Rounding the Curve

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As it is with so many women, Sandy Wyeth’s (not her real name) “aha” moment was really an accumulation of moments: glancing at her silhouette in a store window, trying on a clingy T-shirt, swimsuit shopping. In fact, she’d been thinking about breast augmentation for nearly a decade, ever since a combination of pregnancy and breastfeeding left her with, as she herself admits, “droopy breasts and excess skin.”

Then one day, not long after her forty-second birthday, all the moments coalesced. “I said to myself, ‘I’m single, and I’m not getting any younger. I don’t want to wait anymore.’” During the consultation with her doctor, she explained that she didn’t want to be a lot larger; she just wanted to fill the skin she already had. Doable, he told her.

Wyeth went ahead with great expectations. What she wasn’t expecting was the post-op pain — “worse than childbirth,” she remembers. For three days, she couldn’t get out of bed. Looking back, she wonders if things might have been easier if she’d given up smoking or taken the full course of painkillers her doctor prescribed.

Now, nine months later, she’s happy to be feeling like herself again (a process that took about six weeks) and is pleased with her new look. The 5’ 8” mom is now “a comfortable D.” “When I wear a dress, I have cleavage,” she says, “and T-shirts and bathing suits look much cuter.” Remembering her post-op pain, though, she’s not convinced she would do it again. “I think it might have been a lot easier,” she says, “if I’d been younger.”

Many surgeries come with their own surprises: more ?(or less) pain than anticipated, a longer recovery, a reaction to anesthesia. On occasion, though, the surprise is a whole lot more unexpected. Like Wyeth, Marilyn Griffith* had breasts that had lost shape and fullness. (She’s even more blunt: “After breastfeeding six kids, I had grandma boobs — nothing but muscle holding up skin.”) So at 35, she decided to go for an augmentation. The surgery itself went well, but immediately afterward, she noticed what felt like an air pocket near her left nipple. Her doctor assured her it would correct itself, but a year later it was still there. On top of that, her breasts didn’t look right: After the saline implants, she says, “my breasts were bigger, but they were still sagging.”

She was leery of a second surgery, but with her husband’s encouragement, she consulted Dr. Evan Sorokin, a Marlton-based surgeon, and was instantly reassured. “He suggested a lift and silicone implants,” she says. “He explained everything to me and then gave me options — something my first surgeon didn’t do.” In retrospect, Griffith realizes that she’d never felt comfortable with her initial doctor, who seemed put off whenever she asked for additional information. Today, though, she couldn’t be happier. “I feel sexy,” she says, “and I love to hear people say, ‘You have six boys and you look so good!’”

The decision to augment what nature has taken away (or never supplied in the first place) isn’t easy for most women; the decision to remove what you’ve always had can be even tougher. For her entire adult life, Hoboken resident Deborah Valenti had felt out of proportion. At 5’ 2,” she was overwhelmed by her size E breasts; she could never find clothes that fit, and she was always self-conscious — a detriment for an investment specialist who spent much of the working day one-on-one with clients. In addition, the weight on her chest caused her to snore, wreaking havoc with her sleep. Then, at 49, she found a lump in her breast; it turned out to be benign, but, she says, “it changed the way I looked at everything.” She decided to surgically address the problem that had bothered her for so long.

She woke up from the surgery feeling great, and slipped on her iPod to wait for the doctor. The only jolt she got was when he revealed her new breasts. “He said, ‘Don’t they look great?’” she remembers, but she found it hard to look past the scars. “I didn’t realize they’d be so pronounced,” she says.

Three months later, the scars have started to fade, and so have Valenti’s concerns about a body that never felt “right.” “My asthma’s better, I’ve stopped snoring, and hey — I can button my shirt!” she says.

We aren’t defined by our breasts, but no other physical feature carries the same connotation of femininity, which helps to explain why, in 2008, breast augmentation overtook liposuction as the most popular cosmetic surgical procedure in the country. But with so many surgeries (more than half a million annually, counting lifts and reductions), errors and misconceptions abound, as even the happiest of stories reveal. We asked two of the state’s most prominent plastic surgeons to discuss what women need to know before they commit to a life- and body-altering procedure:

To find the right doctor, use your head … Make sure he or she is board-certified, specifically by the American Board of Plastic Surgery. “For ten bucks and a postage stamp, you can create a board in America,” warns Englewood plastic surgeon Dr. Richard D’Amico, a former president of the American Society of Plastic Surgeons. Expect a thorough consultation, he advises. “It really shouldn’t be five minutes and a cloud of dust.”

… and follow your gut. If the relationship doesn’t feel right — if the doctor seems offended by your questions, doesn’t advise you of potential risks, or dismisses your concerns — find someone else. “Make sure you leave feeling cared for as an individual and that all your questions have been sufficiently answered,” says Dr. Paul Figlia, a West Orange surgeon.

Understand your surgery. Among the questions to ask, says Figlia: Do I want to become pregnant in the future? (Pregnancy can change breast size in unpredictable ways.) What are the pros and cons of silicone implants and of saline implants? Will the implants be placed below or on top of the muscle? And keep in mind, says D’Amico, that “implants don’t lift breasts.” If your breasts sagged before surgery, they’re likely to keep sagging unless you have them surgically lifted. If you’re feeling considerable pain after surgery, ask why: Augmentation patients, for instance, are generally given pain-relief “pumps” that drip novocaine onto the muscle, which should provide significant pain relief for the first three to four days post-op.

Follow instructions to the letter. Stop smoking if your doctor advises it, and take all pre- and post-op medications as directed. Remember, says D’Amico, that recovery requires time. “It’s Mother Nature’s rule,” he adds, “and you can’t shortcut it.”

Cosmetic Breast Surgery 101

Breast Augmentation While the patient is under general anesthesia, the surgeon makes a small incision, either in the fold underneath the breast or the area between the areola and the breast skin, through which an implant — filled with either silicone gel or saline — will be inserted. Depending on a number of factors, the implant can be placed above or below the pectoral muscle, but “it’s a little less natural-looking when placed over the muscle,” says Brian Glatt, M.D., a Morristown plastic surgeon. “And placement there can predispose the patient to developing what’s called ‘capsular contracture’ [a gradual hardening of the implant] and to the breasts becoming more droopy sooner than they would have otherwise from the weight of the implant stretching the thinned-out tissues over time.”

Recovery: Patients can expect to take pain medication ?for several days and to wear a sports bra for about three weeks. The typical patient is back to work in a week. Common risks: Leaking or hardening of the implant, scarring, and changes in nipple sensation — “although the risk of sensation loss is actually greater with lifts and reductions,” says Harris Sterman, M.D., chief of plastic surgery at Holy Name Hospital in Teaneck. Cost: $2,500–$8,000 (independent of anesthesia and facility fees), plus the price of implants ($400–$600 each for saline; $800–$1,200 each for silicone)

Breast Reduction After general anesthesia is administered, the surgeon makes an incision — either lollipop-shaped (around the areola and down vertically to the bottom of the breast) or anchor-shaped (like the lollipop, but with an additional horizontal incision at the bottom) — and removes excess tissue, fat, and skin, both surgically and, sometimes, using liposuction as well. Especially droopy breasts may require removal and raising of the nipple and areola. ?Recovery: Patients may wake up with tubes under each arm to drain excess fluid and generally spend two days in the hospital after surgery. Pain medication is prescribed for at least the first few days, and patients wear a surgical bra for about three weeks. Recovery varies according to the size of the reduction, but in general, most women are back at work in four to six weeks. Overall, “it’s a lengthier procedure than augmentation,” Sterman says, “and it can result in a little more blood loss.”

Common risks: Scarring, loss of nipple sensation, problems with breastfeeding, and breast asymmetry. Cost: $9,000–$14,000 (independent of anesthesia and facility fees)