The unusual question women ask me about breast augmentation [Dan Zegzula, MD, Portland]

Dr. Zegzula (00:00):
Dan Zegzula. I'm a plastic surgeon, Portland, Oregon at the Portland Plastic Surgery Group.

Eva Sheie (00:07):
So when someone comes to see you for breast augmentation, what's the first question they usually ask you?

Dr. Zegzula (00:12):
I think many times they are curious to know what their options are. What are my options for breast augmentation? Am I a candidate for breast augmentation? And then most patients coming in nowadays have done some research on their own. They've done a little bit of reading, or they have friends and they've heard some things and they want to run through the things that they've heard, see if it's accurate. But they really want to know what their options are, which I like, because after I get a nice, I sit down and meet with them, get to know them, get the history, get their medical history, then we can really get into the nitty gritty of, are you a good candidate? Do you need anything else besides just an implant? And what size range are we looking at? Some of that, of course, has to do with the patient's desires for size, but also equally important is their anatomy.

Dr. Zegzula (01:07):
Not everybody can always get the size implant that they were hoping to get, especially if they're thinking about really big implants because their tissues and their frame just won't support it. So those are patients that I take a especially long time to really go through the process and explain to them what's going to fit them, what's going to be safe, what's going to be long lasting, what's going to have a lower rate of complications? Because when you start pushing the envelope, sometimes in those patients, although it may look good for three, six months, then if their tissues can't support the implant, then we're going to have a problem. So breast augmentation consultations are very unique. Everybody's consultation is a little bit different, and we go over a lot of things like that, like what their tissues are like, what their desires are, and sometimes wish pictures is helpful too. They can bring in pictures of what they would like to look like, and we'll usually meet patients at least twice before having surgery, so we'll make sure that we're all on the same page.

Eva Sheie (02:04):
Is there a celebrity or a model or an influencer that you see coming in on those wish picks sometimes? Have you noticed a pattern?

Dr. Zegzula (02:11):
Sometimes I get wish picks that are a little outlandish in terms of the size, but many times they're very subtle, which is also very helpful. I know that that patient's wants a really subtle, natural looking breast augmentation. Maybe nobody will know, but she's happier. She doesn't want to have to explain to her friends what she had done. But then the flip side is that sometimes, yeah, there's some very large breasts that they want us to emulate. Luckily, in the past, probably four or five years, the advent of using mesh in breast augmentation and especially in breast revisionary surgery, has really helped us with the patients who want the larger implants because as I alluded to before, sometimes their natural tissues aren't going to support that implant very well. And supporting scaffolds like mesh or acellular dermal matrix can help support the weight of those implants. So we do have options to try and get patients to their desired size. We have more tools in our tool belt to handle those situations.

Eva Sheie (03:12):
Does the mesh stay in there forever?

Dr. Zegzula (03:14):
The meshes that we use in breast do dissolve over time. They're made up of materials that will break down, and there's basically two kinds, one that sticks around about a year and one that sticks around about two years. And as those meshes slowly break down, as the body slowly converts that material into CO2 and water is really what it breaks it down into. It also lays down collagen in the area and so you get your own natural reinforcement that takes the place of the mesh over time, which is kind of a cool concept.

Eva Sheie (03:49):
It used to be only really used in revision. Right? But now, is it possible that you can use this mesh in a first time augmentation?

Dr. Zegzula (03:58):
Yes, definitely. I was recently at the aesthetic meeting, which was the Aesthetic Society used to be called the American Society of Aesthetic Plastic Surgeons, A-S-A-P-S, and now they just call themselves the Aesthetic Society. They had their annual meeting last week, and I saw several lectures about using mesh in breast surgery. And some surgeons, actually, several surgeons were talking about using mesh at the primary surgery, especially in patients who they feel have thinner thin tissues or weak tissues, and they'll put it in right away. They feel that they have less long-term problems with implant malposition that is the implant drifting out of position, either sitting too low or perhaps too off to the side. And they also feel like they're having less scar tissue problems. And a little bit of the science behind that is that when the mesh is dissolving, it lays down a different type of collagen than the collagen that a normal breast implant capsule would have. That collagen has a tendency to thicken and shrink over time, where the collagen around the mesh or where the mesh was stays more like itself, more supple and flexible. So they're feeling like they're having less capsular contracture as well. And I think it remains to be seen under large studies to see if that's really holding out if the results are that good. But I think it's intriguing and it's something that I'm going to be incorporating into my practice.

Eva Sheie (05:29):
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. Where Before Meets After is a production of The Axis, the podcast agency for Aesthetics, theaxis.io.