Episode 14: Giving Your Breasts A Complete Beauty Now Makeover with Dr. Brent Moelleken of Extreme Makeover
Giving Your Breasts A Complete Beauty Now Makeover with Dr. Brent Moelleken of Extreme Makeover
Announcer: This program is brought to you by personallifemedia.com.
Teri Struck: I'm Teri Struck, host of Beauty Now, I'll be your weekly host on the quest to remain ageless. We get the lowdown on lipo, lifts, lasers, hormones, rejuvenation, and more, from experts on everything beauty. Today we welcome Dr. Brent Moelleken, a prominent and well known board certified plastic and re-constructive surgeon whose been featured on my favorite show: Extreme Makeover, as well as one of my favorite magazines: Vogue.
Dr. Brent Moelleken: It's always good as a patient to listen and see what makes the most sense when you hear the plan of the doctor. So, if there is drooping in the breasts, often we need to do a lift, otherwise if we just put an implant to a droopy breast, then the nipple might be very low, and the implant might be very high. Now rupture means that the outer shell of the breast implant breaks, for whatever reason. Now if there's salt water inside the implant, then the woman knows right away because the breast's flat, and the other one's normal, so they know right away. But if it's a silicone gel breast implant, then it's harder to determine whether there's been a rupture. I think there's probably more paperwork to sign when you get a breast augmentation than there is when you buy a house.
Teri Struck: Haha. That's sad. That's sad. Forget it.
Dr. Brent Moelleken: Important question is, you know, is your doctor really, really reputable, that's the most important thing.
Teri Struck: Welcome Dr. Molleken.
Dr. Brent Moelleken: Well it's good to be here.
Teri Struck: Thank you so much for talking to Beauty Now today.
Dr. Brent Moelleken: Well it's my pleasure.
Teri Struck: We're going to be talking about everything breasts today.
Dr. Brent Moelleken: Great.
Teri Struck: Can you walk us through a consultation?
Dr. Brent Moelleken: Yes.
Teri Struck: Feeling kinda low about your breasts. No pun intended, but I know it's a little bit embarassing when you come in. Talk us through it.
Dr. Brent Moelleken: You know, women I think are always a little bit self conscious about showing their breasts to somebody that they barely know, it's kind of amazing that it even happens at all, but people come in and they're bothered enough by a problem. Either their breasts are too small or they're too large or they're too saggy or some other problem, asymmetry. So they come into their plastic surgeon's office and hopefully they've done a little bit of homework by this point. You don't want to go into just anybody's office, you want to do a little bit of homework, make sure your doctor is board certified by the American Board of Plastic Surgery. You know, look at his credentials, check out the website a little bit, and then you come in for a consultation. So you'll typically sit across the table from the doctor, and um, you know, hopefully the doctor will do a little bit of a history. And that means the doctor will ask you about the, you know, what you've been through in your life, and what your medical history is, whether you have allergies to anything. Then after all that's done, you'll probably get down to the nitty gritty and say 'well, what's on your wish list? What is it about your breasts you'd like to change.' And at that point women will kind of tell the doctor what it is that bothers them about their breasts. Then, you usually have an examination and you check it out, see what the problem is and then the doctor will give you his opinion. His or her opinion on what can be done and how you can make 'em better.
Teri Struck: And I know there's several different kind of implants, so you go through all the different types of implants so can you explain that process. It's a little bit overwhelming.
Dr. Brent Moelleken: Yes it's very overhwelming, and we usually budget a full hour to spend with patients when they come in for a consultation. Now, there are many many different types of implants, and implants are, you know, just, to state the obvious, they're for ladies who for whatever reason want to have a larger breast volume. A lot of times that's due to childbirth and a lot of times it's just due to the fact that they don't have as much volume as they'd like to have in their breasts.
Teri Struck: Or they've lost weight. I know a lot of my friends who've lost weight need to get an implant just to make them rounder.
Dr. Brent Moelleken: Exactly, weight loss is a big one too. And that gets, and that gets tricky. Now let's say that we do decide, that you know, breast augmentation is in order. Um, lots of different types of implants, lots of different types or different ways of getting the implants into the space, you know, where they're going to enhance the breasts. Now the first consideration should be do you put them above the muscle, or below the muscle. Now every doctor has their own opinion on whether above or below the muscle is better. In general we like to go below the muscle because it's better hidden, and it tends to look more natural and more like real breast tissue.
Teri Struck: Whose a good candidate for above the muscle?
Dr. Brent Moelleken: Well above the muscle, if there's some sagginess to the breast and the patient doesn't want to or isn't a candidate for a breast lift, then you may want to consider going above the muscle cause it's not really good to put a breast implant below the muscle in a breast that has a lot of sagginess. Sometimes you can get what's called a double bubble problem, where the breast is a little bit saggy, and then then the muscle and the implant unit behind it, you see sort of two bumps below the breast. You kind of want to avoid that.
Teri Struck: So that's if it's below the muscle?
Dr. Brent Moelleken: That's if it's below the muscle in a saggy breast.
Teri Struck: Oh, I see, ok. But if it's above the muscle, you're saying you can get sagging as well.
Dr. Brent Moelleken: Well the sagging is either there or it's not there, you know that droop of the breasts is either there or it's not there, usually that can be determined by um looking at the woman and the test we all look for is where is the nipple relative to the fold of the breast, underneath the breast. That's the critical question, and if the nipple starts to get at the fold or below the fold that's drooping, that's call ptosis or drooping of the breasts, that's when we need to think about, you know, boy do we need a lift, in addition to the implant? Now doctors totally disagree on, which makes it very confusing cause you'll talk to two reputable doctors who'll have a completely different plan, so you know whose right. And you know maybe there is no right answer, but it's always good as a patient to listen and see what makes the most sense when you hear the plan of the doctor. So, if there is drooping in the breasts, often we need to do a lift, otherwise if we just put an implant to a droopy breast, then the nipple might be very low, and the implant might be very high. And that doesn't look good.
Teri Struck: That's like so confusing. Now if you have a breast implant are you able to do a lift afterwards?
Dr. Brent Moelleken: Doctors need to be very very cautious when they do a lift and an implant at the same time because you need to consider the blood supply to the, especially the nipple areola, cause if you're doing too much surgery, let's say you're doing a big lift, plus you're doing an implant. Imagine this, you're stretching the skin by putting in an implant and you're shrinking the skin by doing a lift, so you just don't want to do too much of that otherwise you can get into a problem with not enough blood supply, then you can have just a horrible result. You can lose a nipple or have a catastrophic outcome.
Teri Struck: And that's pretty rare, isn't it?
Dr. Brent Moelleken: It's very rare but it does happen. You know, it does happen, and when aggressive lifts are done at the same time as large implants are put in, then the body may just not be able to handle it.
Teri Struck: Why do some of these implants rupture?
Dr. Brent Moelleken: Implants are devices, just like any other device. And they have a certain rupture rate, and the rate is roughly a little bit less but roughly one percent per device per year. So that means in ten years, you know, one percent per device per year, so about twenty percent of people would have a rupture.
Teri Struck: And rupturing's not the same as getting a hard breast. Why does that happen.
Dr. Brent Moelleken: Now rupture means that the outer shell of the breast implant breaks, for whatever reason. Now if there's salt water inside the implant, then the woman knows right away because the breast's flat, and the other one's normal, so they know right away. But if it's a silicone gel breast implant, then it's harder to determine whether there's been a rupture. Scar tissue always covers every breast implant made, there's always scar tissue. Hopefully it's very mild scar tissue. And if there is a rupture of a silicone implant often silicone will just stay within that scar tissue, and people will have no idea that they have a rupture.
Teri Struck: So do you recommend silicone or saline or what's the indication for any woman?
Dr. Brent Moelleken: It's a very very personal decision on whether to choose silicone or saline. I don't think that there's any relationship between autoimmune diseases and silicone gel implants, the studies just don't bear that out any more. So that question is kind of put to rest now. But if a silicone gel implant ruptures, it's not good. The silicone can be reactive to the tissues. It can cause a scar to form around the breast implant. Or very, very, very rarely it's possible that the silicone could get out of the capsule and you know into vital structures such as the armpit. That's why most doctors would recommend if there is a ruputre of the silicone gel implant, most doctors would recommend to replace that implant. Now the whole, the FDA has just approved silicone gel implants for anybody over 22 years of age.
Teri Struck: Why, why that age group?
Dr. Brent Moelleken: Um, who knows, the FDA has, has reasons for choosing things that no one really knows, even sometimes they go against their advisory committee. A couple times recently the advisory committee has recommended one thing and the FDA, you know, reverses that. So you never know what they're thinking exactly. But the FDA we do know is very very concerned about silent rupture of silicone gel implants, now silent rupture means that there's a rupture of the silicone but you don't know about it. That's what the FDA is concerned about. So, anyone who gets a silicone gel implant now, the FDA is recommending that they get follow up MRI studies. Now here's the problem. An MRI study is very expensive, could be a thousand dollars, and insurance is not going to cover it. So if the patient is going to spend a lot of money for a breast augmentation and then three years after their surgery they're going to have to have an MRI and every two years after that. That's a lot of money just for looking for implant rupture that may not have occurred.
Teri Struck: So do you have to sign something for that, I mean if you, I thought with the approval you don't have to sign something. Is that true?
Dr. Brent Moelleken: I think there's probably more paperwork to sign when you get a breast augmentation than there is when you buy a house.
Teri Struck: That's sad. That's sad. Forget it. No, I'm all pro breast implants. Don't get me wrong. Ok, explain the difference between saline and silicone though, what if you go for the saline?
Dr. Brent Moelleken: When you hand a woman a saline implant, and you hand her a silicone implant, every single person is going to say the silicone implant feels better. The silicone implant feels more like real breast tissue. The saline implant feels a little bit firmer. Now that doesn't mean you can't get a good result with a saline implant. You can get a great result with a saline implant. But it's not quite the same as a silicone gel implant. That's why people are trying so hard, you know, to get their silicone implants put in. It's just a big, there's a big push now that the FDA has legalized silicone gel to get silicone gel implants rather than saline implants. Now the plusses and the minuses. So silicone feels better. Silicone is better for things like asymmetry, when there's a difference in size of the breasts and you have to put a different sized implant on each side. You get better results with silicone than you do with saline. But there are people who are very frightened though about silicone gel implants. And for those patients it just wouldn't be right to put a silicone implant in when they're so frightened that they might have a complication from the silicone. So those patients might be better off with saline.
Teri Struck: Right I agree with that.
Dr. Brent Moelleken: Yeah, and silicone does cost more. I believe they're between $1800 and $2000 for a pair of implants. Unbelievable that that's what they cost.
Teri Struck: And silicone's more expensive than saline.
Dr. Brent Moelleken: Silicone's much more expensive than saline.
Teri Struck: Well we're going to be right back with Dr. Brent Molleken. I'm so interested to talk to you more about this and get to the bottom of this so all women can have perfect breasts. We'll be right back with Beauty Now.
Terri Struck: Hi we're back with Dr. Brent Molleken. He's been featured on Extreme Makeover and we were just talking about saline versus silicone implants with everything else. Welcome back.
Dr. Brent Moelleken: Well it's good to be back.
Teri Struck: Thank you, and so we were just talking about silicone versus saline and you were talking about the pros and cons.
Dr. Brent Moelleken: Right, so so we talked about how silicone implants actually do feel more realistic, feel more like breast tissue than saline implants do. That's why there's a big premium on it. But for patients who are worried about 'gosh will my silicone implant rupture? Will I have health problems? Will they leak?' You know, that kind of patient whose always worried about a silicone gel implant, it's better if they don't get it. They're better off with a saline implant.
Teri Struck: For their own peace of mind.
Dr. Brent Moelleken: For their own peace of mind.
Teri Struck: So I remember hearing a couple years back about the teardrops or things that could actually be fitted to your body. Is that still, do people still do that?
Dr. Brent Moelleken: I think the teardrop shape. When you hold up a teardrop shape implant it looks wonderful, it has a swoop on the top and it really really looks like a natural breast. But, what I've found is when the teardrop shape goes in the body, it doesn't look that different from a conventional breast implant.
Teri Struck: The reason why you'd want to get your breast fixed in the same place.
Dr. Brent Moelleken: Exactly, so when you put a little bit of pressure. Even when they sit on the desk in the physiologically shaped implant, they start to look like a round implant. Plus there's a little polarity of the implant, so you have to make the pocket, when you're doing the surgery, exactly the size of the implant. You can't allow the implant to rotate.
Teri Struck: Well that's actually, you brought up a good point. How do you put those implants in, and what type of scars do you have?
Dr. Brent Moelleken: Ah, now my favorite incision to put in breast implants is the below the breast incision, for a number of reasons. One of the other very very popular incisions and it's not a bad incision, and we do it sometimes is around the areola. And the reason people get that is that there won't be any scar below the breast, which is true, but there is a scar in the areola, and especially women who are very very protective of their breast sensation. We know that cutting near the areola will damage more nerve than cutting below the breast, so there's probably a higher chance that women won't be able to feel their nipples or will feel less of their nipples if they have an around the nipple incision.
Teri Struck: Now that is so interesting, that is good to hear. I never knew that.
Dr. Brent Moelleken: Yeah, yup. And so those are the two most common incisions. The armpit incision is still used and some doctors do a beautiful job at it, but the problem is that it's very hard to get the placement exact of the implant. So that incision tends to have a little bit higher complication rate with respect to you know, one implant being higher or lower than the other.
Teri Struck: What about the bellybutton, I've heard about that.
Dr. Brent Moelleken: Yes, the bellybutton is big now. The bellybutton is big, and what that involves is an incision through the bellybutton and a tube is inserted, and it the tube tunnels, goes, all the way from the bellybutton up to the ribcage, jumps over the ribcage then makes a space typically below the muscle. And then the implant, the saline implant only, no silicone implants, saline implant only, is then put in like a little taco, then it's unrolled then inflated in the body. And that's for patients who absolutely don't want to have a scar around their nipple or below the breast, that may be something to consider.
Teri Struck: That seems scary to me, but I mean it's amazing what doctors can do today.
Dr. Brent Moelleken: Yeah, that is, it is an amazing approach. We don't care for that approach because, um, for a number of reasons, but, you know, many doctors do a great job at bellybutton implants and and, their patients seem to like it.
Teri Struck: If you're an A and you want a D, what do you say?
Dr. Brent Moelleken: I'm a big believer in measuring, and that means that we take the patient beforehand and say 'ok, how wide is your breast?' So we measure the breast and how wide it is, and we try to put an implant that's actually smaller than the width of the breast. And you may say “well that sounds totally obvious, of course you do that.” But many doctors don't believe in measuring, they just believe in putting in a really really large implant. The problem with putting in a large implant is that the skin will stretch. When you're putting something in and stretching it out, the skin is going to become thin. So women who have had very large breast implants often have many re-do surgeries because they need lifts, the skin gets thin, they have complications, they see a lot of rippling of their implants. Their implants are very visible. All these are problems when we put in too large of an implant.
Teri Struck: Do, um, women that get large implants, are they more prone to getting encapsulated?
Dr. Brent Moelleken: Probably the rate of encapsulation is similar. However, the rate of re-do surgeries for women with very large breast implants is without question much higher. Scars tend to be worse, they just tend to have a lot more problems down the road. Now we think as doctors and hope as patients that once this breast implant is put in that we'll never need surgery again, in fact the average is that after 10 or 15 years, for whatever reason the breast implants will need to be redone. And that's something patients should calculate in. You know, it's not just 'you get your surgery; you'll never need to think about it again.' Probably in 10 or 15 years you'll need re-do surgery.
Teri Struck: And that's on them, right? That's not on the doctor
Dr. Brent Moelleken: Correct, that's, the patient needs to pay for that.
Teri Struck: Right. What about massaging the breasts after surgery. I mean, does that help, so you won't get hard, I mean is that realistic?
Dr. Brent Moelleken: Well the most important thing to um avoid capsular contracture, which is excessive scar forming around the breast. The most important thing is how the surgery's done. So the surgery shouldn't be done in a factory, where, breast implants are done just one after the other. It's a very personal thing, and we want to make sure that there's no bleeding. Now bleeding in the area of surgery will give a higher risk of having a capsular contracture later on. We definitely don't want to have any bleeding, and we want to control, you know, how clean the operative site is afterwards. Also we know that bacteria, any bacteria that get in are also very bad for promoting capsular contracture, you know, later on. So how do we avoid bacteria. You know, obviously good sterile technique. Be very gentile with the tissue. Plus in many operating rooms, you know, that are highly accredited there are filters in the ceiling that will filter the air. Or if a doctor is putting in a saline implant, you want to know 'is that saline coming directly from the bag into the implant, or is it sitting there in a bowl that the doctor just injects. All these little things may make a difference in the long run about how many microscopic bacteria get into the implant and may cause scar tissue later on.
Teri Struck: That is such a good point you would never think to ask that question, never thought of it before.
Dr. Brent Moelleken: Right. Now people will, people listening will think wow, that's the important question to ask, but that's not really the important question. The most important question, you know, is: is your doctor really really reputable? That's the most important thing.
Teri Struck: And we're seeing that with every field now. I keep stressing this is please do your research.
Dr. Brent Moelleken: Please do your research, absolutely. I hate doing re-do surgery, so please do your research.
Teri Struck: I just interviewed somebody else who was saying, who was in another field and he said “I wouldn't dream to touch your nose.” And it's so true. I mean it makes such great sense, cause I mean there's great dentists and dentists are now applying to be plastic surgeons, but that's not what they went to school for. So they need to do the research.
Dr. Brent Moelleken: Yeah, it's very important. It's so tough to know, you know, which doctor to go to, but if you do pick someone whose board certified, you know, in plastic surgery, then you know at least you're getting a board certified plastic surgeon. But there are many other steps to take.
Teri Struck: Great to have referrals.
Dr. Brent Moelleken: Great to have referrals. If your local doctor, you know, if they start mentioning the same name, you know a lot of your friends have gone to that same person and they have just a good reputation in the community. You know, you don't want to jump into anything just because there's a new technique. A lot of times these new techniques don't work out. Most new techniques don't work out.
Teri Struck: Exactly, I've heard that before too. That's really good information.
Dr. Brent Moelleken: Yeah, but yet whenever a new technique comes out people just line up for it.
Teri Struck: It's so true. I'd probably be one of those people but now I'm educated so that's great.
Dr. Brent Moelleken: Yeah, it just boggles my mind, you know when, a new technique comes out, it's just. Even if you bought a car you wouldn't do that. If the new, you know, nuclear powered car came out you wouldn't go run out and buy one cause you want to know if they explode first.
Teri Struck: It's so true.
Dr. Brent Moelleken: It's so simple, yet people would go out and they hear about a new laser, and off they go, and they want to be the first to get the new laser, without even knowing if it works or not.
Teri Struck: Well, and also having a qualified doctor.
Dr. Brent Moelleken: Right. A qualified doctor will not do crazy procedures on his patients, period. So that's the whole judgment that goes in. It's very hard for a patient to educate themselves to the level of a plastic surgeon who went to, you know, to medical school.
Teri Struck: Well even a doctor even if it's not a plastic s-or surgeon or doctor or any, I think that's just we all look up to doctors. And i think everyone has to realize everybody has their specialty.
Dr. Brent Moelleken: Right, everyone has their specialty and there are good doctors, and there are not so good doctors.
Teri Struck: That's great, that's true. Very true. Before we go, I want to touch on breast lifts.
Dr. Brent Moelleken: Ok.
Teri Struck: Could you explain to our listeners about lollipop scar, and a anchor scar, all those kinds of things real quick.
Dr. Brent Moelleken: Sure. There are many different kinds of lifts. From weaker lifts that move the nipple or the areola around a little bit, now usually up. Those lifts are done usually around the nipple alone, and they tend to be somewhat weaker. Now the stronger lift are a lift like the lollipop where the incision would go, you know, around the areola, but then also down to the bottom of the breast fold, and there are many variants of those, but let's just say the lollipop is a member of the short scar incisions. They call them short scar incisions. And for the real lifts most doctors use whats called an anchor. Which means an incision around the areola, down the bottom of the breast and at the bottom of the breast. Now if you think about it, what is a lift? What is a breast lift? What you're doing is you have too much skin for the amount of breast that you have, and so you want to do a lift to remove the extra skin. Now when you remove extra skin, you have to sew it up somehow. Now if we're doing it just around the areola, there's going to be a lot of gathering, just like if you were sewing clothes. If you sewed a big circle to a small circle, there'd be a lot of gathering of the fabric. Well the same thing goes with the breast. If you're doing a big lift, and you're doing it all around the areola, you can sometimes get a lot of gathering. So rather than to have a bad scar around the areola, it's sometimes better to take part of that scar and hide it on the way down to the bottom of the breast fold, and that would be more like a lollipop, or if you're really taking a lot of skin away, because there's way to much skin for the amount of breast that there is, then the anchor incision, with an incision at the bottom of the breast, you know, at the fold, that is a lot of times better for the patient. But your doctor, any doctor doing breast lifts should be able to go through all the options with you, and kind of show you pictures, and give you the plusses and the minuses of each technique.
Teri Struck: And is that the same as a reduction, the same scar?
Dr. Brent Moelleken: The reduction scar is the same as we use for a lift. Just when you do a reduction you reduce the volume, the size of the breast, in addition to doing the lift.
Teri Struck: So you're taking out more skin when you're doing a reduction than a lift?
Dr. Brent Moelleken: Not necessarily. It's just you're taking out both volume and extra skin. In the case of the lift, you're just taking off the extra skin, and repositioning the nipple, and making the breast shape pretty again.
Teri Struck: So bottom line, really everybody is different, I mean, everybody needs a consultation to see what's right for them.
Dr. Brent Moelleken: Everyone is different. And it's not a bad idea to take your let's say three or four favorite, you know, picks once you've done your research and talk to them all and see what they say, and see which of the plans make sense. Surgery should make sense. A doctor should be able to explain it to the patient and tell them why this option would be better than another option.
Teri Struck: And last but not least, the scars, when do they go away?
Dr. Brent Moelleken: Scars are different in every patient. Some patients heal beautifully, and you can barely see the scars. Some patients heal terribly and the scars look horrible. Now the good news is that scars tend to fade. They'll usually fade slowly, and there are many things your doctor can do with you to help those fade, and to help them look their very best, but a lot of it is luck of the draw and genes, genetics, that determine how a scar will heal, and of course the technique of the doctor.
Teri Struck: And what can you do to help your scars heal.
Dr. Brent Moelleken: There are many things you can do to help the scars heal better. Now doctors can keep a close eye on their patients and see them often in follow-up. And they can induce blood injections if it looks like the scar is starting to widen. They can put various creams: antioxidant creams or silicone based creams. There's silicone sheeting that can be used, that's little silicone, almost like a band-aid that goes over the incision. And all these things have been proven to, um, you know, reduce the scarring. But if you think about it, if you want a good scar, you better do the surgery well. You'd better not put a lot of tension on the closure. Now let's say you did a really big breast augmentation, and at the same time, now those scars are going to stretch. No matter how you slice it, those scars are going to stretch, and probably not be good scars. So you really want a good doctor, thinking about all those problems that go into, not just 'oh I want beautiful huge perky breasts.' Well, you know, a lot of people do.
Teri Struck: Every woman does.
Dr. Brent Moelleken: Everyone does, but well many people do. But it's not always the best way to get a good result for everybody.
Teri Struck: Before we go, oldest patient.
Dr. Brent Moelleken: The oldest patient, well huh. I had a lady who was deep in her 70's who had a breast augmentation and breast lift. All her kids were gone, and they were all out of the house, and she had just been work work work work work all of her life, and finally she just decided to, you know, fix her breasts up. She was in her 70s and she was very
Teri Struck: I love it
Dr. Brent Moelleken: happy.
Teri Struck: Go girl, I love it. What I'm all about. Thank you so much Dr. Brent Molleken for being with us today. For our listeners that want to get a hold of Brent Molleken you can go to personal life media dot com. Any questions, email@example.com. We're gonna link our website to him so you can find him in Beverly Hills, or Santa Barbara. Thank you so much for being with us today.
Dr. Brent Moelleken: My pleasure.
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