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Adrian Richards: Hello, my name is Adrian Richards. Welcome to the Plastic Surgery Podcast, providing information for patients, by patients. I am a consultant plastic and cosmetic surgeon, and during the podcast I'll be talking to specialists in particular fields to get the latest updates on treatments. During the second part of these podcasts, I'll be talking to patients that have undergone these treatments to get their opinions and views on how the treatments work. [music]
Adrian: Today on the podcast, I'm going to be talking to Lisa Sacks. Lisa is a plastic and cosmetic surgeon who specializes principally in breast surgery. Lisa is going to be talking to us about her views on vertical scar and mastopexy. Following this interview we're going to be hearing from Heidi, who's recently undergone a similar procedure, performed by myself. I'm here with Lisa Sacks. I've talked to you before. Lisa is a very well known breast surgeon, principally concentrating on breasts, would that be fair, Lisa? In the Bristol area. I've known Lisa for some time and I know you've got a lot of very interesting things about particularly breast reductions, modifications to limit the scarring. I'd be interested to hear about those.
Lisa Sacks: My special interest is making lovely breasts with the least amount of scars possible. When I was in training, I was happy with my breast reduction results and so were my patients. But when I looked critically at the photographs afterwards, I didn't like the long scarring in the intra mammary fold.
Adrian: Just explain to me again, there's the traditional or what we call the "Y" pattern.
Lisa: Yes. Or what the patients know as the inverted T scar...
Adrian: The anchor.
Lisa: Or the anchor. So the scar goes around the areola vertically down the breast, then across the underneath fold of the breast. That's the part where it can be quite ugly: either protruding into the cleavage or else extending under the arm which could be visible in swim suits or short sleeves. I went off to Belgium and I spent a year with a lady called Madeline Lejur. She didn't invent this procedure, but she promoted it extensively, and I learned this technique from her. This is a good technique for breast reductions and for breast lifts. What it does, is it's eliminated the horrible part of the scar, the scar under the breast. It's retained the area around the areola and the vertical part.
Adrian: That's called the "lollipop" scar or something like that?
Lisa: The lollipop scar, exactly. The amazing thing about the scar is that if the surgery's well done, at a year or two one hardly even sees the vertical scar. It becomes quite faded and indistinct.
Adrian: You've talked about that before, that's often the scar people are most concerned about before the operation, isn't it? It heals quite well, doesn't it?
Lisa: Yes. Often the only telltale sign that a person has had this operation, one is that they've got very pert breasts, much perter than they would for their age. The other is if they've had children, a woman who's had children, the color of the areola is usually blurred and indistinct.
Adrian: At the junction.
Lisa: The outside, yes. After surgery there is a more circumscribed area.
Adrian: Can that be faded with medical grade tattooing at all?
Lisa: It can. It can. I've never yet met anybody who wanted to do it, because that they felt the positive aspects outweighed the need to do that. But that's another point that I want to come to. This technique not only has a reduced amount of scarring and less pain, there's some other important factors, which for me as a surgeon mean a lot. It gives a good long lasting result of shape.
Adrian: Better than the traditional?
Lisa: I think so. That's my feeling and I follow my patients as long as they will come and see me. Certainly, for a minimum of five years. And I ask young women to come back if they've had children and tell me how things went. Some patients I've seen 10 years later. The other good thing about this procedure is the pattern of tissue one cuts out gets bigger, the bigger the breast. What it means to me is that this technique has got an inbuilt safety mechanism, where the likelihood of losing the nipple at the time of surgery is reduced.
Adrian: Explain that to me, Lisa. In the really old-fashioned techniques, the nipple was completely removed and replaced as a skin graft, wasn't it?
Lisa: Many surgeons have a fairly large threshold to do that called a "free nipple graft" in big breast reductions.
Adrian: I myself would never do that now.
Lisa: I have only ever done it once in my career, in a woman we took three and half kilograms, nearly seven pounds off each breast. I thought that the nipples looked so terrible I've never done it again. The traditional T pattern of breast reduction, the width of the fla the part of the breast that supplies the nipple with blood supply is the same width whether it's a reduction in a big breast or in a large breast.
Adrian: It's longer in a big breast.
Lisa: It's longer in a big breast. Now with a vertical technique, it's actually much wider in a big breast. In a big breast where you need the safety belt...
Adrian: Yes, the blood supply.
Lisa: And have a good blood supply. It expands because the breast is even bigger and you're taking off more tissue. This is what I love the most about this procedure. Many surgeons around the world will use this procedure for small breast reductions. I specialize in this procedure in my practice for big breast reductions because I think it's safe.
Adrian: Just to go back to, just to clarify a point the nipple in all these cases the blood supply is kept intact.
Lisa: Yes, on a stalk.
Adrian: Ideally, the nerve supply on a stalk. And it's really where this stalk is orientated and how wide it is. The wider, the more blood that goes to the nipple.
Lisa: That's right, and the safer.
Adrian: And safer, the more safer.
Lisa: Losing the nipple...
Adrian: ...or part of it.
Lisa: ...is the most dreaded outcome of breast reduction surgery. Although we talk about it a lot, it is quite rare. When it happens it's very, very stressful both for the patient and for the surgeon. So anything we can do to minimize this I think is important.
Adrian: I 100% agree with that. Some surgeons I know reserve the short scar, vertical scar slightly more for the smaller breast. Then the bigger breast reductions, say over half a kilogram per side, perhaps do a bit more of an anchor, a traditional "Y" pattern resection. How does that work in your practice, Lisa?
Lisa: I have not done an inverted T scar for 12 or 13 years. I've been accused of having religious fervor about this technique. Perhaps that is true because I am a believer that women who have large breasts can not only have smaller breasts, but can have smaller breasts with no scarring with a beautiful long-term result. Those are the things I strive for, and I just believe in this technique. I use it uniformly in all my breast reductions. 67% of my breast reductions are over half a kilo, and I will take out up to three kilograms per side without needing to resort to a free nipple graft.
Adrian: The question is also, how small can you get the breast if someone really wants a quite dramatic reduction? Can you do it with the inverted, the vertical scar?
Lisa: That's an excellent question. I keep having patients come to me who have either seen another surgeon for an opinion, or alternatively people have had a breast reduction in the past and just haven't been reduced enough, tell me that the surgeon said they could only be reduced down by two sizes. When someone takes a DD, that's not useful at all; the thing about a vertical scar is one can actually tailor make the result to suit the patient. My patients chose what size they want to be. I can't guarantee it, of course, but I am so confident that I can give it to them, they go out shopping and come in for their operation with the sports bra that they are going to be.
So I have no problem saying to a patient who has a DD, if she wants to be a C cup, I'm happy to make her a C cup. If a patient is carrying extra weight, I tell them that I would like to make their breasts in proportion to the weight that they are. Because women that have large breasts universally lose weight after breast reduction surgery, which just proves that one can't exercise with watermelons on one's chest.
Adrian: Absolutely. Well, Lisa thanks very much. I think your techniques are real advanced, and I appreciate you coming in to tell me about it.
Lisa: Thank you.
Adrian: If anyone would like information about any of these techniques, could I have the ‑ have you got a website, Lisa?
Lisa: I have a website. My name is Lisa Sacks and it's Lisasacks.co.uk. There's a lot of information on the Internet about the Lejur, or the Lassus, or the lollipop breast reduction.
Adrian: Just to say, Lassus was the French gentleman who developed the technique, and that's Lassus, and Madeline Lejur as recently I saw it popularized.
Lisa: That's right.
Adrian: Thank you very much, Lisa.
Lisa: Thank you very much, Adrian.
Adrian: Talk to you soon. [music]
Adrian: So I'm here this afternoon with Heidi, who's a patient I'vetreated recently. It's interesting; we had a joint procedure which was a breast uplift combined with a tummy tuck. Now we're six weeks following surgery. Can you tell me how you feel, Heidi?
Heidi: A lot better than I expected, to be honest. It was a big surgery. I don't think I really was ready for how that felt although everybody told me I was given enough information. But I'm amazed after six weeks just how well I feel and how well I've healed, and the little scarring. It's only a little bit of redness and the results was better than I expected as well. I'm so pleased.
Adrian: That's good. Can you tell me a little about yourself, your background? I know you're married and you've got children. Can you tell me how let's just talk about the breast first. Can you tell me how they change with the children, how they were before the children?
Heidi: I've had three children and I breast fed three children. My breast size went up dramatically with each pregnancy. I would say after the third pregnancy after finishing breast feeding I was still left with fairly large breasts, between a D and a DD. The shape had changed considerably. My left breast was always more than slightly bigger than the right. They had just lost all fullness and the elasticity had gone. Wearing underwear was difficult to fit in without falling out of the front, constantly tucking myself in. So it had sort of worn me down over the years, really.
Adrian: Can you tell me a little bit about the operation you had, was it what you expected? And a little bit about the recovery period, the hospital stay and the recovery period.
Heidi: I was actually amazed at how little pain I had with my breasts. Even days after the surgery I expected more pain. So that was really lovely. Immediately, even though I had swelling I could see the difference in the shape which was amazing. I just didn't expect to see the skin to look so good. It was great, little pain. Very little dressings. I expected to be wrapped up so much more, so it was all quite surprising, actually.
Adrian: That's something that we've moved away from now. We used to use big padded dressings. Now we just tend to put a layer of glue on the incision, then the tape and the bra, as you know. How long were you in hospital for your breast surgery?
Heidi: Two days, and the hospital stay was very good, actually. I really appreciated the care without intrusion, and I felt very comfortable with the nurses. They weren't patronizing or judgmental; they really looked after me. The food was really good when I had an appetite. It was all really positive.
Adrian: That's good. This is big surgery. The point I so often make to people is that it's not something to be taken lightly. From the breast point of view, how have you recovered in the last six weeks?
Heidi: Really well. The pain wasn't really like sharp pain or deep pain, it was more like a twinge kind of pain. Obviously, there were certain things. You can't reach up and lift anything heavy or too high, but generally they didn't the breasts alone wouldn't have stopped me. I could have been back at work within a week, I think, with my breasts. The pain was very minimal. As long as you keep wearing the right bras and wear them all the time, it really wasn't a problem.
Adrian: OK, and now we're six weeks down the line. Can you tell me how the breasts look, how the scarring looks and reactions from family?
Heidi: The scarring is just they're just slightly red, very thin lines that will diminish. I am using the Bio Oil as instructed. The shape actually they were very high initially. They've dropped very slightly but they look so natural. Apart from the scars which will fade, they don't look like I've had anything done: they look very good.
Adrian: Just remind me where the scars are, Heidi.
Heidi: The scars are underneath the breasts in the natural crease line, around the nipple, although the scar around the nipple could be hard to see I think, in a few weeks. There's a vertical scar from the edge of the nipple down to below the breast.
Adrian: Just to clarify, there are different types of breast uplifts: around the nipple scar, a lollipop scar, a short transverse scar, longer transverse scars. So you just had a small transverse scar in the fold, which hopefully you wouldn't see.
Heidi: Yeah, it looks really, really good. The skin looks really good. It's just a thin red line, and I know that will go in time. So I'm really, really happy with the natural shape I've got, actually.
Adrian: OK, so what kind of feedback have you had from your partner and things?
Heidi: Really, really positive. My husband was really pleased with the natural shape. Also, I've still got nipple sensitivity, which is fantastic. My girlfriends have just been really, really amazed, the friends that I've shown. They just think they look marvelous, absolutely marvelous.
Adrian: And have you I mean, a mastoplexy reshapes the breast but doesn't change the size. Have you changed bust size?
Heidi: Yes, I've gone down to a C cup, which is fantastic. I mean proportion, it's very minimal. I was about a D cup. My right breast was slightly bigger anyway so it's reduced slightly so that they are more even. A C cup is lovely; it's lovely to go and try on bras that actually fit both breasts properly, actually.
Adrian: Brilliant. Well, thank you very much, Heidi, for taking the time to talk to us today. Is there anything you'd like to add for anyone particularly considering this form of surgery?
Heidi: It's not something to go into lightly, although I came and chatted to everyone here about four times before embarking on the surgery. I had lots of information, homework to take home and read up about, which was brilliant. So definitely, even if you're thinking about it, just come and have a chat.
Adrian: Brilliant. Well thank you very much for coming in today.
Heidi: It's a pleasure. Thank you. [music]
Adrian: That will do it for today. Thanks for listening to Plastic Surgery Podcast, providing information for patients, from patients. For further information or to leave feedback, please visit the Aurora website at www.aurora‑clinics.co.uk. If you'd like to schedule an appointment with one of our surgeons, please call 01844 214362 or email us on info@aurora-clinics.co.uk. We're very keen to get the feedback, and if you are considering any of these treatments and you'd like me to ask one of the resident experts about any topic, please email us or send us an audio file which can play on the podcast. I'm Adrian Richards. Thank you for listening to the podcast, and thank you to all of our guests.
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