Fuller Breasts Using Your Own Tissue? Auto-Augmentation Explained

Announcer (00:00):
You're listening to The La Jolla Cosmetic Podcast with Monique Ramsey.

Monique Ramsey (00:05):
Ever wondered how you can get a perkier, fuller look using only what you've already got? A while back, we had Dr. Luke Swistun on to talk about auto augmentation after implant removal. Well, today he's back to share how this same clever technique is changing the game for breast lifts, even if implants were never a part of the story. So welcome back Dr. Swistun.

Dr. Swistun (00:30):
Thank you for having me, Monique.

Monique Ramsey (00:32):
So can you break down for us what a breast lift with this auto augmentation involves for women who've never had implants? So maybe they just had kids and they're a little more droopy than they used to be. So what's sort of this big idea behind using your own tissue and maybe fat for reshaping?

Dr. Swistun (00:52):
Yeah, so we're talking about the auto augmentation technique, which basically just uses all the tissue that's available on the breast that's already there and just reshapes it, tacks it into the best shape. And this is distinct from or as opposed to fat grafting, which is a different procedure where we actually borrow fat from another place in your body and then grafted onto the breast. So today I was just going to focus on reshaping only the existing breast tissue into a much better contour. Classically, when we think about lifts, most patients are aware sort of that a normal lift, a standard lift does sacrifice some breast volume. And that's sort of the classic teaching. That's the classic understanding. And in fact, if you do it kind of like the old school way where breast lift, that's true. There's a lot of breast tissue on the bottom of the breast that just gets sacrificed and literally just thrown away.

(01:39):
And the reason that was done is because the implant was usually used as a supplement to that tissue that was removed to give the patient more volume. Auto augmentation is a fairly straightforward technique. There's no secret to it. There's no magic to it, but it does take a little bit more time, a little bit more precision, a little bit more commitment and diligence and comfort with the technique. I don't know why it's not done more widely, why it's not more widely applied. I have theories about that, honestly. First of all, it's not really taught in training programs. I went through multiple training programs. I went through University of Illinois where I went through general surgery and obviously rotated on a lot of plastic surgery rotations. I've never seen this done by anyone. Everyone basically just went to the implant for giving the breast some volume, even when they're just doing a lift on the patient who has had complaining of some droop, like, well, we're going to remove some tissue, lift everything up and just put an implant in there just to make it look better just to offset the volume that we're going to remove during your lift.

(02:38):
That was sort of the logic. When I went to University of Utah, same thing. I trained with multiple plastic surgeons and there was really not any discussion about reusing, reshaping the breast with the tissue that was already there. And then even when I went to Beverly Hills and trained with 10 plastic surgeons who did aesthetic plastic surgery, primarily even, they basically rely on the implant to give that final aesthetic and that final volume. Really the advantage of an implant is that you can pick your volume. So if you really want to go bigger or a lot bigger, the implant's sort of the only choice. What I found is that most patients don't really want to be bigger. The question that never gets asked after someone comes to your office after three or four pregnancies and breastfeeding and things like that, when the breast shape has changed, the question to ask is, are you happy with your volume As if to say, if you were going to take the breast tissue that you already have and gather it up high in, let's say a bra, like a non padded pushup bra, would that be enough volume for you or do you want more volume?

(03:38):
And I'm surprised most patients will say like, no, that's actually enough volume. I don't need the breast to be bigger. I just need it to stay up here. That's all I want. And that's where these auto augmentation techniques come handy because this is all we're doing is basically taking all that volume that's already there and reshaping it higher and tighter towards the center.

Monique Ramsey (03:55):
If you're using the existing tissue. Is the ideal candidate for this procedure, somebody who already was a B or a C or a D before they had kids?

Dr. Swistun (04:06):
Correct. So another great question to ask is were you happy with your shape and volume before your pregnancies? Because chances are you didn't lose breast volume. Okay, the breast volume got redistributed. It is now distributed over a wider area. The whole breast is lower and wider and therefore more deflated centrally, but the volume is still there. In fact, most patients actually gain a little bit of volume as they age. Every time you go through a pregnancy, there is a hormonal stimulation and there's a little bit of glandular hypertrophy in everybody. So the glands grow a little bit. A lot of patients actually do gain a little bit of weight during their lifetime. So maybe when they were in their twenties, they were like 115, 120, 130, and now they're like closer to 130, 140, 150, 160. So some of that volume is in their breast as well. And then another time when a lot of women gain volume of the breast is during menopause because a lot of those hormonal shifts also induce glandular hypertrophy, more breast tissue growing. So most patients later in life, if they started off with a B, they're probably bigger than a B. If you just reshape that tissue, well, maybe even a C or more. And again, I run into that scenario a lot.

Monique Ramsey (05:17):
Well, I think for the women, I'm one of them who never had an implant, but I was a C cup before I had kids. So then after kids, I was just a very droopy, maybe dup and I didn't want an implant. And so I had Dr. Lori Saltz, this is, I dunno, 17 years ago, lift everything up without an implant because I was really, but she didn't really do it very often. I just know my body and I know I would have some weird reaction, and so I didn't want to go there. So I think really, like you say, women don't really know that this is possible. And if you just had a straight breast, it did seem almost like a breast reduction. So of course then you're thinking, oh, I got to put an implant in there to make it all right. But really using what's already there and like you're saying, you kind of reposition it in a way that, tell me about how that works.

Dr. Swistun (06:14):
Correct. So exactly on the right track, this technique for me evolved because out of necessity, basically as you know, the vast majority of what I do is removing implants and the patients are naturally going to be smaller. And these are patients that are already decided I will not have another implant in my lifetime. Let us do what we can with the tissue that I have. And the priority is always the shape of the breast. If we can make 'em as youthful as possible, then that usually tends to be the priority for patients. And most patients think like volume is secondary. I just want 'em to be youthful and perky. And if they're a little smaller, I'm fine with that. So because I'm in this situation all the time, I've developed more and more put lot more and more thought into how do we salvage everything that's already there.

(06:54):
And there are techniques described that I've never done in training in residency, but I've read about them. They're used in other countries, they're used around a lot. One of them is called the Robero flap, which is basically taking the bottom of the breast and removing the skin and then just repositioning it higher on the chest and using that as the underlying volume. It almost acts like an implant in and of itself. There's ways to secure it and have it stay there. Another technique is just moving tissue from the sides and the tissue that would get sacrificed kind of gets rolled in and up instead. And then there's some central breast tissue basically beneath the areola that we can also remove the skin, but then use that for volume. So combining all three of those maneuvers, each one of them has been described separately, but I just kind of combine all of them in order to sort of maximize that opportunity. So really the difference in my patients between the before and the after is just the skin, the extra skin that has grown in response to the breastfeeding that is now removed and the skin envelope has been readjusted and the breast tissue underneath has been reshaped and sacked to be higher and more projected forward and less off to the side and more towards the cleavage. And then the skin has been just wrapped around that. Again, this is a common thing for explants, but it works in straight lifts as well, just the same way.

Monique Ramsey (08:13):
And what would you say are the biggest advantages of preserving the patient's own tissue versus a classic breast lift where it gets disposed of?

Dr. Swistun (08:22):
Well, I mean obviously volume, right? So a classic breast lift will improve the shape. A breast lift with an auto augmentation will keep as much volume as possible that's already there. So again, a couple extra steps. We have to remove the skin. We have to be very careful to preserve the blood supply to that tissue. We have to test that tissue to make sure that it'll survive in the long run. If you Google auto augmentation complications, that's the first thing they're going to talk about. Tissue necrosis, all that tissue that gets reshuffled in there, is that going to survive? Is that going to die? Well, there are techniques that we can use to check to make sure that it survives, but they do take a little bit of time in the operating room to do that. But ultimately, once we're committed to it, and once everything is there and alive, we can just reshape it.

(09:05):
There's a step that I kind of like to, it's like right in the middle of the surgery where everything is made available, all the tissue is kind of dissected out, and then there's a moment of artistry I suppose, that gets in there because everybody's tissue is a little bit different. Some patients have a little bit more on the bottom, some more on the side, some more in the center. So everyone has a different three-dimensional puzzle to put together in order to arrive at that final shape and then wrap the skin around that. So again, there's a little bit of artistry involved. They're not all straightforward cases, and maybe that's another reason that it's hard to teach. It just really comes from experience. So maybe that's another reason why we don't see it in residency programs a lot, but it's definitely possible in the vast majority of patients. Obviously the advantage is preserving the shape and the volume, and if the patient's comfortable with that shape and volume without an implant, then all of the advantage of not having to deal with a foreign object in your body come along with that.

Monique Ramsey (10:01):
Right. And if you put in the foreign object, then in 10, 15 years, 20 years, you have to take it out and decide what to do again. And think of that times your lifetime, two, three surgeries more, almost no matter what age you are, there's going to be more surgery down the line and there's some risk there. There's some expense for sure. So for patients, if you do this technique, how long can they expect the results to last? And do they ever have to have a revision down the road?

Dr. Swistun (10:40):
Theoretically you're just resetting the clock because think about what changes the breast shape in the first place. It's usually an event like a pregnancy where the breast volume expands rapidly and the skin grows in response to that. And then when you stop breastfeeding, the skin does not shrink back and it basically reshapes into a droopier lower and wider, less projected breast. So we're basically resetting that and putting it back to like it was, we're adjusting the skin, we're removing all that extra skin, so that's no longer there, so it's not going to droop, and we're restacking all that tissue in new places. So theoretically it should stay there the way it is, assuming nothing else happens like that. So if you're done breastfeeding, probably not going to happen. And the other event that patients I recommend avoiding is gaining a lot of weight because if you gain a lot of weight, then that breast will get a lot bigger. And then if you lose that weight afterwards, then that's going to be the same scenario as a massive weight loss patients. Again, extra skin, extra skin. I suppose if you maintain your weight reasonably well, then that results should maintain itself basically indefinitely.

Monique Ramsey (11:44):
Yeah. And how would you describe maybe the look and feel compared to an implant-based procedure? I mean, I know for me everything feels, I never had an implant, but everything feels normal and natural, and so is that what they can expect really?

Dr. Swistun (12:02):
Correct. I mean that's once everything heals, then it's just your natural normal tissue, assuming no complications, assuming I've done my job and made sure that the tissue that we can use will survive in the long run. I suppose if patients did have fat necrosis, then there would be a little harder lump in there, maybe some tissue that kind of scarred in, stuff like that. I really haven't come across that. We typically do see that early on when tissues are swollen still and they're declaring themselves, but in the long term, things tend to smooth out, but that's sort of the worst case scenario. Even then that's not cancer or anything dangerous. That's just a mask that may be uncomfortable, that can be removed in the future, that can be followed radiographically if it has to be.

Monique Ramsey (12:41):
And speaking of that, so you go get your mammogram, is there anything you need to, if a woman has an implant, they have to disclose that for the mammogram. Is there anything that is going to look different to a radiologist on that kind of an exam?

Dr. Swistun (12:57):
Well, there may be, but the radiologists deal with that all the time. The patient basically says, I had a breast lift or I had breast surgery, and there's going to be some expected scars related to that. Then the radiologist, as long as they're aware of that, they should be able to tell that apart. That happens all the time in reconstructive breast surgery. Patients who had cancer and had breast cancer reconstruction, either tissue-based reconstruction with flaps or implant-based, there are surgical breasts that we image for cancer screening all the time, and there are associated scar patterns that radiologists are familiar with and they just follow them. If they're ever suspicious, it's like, Hey, I think this is a scar, but let's make sure they can always biopsy it to make sure it's just scar tissue or they can just follow it a little bit more closely every six months instead of every year just to make sure it doesn't change. But those protocols are just normal.

Monique Ramsey (13:47):
Easy. Now, what would you say to somebody who worries, they're thinking, oh, this sounds like the procedure for me, but maybe do I not have enough natural tissue for getting everything lifted, lifted and perky again?

Dr. Swistun (14:03):
Well, again, I would just have a discussion with them. There's no right or wrong answer on this, but if someone says, I would just like to be a little bit bigger, then what I would recommend is actually let's try to optimize the shape and the volume that's already there. Let's do a lift with an auto augmentation and let that heal and let the patient try it out for six months to a year and then decide at that point once, let's say the patient comes back a year later, it's like, yeah, I love the shape, but they're still a little bit too small. Well, what are we looking for if we're looking for a little bit more volume than you can go and do fat grafting, so we can do liposuction and borrow fat from another area in the body and then graft it into the breast, and we know that we will get some predictable result. Again, the fact grafting has its own limitations. That's another topic that we can discuss in another podcast, but to say it doesn't give us as much volume as an implant because if you put in a 400 cc implant, you're going to get 400 ccs of volume extra.

(15:00):
Whereas with fat grafting, it depends on how much tissue there is to begin with, how much fat we can harvest from the patient, and then the survival rate and the techniques. But in general, there are definitely visible improvements. So if somebody says, I like to be a B, but it's a little deflated up top, I just want to be a fuller B, or maybe even a small C fat grafting is good for that. And the huge advantage of that over an implant, obviously it's going to be your last surgery. Once that surgery is done, once your fat graft takes, you don't need another surgery in the future. If the patient really wants to be bigger, then an implant is an option for them. And then I personally spend about an hour discussing all the risks of having implants, including the one that implant will have to come out and we will be in this same space again 10 years from now, 15 years from now, or maybe even two or three years from now if there's complications earlier. So you're sort of kicking the can down the road if you are getting an implant, which again is for some patients, that's the choice they want to make, and that's okay as long as they're making an informed decision.

Monique Ramsey (15:58):
Okay. I have a dumb question. Are you ready?

Dr. Swistun (16:00):
No such thing.

Monique Ramsey (16:02):
Okay. So you said complications with an implant, and so then of course the first one that everybody thinks of is a capsular contracture. Is there any capsular contracture or a capsule even when you do an auto augmentation?

Dr. Swistun (16:16):
No, no. I mean, a capsule is basically your body's response to a foreign object inside of you. So a capsule is made by your body to any foreign object that's inserted. Obviously implants, but also pacemakers, artificial joints, shrapnel, whatever we put in the body, the body will recognize it as basically a foreign object and make a scar around it just to protect itself. When we're rearranging your own tissue, the body doesn't make a capsule in any place. It does scar in certain places when they layer breast tissue on top of itself, there is scar layers that form in between, but those are very different because they're not, first of all, they're not being driven by the presence of a foreign object. They're just scars what single layer scar between tissues. And we have a lot more control over those scars because as soon as they heal, we can do breast massage, tissue massage, we can do range of motion exercises with the chest and the arms and the shoulders so that we can optimize and allow that scar tissue to remodel optimally to your anatomy and to your range of motion into your activities. So basically it has a negligible effect in the long run.

Monique Ramsey (17:25):
Interesting. Okay. So it wasn't a dumb question.

Dr. Swistun (17:28):
Not at all. Okay. It's a common question.

Monique Ramsey (17:30):
Well, yeah, just because you think about, I think as patients are considering a procedure, you think, okay, what are the biggest risks? What could go wrong? And what are those things? And because I think if you know what to be prepared for, but if that's not one you have to worry about, I love that there any situations where there might be a reduction alongside of all this where there's just way too much they don't want to be, even if you took all their tissue and moved it around, it would still be that their breasts are too big.

Dr. Swistun (18:03):
Absolutely. So that's basically a reduction lift or just a standard reduction. So this is when I tell patients once we we're doing breast surgery, they're sort of in control of what they want to do with their breasts. I always kind of start the conversation was like, well, a standard lift is one option. Standard lift will remove a little bit of breast tissue. You'll probably go down half a cup size and maybe a full cup size depending on where that tissue is. And then you'll have a nicer perkier shape with a little bit less volume. That's a standard lift. Or you can go one way or the other on the volume. You can actually say there are patients who say, I have too much breast tissue. I've always had too much breast tissue. Let's do a reduction. That's fine. So we can just remove a lot of the breast tissue.

(18:47):
Usually it gets removed from the side and from the bottom, and then we're keeping the stuff that's high, what's going to give us the best shape. And then you can combine that basically lift with a reduction procedure at the same time. Or there's the other spectrum of patient that says, I absolutely want to keep everything I have. I've always been small. I want it to be bigger. I definitely don't want to sacrifice any of the tissue. Then yes, we take the auto augmentation route, we do a lift with an auto augmentation and preserve everything possible, and then possibly have the patient come back for fat grafting in the future if they still feel they're too small.

Monique Ramsey (19:20):
Now, is recovery any different if you have an auto augmentation with a lift than if you were to have a lift with an implant?

Dr. Swistun (19:29):
I think it's easier and a little less risky because we're just, again, rearranging breast tissue. The dissection tends to be limited to above the muscle, whereas typically with implants, most implants will be placed below the muscle, so now you're actually lifting the muscle away. So there's complications that go up a little bit with regards to that because now we're actually engaging the musculoskeletal system in that implant, in that augmentation procedure. So we're dissecting out more space. There's more blood flow, more big blood vessels underneath. So I think your rates for hematoma or stuff like that is higher. And also there is that unpredictability of what's going to happen with that implant over time. Those are, in my opinion, wildcards at best. They stay in the right place for 10 or 15 years and then they rupture eventually, and then they have to be replaced. But at worst, they can have complications a lot earlier. You can have a capsule contracture early, you can have malposition, patient can decide, actually, these don't feel like me. This is another thing I get all the time. There's a bunch of patients I explained to who basically said I hated, hated them as soon as I had them because they just feel foreign to me.

Monique Ramsey (20:36):
Oh, interesting.

Dr. Swistun (20:38):
They just never felt like me. They're always this extra device on top of me, and I just never liked them, and I just went 'em out and here we are three or four years after their augmentation and we're

Monique Ramsey (20:47):
And a lot of money too.

Dr. Swistun (20:50):
Correct.

Monique Ramsey (20:50):
I'm always thinking about the bank account. I mean, it happens now. I would think, and I don't know the percentage of women, there's a percentage of women who breasts are different sizes. And so in these auto augmentation land procedure, can you help also then if one breast is larger than the other, can you help make them more symmetrical?

Dr. Swistun (21:19):
Absolutely. I would say probably close to a hundred percent of women. They're not symmetric. Most of them are not significantly asymmetric that they actually notice, but once we start measuring and drawing and all this stuff, then most people say like, oh yeah, this one is a little bigger. This one measures a little lower and stuff. Nobody's perfectly symmetric. I can think of two people that I thought I told them like, you're as close to symmetric as I possibly as I've seen. But in general, that's not a thing. So yes, that is an opportunity for us to actually improve symmetry. Typically when we do a breast lift with an auto augmentation or with a reduction, let's say, let's talk about the auto augmentation scenario. Typically the smaller of the two breasts will determine the volume for both in the vast majority of cases because what we do then is basically you start with the smaller breast and you shape as best as we can with the tissue that we have, and then we move on to the larger breast and we do a matching reduction as in take a little bit more tissue away from the larger breast to match the smaller breast.

(22:18):
And that is 99% of the time what the patients would ask me to do to improve their symmetry, especially if they've been significantly asymmetric from the beginning. And they know this. There are some patients, very few that will actually commit to two surgeries right away because what their goal is, is to actually have the bigger breast determine the size for both. So what we do is we do a breast lift individually for both breasts without sacrificing any tissue and knowing that one breast will come out bigger and one will come out smaller, and then these patients will come back six months later for a fat graft to the smaller breast and possibly to both sides depending on how much fat we can get from them. These are typically patients who are thinner, who have very limited fat that they can donate on their body, but still want to maximize their breast volume so that there's no reason to sacrifice any breast tissue at any stage. So basically we make a asymmetric temporarily and then we bring them back for a fat grafting session six months later, and we do liposuction and again, take all the fat that we can and then graft the smaller breast and then maybe the larger one slightly as well to match both of 'em that way. That's again, a very rare situation because you're committing to two surgeries from the, which is what most people don't want to do that.

Monique Ramsey (23:37):
But especially for somebody who's really small, that would make sense.

Dr. Swistun (23:42):
I mean if they have a defined goal from the beginning, then that's the way we do it.

Monique Ramsey (23:46):
So can you walk us through maybe one of your more memorable cases where a patient chose to do a breast lift with an auto augmentation and they saw a big transformation?

Dr. Swistun (23:56):
I mean, very recently there was a young patient who was in their late twenties and actually underwent a massive weight loss. I saw her originally a year prior to our surgery, and at that time she was 80 pounds overweight, and she actually came in for a breast reduction because she had shoulder, neck and back pain because of her large breast volume. And we also talked about other goals like maybe weight loss, and she was considering going on tirzepatide for weight loss. So we went ahead and said, well, why don't you do that first? Because once you gain to get to your happy weight, then we can reexamine your breast tissue and see if that's still the appropriate surgery because we're talking about a big change. 80 pounds is a lot. So that's exactly what we did. We actually ended up rescheduling our visit to a year later, and she did exactly lose about 80 pounds.

(24:44):
Was it a little bit more like a year and a half I think. And then she was basically a massive weight loss patient. She looked stunning everywhere, except the breasts were now much lower. So they've lost a lot of volume because the weight loss, but the skin has not tightened up. Obviously the skin has draped lower. So now we had a patient who had basically a very droopy breast, and it was smaller than before. And now I asked her, do you still want a reduction? And she was like, no, no, actually the size is great now I just need 'em to be higher. And that's exactly what we did. So we went ahead and just did a breast lift with and auto augmentation and just restored a very nice youthful contour and gave her a really proportionate, nice looking result overall without doing the reduction, actually preserving the tissue. And I'm glad we did that because if we did the reduction first and then she lost 80 pounds now her breasts would've been too small for her preference.

Monique Ramsey (25:35):
And what do you think surprises patients most about this approach?

Dr. Swistun (25:40):
That we can make the breast look like it has an implant without having an implant? This is one of my favorite before and afters that I actually showed patients is this is a before, and this is an after of a breast with an auto augmentation. It looks like a very nice full youthful contour, and everybody assumes that there is an implant in there. It's like what size implant is that i's like, no, there's literally no implant. This is just her tissue rearranged. The only difference between those two pictures is 20 grams of skin that was removed from the bottom and then reshaped, but all the breast tissue was tacked. And once we started analyzing how we did this, it's like, oh, yeah, there's so much tissue on the bottom underneath the fold that we could have used and put back up there. And then there's stuff on the side that we brought in from the side and towards the center more.

(26:22):
And then they can see that, and it's like, oh, yeah, I can visualize how you could three dimensionally restructure this and get that same volume. But it's, the surprise is usually that if a breast is low and wide, it looks deflated. That's the words that patients use, and therefore patients sort of assume that the volume is gone. But in reality, the volume is not gone. It's redistributed. It's low, it's below the breast fold and it's wide. It's on the side of the chest, and there is deep projection centrally. So the whole thing looks lower and wider and pancaked, but that's not the same as losing that volume. That's just volume redistribution. And what my job is, is to take all that volume and put it back where it's supposed to be, and that's what surprises the patients the most. I didn't know this stacked up to that much contour, that much volume.

Monique Ramsey (27:07):
That they had, that much that could be rearranged. Right.

Dr. Swistun (27:11):
Going back to that original question of when I asked patients, are you happy with the volume that you have, if we were just to put it in a nice non padded pushup bra, and if the answer is yes, then you don't need more volume and you don't need an implant. You just need to have your breast tissue reshaped appropriately and save everything that's there.

Monique Ramsey (27:29):
I love it. It's like on the HGTV and they classically restoring a house, and they're not going to bring in brand new stuff. They're going use old stuff and rearrange it and make it look fabulous. And I think it'd be cool, I don't know if you're a sculptor, but I feel like there's a cool way that you could take clay and some sculptors are sculpting out stone and taking stuff away. And in a way, it's almost like making it with clay and moving stuff around to get where, I don't know. Your kids are too old for clay.

Dr. Swistun (28:07):
Well, interestingly, I do have a visual arts background.

Monique Ramsey (28:10):
Yeah, I know you do.

Dr. Swistun (28:10):
I do have a visual arts degree out of undergrad, which include its sculpting actually. I mean, most of the videos,

Monique Ramsey (28:17):
Oh, let's do it.

Dr. Swistun (28:18):
I mean, I was drawing photography, ink and sculpting was a part of that as well. But I suppose you can show that with clay. I mean, one video that I do show patients in consultation, and this is the patients that can stomach it usually, who's somebody who's in the medical field that can actually tolerate that is the intraoperative video on how we do this. And it's about a four and a half minute video that we have that really shows what that tissue does and how the tissue is rearranged. And it makes a lot of sense just looking at that. So that's an easy thing to show to anyone at a consultation. If they can stomach it.

Monique Ramsey (28:52):
Can handle the gore? That's why I'm thinking play-dough.

Dr. Swistun (28:55):
Yeah, but that's a good idea. I haven't thought about that.

Monique Ramsey (28:58):
Yeah. Well, I don't know. Anyway, last question is really how can women find out if this is the solution they're looking for? Is it just a conversation?

Dr. Swistun (29:09):
I suppose. I mean, the easiest if unsatisfied with the shape of their breasts, there's two sort of things to think about. There's the shape and then there's the volume. And these are two separate considerations. They're separate variables. I guess we can say we can change the shape and keep the volume, or we can change the shape and reduce the volume or reduce it significantly. But it's only in that situation where you actually want to add a lot of volume to the breast that an implant would be necessary, even adding a little volume, consider fat grafting and then have to deal with an implant. But I think that's the question you need to ask themselves is, like I said, again, that same question I keep repeating, but if you put in a pushup route or if you just bunch 'em up like that, is that enough volume for you? If it is,

Monique Ramsey (29:55):
Yeah,

Dr. Swistun (29:56):
Let me just do the procedure. That'll keep 'em up there for you.

Monique Ramsey (29:59):
Yeah, I love that. Well, and I think there should really, everything I've been reading lately, the trend really has been just in the last year more vocalized or in print in the media of just people are wanting something more natural, not just more natural, meaning not a foreign object, but also more natural. Meaning the appearance.

Dr. Swistun (30:22):
Right, the athletic appearance as opposed to the voluptuous sort of augmented. I agree. I agree. I mean, there's very few people are asking for a lot of volume. The Pam Andersons and the Baywatch generation has sort of gone by the wayside, at least in my patient population. Most patients just say, I just want yoga boobs, or I want ballet boobs. I mean, this is the new terms that patients throw around to me nowadays, is just something that's athletic, that fits my Lululemon outfit that I can show off at the, I just want to have enough fullness here to be nice and proportionate. I don't need a lot of volume. I don't want to be voluptuous. I don't want them to walk in front of me into a room. All these things that used to be the priority. And then the other thing is that without implants, they're just so much more comfortable. I really believe that having implants is playing life in hard mode.

(31:13):
If you're playing a video game, you can set it too hard and just really struggle, or you can just put it too easy and your life is just so much more comfortable. Having an implant, to some extent, always makes things just a little bit more difficult. You have to compensate for those implants, especially if they're under the muscle, and also, especially if they're large. And eventually that implant has to come out in just a matter of time. And then patients are surprised how much more comfortable their life gets after we get them out. So if we can avoid that altogether, more power, more power to the patient.

Monique Ramsey (31:45):
Right, right. Well, thanks everybody for listening. If you have any questions, check the show notes because we have links. You can set up a consultation with one of our patient coordinators, Dr. Swistun, patient coordinator to discuss a consultation with him. You will have links to before and after pictures. And we thank you all for listening, and thank you again Dr. Swistun for joining us.

Dr. Swistun (32:07):
Thanks again, Monique.

Announcer (32:13):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment, or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego Freeway in the Ximed Building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com or follow the team on Instagram @ljcsc. The La Jolla Cosmetic Podcast is a production of The Axis T-H-E-A-X-I-S.io.