Posts

Breast Surgery Plastic Surgeon Dr. Sophie Bartsich on Breast Implants and the IDEAL IMPLANT

Ask Dr. Sophie Bartsich why she chose to become a plastic surgeon and she’ll tell you it’s because it unites everything she likes to do: medicine, surgery, working with her hands, and art. Dr. Bartsich practices in New York City, where she aims to restore form and function for each of her patients while seeking an intuitive balance. She is recognized by her patients as a kind, caring doctor who is passionate about her work.

What is unique about your practice compared to others in the New York area?

“I really feel like aesthetic surgery should be a ‘fake out.’ You should not know that someone had work done, it should just look natural. The majority of my patients are looking for something natural, low maintenance, low worry, and very high impact. They don’t want other people knowing exactly what they did, they just want to look and feel great. I try and give that to my patients. During a consultation, I also give my patients a lot of information because I want them to be educated about their choices. I have a very information-driven and natural result-driven practice, and I don’t think that represents most other plastic surgeons.”

Why did you become interested in breast surgery in particular?

“As a resident in training, my program was in the 99th percentile for breast surgeries. I didn’t even realize that that was unique to our program, so for a very long time I thought breast surgery was 60, 70 percent of all plastic surgery. It never occurred to me that it wasn’t! I became very well trained in breast surgery, but it’s also something that I just responded to. I think every surgeon has their tissue, and every surgeon has their body area, and they just respond to some and not to others. I just instinctively responded to breast surgery.”

How is your approach to breast surgery different from other plastic surgeons?

“Whether it’s reconstruction or cosmetic, I think there are a lot of things that you can make unique within breast surgery. There are a lot of ways you can technically approach things that limit post operative pain. I think it’s really important that the nipple be shaped exactly right, instead of considering it as an afterthought. It’s the focus of the whole breast.

“I put a lot of emphasis on symmetry and balance. I think as a woman, I can understand things that maybe a male surgeon might not. For instance, if you go to buy a bikini and you have to purchase two really expensive separate pieces because you can’t just buy a set, it’s really annoying. To me, that defines you not being balanced. If you were balanced, you could buy a set. Balance and harmony are really, really important to me. My goal with each patient is to find that balance.

“The breast tissue is also a tissue I’m very familiar with and comfortable operating on. I enjoy performing breast surgery because it’s a very high reward for my patients and a very high reward for me. I believe it’s important to listen to my patients and understand what they want, and then apply some very basic principles of aesthetics and balance. When you do that, I think you get a great result.

“The other thing I really love about breast surgery is it’s ‘undercover difficult,’ and I like things that are undercover difficult. It might seem really easy to take an implant and pop it in. Any surgeon could take an implant and pop it in. But it’s actually very challenging to get just the right size, just the right shape, and put it in just the right place. It’s very deceptive, because it sounds easy. Everyone knows that a rhinoplasty is difficult, they know that doing a nose is hard and every little thing shows and everyone sort of sweats it out when they’re going to do a nose.

“When it comes to breasts, I think a lot of people are like, ‘Eh, that’s no problem,’ and they send their patients home with a bunch of sizes. They tell them to choose one and they pop it in and they just expect it to be fabulous and it’s not like that at all. You have to understand a lot of things about how tissues reacts, how much breast tissue you have, how stretched it is, babies, no babies, future plans, level of activity, etc. I think there’s so much that goes into it. It takes a certain level of intuition and experience and it’s actually really hard to get a great outcome. If you really know what you’re doing you can get a great result with the satisfaction that what you did was difficult.”

Has the selection of breast implants changed over time? What is your experience with silicone gel and traditional saline implants vs. IDEAL IMPLANT® Structured Breast Implants?

“I’ve never really liked traditional saline implants. For me, the natural look is very important and I found it very difficult to get it with those implants. The way traditional saline implants feel has also been a problem for me and my patients. It doesn’t feel natural. I always had a bit of a hesitation with silicone gel implants, because once you’ve cleaned up a few ruptures, you get a little nervous about it. But the look and feel was so great, and so disproportionately better that I felt like it tipped the balance.

“So, for a really long time I was very pro-silicone gel. I never really subscribed to the form-stable implants that much. To me they felt a little too firm. I also really didn’t like the idea of them rotating. I don’t like having the potential for an additional complication in an elective procedure on a young, healthy person. I felt that was an unnecessary added risk. The textured implants also made me a little bit uneasy. I was never that into using them. When the overfilled silicone gel implants came out, I liked them because they gave women a little more upper pole fullness.

“Most women who are getting a breast augmentation want to finally wear something that’s low-necked that shows off their cleavage. I mean, that’s the whole point. You don’t want to overdo it, but you need something there or there’s nothing to show. I always felt like the silicone gel implants sagged a little and the form-stable ones were skinnier up top, which is exactly where you want more.

“In addition to that, in the last couple years I’ve had several patients who’ve had MRIs done because there was a question about their existing silicone gel implant. I’ve found that sometimes MRIs are not actually very reliable. In some instances, a patient’s MRI said the silicone gel implant had ruptured, and then when I went in to operate on it, it actually hadn’t. I’ve had one or two patients where an MRI showed the implant wasn’t ruptured, but based on my clinical exam I really thought there was a concern, so I went in and it turned out it was ruptured.

“I became frustrated with the constant monitoring of the silicone gel implants, but they looked and felt good so I just dealt with whatever other issues came up. I wanted an option for my patients that felt psychologically and physically healthier and didn’t have these other concerns or challenges attached to them

“When I found IDEAL IMPLANT, I was very excited about it. I remember thinking, ‘If it looks and feels even half as good as silicone gel, I’m probably going to to try it because I think my patients will respond to that. Plus it will make management and monitoring easier and calm a lot of my concerns.’ So I did a few IDEAL IMPLANT cases and my patients were very happy. Then I did a few more and those patients were also very satisfied. When a patient comes in and I discuss all their implant choices, they’re excited to see that there’s something like that. People like the structure, the stability of the shape, and the feel. I’ve had no one complain it didn’t feel normal or natural. The IDEAL IMPLANT has been a very welcome addition to both my practice and my patients.”

What kind of changes have you seen in the last few years of what women want or expect out of breast surgery?

“I’ve seen changes in both the patients and the surgeons, but I’ve seen more changes in the patients. When I was in training, we were taught the most frequent complaint among patients after breast augmentation was, ‘I should’ve gone bigger.’ I think this was very much the teaching a while ago. A lot of the surgeons in practice who are maybe five or ten years ahead of me still have that sort of indoctrinated. So, there was a time when surgeons were putting in as big an implant as they could because they really didn’t want the patient to come back and say, ‘I wish I had gone bigger.’ I think those days are over. Celebrity trends and general lifestyle trends are moving more and more towards the natural look. People are getting plastic surgery earlier on but they’re doing less drastic things. I tell my patients, ‘Listen, no one will know they’re fake unless you feel like showing them,’ and they really like that.

“In my personal opinion as a woman, there’s also a fine line between wanting to be noticed, but not necessarily wanting too much attention. Most women don’t want to walk around broadcasting that they had a breast augmentation. They want to look good in a dress, they want to look good in a T-shirt and jeans. It’s not just about the bikini. They want to feel comfortable. They don’t want to wear an orthopedic device which calls itself a brassiere, because that’s sort of the point we’re at with underwear now. Women are doing this for themselves, they’re not doing this for other people. I think sometimes that also gets misunderstood.”

“Today’s patient is very educated, very sophisticated. There’s also a lot of concern about health.
In the last couple of years, my patients have become more concerned about silicone gel in particular. More and more people are coming in and saying, ‘I really don’t like the idea of silicone gel in my body.’ Patients have access to information on a scale that never existed before. Things are very different than they were ten years ago. If there’s a potential problem or complication a patient is worried about, they will look it up and find out more about it. Women in today’s world want to have peace of mind. These are women who are working and have children and have lives and marriages and households, and the last thing they need is something else to worry about and monitor all of the time.”

How do you help women determine the best size of breast implants for them?

“That’s an important question, because the way most people think about size is A, B, C, D. Those are not exact measurements. The sizing system for bras is actually not anatomic. It’s not based on anything real. Most people have no idea where these sizes even came from. In actuality, bra sizes are a leftover of the old school corset sizing system.

“All your cup size really measures is your projection, or how far from the chest wall your breast goes. If you are narrow and short breasted and perky, you might go pretty far out of the chest wall and have a tiny little breast. If you are wide and high and saggy, and things are sort of all over the place, you might go that same distance from the chest wall and measure the same letter but be five times bigger breasted. That’s why those sizes don’t really mean much.

“A patient might come in and say, ‘Well, I’m a B and I want to be a C,’ or, ‘I don’t want to be a D.’ The first thing I have to dispel is the fact that those letters are actually anything to hold onto. I know what they mean when they say that, and it’s sort of a guide and a concept, but it’s not a measurement. The most important measurement of the breast is its width. Unless the fit model has the same width breast as you, the foundation of the bra is wrong and you’re just trying to squeeze things either narrower or wider depending on how things measure out. So the most important thing is that the implant has to be the same width as the breast. It’s like a foot in a shoe. If you go into to a shoe store and you just pick whatever shoe you think looks nice but you don’t actually pay any attention to size, it’s not going to fit.

“A lot of my breast augmentation patients will show me a picture and say, ‘I really don’t like this,’ and the first thing I say is, ‘It’s not the implant’s fault.’ With implants, (in terms of size), there’s sort of a range. I tell all my patients, ‘There’s a range that will fit you. There is some wiggle room within that range, and you can go on the lower end or the higher end.’ Once you know what that range is, then the patient can give you feedback. Patients can tell you they want to be higher up or lower down within that range. Sometimes people will come in and say, you know, ‘I’m getting married in six months and I want to look classy in my wedding dress. I want to fill it out and not have to worry that I’m not wearing a bra, but I don’t want it to be weird.’

“I understand a woman’s perspective. I know what having breasts means and how the world responds to your breasts and how you feel about your breasts and how you wear them. Because, basically, you wear them. Breast implants are just like anything else you wear. If they’re sized right and proportionate and fit your lifestyle, then they’re going to work great and enhance everything and make you feel awesome. Size is important and the patient can give you guidance, but they can’t pick it because it has to be chosen with training.”

Do you have a preference on placement of breast surgery incisions? What do you say to women who are concerned about scarring?

“A lot of plastic surgeons like to use the trans-axillary technique for breast augmentation. That places the incision in the armpit (axilla). I don’t like that approach. I never really understood why anybody would think the armpit was hidden on a woman. If you go to a black tie dinner, your armpit’s open. It’s not just on the beach or in the shower. It’s shaved and it’s open and everyone can see it. The minute you reach to get your champagne glass, everyone’s going to see it. So that’s not hidden, and if it doesn’t turn out well, you’re stuck with a scar on your armpit. On top of which, technically it’s a difficult surgical approach. So I never really understood the benefit of that either. It makes the surgery much more difficult for a potential scar in a really bad place.

“I also don’t like to make incisions around the nipple, because the areola transitions to skin as a fading rather than a definite line. I’ve done a lot of research on the bacteria that live in the breast. Many people don’t know that bacteria can cause you to get infections when you’re nursing. They’re all in the ducts and they all converge on the nipple where all the ducts meet. So if you do that approach, you’re potentially contaminating the implant and you have a higher risk of contractures. You also have less area to work with, and what if the breast tissue that you just went right through doesn’t line back up again? Now you have an additional problem.

“In my professional opinion, the incision under the fold, or the inframammary approach, makes the most sense. Even if you don’t have a fold, once you have a breast augmentation you’re going to have a fold. That, to me, is the most hidden spot. When my patients come in for post op, for me to see the scar they have to be completely undressed and lift their breast for me. If they’re just standing there, I don’t see it. If my patients have an issue with the scar, that’s about as hidden as you’re going to get. It’s also an area that lends itself to revision if you ever have to cut the scar out for some reason, which is really not very common. You can do that in that spot, but you can’t do it around the nipple. I prefer to make my incisions under the fold. You have the most visibility during the surgery, you have the most control over the surgical field, and the scar is as hidden as you’re going to get.”

What specifically do you like about IDEAL IMPLANT?

“I don’t want to do anything to someone else I wouldn’t want done to myself. I think a lot of the implants I’ve used in the past gave me excellent results, patients were happy, I think that they’re still very reasonable alternatives to use, and I still offer them to my patients. But when I first started using IDEAL IMPLANT® Structured Breast Implants, I thought to myself, ‘I’m sure there’s going to be a couple of patients who just really like the idea of this,’ but I was shocked at just how many patients started requesting it once I introduced it to my practice.

Since I started using IDEAL IMPLANT, I’ve had almost no patients choose anything else. That’s not because I’m pushing one implant over the other, and it’s not because I say to them, ‘Well, this is the one that I want you to use, and also there’s this other stuff.’ I don’t think that’s fair. I think that silicone gel implants are still fine and I’ve gotten amazing results for years. I’ve had many patients in the past who have chosen silicone gel that are happy, they like the feel, they like the look. But, I think there’s something IDEAL IMPLANT offers that I’m responding to and that my patients are responding to.

“So, for me, IDEAL IMPLANT has been a very welcome addition to my practice, and for my patients it’s been wonderful. I’ll tell some of my existing patients who need a revision for whatever reason, ‘Two years ago I didn’t have this option, but just so that you know, this is a new implant I’ve been working with,’ and the majority of them say, ‘Oh, I think I want that instead, I like the idea of that.’

“Also I’ve had a lot of patients who come to me who’ve had silicone gel implants placed many, many years ago and they’re sort of at a loss of what to do. These patients will say, ‘Some people say I should take them out, and some people say leave them alone, and it’s been 15 years. What do I do?’ I’ve had some changes in my approach to that question as well. Now I’m leaning towards the opinion that after a certain amount of time maybe that patient should think about switching them out.

“A lot of those patients say to me, ‘If I’m going to do it, now that I have another option, I think I might actually do it with IDEAL IMPLANT instead. I just don’t want to have to worry about these things again, and it’s really challenging to monitor something all the time. Since we’re going back, let’s just go to something simpler.’ The results have been great and the patient satisfaction is very high. Overall, IDEAL IMPLANT® Structured Breast Implants are a wonderful addition to my practice.”

Considering breast implants in New York City? Contact Dr. Sophie Bartsich today to discuss your options. Simply call 516-773-9200 or visit www.doctorsophie.com. Dr. Bartsich’s office is located at 960 Park Avenue, New York City, NY 10028. Call today for more information on IDEAL IMPLANT® Structured Breast Implants.