Contact our breast augmentation (enlargement) surgeon in the Chicago and Winnetka area. Breast implants and many other procedures are available from John Q. Cook, M.D.

737 North Michigan Avenue
Suite 760
151 East Chicago Avenue (Entrance)
Chicago, Illinois 60611
312-751-2112
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118 Green Bay Road
Winnetka, Illinois 60093
847-446-7562
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Breast Augmentation - Chicago and Winnetka

Dr. Cook's Artistic Differentiation

Breast Augmentation Surgery, also known as breast enhancement or enlargement surgery, is an area of expertise for Dr. Cook.   He has extensive experience in breast reconstruction surgery due to his work at Rush University Medical Center, a  major center for the treatment of breast cancer.   Because Dr. Cook has addressed a number of challenging cases in breast reconstruction, it has provided him  with a depth of experience and judgment that might not be available in a more routine practice. With the knowledge that he has gained from breast reconstruction surgery he has developed several techniques of the breast augmentation operation to help with particular breast shapes. Just like any plastic surgery, this operation should not be performed in a routine manner. There are many nuances of breast shape and position which require a highly skilled surgeon in order to produce a natural result.

Dr. Cook has the artistic vision and extensive experience to produce consistent high quality results for breast augmentation patients at his Chicago centers. "My goal is to produce a natural breast, not a cartoon of a breast.”

Below is a brief overview of breast augmentation surgeries.  As an educational service, we also offer the sections 10 Questions You Should Ask and 10 Things You Should Know about breast augmentation surgery.

• Breast Augmentation
• Breast Implants
• Breast Augmentation Procedure
• Breast Augmentation Recovery
• Breast Augmentation – 10 Things You Should Know
• Breast Augmentation – 10 Questions You Should Ask
• Breast Surgery Interview with John Q. Cook, M.D.

BREAST AUGMENTATION

Dr. John Q. Cook has made breast surgery a primary focus of his career. Breast augmentation, or enlargement, at our Chicago and Winnetka-area centers uses breast implants to add volume and contour to the bust. Dr. Cook prides himself on the successful outcomes of the many women he has helped attain larger, more youthful-appearing breasts that look natural and not as though they have even had plastic surgery. "My goal is to produce a natural breast, not a cartoon of a breast.”

BREAST IMPLANTS

Patients can choose between breast implants filled with silicone gel and implants filled with saline solution (salt water).  These implants are available in a wide variety of shapes, volumes, and projections.  Patients in our practice are well-served by Dr. Cook’s extensive experience with both types of implants.  Dr. Cook was selected as a clinical investigator for national studies conducted using saline implants designed by the Food and Drug Administration.  He also has served as the principal investigator for saline and silicone gel implant studies involving breast reconstruction at Rush University Medical Center.  Because he has been in practice for twenty years Dr. Cook has a long term perspective on the behavior of different types of breast implants that is very much to his patients’ advantage.

SALINE BREAST IMPLANTS

Saline implants come in a wide range of shapes and volumes.  The outer shell of the implant, which is made of silicone polymer, contains a valve that allows the surgeon to fill the implant with saline (salt water) solution.   The surgeon makes a short incision, creates a space for the implant, then fills the device to its optimum volume.  In general, saline implants can be inserted through a shorter incision than would be required for a silicone gel implant of similar volume. 

SILICONE GEL IMPLANTS

Like saline implants, silicone gel implants have an outer shell of silicone polymer.  There is no valve, since the implant is filled by the manufacturer with silicone gel.  Particularly in thin patients, silicone gel implants have artistic advantages, since the overall feel of the breast is more natural, and there is a lesser likelihood of rippling or irregularity.  In some cases, a rupture of the implant shell is difficult to detect and may require an MRI study for definitive diagnosis. 

For over a decade the Food and Drug Administration restricted the use of silicone gel implants to three groups of patients: breast reconstruction, augmentation combined with mastopexy (breast lift) and replacement of existing gel implants.  Only surgeons who participated in the implant studies designed by the FDA were allowed to use these devices.  Many plastic surgeons did not participate in the studies and did not provide their patients with the option of using silicone gel devices during the greater than ten year period when silicone gel implants were restricted devices.  When silicone gel implants were re-approved by the FDA for use in breast augmentation surgery, many plastic surgeons had little or no experience with the devices.

Dr. Cook provides patients at his Chicago and Winnetka centers with a greater than 20-year experience in the use of silicone gel breast implants.  The experience he has acquired in the use of these devices to solve complex problems of breast reconstruction works to the advantage of all patients who come to him for breast surgery.

Since silicone gel implants have been released by the FDA for general use in breast augmentation, a large majority of patients prefer these devices to the saline implants.

BREAST AUGMENTATION PROCEDURE

The specific plan for your breast enlargement is determined during the breast augmentation consultation at our Chicago or Winnetka center. Dr. Cook will obtain a sense of your goals and personal observations about breast shape, volume, and visual balance.  During the physical examination Dr. Cook will obtain detailed measurements of your breast and share with you his observations regarding possible surgical strategies.  Whether your goal is simply to increase volume by a cup size or to obtain a more significant enhancement, Dr. Cook will make recommendations with an eye to obtaining an artistically pleasing and naturally balanced result.

Dr. Cook will carry out your surgery in a fully-accredited outpatient surgical center that is near his Chicago office.  The anesthesia team and the staff of the operating and recovery room are highly experienced and meet Dr. Cook’s extremely high standards.  Prior to your surgery you will review the surgical plan with Dr. Cook and he will mark key reference lines in the breast area.

Many of our patients comment on the quality of the anesthetic experience.  You will typically have no recollection of the surgery itself or the events immediately before or after surgery.  Because of the agents chosen for your anesthetic, most of our patients are able to avoid the “hangover” effect during the recovery period.

The surgical incision is chosen based on your preference, Dr. Cook’s experience, and the specific structural requirements of your breast.  The incision will lie either in the fold beneath the breast, at the lower border of the areola, or in the armpit area.  The implant is positioned either directly beneath the breast or, more commonly, beneath the breast and the pectoral muscle.  Dr. Cook has a range of techniques that allow him to address issues of breast shape and structural balance and he will apply these as needed to optimize your outcome.

Dr. Cook makes generous use of a long-acting local anesthetic, which aids your comfort during the early recovery period.  Patients typically make a quick recovery and are able to leave the surgery center 30 to 45 minutes after the completion of the surgery.

BREAST AUGMENTATION RECOVERY

Many patients come to see Dr. Cook from a considerable distance.  We are able to provide accommodations at a boutique hotel near our office or at a hotel of your preference.  We can provide an experienced caregiver who will optimize your recovery experience.  Some patients from the Chicago area who have young active children find that a first night at the hotel is a good idea.

If you recover at home, a friend or family member should be available to help you during the afternoon and evening of your recovery.  For the first few days after surgery, it is prudent to have a friend available to help with meals and light activities.

It is normal to experience some degree of pain after breast augmentation surgery.  Our goal is to minimize the pain with a combination of long-acting local anesthetic, pain medications, and medications that help to relax the pectoral muscle.

Most patients are able to return to normal light activity 3 to 5 days after the surgery.  Friends and co-workers may notice that you appear a little stiff, similar to someone who has pulled a muscle.  We encourage our patients to return to gentle exercise such as walking as soon as comfort permits, but you should avoid heavy or jarring exercise for a month.

As with all surgery there will be zones of swelling, bruising, and numbness, and these will take a number of weeks to fully settle in.  Many patients experience a period during which the nipples are oversensitive; it may take several months for this to return to normal.

Our highly-experienced staff will guide you through the recovery process.  We will do our best to anticipate your needs and provide suggestions to make the experience as comfortable as possible.

 10 Things to Know About Breast Augmentation Surgery

1. Breast augmentation, or as I often call it, breast enhancement surgery, produces a consistently high level of satisfaction among patients who choose the operation for the right reasons. The probability of long-term happiness with your decision is, in my opinion, enhanced if you select a highly qualified and committed surgeon, the surgery respects the natural anatomy of the breast, and you are educated as to realistic expectations about the surgery.
2. Patients can choose between implants that are filled with silicone gel and implants filled with saline solution. Saline implants consist of a silastic shell with a fill valve mechanism. Sterile salt water solution is added to the implant after it has been placed into its location beneath the breast. One of the advantages of the saline implant is that it allows for a smaller access incision than was typically used for silicone gel implants. Silicone gel implants also have an outer shell of silastic, the solid form of the silicone polymer. They are filled by the manufacture with a form of silicone that has a thick, gel-like consistency. In general, contemporary silicone gel implants contain a gel that is much more sticky or cohesive than the much thinner gel that was present in previous generations of implants. If such devices suffer a break in their shell, the gel tends to hold together. Although there are minor differences between the implants provided by the two main manufacturers in the United States, the issues of greatest importance include selection of the proper operative plan and the skill of the surgeon.
3. There are several distinct advantages to placing breast implants in the plane underneath the pectoral muscle. These advantages include a better transition in the upper portion of the breast so that an unnatural implant bulge is less likely to result, easier mammographic visualization of the breast, and perhaps a diminished likelihood of contracture, or hardening around the implant. There can be specific aspects of breast anatomy that favor the placement of the implant in the subglandular plane, immediately behind the breast. In the majority of circumstances, however, the best artistic result will probably be obtained with the implant in the plane underneath the muscle.
4. If the breast has settled due to pregnancy, weight loss, or other factors, more advanced techniques may be necessary for proper breast correction.  You can easily check the position of the nipple by standing in front of a mirror and either placing a tape measure, a pencil or other object in the natural fold under the breast.  If the nipple is sitting below this level, some form of breast lift surgery will be necessary to provide an acceptable long term result.   Beware of  physicians who would recommend a “correction” that consists of a big implant just behind the breast tissue.  In general, this will lead to even more thinning out and settling of the breast and set up a vicious cycle.
5. The natural architecture of the breast must be respected.  Before you seek consultation, learn about the architecture of your own breast.  You can stand in front of a mirror and if you gently support the breast with the opposite hand, you can see where the natural base of the breast lies.  Unless there is an abnormality in your fundamental anatomy, make sure that the surgeon designs an operative plan that respects this natural architecture. 
6. Always consider the effects of lifestyle and activity patterns in your choice of surgery. Patients with breast implants can participate in a full range of sports, although one might want to exercise caution if you engage in a sport that involves frequent blows to the chest, such as skydiving or kick boxing. Factors which will definitely influence the early weeks after your surgery include: responsibilities for small children, the need to lift heavy objects at work, and your ability to modify your sports and workout pattern for at least several weeks. These issues should be discussed in detail with your surgeon and his team prior to the operation.
7. Implants can deflate, and scar tissue can form around them.  These, in my opinion, are the truly important long-term issues with regard to breast implants. With saline implants, as with any implanted medical device, there is the possibility that the device will break.  If this happens, salt water that was in the implant is naturally absorbed by the body and the breast will lose its pleasing shape.  A relatively minor surgery will be necessary to replace the device.  If the shell of a silicone gel implant ruptures, the effect will be more subtle.  Patients will notice a change in breast shape, consistency, or firmness.  In some cases it is necessary to carry out an MRI study to make the diagnosis.  As with saline implants, surgery will be required to replace a ruptured silicone gel implant.

   Most of the studies from the manufacturers indicate a deflation rate of approximately five percent in the first ten years after surgery.  Anyone who tells you that their patients never experience implant deflation is simply not being truthful.  In general, patients who experience a deflation tell me that they do not regret their original decision to proceed with breast augmentation surgery even with the need for additional surgery to replace the device.

   As with any implanted medical device, scar tissue forms around breast implants.  Up to a point this is desirable, in that it helps to maintain the implant in proper position, almost like an internal brassiere. If there is too much scar tissue, however, this can make the implant feel firm and distort the shape of the breast.  This is known as capsular contracture.  In some patients it is necessary to perform surgery to release this scar tissue. 

8. Please do this surgery for you and you alone.  This operation will not salvage a bad relationship.  It would also be unwise to undergo this surgery simply at the request of a boyfriend or spouse.  Remember that it is you, not he, who will experience the surgery, the recovery, and the long-term results.
9. Giant implants in petite people look silly and get worse over time.  I am sure there are many surgeons who will dispute me on this point, but my opinion is based upon long-term experience and patients who have been referred to me because they are dissatisfied with surgical results.  The more an implant overwhelms the breast, the more it will take on the characteristics of the implant and not natural breast tissue.  Very large implants will thin out the remaining breast tissue that you have.  The result can be a thin covering of skin over an unattractive wrinkled looking implant. 
10. Please do your homework before you select your surgeon.  This is an important decision and you shouldn’t rush into it.  If you can’t find someone who you think is compatible with your goals and expectations, it is better to continue your search until you have found a doctor who can work well with you than to rush into an operation that you may regret. 

10 Questions to Ask About Breast Augmentation Surgery

Breast augmentation surgery should carry an extremely high level of patient satisfaction.  In the last few years, however, I have noticed an  increase in the number of patients who have been referred to me because they are unhappy with the results of breast implant surgery.

I think there are several reasons for this apparent contradiction.  First of all, there is an increase in the number of marginally qualified doctors who perform this surgery.  Second, there are some individuals and organizations that have chosen to aggressively approach this field as an exercise in marketing.  The only interest is in selling a product.  No time is taken to see whether the operation is appropriate for the patient’s needs or anatomy.

One of the most valuable services that a doctor can provide his patients is to say “no.”  If a patient is asking for an operation that will damage her breasts in the long run, or who has personal or medical reasons why this may not be the best time for surgery, then it is the doctor’s obligation to inform the patient as to why she should not proceed with the surgery.  To me, this is inherent in the concept of being a physician – one must always put patients’ interests first.

This role as trusted advisor (and, dare I say it, friend) is even more important in our current era of hypermarketing.  As the advertising campaigns become increasingly glossy, as the websites become increasingly “enhanced” to promote unrealistic expectations, patients are increasingly confused about what are the realistic outcomes from this operation.  In my opinion, it is the doctor’s job to help his or her patient make a decision that is realistic, offers long-term value, and is tuned to her personal concept of beauty as well as her lifestyle.  This result simply cannot be achieved unless the physician and patient take the time to establish clear communication.

To help you, I have put together a list of ten questions that anyone considering breast surgery should ask.  If you ask them of me, I will be honored.  If you ask them of another doctor, it will help you select someone who is proceeding from a genuine interest in your well being.

1. What is your training and what are your credentials?
   Remember that it is legal for anyone with a medical license to perform this type of surgery. To become a physician who is certified by the American Board of Plastic Surgery, the individual will have completed training in an approved residency program. This training lasts anywhere from five to eight years after the completion of  medical school. The individual will also have been examined over several years in a rigorous series of oral and written examinations. The advantages of choosing a physician with these credentials should be obvious. Almost all board-certified plastic surgeons are members of the American Society of Plastic Surgeons. Plastic surgeons with a particular interest in aesthetic plastic surgery are selected for membership in the American Society for Aesthetic Plastic Surgery.
   
   When evaluating a person’s credentials to look at the entire educational past that individual has followed. Take a look at the medical school and residency programs. Are these leading institutions? How about their undergraduate years? My point is simply that if there is a consistent path of educational excellence, this might give you an idea about how seriously this particularly doctor takes his or her work.

2. What is your experience in performing plastic surgery of the breast?
   Of course, there should be other criteria than mere surgical volume for selecting a physician. That said, there is probably an advantage in seeking the services of someone who has extensive experience with breast augmentation surgery. I would also suggest that this experience should extend beyond routine operations. There may be nuances of anatomy in your particular breasts that require more unusual or advanced techniques in order to obtain the best possible outcome. I also feel that there is an advantage in selecting a surgeon who has experience with reconstructive breast surgery, as the challenging circumstances that he or she will have encountered will work to your advantage.

3. What is your artistic vision? What do you think looks good?
   Breast augmentation surgery is very much about visual aesthetics. It is very important that the patient and her surgeon establish a clear communication about their mutual goals. If, for example, you desire a natural result while the surgeon is for some reason attracted to an “overdone” look, there probably will be a mismatch.

4. What are you trying to achieve in my particular case?
   As a general rule, we stand a much better chance to achieve our goals if we are able to articulate them clearly. I would suggest you select a surgeon who can clearly express to you the specific goals he or she is attempting to achieve in your breast. There are many nuances in this surgery. It is not enough just to make them “bigger.” In my opinion, a big unnatural looking breast is a decided step down from a smaller, naturally appearing breast.
   
   With breast augmentation surgery, there are a number of choices that you and, your doctor will make. These include the access incision to the breast, the location of the implant (under the muscle or just under the breast), and the type of implant that is used. At the very least, the doctor should be able to explain to you why he or she has made this selection for you. 

5. What is the accreditation of the facility where you will perform my surgery?
   Whether your surgery is in a hospital, an outpatient surgery center, or a doctor’s office, you should carefully check the accreditation of that facility. In general, the higher the level of accreditation, the better. 

6. Who will administer the anesthesia during my surgery?
   There are many possibilities. These include MD graduates from approved residency training programs, nurse anesthetists who perform anesthesia under MD supervision, and a whole host of other less-qualified individuals. All I can tell you is to do your homework carefully here, as you may be surprised to find out who is giving your anesthesia. I also think that it is important that you meet the person who will be giving your anesthesia prior to the surgery. This usually occurs the morning of surgery. The anesthesiologist or nurse anesthetist should take the appropriate time to ask questions about your medical history and make certain that this will be a safe experience for you.  

7. What types of breast surgeries do you perform?
   This is a good question to help you discriminate between the breast implant assembly lines versus a physician who is truly going to approach you in an individualized manner. In my opinion, if a doctor says to you that he or she just does breast augmentations one way and they all look good, you are not buying the services of someone who is serious in their work. Whether an individual performs five, fifty, five hundred, or five thousand operations, each patient should be approached in an individualized manner. 

8. What is your hospital affiliation?
   If you have lived in a community for a while you probably have a fairly good idea of what the leading hospitals are. If not, ask a friend who has lived in the community for a number of years. As a general rule, the leading hospitals are far more selective as to who they will allow on to their medical staffs. This is just one more way of helping you to sort through the confusing lists of doctors that you encounter. Even though the surgery will probably not be performed in a hospital environment, the hospital affiliation remains a useful gauge for selecting a physician, in my opinion. Remember, too, that in the extremely unlikely event of a serious complication, your doctor will probably draw upon the resources of the physicians at his hospital. You would certainly want a first-rate team working on your behalf. Often, but not always, leading physicians in a geographical area are affiliated with major teaching hospitals. If you are interviewing a physician who is not affiliated with a major teaching hospital, another indication of their level of commitment to their field might be whether they have offered any teaching courses or delivered any lectures at national meetings

9. How will the operation protect the natural form of my breast? 
   If you just get a blank stare in response to this question, then you may be dealing with an individual who has not given much consideration to the long-term consequences of surgery. In my opinion, the single most common source of a long-term result that is artistically disappointing is a lack of respect for the natural architecture of the breast. You can easily recognize the natural base architecture of your breast as you stand in front of the mirror and support your breast with the opposite hand. You will be able to see a visual transition point where the breast border exists. The thinner you are, the more you will regret if someone selects for you an implant that violates this natural architectural border. In my opinion, this is not too different from putting an addition on a house that extends past the natural foundation line. There can be valid and appropriate reasons to change the fundamental breast architecture. For example, a patient with an element of congenital breast abnormality will, by definition, need an intelligent restructuring of the basal architecture of the breast. If, on the other hand, you have relatively normal breast anatomy, I would strongly suggest that you try to preserve your natural architecture. At the very least, it is important that the physician who examines you measures and notes the key architectural dimensions of your breast and is able to formulate an intelligent plan for you that takes these issues into account. If this does not happen during your examination, then you may want to seek a higher level of sophistication.

10. Are you evaluating the whole patient or just the breast? 
    Safety in medicine comes from attention to detail. If you have a consultation, pay attention to the questions that are asked with regard to your medical history. As a bare minimum, they should have obtained information about allergies, current medications, whether you are a smoker, whether you have had any surgeries, how you have healed from any previous surgeries, and whether you have any active medical conditions that might influence the safety of the operation. Remember that it is not just enough that you have entered this information on a form. Did the doctor review the medical history with you? If not, I think there might be others who are more concerned for your well being. Did the doctor take any time to get to know you as a person? This does much more than just make the experience warm and fuzzy. With breast surgery in particular, information regarding the type of work a person does, the type of exercise she enjoys, whether or not she has young children, and plans for future pregnancy can have a significant bearing on the specific recommendations that we make.

As a final word of advice, trust your instincts. There are different styles of patients and different styles of doctors.  If you don’t feel that you have “hit it off” with your doctor and his or her team, you should continue your search. Since I have been in practice in the Chicago area for a good while, I have a decent sense of which doctors take a sincere interest in their patients’ well being and work extremely hard to produce high-quality results.All I can tell you is this, if that little voice tells you that something isn’t quite right here, then please respect it. Shortly after your visit to the doctor’s office for consultation, give yourself a brief exit interview. Ask yourself the following questions. Did they take the time to learn your medical history? Do you think that the doctor has a good understanding of your goals? Does he or she share your vision? If your instincts say yes and you have answered these questions in the affirmative, then it is very likely that your decision to proceed with breast augmentation surgery will be one that you will be pleased with, both now and in the future.

Breast Surgery Interview with John Q. Cook, M.D.

Question:  How did you become interested in breast surgery?

JQC:  I was intrigued by the challenges that are inherent in breast surgery. With breast surgery there is both an artistic and a functional consideration. In other words, you need to create an attractive breast shape and the breasts should also feel and move as naturally as possible. It is also important to work with techniques that are most likely to maintain normal breast sensation. Because of my work at Rush, I have many patients referred to me for breast reconstruction surgery. The majority of these patients come to me for reconstruction after breast cancer surgery, but there are also patients who have congenital problems and are born with abnormal breast shapes. This helped to raise the level of technical demand that I place upon myself and sharpen my sensibilities to the many different varieties of breast shape and form. So often this type of surgery is trivialized. There are even some doctors who refer to the operation as a “breast job,” as if to suggest it’s a very standard operation. Nothing could be further from the truth. If you are aware of the subtleties of different breast shapes, there are a number of specific technical challenges that are presented, and you must have a repertoire of techniques in order to address these challenges properly.

Q:  You have developed a reputation for the natural quality of your results with breast surgery. How do you achieve this?

JQC: With any operation that I do, I try to develop a set of artistic principles that I will always be true to.  This can only come from experience and the necessary mental discipline to try to look at each patient with a fresh set of eyes.

I also feel that patient education is very important. It is so important in this surgery to have a clear communication between the surgeon and patient so that we share the same goals.  All you have to do is turn on the TV and you will see many examples of what I consider perfectly awful breasts.  They obviously are fake and they don’t move like natural breasts. There are patients who come to my office who honestly want this type of result.  For my part, I am not interested in creating it and tell them so. I do this for two reasons. First of all I don’t agree with the goal artistically, so how can I give that patient my best work? Even more important, the over-enlargement of a breast will leave the patient with problems over the long-term, so if I perform this type of surgery, I don’t feel that I am acting in my patient’s best interest.

Q: Why? What problems have you seen?

JQC: If you place an implant that overwhelms the natural breast, there will be over time a very undesirable thinning out of the natural breast tissue. In extreme cases of surgical misjudgment, this can lead to a patient where there really is just an implant covered by skin. Under these circumstances, the irregularities that are present in all breast implants will show through and the patient will be very disappointed. Another mistake that I see less disciplined surgeons make is to place a very large implant in a breast that has drooped to the point where it requires a breast lift. Time and gravity will only stretch this breast out further, but now you have the problem that the tissue has become so thin that a breast lift may not be a very safe procedure. Also I just can’t get behind the creation of cartoon-like results. I have spent so much time studying human form that I have developed a reverence for the many varieties of beauties that God and Mother Nature have created. In my opinion, it should be the role of the surgeon to perceive this beauty and attempt to build upon or enhance it rather than to violate and destroy it.

Q: So you don’t operate on everyone?

JQC:  Absolutely no. If I operate on everyone who comes to my office just because they have the wherewithal, then I have abandoned the most important responsibility I have to my patients. I have tried to build my practice with a spirit of service at its center. Part of this service is to use my experience to the patient’s benefit. In other words, I develop a sense of what will work and what won’t work both functionally and artistically, and I just couldn’t live with myself if I were to betray those principles. Sometimes the very best thing that you can do for a patient is to convince her that she really shouldn’t have a particular operation, because what she is looking for won’t be achieved. I always make a point to explain to a patient the reasons for my recommendations, and I think that most people respect this honesty. Unfortunately, in our culture there will be some people who will just hop from surgeon to surgeon until they will find someone who will carry out their wishes.

I also think there are different types of doctors for different types of patients. I think that in my field the best results are achieved when the doctor and patient share the same set of priorities.

Q: Who are your patients?

JQC: I have a wonderfully diverse base of patients.  Many are referred by physicians who have seen my work or by patients on whom I have performed surgery.  Some patients come to me because they appreciate the information on my web site.  Most of my new patients have a general sense of my bias in favor of naturalistic results.  This doesn’t mean that I only carry out modest enhancements.  There are many patients whose physical dimensions will permit a substantial enlargement yet will allow me to maintain a natural result.

Q: Could you describe for me what the experience is like for someone who undergoes breast surgery?

JQC: I make use of several high quality surgical facilities near my office. Other than the quality of her surgeon, the most important factor for elective surgery is the quality of the facility in which the surgery is carried out. In this sense, I serve as my patient’s intermediary since I know what it takes to make a surgical facility safe. The surgery must be staffed by top quality anesthesiologists and nurse anesthetists and have a well-trained in-depth staff with a full range of equipment. After all, if the surgery can’t be done with a reasonable safety profile, it shouldn’t be done at all. There is, quite frankly, in some of the lesser grade free standing surgery centers that I have seen, as well as some of the office based-facilities that I have seen, a dangerous tendency to cut corners. I meet each patient for surgery in a private area where I review our plan and make certain markings that will guide me during the surgery. The surgery is very quick from the patient’s perspective even though it usually takes about 2 hours. The patient will spend another hour or so at the facility and then return home for recovery. For patients who come from out of state or who want to avoid the traffic going home, we offer a wonderful arrangement at a small European-style hotel near our office.  We have several highly experienced caregivers who can help our patients recover in comfort and complete privacy.

Q: Are there any surgical bandages?

JQC: When the patient awakens from surgery she is wrapped up in what is essentially a bulky tube top dressing. This stays in place until about 3 or 4 days after surgery. At that time the patient comes to our office where the dressing is removed and she is fitted with a gentle support bra.

Q: How long do most people have to take off from work?

JQC: This, of course, depends upon the patient’s occupation and activity pattern. For many of our patients, who are at an executive or technical level in their work, they don’t have to do much heavy lifting. Often a patient might have surgery on a Thursday, recover over a long weekend, and be back at work the next Monday or Tuesday. Of course, she would not want to go back to an extremely busy schedule, but use common sense about this.

Q: How about exercise and other activities?

JQC: After the first few days, I encourage my patients to go back to mild non-jarring activities such as walking or treadmill. What I don’t want to them to do, of course, is jar the breasts with running, weight lifting or racquet sports. For these more vigorous sports, I generally recommend about a month’s time off.

Q: I know there are several possible incisions for breast augmentation surgery and different places that you can put the implant. Can you describe these for us, and your feelings about the different choices?

JQC: There are three main possibilities for incisions. The inframammary incision is placed in the natural fold under the breast. The periareolar incision is placed along the lower border of the areola and the axillary incision is placed near the armpit. I have used all of these incisions many times. In most patients, I believe that the inframammary incision is the best since it provides the best visualization and allows for better ability to carry out some of the more sophisticated techniques. I use the periareolar incision less frequently than I used to, because of some data from lactation specialists that I have spoken to which would tend to suggest that there might be more of a problem with nipple sensation with this approach. That said, in some patients, it’s the best choice. The axillary, or underarm approach, can be useful in patients who have extremely poorly developed breasts, especially if they have the type of skin that has shown a history of scarring. There are also some surgeons who make use of an umbilical, or belly button approach, to this surgery. I personally find this approach to be less accurate and at least one of the implant manufacturers has stated that if this approach is used the warranty of the implant will be voided. In actuality, the incision is probably the least important part of the operation, at least if you are dealing with a careful surgeon.

Q: How about where you place the implant?

JQC: There are two main planes in which you can position a breast implant. The subglandular plane is the space immediately under the breast. In the subpectoral plane, the upper portions of the implant will be covered by the pectoral muscle, the muscle that you use when you do a push-up or bench press. In the vast majority of patients, I place implants in the place underneath the muscle. There are three particular reasons for this. First of all, it is easier to get a good quality mammogram. Second, there is some data to suggest that implants in this place are less likely to develop hardness over time. Finally, there is an artistic reason, since almost all breast augmentations, at least in this country, are performed with the saline, or salt water filled implants, the subpectoral position helps to lead to a natural result. For most patients, when a saline implant is placed just under the breast tissue, you obtain a very round upper portion of the breast which simply is never seen in nature. The pectoral muscle helps to control the shape in the upper portion of the breast so that there is not this effect resembling a half a grapefruit on the chest.

Q: Are there different types of implants you can use?

JQC: Yes. Patients and surgeons today are blessed with a wonderful variety of implants.  There are implants that are filled with silicone gel and implants filled with saline or salt water solution.  There are implants with varying shapes and varying degrees of projection.  There are implants with smooth surfaces and implants with rough surfaces.  This can all be quite confusing for the patient.  We try to help each patient sort out these details during the consultation.

Q: Earlier in this conversation, you mentioned you had developed your own approaches to specific types of breasts. Can you tell me a little bit more about this?

JQC: I am particularly proud of the work that I have done with the so-called “tubular breast.” With this type of breast there is a very tight base to the breast and the nipple and areola tend to be enlarged and to be over-projecting. Standard breast surgery techniques will not produce a good result. I have worked out a technique,which, in selected patients in this category, can minimize the scars that are often a part of the procedure. Another technique is one that I have developed for the post-partum breast. This technique addresses the situation where the breast has settled but not to a point where a breast lift is necessary. The technique allows me to position an implant underneath the pectoral muscle and allow the implant to properly fill out the lower portion of the breast. A third technique, not my own, but one where I was an early adapter, is the technique known as periareolar augmentation/mastopexy. With this technique, a breast lift can be performed by means of an incision that just runs around the border of the areola. Through this same approach, I can position an implant in the proper plane to fill out a breast that has lost its volume after pregnancy.

Q: Are there any words of advice you would like to give us regarding how to find the best surgeon for this work.

JQC:  First of all, you need to check the credentials of your surgeon very carefully. At a minimum, make sure that the surgeon is a member of the American Society of Plastic Surgeons. This organization essentially includes all surgeons who have passed the rigorous board examination of the American Board of Plastic Surgery and have a record of practicing in accordance with strict technical guidelines. Unfortunately, it is legally possible for individuals with very little surgical training to take weekend courses in breast surgery and represent themselves as experienced plastic surgeons. You might also want to look at hospital affiliations. Most people have a pretty good idea of what the better hospitals are in their city or town. Even doctors who perform surgery in their own offices maintain hospital affiliations and this can be, in general terms, another screening device to help select a leading surgeon. You might also want to particularly consider surgeons who are members of the American Society for Aesthetic Plastic Surgery. This is a subset of board certified plastic surgeons who maintain practices with a particular focus in aesthetic plastic surgery. Finally, equally important to all of this, is to trust your instincts. I personally don’t think much of the idea of running around to ten different surgeons, but I do think it is important to listen to your instincts when you interview a particular surgeon. If you sense that he or she isn’t taking the time to address your particular goals, or doesn’t show much passion for the type of surgery that you are interested in, then there is probably someone in your community with a greater depth of experience or interest.

Q: Is there a typical patient who comes to you for breast surgery?

JQC: Absolutely not. Each person presents me with a specific set of needs and roles and also particular nuances of the anatomy, which I must carefully observe to develop my treatment plan. That being said, there are certainly several patterns that I observe in terms of life circumstances. The first general group of patients includes individuals, often in their 20’s but sometimes in different age groups, whose breasts are underdeveloped relative to the proportions of the rest of their body. A second common picture is the patient who comes to me after she has completed childbearing and breastfeeding. The natural changes which occur in the breast after these life events can sometimes produce a breast shape that is not ideal from the patient’s point of view. Sometimes the correction can be carried out with an implant alone and sometimes an implant with a breast lift is necessary. Sometimes these patients will combine breast surgery with other body contour surgery, especially procedures that restore tone to the abdomen, an operation that is commonly known as a “tummy tuck.” Then there are patients where the fundamental issue is that of breast shape and balance. There may be differences in the way the two breasts developed or perhaps unusual development of both breasts. Over the years these patients may have become very self-conscious about their breasts, and this can interfere with their enjoyment of life’s normal activities. The surgery can help to break this pattern. Nothing makes me happier than to see a desirable change in a person’s sense of well being after one of these surgeries.

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