Read a breast augmentation review by a recent patient

I strive to perform the best breast augmentation in New York City, and I am always thrilled when a patient feels that I have achieved this personal and professional ambition. Here, a recent patient has submitted a verified review of me and her experience. No review in my practice is ever compensated, coerced, or otherwise altered. All reviews and testimonials are subject to independent review and IP address verification.

Verified review from a recent breast augmentation patient. Submitted via RealSelf.com.

Breast Reconstruction 101: A basic primer about reconstructing your breasts after cancer

Before and after autologous breast reconstruction (SGAP flaps). Image credit breastcancer.org.

This was an invited article for Healio.com, an online journal for doctors.

Breast Reconstruction 101: A basic primer about reconstructing your breasts after cancer

May 20, 2015
By Dr. Lara Devgan

Breast cancer has a prevalence of 1 in 8 American women, with its incidence ever-increasing as screening becomes more widespread. While breast cancer can be a trying and life-altering diagnosis, plastic surgical techniques for breast cancer reconstruction have improved significantly over the past several decades. Women facing mastectomy have a variety of options when it comes to breast reconstruction, and post-operative results are better than ever.

To Reconstruct or Not to Reconstruct?

Although I am a proponent of breast reconstruction as a way to rebuild a sense of normalcy after breast cancer, it is worth mentioning that breast reconstruction is not required. Some women, for a variety of reasons, opt not to proceed with breast reconstruction. As long as you are fully aware of your options (and you know that all American insurers are required to cover your plastic surgical reconstruction after cancer), opting not to reconstruct your breasts is a perfectly valid personal choice.

Immediate or Delayed?

The current standard of care is for most women to undergo immediate breast reconstruction, meaning that your breasts are recreated by a plastic surgeon at the time of your mastectomy. However, in some situations, women undergo delayed reconstruction, which can happen any time from days to years after the cancer operation. Delayed reconstruction can be an option as a result of patient choice, need for radiation or chemotherapy, need to expedite the surgical procedure, infection, comorbidity, or some combination of these reasons.

Implants or Tissue?

The major choice for a woman and her plastic surgeon to make regarding breast reconstruction is whether the breast mounds will be reconstructed with her own tissue or with breast implants. Currently, in the United States, the vast majority of breast reconstruction is performed with implant-based techniques, either in 2-stage (tissue expanders followed by implants 3 months later) or in 1-stage (implants placed at the time of mastectomy) procedures.

Both techniques have their roles, and neither one is superior to the other in all cases.

Implant-Based Breast Reconstruction

The benefits of breast implants include an easier, shorter operation, more predictable post-operative results in many patients, the lack of a second surgical donor site, and minimization of scarring. Most women, and interestingly, most female plastic surgeons prefer implant-based techniques. Implants can be especially helpful in very thin or athletic women, who have little extra body fat and desire a quick return to normal life after surgery. In addition, many women like the "augmented" look that can come with breast implants.

Breast implants can be problematic in women who require radiation therapy, women who smoke, and women who have a higher risk of infection (such as those with diabetes). In addition, breast implants carry with them higher risk of infection in all patients, as well as risks related to implant rupture, implant failure, and capsular contracture. Breast implants are not considered lifetime devices, so women who get implant-based breast reconstruction will likely need additional surgeries at later times. Moreover, many plastic surgeons feel that implants used in breast reconstruction look better initially than they do after several years.

Autologous Tissue Breast Reconstruction

Tissue-based reconstruction uses extra skin and fat on a woman's body to rebuild the breast. The most common donor site for autologous tissue reconstruction is the abdomen. Other donor sites, such as the inner thigh, buttocks, and outer thigh have also been described. The technique used for constructing a breast in this way is referred to as either a free or pedicled flap.

The major benefit of autologous tissue reconstruction is that it recreates a breast that mimics the normal human breast in tissue type and tissue feel. This means that it can look and feel quite natural, and that it ages with a woman and changes with her as her weight changes. Autologous tissue reconstruction is also regarded as the safer technique in many women who have radiation damage to their tissue or who will require radiation after surgery. Because there are no foreign bodies placed, risks of infection are lower overall.

The disadvantages of this technique include a long, technically complex operation, a protracted recovery, a second surgical site, additional scarring, and potential need for revision operations to sculpt the breast mounds.

Nipple Reconstruction

Three to six months after the breast mounds are reconstructed (either with implants or tissue), many women will be ready to progress to nipple reconstruction. As nipple sparing mastectomy becomes more common, this technique may become less popular overall and may play a role more prominently in those who have sub-areolar disease.

Nipple reconstruction is a short outpatient procedure wherein local tissues on top of the breast are rearranged as a flap in a configuration that gives the breast a nipple-like cylindrical projection. This procedure is generally tolerated well and can be performed under local anesthesia only in selected patients.

Areolar Tattooing

At least three months after nipple reconstruction, the areolae can be tattooed to mimic the pigmentation and three-dimensionality of an anatomic nipple-areolar-complex. Techniques in medical tattooing have evolved significantly, and very impressive results are achievable in skilled hands. For women who prefer to avoid tattoos, a full-thickness skin graft harvested from the groin is an alternative method to achieve areolar pigmentation.

Overall Care

In order to achieve the best possible aesthetic appearance after breast cancer surgery, it is essential for your plastic surgeon to perform a thorough pre-operative evaluation; consult with your breast surgeon, oncologist, and radiation oncologist; have a discussion with you about your preferences and desires; help you weigh the risks and benefits of the various types of breast reconstruction; and answer your questions about recovery and long-term care.

While breast reconstruction can be a long journey, many women feel that rebuilding their breasts after mastectomy has elements of both physical and psychological healing. Indeed, many of my patients have told me that undergoing breast reconstruction is what ultimately allowed them to put their cancer diagnoses behind them and move forward with their lives.

For questions about this article, I can be reached via www.LaraDevganMD.com.

Click here to read Dr. Devgan's full article on Healio.com.

Do you need stitches for that cut?

Actual patient of Dr. Devgan, before and after plastic surgical repair of facial laceration (stitches for cut on face)

When do you really need to get stitches for a cut?

Getting a cut in your skin from an accident is incredibly common-- whether you tripped and fell, got into a car accident, or had a sports-related mishap. Cuts (or lacerations) are even more common in children than adults-- with playground accidents, bad weather, and general mischievousness being the major culprits.

The big question is: does a cut require stitches? And if a cut requires stitches, do you need a plastic surgeon?

If you have any of the following situations, you need medical attention:

• significant bleeding, or bleeding that doesn't stop
• a cut on a sensitive area of the body (the face, the hands, the genitals, or the breasts)
• a cut that reveals deeper tissue (pale dermis, yellow fat, red muscle, white bone, or white cartilage)
• a cut that is longer than 1 cm
• a cut that is gaping open or opens widely when you move the area
• a cut that is from a cat bite, dog bite, human bite, or other animal bite
• a cut where you may have foreign bodies trapped in your tissue (broken glass, asphalt debris, or other object shards)
• a situation where you may have other injuries, where you blacked out, where you don't clearly remember everything that happened, or where you don't feel normal
• anytime you are not sure, seeking medical help is always the best answer

Do you need a plastic surgeon to do your stitches, or will any doctor suffice?

You are not obligated to have a plastic surgeon repair the majority of cuts or lacerations. In fact, most cuts will heal with minimal to no medical intervention at all. It is part of the magic of the human body-- it (mostly) heals itself. Indeed, in many ERs and medical centers, a physician's assistant, intern, resident in training, or ER doctor is assigned to repair your laceration. This is perfectly fine.

Before deciding if you want a plastic surgeon to repair a laceration, you must ask yourself: how do you want the scar to look after the cut heals?

Wound healing and repair is a fundamental part of the discipline of plastic surgery, and a plastic surgeon's surgical techniques can help you get the best possible cosmetic result. 

You may benefit from a plastic surgeon if:

• you are concerned with how the wound will look after it heals
• you want to avoid or minimize scarring
• the cut is on a cosmetically sensitive part of your body (especially the face, hands, or breasts)
• the cut is on a child, especially a child's face
• the cut shows deep tissue, is gaping, is large, or is complex

If you would like Dr. Devgan to help you with surgical laceration repair, please call (212) 452-2400 at any time, 24 hours a day.

Actual patient of Dr. Devgan, before and after plastic surgical repair of facial laceration (stitches for cut on face)

Actual patient of Dr. Devgan, before and after plastic surgical repair of facial laceration (stitches for cut on face)

Actual patient of Dr. Devgan, before and after plastic surgical repair of facial laceration (stitches for cut on face)

Actual patient of Dr. Devgan, before and after plastic surgical repair of facial laceration (stitches for cut on face)

Dr. Devgan featured in art exhibition about one patient's breast cancer journey

Artist: Annalisa Iadicicco. Medium: photograph printed on transparent photo paper and installed on a reclaimed window. New York, New York, 2015. The artist's mother is pictured here, with Dr. Devgan.

Dr. Devgan is honored to be featured in contemporary artist Annalisa Iadicicco's new exhibition "Seek side by side silently," which documents a walk through breast cancer, depicting the emotional turmoil of a caregiver.

Pictured above is Dr. Devgan with the artist's mother in the apprehensive first moment she looks at herself after mastectomy (when her breasts were removed). The stunning exhibiton opens May 14, 2015 at The Factory in New York City.

For more information on the artist, please visit www.annalisaiadicicco.com.

Mini breast augmentation

The latest trend in breast augmentation in New York City is the use of small volume breast implants (less than 300cc). Although some patients favor larger implants, many Manhattanites prefer sizes that are more discreet. 

Small volume or "mini breast augmentation" allows for a more natural, yet still full and feminine, result. Women choose small volume breast augmentation when they want a boost in size and contour, but they don't want their breast augmentation to be immediately obvious.

Although many factors play a role in choosing the correct implant size, these are some general rules of thumb to consider:

• In many women, a volume of 250cc correlates with approximately one cup size.
• Placing implants "under the muscle" (or in the "dual plane") makes them appear about 50cc smaller
• If you have a wide chest build (broad frame), you will need a larger volume to accomplish the same size increase. The opposite is true for those with narrow frames.
• If you have very loose or floppy tissues (frequently seen after childbearing, breast feeding, and weight changes), your tissue may be able to accomodate a larger volume.
• Using a small volume silicone breast implant means a smaller scar.

Actual patient of Dr. Devgan, before and 1 month after breast augmentation.

Actual patient of Dr. Devgan, before and 1 month after breast augmentation.

Actual patient of Dr. Devgan, before and 1 month after breast augmentation.

Actual patient of Dr. Devgan, before and 1 month after breast augmentation.

Actual patient of Dr. Devgan, before and 1 month after breast augmentation.

Actual patient of Dr. Devgan, before and 1 month after breast augmentation.

Actual patient of Dr. Devgan, before and 1 month after breast augmentation.

Actual patient of Dr. Devgan, before and 1 month after breast augmentation.

Actual patient of Dr. Devgan, before and 1 month after breast augmentation.

Actual patient of Dr. Devgan, before and 1 month after breast augmentation.

Actual patient of Dr. Devgan, before and 1 month after breast augmentation.

Actual patient of Dr. Devgan, before and 1 month after breast augmentation.

Actual patient of Dr. Devgan, before and 1 month after breast augmentation.

Actual patient of Dr. Devgan, before and 1 month after breast augmentation.