Inside a breast augmentation consultation [Lee B. Daniel, MD, Eugene]

Eva Sheie (00:00):
When someone comes to see you for breast augmentation consultation, what is usually the very first question they ask you?

Dr. Daniel (00:08):
I think they've really mostly done their research now, so they do want to know what my recommendations are and such, but before the exam, it's the basic questions about where I've trained, how many have I done, things like that. I've been at this long enough that I've clearly lost count with the numbers that I've done. But I think once they get to me, they've already interacted with my staff enough that they already feel comfortable. I've got a great patient care coordinator, and then my surgery side manager sees patients with me and she does the initial sort of meet and greet. Then I come in and see them and then I leave and let them then get undressed for their exam, do the exam quickly, leave again, and then come back. And then in regular clothes allow them to feel a little more comfortable and then more as a person to person type of interaction, we can have a good conversation about options at that point. It's hard to really get into an actual first question until we've really done the exam and have an idea of which direction we're going.

Eva Sheie (01:16):
Is sizing usually the first thing then that comes up is that?

Dr. Daniel (01:19):
Well, that's always part of it. And I trained at UT Southwestern. We talk about dimensional breast augmentation, which John Tebbetts, rest his soul, was the main guy who wrote the book, The Best Breast. We trained under him, and he was much more about diameter and projection of implants rather than CC volume. What I spend a lot of time talking to patients about too, because they come in and say, well, I want to be a C plus. Well, no bra ever says c plus and bra manufacturers aren't held to a standardized sizing system for a letter cup size. So the way to ferret that out size wise in my practice is that we talk about some of the centimeter diameters. I make a lot of measurements here and such, and we talk about where they want to go. But the main thing with plastic surgery being such a visual specialty, I have people find pictures of breasts that they think would be attractive on them, and then we can look at those together at their pre-op visit.

(02:21):
We review those photos. I use those photos to help determine maybe a range of implants that I'll bring to the operating room for those patients. And I really feel like I've never been in the operating room without the number one implant for any patient in my career. Actually, the patient's pictures that they provide, I take them to the operating room, post them on the wall so that we have that as referenced, but by the time I get to the OR, that's welded in my head already, so I really know where we want to go. But with sizing in the operating room, one of the techniques that I do typically employ is using an intraoperative sizer, and then I can test how their tissues receive a certain volume, certainly, or diameter or projection. But I can also see it factors in the curvature of the ribs, the texture and tone of the breast gland tissue, the laxity of the skin, the muscle thickness, all those things.

(03:16):
You can't really tell by sizing somebody with a breast implant in their bra, but without really doing it inside. So I think it takes some of the guesswork out a little bit and it's very predictable. You never say never in medicine, but I really virtually never hear a patient post-op say, wow, these are too big, or, wow, these are too small. And I think that that's because we spend the time to review photos together. We talk about what their goals are, where they want to go. It's interesting with the changes in fashion. I think we're going maybe back to smaller implants a little bit now. It depends on what TikTok site you look at, of course. But there are a wave afoot of people who want maybe just a little bit of improvement, but don't want anything that's crazy. So that's something that we talk about all the time now, and the pictures really helped me to ferret out, what's going to be best for every patient.

Eva Sheie (04:18):
When people bring in those wish pics for you, is there a celebrity or an influencer or a photo from your website that comes in a lot? Is there a pattern there that you can spot?

Dr. Daniel (04:26):
Not really. I mean, there's so much of that out there. I direct them to my website, so they use those as photos, direct them to RealSelf so that they could find good before and after. I certainly want to make sure that we're doing apples to apples because maybe somebody who's had a gastric bypass or been on ozempic and has lost a lot of weight that needs a breast lift at the same time as their implants, she may bring in a picture of a 19-year-old centerfold. So that's not really practical. But it is funny, I use this as a reference all the time, but I was talking to a patient years ago that said, well, I don't want to be too big. I don't want it to be crazy. I don't want it to be something everybody notices when I first walk in the room. And then she brings out a picture of Pamela Anderson, and I'm like, okay, we've got a disconnect. But that's why I do the pictures, because what is in their mindset may not necessarily what is in my mindset, and that gets back to just those cup size disparities between the bra manufacturer.

Eva Sheie (05:34):
Okay. Give us your Instagram handle and your website.

Dr. Daniel (05:37):
Drleebdaniel.com. We have a couple of other sites, but that'll direct you. And then Instagram handle is pretty easy to remember: Best Plastic Surgeon.

Eva Sheie (05:45):
That's you?

Dr. Daniel (05:47):
That's me.

Eva Sheie (05:49):
I finally found him.