Dr. Joshua Waltzman on Breast Augmentation, Silent Rupture, and Why He Likes IDEAL IMPLANTS

At Waltzman Plastic Surgery in Long Beach, California, you’re in the capable and experienced hands of board-certified plastic surgeon Dr. Joshua Waltzman. A Long Beach native and USC alum, Dr. Waltzman offers both invasive and noninvasive treatments for the face, breast and body. In a recent interview, he spoke with us about his practice, the breast augmentation process from start to finish, and the new IDEAL IMPLANT® Structured Breast Implants.

Why should patients choose your practice over others in the area?

“Women choose our practice because they feel very comfortable here. I’m the only surgeon, and our staff is small. Patients aren’t walking into this overwhelming office with multiple doctors and clinicians and equipment surrounding them. When they walk in, they feel like they’re coming into our family. Patients will talk to the staff and get to know each other’s families. We really do have a sense of community here that distinguishes us from other practices. My staff and I also spend a lot of time with our patients. I am deeply invested in listening to all of my patients’ concerns and goals. When it comes to breast augmentation, there are a lot of specific things women are looking for that are important to hear and discuss before the surgery takes place. So I think taking the time to listen also sets us apart.”

Who makes a good candidate for breast augmentation?

“Someone who is in good health, doesn’t smoke, has breasts that sag or have lost volume, these are all women who are good candidates for breast augmentation. Most women who come in want to have bigger breasts, and I try to explain that an augmentation alone will simply make you a natural, larger version of what you are. So, if your breasts are naturally close together, after an augmentation they will still be naturally close together, just bigger. And on the flip side, if your breasts are naturally spaced a little bit further apart, your augmentation will make them larger, but they will still be spaced the same distance apart.

“If women are desiring to have other changes made, whether it’s making the nipple position higher, making the breasts smaller, or changing the overall architecture or shape, then we have to talk about other procedures in addition to augmentation alone. Typically, my patients are moms who are done having children, they have some volume deflation from the breasts after breastfeeding, which is natural, and also some descent or lowering of the nipple position. And in some of those cases, we have to combine a lift, either at the same time, or before doing an augmentation.”

Can you guide us through your specific breast augmentation process?

“It all starts with a physical exam. Taking really detailed measurements of the patient to customize their augmentation or their implant selection choice is paramount. Beyond that, we talk about implant placement. We talk about why I might choose to place the implant above or below the muscle. Of course, that’s influenced by the patient’s starting breast size and how much soft tissue, or how much breast they initially begin with.

“Another choice we make is the location of the incision. I prefer to do most all of my primary augmentations (meaning first time breast augmentations) through what’s called an inframammary approach, which is a small three- or four-centimeter incision tucked right in the breast fold. There is a lot of data that shows that this approach leads to lower capsular contracture rates, lower infection rates, and it gives the surgeon a much better view of the implant pocket when you’re designing it. It’s really the best approach for breast augmentation. The scar is always there, but it fades quite nicely. And when it’s in that fold, it really is a non-issue. Now, if a patient comes to me and has pre-existing scars from elsewhere on the breast, whether it’s an areola scar or elsewhere on the breast, I’m happy to use those. But my preference is for an inframammary approach.

“We talk about all the different types of breast implants out there, and discuss which one the patient might have a preference for. The patient’s physical measurements will help dictate implant selection to a large extent. We also talk about what their goals are. Are they just looking for a subtle natural enhancement? Or are they looking to revolumize what they have lost after pregnancy and breastfeeding?

“In my office, I like to use a 3D simulation software. I scan all the patients in the exam room during the consultation. It takes about 30 seconds. And on the iPad, right there, we can do a full 3D simulation and start trying on different implant sizes with pretty good accuracy. That’s been a great way for patients to picture how they will look with a certain pair of implants. It’s one thing to see implants on a before and after picture of someone else. You may not know anything about them. They might have a different frame. Before and after photos usually mean very little to a patient, until they see how the implants will look with their own skin markings, freckles, etc. If they have a tattoo, that will also be in the 3D simulation, and that really drives it home for them.”

What are your thoughts on silent rupture with silicone gel implants?

“I’ve had multiple patients who have experienced some type of silent rupture. The more common scenario is that I find the rupture during an implant exchange and/or upsizing or downsizing. I discover it once I am operating on the patient, which is really the ultimate silence. It wasn’t identified with any preoperative imaging, so my patient didn’t even know about it.

“With older silicone gel implants, the gel can be pretty messy. It’s much stickier, it tends to run. Getting all that gel out requires additional time in the operating room. With some of the newer generation silicone gel implants, the gel is more cohesive. If there’s a rupture, the implants tend to come out quite a bit easier. But obviously, with saline implants, that’s not an issue. You know right away if there’s a rupture, and in that case, you’re only spilling a little bit of saltwater into the breast cavity which easily gets absorbed harmlessly by the body.”

Why do some surgeons still push silicone gel implants on certain patients?

“Silicone gel may be the right choice for patients who have very thin tissue coverage. So, either they’re very thin patients, or their breast tissue has been stretched, and their breast tissue coverage is very thin. For women with this thin breast tissue coverage, they may be able to feel a more obvious difference between silicone gel implants, saline implants, and the IDEAL IMPLANT.

“So that’s one thing I bring up for patients that are very thin. But I always try to give my patients the option that they are most comfortable with. Sometimes my patients will say, ‘Oh my sister had saline, my aunt had saline, my mom had saline. I’m having saline,’ and there’s not even a discussion to be had.

“I think educating my patients and presenting all their options, including the risks and benefits of each one is always the way to go. At least that’s how I do it in my practice. And there are certain patients who will push for one direction or the other, but for the vast majority, it really is kind of a decision for both of us.”

What are the the benefits to the new IDEAL IMPLANT technology?

“There are many benefits to the IDEAL IMPLANT. My experience with the IDEAL IMPLANT has been only positive. I routinely present it, during all of my breast augmentation consultations, as a third option. For breast augmentation we have silicone gel, regular saline, and then we have the IDEAL IMPLANT, which is a structured saline implant. The IDEAL IMPLANT is surrounded by a silicone shell, but it’s filled with saline. The inner shells provide more structure to the implant, and the inner baffling on the shells helps prevent that water balloon effect that women with saline sometimes complain about.”

How can a woman know if there is a leak or rupture in her IDEAL IMPLANT?

“With traditional saline, once an implant is popped or ruptured, it’s completely gone. It’s more of an all-or-none type phenomena. That creates some aspect of emotional distress because the woman will have one breast that is fully inflated and the other will be completely deflated. And that could be troublesome for finding bras and clothing, going out, all these things, until you have the implant fixed. The IDEAL IMPLANT brings peace of mind to a lot of women. If there’s a problem with your implant, you’re going to know fairly quickly. You’ll notice some deflation, but due to the dual chamber nature of the IDEAL IMPLANT, it’s unlikely that both the front and the back chamber of the implant are going to become ruptured at the same time, so you won’t lose all of your volume. This can buy the woman some time before she actually needs to have the implant fixed.”

What types of patients can benefit from the IDEAL IMPLANT?

“Patients who are good candidates for the IDEAL IMPLANT are those who are looking for a fuller, rounder breast look. The IDEAL IMPLANT gives women a moderate plus-to-full kind of profile if you equate it to the silicone gel equivalents. If a patient wants to fill out a deflated breast pocket, I also think the IDEAL IMPLANT is a great option.”

What has been your experience in terms of patient satisfaction with the IDEAL IMPLANT?

“Patient satisfaction after IDEAL IMPLANT has been incredibly high. I’ve had no patients come back saying they wish they’d picked another implant. I present data to my patients on the lower rupture rates and lower capsular contracture rate for the IDEAL IMPLANT. This data gives my patients even more peace of mind. I’ve had a number of IDEAL IMPLANT patients who have actually slept good, based on that data alone. I haven’t had anyone complain of the IDEAL IMPLANT rippling like other saline implants tend to do. Overall, I’ve been very impressed with the positive feedback I’ve received on IDEAL IMPLANT. My thought is, since we have this new breast implant technology, why not use it?”

Considering breast implants in Long Beach, CA? Contact Dr. Waltzman today to discuss your options. Simply call (562) 448-6100 or visit www.waltzmanplasticsurgery.com. Dr. Waltzman’s office is located at 3828 Schaufele Avenue, #360 Long Beach, CA 90808. Call today for more information on IDEAL IMPLANT Structured Breast Implants.