Bershof Plastic Surgery: 303.399.7662 Body By Design: 303.399.9609 4500 E. Ninth Ave, Suite 100
Denver, Colorado 80220

Fax #: 303-399-1314

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Breast Augmentation Q&A

Wednesday, July 6, 2011
A lot of my girlfriends have had their breasts enlarged. Some look good while others look too round and fake.
Breast augmentation is called an "augmentation" because it "augments" the existing anatomy more so than it actually creates it. Other factors come into play, such as the patient’s desire for size, pre-existing anatomy, and where the implant is placed.

The roundness in the upper half of the breasts that is often considered undesirable can be due to several factors including placement of the saline implant on top of the muscle, placing very large implants, or not making the implant pocket big enough to accommodate the implant. Saline implants tend to be rigid so softening of the contour is achieved by going under the muscle.

The key to achieving a patient's desired look, and this holds true with any cosmetic surgery procedure, is understanding what the patient is hoping for and designing a sound surgical procedure. If you want to know if your surgeon is a Board Certified Plastic Surgeon and a member of the American Society of Plastic Surgeons, call 1-888-4-PLASTIC.



You may be interested to know that liposuction is the number one cosmetic procedure performed in the United States for both men and women. Women commonly have liposuction performed on the hips, thighs and stomach. For men, liposuction is often done around the waist especially the "love-handles" and the stomach. Liposuction can be performed around the neck and is often combined with a facelift or necklift.

Liposuction is not a good method for weight reduction and it does not take the place of appropriate diet and exercise. Liposuction is an excellent procedure for sculpturing and slimming areas resistant to exercise and dieting. Most plastic surgeons feel that the best candidate for liposuction are those who are close to their ideal body weight and physically healthy, but have fatty deposits in particular areas.

The standard principle of liposuction involves using a cannula to suction out fat from an area of fat burden. Some years ago, tumescent liposuction was developed, which involves instilling the tumescent fluid under pressure into the area to be suctioned. This technique not only improved the results from liposuction but also allowed for larger volumes of fat to be removed.

The ultrasound liposuction technique still involves a variation of the standard cannula and the tumescent technique, but also adds an ultrasound current to the tip of the cannula. The ultrasound current further dissolves fat and probably improves results for certain areas.

What are even more important in liposuction are the skill, experience and artistic judgment of the plastic surgeon performing the procedure. Understanding male vs. female fat distribution anatomy, recognizing end points, utilizing different cannula techniques, and sculpturing are equally or more important issues. Don't get caught up in the latest technology buzz; there is no substitute for a skilled and experienced surgeon.

Liposuction is performed on an outpatient basis with local anesthesia and IV sedation or with general anesthesia. Some patients stay over night in the hospital, especially if they have larger volumes of fat removed. Healing after liposuction is gradual but most patients return to work within one week and can resume full activities within one month. Although the results of liposuction are seen immediately, there is swelling that can take up to three months to resolve. In fact, the initial swelling and bruising resolves within several weeks and the final new body contour will continue to improve.

If you want to know if your surgeon is certified by The American Board of Plastic Surgery, call 1-888-4-PLASTIC.


How to Pick a Plastic Surgeon

plastic surgeon has trained in a two to three year residency in a plastic surgery program approved by the American Board of Medical Specialists (ABMS). The ABMS is an organization of 24 approved medical specialty boards. The intent of the ABMS is to provide assurance to the public that those residencies certified by the ABMS have an approved training program and an established certification process assessing ability to provide quality patient care within that specialty.

Step 1. Go to Click on Member Boards. There are 24 member boards of the ABMS in the United States. Your surgeon should be certified by The American Board of Plastic Surgery, which is one of the 24 member boards of the ABMS. If a different board that's on the ABMS list certifies your surgeon, they may be board certified BUT they're not a board-certified plastic surgeon. And if the surgeons supposed board does not even appear on the ABMS list, it is not a recognized board, sometimes referred to in the industry as bogus boards.

After training in an ABMS approved residency training program, a plastic surgeon usually enters practice and begins a 2-3 year process of becoming certified by The American Board of Plastic Surgery (ABPS). The mission of The American Board of Plastic Surgery is to promote safe, ethical, efficacious plastic surgery to the public by maintaining high standards for the education, examination and certification of plastic surgeons as specialists.

Step 3. Go to You can also call toll free the American Society of Plastic Surgeons at 1-888-4-PLASTIC. From the web site or from the phone call, you can ask if the surgeon in question is a plastic surgeon and whether or not that surgeon is certified by The American Board of Plastic Surgery. If they're not on the certified list by calling 1-888-4-PLASTIC, they're not a board-certified plastic surgeon.

There is also a great deal of useful information at Make sure you go to dot ORG (.org) not dot COM (.com).

Plastic surgery residency approved by the American Board of Medical Specialists Certification by The American Board of Plastic Surgery Membership in the American Society of Plastic Surgeons.

Step 4. Buyer Beware! The Yellow Pages, Newspaper, TV, and Radio perform absolutely no screening of whom they allow to market themselves as plastic surgeons. Anybody can list themselves as a plastic surgeon under that heading in the Yellow Pages and anybody can place an ad in the Newspaper appearing as if they're a plastic surgeon or cosmetic surgeon. You would think there would be some accountability in the media but there isn't.

Step 5. At your Consultation, it is okay to ask a plastic surgeon how many of a particular procedure they have done. But don't get hung-up on numbers; they're only part of the equation. Ask to see Before and After pictures and be suspicious if there are few if any pictures to show. Make sure the pictures being shown are of that surgeons own work and not some other plastic surgeons results. Also ask for references, that is, the first name and a phone number of patients to call whom have had that operation performed by that surgeon.

Step 6. Hospital Based vs. Office Based Surgery. Be suspicious if a surgeon performs surgery out of their office. Although many good plastic surgeons have an office based operating room, its also a loophole for non-plastic surgeons. In most places in the US, there is absolutely no supervision of office-based surgery. A doctor who was practicing general medicine one week can take a weekend course and start performing liposuction that next week in their office.

With hospital based operating rooms, however, there is a credential process, peer review, and oversight. Hospitals do not allow surgeons to perform procedures in their hospital that's not part of their specialty.

In conclusion, verify if the doctor is certified by The American Board of Plastic Surgery by calling 1-888-4-PLASTIC or going to Don't base your decision solely on advertising but solicit referrals from friends or family. Look at Before and After pictures. Call a few patient references. Be leery of office based plastic surgery.


Breast Augmentation Part 2

There are three choices for breast augmentation incisions: nipple, breast crease and armpit. Each approach has its advantages and disadvantages. When you look at the entire scope of breast augmentation, such as size, shape, and symmetry, where the incision is placed is less important.

Because of the inherent ripples that can occur with saline implants, most plastic surgeons place saline implants under the chest muscle in order to hide the ripples and also hide any unnatural roundness to the implant.

So-called teardrop implants sounds good in theory but that theory doesn't translate into reality. Be leery of advertisements claiming to use anatomic, teardrop or biodimensional implants; their use is very limited in augmentation surgery.

Textured implants were originally invented in an attempt to reduce scar contracture around silicone gel implants. However, saline implants enjoy a much lower contracture rate and also, going underneath the muscle reduces contracture rate, too. Therefore, there is often no derived benefit in adding textured saline implants into the mix. In fact, textured implants likely have a higher ripple rate and rupture rate than smooth implants, and because of their texture, don't move as naturally as a smooth implant. Textured implants might be used for women who have recurrent contractures.

Final breast size is ultimately up to the woman although an experienced surgeon can help guide that decision. Most women often augment near the C-cup range, from a full B to a full C or small D.

The operation is called augmentation precisely because it augments the woman's given anatomy. Implants don't create the anatomy as much as they augment it. Most women have suitable anatomy such that simply making the breasts fuller; paying attention to anatomic landmarks, and filling out lost volume will achieve a great result. Some women need adjustment to the anatomy, such as a breast lift, in order to improve shape. A plastic surgeon conversant with breast augmentations can help a woman decide what her options are.

Breast augmentations should be performed only by plastic surgeons certified by The American Board of Plastic Surgery (call 1-888-4-PLASTIC). Be leery of office-based surgeries. Despite what the public thinks, any doctor can perform a breast augmentation in their office, whether or not they're a plastic surgeon. There is no government regulation. Hospitals and outpatient surgery centers at least credential their medical staff adding a level of security for the public.


Breast Augmentation Part 1

Reasons a woman might desire a breast enhancement operation include small breasts, sagging breasts, loss of breast fullness after breast feeding, and to fit better in clothes, strapless dresses and swimming suits. A woman should only undertake a breast augmentation, or for that matter any cosmetic plastic surgery operation for herself.

Breast augmentation is almost always performed in a hospital or outpatient surgery center, where general anesthesia is available. If it is being performed in a doctor's office or in an office operating room attached to a doctor's office, be suspicious of the surgeon's credentials since office based surgery is totally unsupervised from peer and government regulation and scrutiny. However, some plastic surgeons have accredited office-based operating rooms.

A breast augmentation takes about 2 hours to perform, is usually performed under general anesthesia, requires several hours of recovery, and most patients go home the same day of surgery. Although post-operative instructions vary from plastic surgeon to plastic surgeon, in general, women are very limited in activities during the first week, return to work at 5-7 days, allowed to perform light non-arm activities in the first month, and return to most physical activities after one month. Don't plan to have a breast augmentation and then go on a beach vacation two weeks later. Plan ahead.

Although there are some risks to the operation they are uncommon. Such risks include bleeding, infection, numbness, inability to breast feed, asymmetry, unhappiness with size and/or shape, implant ripples, implant leaks or ruptures, and scar. Almost all patients who undergo breast augmentation are happy and few experience risks or complications.

The only implant that is available for first-time breast augmentations are the saline implants. Saline implants are made of silicone rubber on the outside and are filled with saline at the time of surgery. Saline implants tend to have more ripples than silicone gel implants and tend to be rounder appearing. Saline implants can also rupture or leak, resulting in complete loss of volume necessitating a replacement operation. If the leak or rupture is within 5-10 years, the implant manufacturers will often provide a new implant free of charge and some money towards a 2nd operation. Silicone gel implants are only available through an FDA study for women undergoing breast cancer reconstruction, redo breast augmentations, and if a breast lift is also being performed alongside the augmentation, provided the woman meets the indications.

Breast augmentations should be performed only by plastic surgeons certified by The American Board of Plastic Surgery (call 1-888-4-PLASTIC).

Aging Face

Facial expressions, especially around the mouth and eyes, send messages to others about how you feel. With all of the emotions and stresses of daily life emanating from your face and eyes, added to the years of sun exposure and the pull of gravity, it is not too surprising that your face often shows signs of aging even before you feel old. There are a number of options available to help turn back the clock of time.

The gold standard for reversing the signs of the aging face is the facelift. When our face ages, the skin loses its elasticity, it begins to hang, and that once sharp anatomy is lost. A facelift can restore the strong jaw line, create a more youthful neck, decrease the jowls and lessen the deep grooves on the sides of the mouth. As part of a facelift, the underlying muscle system is also often tightened, which not only creates that more youthful look but likely gives longer lasting results.

A neck lift is really a subset of a facelift such that when you are getting a facelift, you are also getting a neck lift, too. Some people only want or need the neck lifted. Often, neck liposuction is added to either procedure if there are some fat deposits under the chin.

A forehead lift is an additional operation. It can lessen the deep forehead grooves and wrinkles including the frown lines, and raise the eyebrows. There are variations of the forehead lift, such as the brow lift. Some people opt for BOTOX® injections above the forehead and frown lines rather than surgery, in order to obtain that smooth, youthful look.

Often accompanied with a facelift is the eyelid lift. As the eyes age, there is excess skin on the upper eyelids and some fat deposits. The lower eyelid fat deposits weaken, protruding forward, causing bulges or bags. These bags coupled with wrinkly skin gives that tired, aging appearance. Removing excess skin and fat, and tightening the skin extends a youthful, rested look to the eyes. It is a powerful way to make a person look younger and rested.

Other signs of aging, such as very fine wrinkles, uneven color and texture, and pigmentation changes, are not corrected with the surgical procedures mentioned above. These types of skin care problems require medical skin care techniques, such as advanced skin care products, office peels, and laser resurfacing. Advanced skin care products include cleansers, moisturizers, and exfoliators, which bring more youthful skin to the surface, as well as products to control pigmentation. In-office peels and lasers literally resurface the skin in one fell swoop, removing the top layer and allowing youthful skin to take over.

If you want to know if your surgeon is certified by The American Board of Plastic Surgery, call 1-888-4-PLASTIC.