My methods for avoiding bad scars after breast augmentation [Andrew Cohen, MD, Encino]

Dr. Cohen (00:00):
This is Andrew Cohen. I'm a board certified plastic surgeon here in Encino, California.

Eva Sheie (00:06):
What is the second most popular question that women ask you about breast augmentation?

Dr. Cohen (00:10):
I think the second most popular question for breast aug would be the incision placement, which would either be through the nipple or underneath the breast called the inframammary incision, and most of the time we'll do inframammary because there's less chance of complications such as encapsulation and nerve sensory to the nipple, things like that.

Eva Sheie (00:37):
So my follow-up question was these are the two incisions that you prefer, the inframammary and the peri areolar?

Dr. Cohen (00:43):
Yeah. I mean there's the trans axillary incision also, which is underneath the armpit. You could go in under the armpit. I just don't prefer it. I get better placement and less complications going directly in, but I was trained to do under the armpit. I think it's a wonderful way to go, if you want to have pain for a month and have superiorly placed implants, you guys go for it. So yeah, not good. The guys that do them all the time talk about how they have to wear shoe laces. You got to wear shoe laces for weeks to push them down and I'm like, well, you don't need to do shoelaces if you go directly in and put the implant where it needs to go. So stop with the armpit incision. It's ridiculous. Sorry, this is my opinion, enough already. You want to go directly in and make the pocket perfect for your implant, not have to deal with complications. So that's just my opinion.

Eva Sheie (01:34):
Well said. When you do the peri alar incision, how do you get the implant in that tiny hole?

Dr. Cohen (01:42):
It opens up. It really does. You make an incision from three o'clock to nine o'clock and the whole thing will open up. When we have retractors, you could get in there. It's not hard.

Eva Sheie (01:52):
It seems like it'd be challenging to fit that big implant through the tiny.

Dr. Cohen (01:55):
It's challenging depending on the areolar. You're right, if you have a little gal , with very small nipples. Yeah. I mean, I've done it before, but it's better to go inframammary cuz you have enough room, so it's just a better incision.

Eva Sheie (02:08):
Are there other things about inframammary that people like?

Dr. Cohen (02:11):
They like that it's hidden under the crease. They like that it heals so well. They like that there's less sensory issues, less chance of encapsulation, which is hardening of the implant afterwards. So there's a lot of good advantages and very minimal downside.

Eva Sheie (02:31):
Can you do that incision if you need a lift?

Dr. Cohen (02:36):
Not really. A lift is where I take skin from around the areolar and lift it, so. I use it for access to putting in my implant, but if we're going to do a lift, I got to take out skin from around the nipple and sometimes vertically as well, depending on where your nipple is.

Eva Sheie (02:52):
The lift really dictates which kind of incision you have to use.

Dr. Cohen (02:55):
Correct, correct.

Eva Sheie (03:03):
How long does it take these incisions to heal?

Dr. Cohen (03:07):
Usually about six weeks, six to eight weeks.

Eva Sheie (03:10):
Do you do anything special to help people heal faster?

Dr. Cohen (03:15):
Everything I do is special. We do silicone cream, silicone sheeting, silver gel, so we usually do about silver gel for about two months, and then silicone sheeting and silicone creams, and there's a lot of different things we do for different incisions. If there's a T with a lift, sometimes we do the NP seal, which is a negative pressure dressing on there, and that could help it heal faster and really much, much better.

Eva Sheie (03:46):
How do you help when an incision is not behaving the way that it should after surgery?

Dr. Cohen (03:53):
Well, hyperbaric oxygen can help. I mean, sometimes I've had to use hyperbaric oxygen, if things open up a little bit. It's very rare to have an opening, but if you're doing a reduction and people lift, sometimes they open up. So we have to do wound care and get it to heal faster. And hyperbaric oxygen is another modality that plastic surgeons use to get things healed faster.

Eva Sheie (04:15):
Is there anything you see patients do that would prevent complications with wound healing?

Dr. Cohen (04:23):
Well, you got to stop smoking. If you're smoking and you want plastic surgery, it's going to be an issue, so stop smoking and that means vaping.

Eva Sheie (04:29):
Definitely don't smoke.

Dr. Cohen (04:31):
And you got to take vitamin C, you got to take vitamin E, or I should say vitamin D. You got to do things to stay healthy. You can't expect to heal and not to do your part. The patients have to understand this is a healing process and it's a process, so you got to go through it.

Eva Sheie (04:50):
Tell us your Instagram and your website address.

Dr. Cohen (04:54):
My Instagram is really easy. It's Andrew Cohen md and my website's also Andrew Cohen md. So we keep it simple.

Eva Sheie (05:03):
Love it. Thank you Dr. Cohen.

Dr. Cohen (05:06):
You got it. Thank you.

Eva Sheie (05:08):
On this podcast, we bring you directly to the doctors who are where before meets after. Links to our guest's website and contact info are in your show notes. Follow us on Instagram @wherebeforemeetsafter. If you're a board certified plastic surgeon and would like to be a guest or a sponsor of the show, go to wherebeforemeetsafter.com for more information. Where Before Meets After is a production of The Axis, the podcast agency for Aesthetics, theaxis.io.