Adrian Richards: Hello, my name is Adrian Richards. Welcome
to the Plastic Surgery Podcast, providing information for patients,
from patients. I am a consultant plastic and cosmetic surgeon.
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
who have undergone these treatments to get their opinions and
views on how the treatment has worked.
[music]
Adrian: I'm here with Lisa Sacks, who is a consultant, who
I've known for some time, in Bristol; isn't it?
Lisa Sacks: Yes.
Adrian: Tell me a bit about yourself, background. You specialize
really in breast surgery, don't you?
Lisa: I've been a consultant for about 14 years now. My background
is that I trained in South Africa. I left there as a consultant
and I worked for a year in Belgium doing a breast fellowship.
Adrian: You really decided early, the breasts were an area
perhaps we need more female surgeons in this area.
Lisa: Possibly. I've always been interested in breast surgery
and once I developed an interest in that area I realized that
many women, in fact, do want to see a woman surgeon. It's quite
amazing how shy many female patients are when they come and
see me. When I get to the part when I want to examine them
they almost seem amazed that I want them to get undressed.
Adrian: Yes, which obviously is a crucial part. And quite
often, I find that some of the patients won't show their partners
or their relatives.
Lisa: That's right. The number of women who, for instance,
have very large breasts will tell me that they sleep in a bra
and that their partners have never seen their breasts. The
numbers are quite astounding.
Adrian: Yeah. So, there is a whole subject there. What I'd
like to talk to you today, Lisa, is about one of the new advances
that we've originally been talking about on an expert panel
in Macrolane last week, weren't we, in the Broad College of
physicians?
I thought we'd take this opportunity to talk a little bit about
Macrolane and where you see it working for people, and who
would be best suited for it. So, first give me a bit of an
update about Macrolane.
Lisa: Macrolane is a product, which is a member of a family
of non-animal produced hyaluronic acid.
Adrian: What is hyaluronic acid?
Lisa: Hyaluronic acid is a naturally occurring product that
we find in joints and synovial tissue. It's a natural product,
it doesn't come from cows, or pigs, or birds, as many of the
other injectable products do.
Adrian: The old collagens that we use to fill out wrinkles
in the face, they often do come from some...
Lisa: Yes, and there's always a very very small risk with
those, problems of having an allergic reaction. But, the nachers,
as the hyaluronic acid products are called, have a much, much,
much smaller risk of anything happening. In fact the incidence
of something happening is almost miniscule. They have a whole
range of products. The ones we know about for cosmetic surgery,
or for furrows and wrinkles and groves...
Adrian: For really on the face.
Lisa: On the face.
Adrian: For typically filling out those lines that come down
from the nose to the corners of the mouth.
Lisa: That's right, and also between the eyebrows. When people
have had their muscles paralyzed to stop them frowning, they
can still be left with a groove that they may want to fill
in. And these products traditionally come in a small syringe
of one milliliter, or else half a milliliter. The newest product
developed comes in much larger syringes, 10 or 20 times those
in the face, and it's called Macrolane and it's used to enlarge
breasts non-surgically...
Adrian: And buttocks?
Lisa: And buttocks, and other areas of the body. My experience
has only been in the breast.
Adrian: Yes. Tell me a little about what sort of patient do
you think is suitable for Macrolane treatment?
Lisa: The patients are self selected, because they've heard
about Macrolane, either on the media, they've read about it,
or they've seen it on the Internet.
Adrian: It's very topical at the moment, isn't it?
Lisa: Very, very, very new. It's only been around, I think,
since January.
Adrian: It was the early part of 2008, wasn't it, yes?
Lisa: Yes. So, these are the patients coming along. And they
are patients who have never wanted an anesthetic, can't afford
the down time; some of them are fanatic exercisers, marathon
runners, and generally people who may have medical problems.
So for them, this is a dream come true. That they can have
a breast enlargement by one cup size in less than an hour,
in an office procedure under local anesthetic.
Now, sadly not everybody coming along is appropriate.
Adrian: Who isn't suitable?
Lisa: People who aren't suitable are people who have quite
a bit of breast tissue already, which may have drooped due
to poor elasticity of their skin. They may have stretch marks,
they may have been very overweight and then lost the weight,
and just really they have droopy breasts. This product is not
for people with droopy breasts, either with enough of their
own breast tissue, or with people whose breasts are completely
deflated like an empty balloon. A small amount of drooping
is not a disqualifying factor, because in fact with a smallish
breast of a B cup with a little bit of drooping, Macrolane,
100 milliliters per breast, can give a little bit of an uplift.
But, if we go back to talking about the pencil test...
Adrian: Tell me about the pencil test.
Lisa: A pencil test is a test that many women are familiar
with, and it indicates the amount of droop that someone has.
So, can one hold one pencil under the breast, or two pencils,
or the whole collection of colors?
Adrian: Pencil case, yeah.
Lisa: Pencil case. Certainly, I think that anyone with a droop
greater than being able to hold one pencil I wouldn't consider
for this technique. Two pencils, I think one is already getting
to the limit.
Adrian: Yeah. And the reason for that is it just wouldn't
give the right result.
Lisa: It would just be converting a small droopy breast to
a larger droopy breast.
Adrian: In those cases, you'd consider some sort of a breast
uplifting procedure.
Lisa: I would. But, in my experience, quite
a few of the patients who I've turned down have said "That's it, thank you very
much, goodbye doctor." In
other words, they wanted Macrolane or nothing.
Adrian: They want a non-surgical option and they're not...
Lisa: Purely non-surgical. And despite showing them lovely
photographs, very natural appearing results of before and after
pictures of small breast implants they didn't want the risk
of surgery. Interestingly, of patients who have had Macrolane,
my big question is what's going to happen to them when they
come up to their year when the product starts dissolving and
they're ready for a topper. Are they going to come for more
Macrolane or are they going to realize the benefits of having
a slightly larger cup size, and in fact realize that they're
ready to take the plunge and have an operation?
Adrian: You are finding that people are sort of perhaps spending...
Because it's difficult to emphasize that Macrolane is not permanent,
is it?
Lisa: Not permanent.
Adrian: So, how long do you counsel your patients that it's
the last straw?
Lisa: I tell patients that from the moment that it's injected
it starts to undergo a process of first absorbing water, and
then very slowly to be reabsorbed.
Adrian: Do you notice the swelling in the first...?
Lisa: I haven't, I don't think that there's a very obvious
swelling. Patients haven't commented on it either. But, the
literature and the research with this product was extensively
carried out in Japan with 1400 patients. And what they found
was that the product lasts from about two months, up to 12
months. And of course it's variable in people. I don't know
what contributes to the variability, whether it's how much
people exercise, or their diet, or whether they smoke or not.
Adrian: We've noticed that even with the facial fillers of
the same basic family, but a slightly finer grade, used more
superficially on the face.
Lisa: That's right.
Adrian: People do metabolize it differently don't they?
Lisa: That's right. The breast Macrolane, the breast injections
are much deeper than the facial injections. They are under
the breast flange, but above the muscle. And this is another
important factor that someone needs to have enough soft tissue
to cover the injection. I don't inject it in one big blob,
similar to a breast implant. I inject it into lots of little
tunnels, like little legs.
Adrian: Where you are trying to shape the breast.
Lisa: It's a real technique for sculpturing the breast.
Adrian: Tell me a little bit about it. Practically, if I decide
to have the
treatment, what does the actual treatment involve? How long
should I be off? What sort of anesthetic is used?
Lisa: The anesthetic used is same anesthetic that a dentist
would use for filling and drilling. It's lignocaine with adrenaline.
I work out the amount of anesthetic according to the patient's
weight. I advise the patient to take off the day of the treatment
and possibly one or two days of work. I know that for breasts
it's been called the lunchtime breast enlargement, but certainly
there is a little bit of discomfort for a couple of days after
the procedure. The type of discomfort most patients describe
to me is that their breasts feel full and tight, similarly
to when they are premenstrual. And the patients who've had
the most problems going back to work are people like hairdressers,
who have their arm elevated.
Adrian: Yes. The same as breast enlargement, really.
Lisa: Exactly. Exactly.
Adrian: So, how many scars? How big are the scars.
Lisa: The wonderful thing about this procedure is that it's
done through a tiny stab incision, a little bit below the intermammary
fold, below the crease. And it wouldn't look anything more
than a puncture mark. It's about two millimeters.
Adrian: Kind of like a small mole or something.
Lisa: Even smaller.
Adrian: And just one puncture site?
Lisa: One puncture site. One puncture for the local anesthetic,
and one puncture site for the other injections. We put in on
average about a 100 cc per breast. I've found this product
particularly useful for asymmetries, where one can really tailor
the amount. So, I might put in 135 on one side and 150 on the
other. And it's really proving wonderful for asymmetries.
Adrian: So, it's a really exciting product. How have your
patients responded to it?
Lisa: Well, my patients - and myself - at the end of each
procedure, we're amazed. Each patient I do just gets better.
And it's a real wow procedure, where it's instant, it's safe,
the results are immediately visible. And the patient has brought
in their sports bra one size bigger than they are already,
not quite believing that it will fit. And they put it on and
can't wait to call their friend or their partner to come in
and see how they look.
Adrian: Wow, that's great. Thank you very much, Lisa, for
coming in and discussing it with me. If anyone listening did
want to get more information from you or contact you, how would
they do that?
Lisa: Yes. Macrolane has a very good website. It's very informative,
in a language that's easy to understand. They have a link of
all the people in the United Kingdom who have undergone training
for Macrolane.
Adrian: So, that would be a good place to....
Lisa: That's a good place. I do a lot of other breast surgery
as well, and I think that people who're doing breast surgery
are well-placed to advise patients whether this is the right
procedure for them or not.
Adrian: Absolutely. Thank you very much for taking time to
talk to us, and I hope to see you soon.
Lisa: Thank you very much. [music]
Adrian: So, I'm here with Kerry this afternoon, who's just
about to undergo some Macrolane treatment. Is that right, Kerry?
Kerry: That's correct, yes.
Adrian: So, just tell me a little bit about the problem with
your breasts? What would you like changed and how are they
now?
Kerry: I would like my breasts changed in the form of... I
breastfed, so I lost a lot of my breasts when that happened.
I've got asymmetry, which means that one breast is smaller
than the other. So, I'm hoping with the Macrolane that it will,
therefore, make them both even and both a nice size.
Adrian: That's sounds good, doesn't it? Do you mind me asking
how old you are, Kerry?
Kerry: I'm 30.
Adrian: And when did have your... How many children have you
got and how old are they?
Kerry: I've got three children, and Jacob is 12, and my other
two daughters, one of seven and one of 18 months.
Adrian: So, that's you've finished, is it?
Kerry: Without a doubt. [laughs]
Adrian: And what were your breasts like before your children
and how have they changed?
Kerry: I've always had small breasts. They've never been ample
enough psychologically to myself. I've always wanted the opportunity
to have bigger breasts, and it's something that I thought about
even in my teenage years, when I knew I wasn't developing as
much as other around me or my age. Even now, I've got that
body of less than the 14-year-old.
Adrian: So, does that run in your family?
Kerry: No, all my family have had quite big breasts, so I
don't know where I got my genes from.
Adrian: That's unfortunate, isn't it? Did they change when
you had your children?
Kerry: They only changed in the fact that with my weight gain
- because I was always below six stone - so I had weight issues
as well. Hence, that stopped the development. And then, when
I had children and gained the weight, I'd sort of grown everywhere
else, but my breasts had remained the same or smaller. So,
my whole proportion is now all out and I just want to get it
back together, and not hourglassly.
Adrian: That's good. So, what sort of size breast are you
now?
Lisa: I'm a 32A-B, which incorporates the one large boob and
the one small breast. So, I find it quite hard to find bras
that actually fit, because if I get 32B, sometimes they can
be too big and if I get a 32A, sometimes they can be too small.
So, I'm just hoping to get a size bra that actually fits and
looks comfortable and looks lovely.
Adrian: Great. So, you're going to be shopping after this.
Kerry: Definitely. I hope so.
Adrian: Yeah. We talked a little bit earlier on. For you,
you've got a really quite a nice shaped breast, but a bit small
on the top. You'd be a really good candidate really for a breast
augmentation or Macrolane. So, what made you go down the Macrolane
route?
Kerry: I decided to try Macrolane because
I'm not quite sure exactly how large I want to go. I know
I want to go fairly big. I've had consultation for augmentation,
and Macrolane is another option. I know it's temporary, but
in that "temporariness" I
can think about my body shape and about what I'm actually looking
for in the future. I'm just quite happy to have the opportunity
to come here today and have the Macrolane and see how it all
goes.
Adrian: Well, Kerry, thank you very much for talking to me.
Your treatment's going to be about half an hour, I think.
Kerry: Oh, I'm so excited. I can't wait. I want it over and
done with. But, can you make them as big as possible, please?
Adrian: I'll tell them.
Kerry: [laughs]
Adrian: So, I'll see you - is it all right if I come and talk
to you after the treatment?
Kerry: Of course you may.
Adrian: I'll see you then.
Kerry: You will do. Thanks.
Adrian: Thanks. Bye.
Kerry: Bye. [music]
Adrian: Hi, Kerry. You just literally got out of the treatment
now, literally 10 minutes ago. Who knew? So, tell me how you
feel now?
Kerry: I am emotional, happy. I've waited a long time.
Adrian: How long have you waited for this?
Kerry: About 16 years.
Adrian: Yeah. And how do they look at the end of the procedure,
do you think?
Kerry: I'm really pleased with them. They're really pert,
and they look so natural.
Adrian: So, tell me, Kerry, just talk me through the treatment.
You're not someone who tolerates local anesthetic really well
at the dentist and things, so just talk me through the beginning,
how it felt, and the result you got.
Kerry: At first, the initial injection did sting; it was a
bit uncomfortable. And with that wearing off, when they put
the canula in and tried to separate the tissue - because I
had tough tissue - it made their job a lot harder, bless them.
It just made it that little bit more uncomfortable for me and
a little bit painful. But, I wear off with the local anesthetic
quite easily anyway, so I was expecting to feel pain. It wasn't
unbearable; it was manageable. I'm just no good with needles,
so I was about to pass out anyway. [laughs] But other than
that, they did a really, really good job.
Adrian: Yeah. I must say, they look really, really good at
the end.
Kerry: They did.
Adrian: Any advice to anyone who's thinking about Macrolane
treatment? You've been thinking about breast treatment for
a long time. So, any advice to anyone thinking about it?
Kerry: I would say if you want really natural looking breasts
without the hassle of being in hospital and having the operation,
or even if you're just looking into having breast augmentation
and you want to try out what size you want to go to, they're
going to feel how you're going to be, then Macrolane is definitely
for you. I've felt like they should have been there from the
beginning, because that's how natural they look. As soon as
I looked down at them, I thought, oh my god, this is how I
should have been born with. And unfortunately I wasn't. But,
whoo-hoo, I'm excited and I'm happy and I'm overwhelmed. Thank
you.
Adrian: It's a pleasure. See you soon, Kerry. [music]
Adrian: That will do it for today.
Thanks for listening to the 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 214 362 or email us on info@aurora-clinics.co.uk.
We're very keen to get the feedback, and if you're considering
any of these treatments, and you'll like me to ask one of the
resident experts about any topic, please email us or send us
an audio file, which we can play on the podcasts.
I'm Adrian Richards, thank you for listening to the podcast,
and thank you to all of our guests.
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