure. Like you don't know what those ladies look like. You only see the ones, you know, the cute ones. 

Ashley: Yeah. That's unfortunate. 

Katie: Well, Well, then it's misleading a little bit. I think. But anyways. 

Ashley: Sure. Well, that's a whole nother issue. 

Before and after photos, right? I've seen a lot of this on Instagram where people will especially then BBLs where they will show. Preoperative photos of someone's standing of their, their buttocks and then their post-op photo is them. They literally are still on the, or table 

Katie: Yeah, just finished

Ashley: and they're all greased up with, I don't know, some kind of like muscle oil and they do a view from the bottom of the table with a butt up in the air. 

Yeah. And the butt looks huge. And then they will orient the photo. So it kind of looks like they're standing. but if you are paying close attention, you can tell they're not, they're laying down. 

Katie: and you could see the stitches. So it's like, okay, this isn't healed. Yeah. I'd love to see healed pictures. 

Ashley: Cause I think, I think that's disingenuous to, to present before and after photos like that. 

Katie: Right. So definitely before and then after, but healed. Sure. And in the same position, 

Ashley: right? Definitely. Not still on the, or table plumped up full of fluid and having, you know, a hundred percent of the fat in there because none of it's gone away and a bunch of fluid from your numbing stuff. And a fish eye view from the, but I mean, it's just, everything is so much bigger and I think it gives people this false sense of what they should and could expect. 

Katie: Right. And I know that BBLs are not the subject, but what you were saying about fat transfer. You know, there's, there's an atrophy of some of that fat. 

Ashley: Yeah. Not all the fat cells survived. Yeah. So regardless of whether it's the buttocks or the breast, same thing, 

Katie: even if you saw that of a breast. You know, whatever. It's not going to end up like that. You know, that is interesting. Do you ever have anyone come in and say, I have lopsided breasts. I need two different size implants 

Ashley: all the time. All the time,

Katie: how do you assess that? I mean, I actually, it's normal to be asymmetry and most asymmetrical. 

Ashley: Right. Most people have some degree of asymmetry. 

Most of it is just by looking at the breast. I mean, you can tell, right. The measurements reinforce what otherwise appears as an obvious source or subtle asymmetry. But with regards to figuring out how much volume that is, I do a lot of it with sizers. So I'll have people try on differential sizers and try to figure out how, at what point do I think and do they think they're pretty symmetric? 

So it's helpful to narrow down what that absolute difference is between the two breasts. And then most of those people tend to have some breast droop too, and not always, but so if it's different sizes, And they don't have any drip. I'll have them fix one side, like let's say, okay. The left side. I know I really liked 300. So I'm just going to keep that I know left side is 300 then for the right side, whether it's bigger or smaller, I'll just have a couple of sizes available and I can try on those sizers during surgery. 

Okay. Yeah. And I'll set the patient up while they're still asleep. And figure out which of those is the closest, they're never going to be exactly the same. Which of the, of those is the closest to the one side that we've set. The volume for. 

Katie: Can you do a custom size. If you can with saline because you're filling in. 

Ashley: Yeah, so you can do whatever random number for saline within the fill range and the silicone implants are prefilled. So, 

Katie: so would, saline be a good option to get the most symmetry. 

Ashley: I don't think so. I mean, not for that reason. I mean, the difference of, you know, let's say the silicone implants come in somewhere in that 20 to 30 ML incremental difference, one size for another. 

If your differences is smaller than that. You're probably not even noticing it. 

Katie: Most people probably might even use these 

with clothes on. Yeah. So I'm looking at you, you know, right. What about. Leaking. Do you have to worry about since you fill the saline? Do you have to worry about it leaking the port in which you fill it. 

Ashley: So there are two ways in which an a salient implant could leak. One is a tear in the shell, or poke in the shell. So it would, the saltwater would extrude through that hole or tear. The other would be a valve incompetence issue. So if the valve stopped functioning, optimally, it could leak, it could leak all the way or could leak partially. I've seen both. 

Katie: Now, if you have saline implants in. And you fill them, you know, halfway up or whatever. Can you go back in through that same port and fill them out more?

Ashley: You could. 

Katie: Later. You can just say it. 10 years. 

Ashley: Sure, but it's another surgery. So 

Katie: why not just replace them? 

Ashley: So like, let's say you're like, oh, I want you to add. 

15 and more MLS. That would be so subtle. It would be hard to justify. The cost 

Katie: went from like added 200 minutes. 

Ashley: Well, then that would be a different implant. Okay. So most implants have maybe like a. Maybe 50, 70 or something ML fill range. Sometimes smaller. So it's only 25, ML range, like let's say, okay, here's a 300 ML implant. You can fill it from 300 to 3 25. 

Or maybe it's a, a four 20, you can fill it from four 20 to four 70, something like that.

Katie: Okay. Now, what about after you've had your implants for 10 years, you decided, Hey, I don't want them anymore. What's it going to be like, if you take them out. Are you going to need a breast lift? Are you going to be super deflated? 

Ashley: Again, that's needs a relative term, but yes, you may want to have something done. So it depends on how big your implants are and how much of that volume they were occupying for your breasts. So the bigger, the implant, I think the more likely. You would want to do something to restore the other, probably otherwise deflated you're be looking breasts that will be left otherwise. 

But yeah, you could either. Remove your implants or remove and replace. You could remove and do a breast left, you could remove and do a fat transfer. There's lots of options. I've done all of the above. 

Katie: I just saw Pam re remove her plants or something like that. 

Ashley: But didn't she put them back in? 

Katie: She probably did. 

Ashley: I can't keep up. I feel like she's been through lots of breast sizes. Yeah. Like Dolly Parton too. Like she's been through lots of breast sizes too. Holy moly. Yeah, those are big

Katie: poor Dolly. She still cute though.

Ashley: So, if you're interested in the breast augmentation and you're healthy and you're wanting to increase the size of your breast volume, my best advice would be to visit a board certified plastic surgeon. Go and have a consultation, discuss your goals. Have an exam. 

And consider the options that are available to you. 

Katie: I do have a question. How much does it typically cost? Like a range. 

Ashley: Oh, so the most price favorable option would be a saline implant. Augmentation only. And that would probably be around. 6,000 something. 

Katie: Okay. That's pretty affordable.

Ashley: Yeah, something like that. Maybe the mid sixes and then as for a silicone, that's going to be in the eights. And then as you add. Lifts or that kind of stuff.

Katie: But starting around six. 

Ashley: Yeah. Not too bad. 

Katie: It's not too bad at all. 

Ashley: And the surgery takes about an hour and hour and a half. You get to go home the same day. Someone has to drive. You obviously can't drive for 24 hours after a general anesthetic. 

And then yeah, once you've been 24 hours after anaesthetic and are no longer taking pain meds, you can drive yourself.

Katie: Sounds pretty easy. 

Ashley: Yeah, it's a lunchtime thing, I guess. 

Maybe not, maybe not though. 

Katie: That's where that gimmick comes in.

Ashley: I don't advertise that. 

Katie: You don't do lunchtime. 

Yeah. Well, I think that's all we have to talk about, about breasts. Anyone has any questions? Kind of monitor Instagram page,

Ashley: which is what nipped and toxxed. Nice. Okay everybody 

Katie: pretty easy



Ashley: yeah got it thanks bye bye