Breast Augmentation: When You Should – Or Shouldn’t – Have Breast Surgery

Whether or not to have a breast augmentation is a highly personal decision, and the reasons women elect to have this procedure performed are as different and unique as the women themselves. However, no invasive surgical procedure is as simple as getting a haircut or a manicure, and while an excellent, board-certified plastic surgeon will help you achieve a beautiful, successful result, breast augmentation is a choice to be considered very carefully. Here are some of the most common reasons why you might think about having breast augmentation surgery.

“I think larger breasts would be a better fit for my body.”

Many women feel that breast augmentation will help create a more symmetrical body shape, particularly if they have full hips. Many women’s fashions are designed for a breast size between a B and C cup, so clothing may fit more flatteringly and comfortably.

“I recently had a baby, and want my breasts back the way they were!”

It is very common for the body to change significantly post pregnancy, due both to changes in body weight and the effects of breastfeeding. Many women experience dramatic sagging and reduction of dermal elasticity, and wish to surgically restore the firmness of their breasts. A breast augmentation can help return the breasts to their previous, more youthful state.

“I lost a lot of weight, and my breasts look worse than they did before.”

Losing weight suddenly, either naturally or with the assistance of bariatric surgery, may result in sagging skin, causing the breasts to droop. A breast augmentation, or breast lift in conjunction with reduction, may help give the breasts a firmer appearance.

“One breast is larger than the other.”

Most women’s individual breasts differ slightly from one another, with minor variations in either shape or size. However, some women have one breast that may be as much as a cup size larger than the other, making finding clothing and undergarments difficult, and even causing physical discomfort. Breast augmentation can even out asymmetrical breasts, creating a uniform look.

“I’ve had/will have a mastectomy, and I’d like breast reconstruction surgery.”

If you’ve had a partial or double mastectomy, you have no doubt considered breast reconstruction surgery so that your breasts are restored to as much of their pre-surgery condition as possible. If you’ve been diagnosed with breast cancer and advised that a mastectomy is the best treatment option, you may want to consult with a plastic surgeon who specializes in breast reconstruction. Dr. Lisa Cassileth has pioneered and perfected the Cassileth One-Stage Breast Reconstruction, which is a total breast reconstruction performed alongside a mastectomy, allowing the patient to emerge from a single surgery with breasts restored to a natural-looking, healthy state.

Making the best decision for you

While the above circumstances are typical for women considering breast enhancement or breast reconstruction, there are also numerous other reasons. However, many of those reasons may not be particularly healthy, or conducive to a successful outcome. These reasons include:

  • Pleasing a spouse or partner who is pressuring you.

  • You found a surgeon who will perform the breast augmentation cheaply.

  • Your employer or potential employer wants you to.

It is extremely important that you consider your options very carefully, and discuss your personal reasons for getting a breast augmentation with your physician. A board certified plastic surgeon who specializes in breast reconstruction and augmentation will provide you with the guidance you need to ensure a successful result.

Cassileth Plastic Surgery and Skin Care is proud to offer a medical team of breast specialists with a reputation for delivering exceptional patient care and exquisite results. To learn more about your breast reconstruction options and schedule a consultation, visit the Cassileth Plastic Surgery breast reconstruction page and begin your journey to a new you!

Should you have the capsules removed when you have an implant removed?

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Most plastic surgeons say, “never”. A small group says, “always”. Why is this and what is the real answer?The truth is that there are situations where the capsules need to be removed. There are three good ones:

1. The presence of a biofilm. This is a low grade bacteria that can cause capsular contracture. Capsular contracture is the presence of a higher, firmer, and often painful, implant. If your implants fell and look abnormal, you may have a biofilm. The biofilm usually entered with an implant on a previous surgery, but wasn’t a strong enough bacteria to cause a true infection. The biofilm does cause chronic inflammation however, which leads to the contracture. You are at higher risk if you have had multiple prior surgeries or an areolar incision.

2. Free silicone. Especially if you have had silicone implants for a while, I often find old silicone in the capsule from an old leaky implant, sometimes form a previous pair. Best to remove it and just “keep it clean”, especially if you are worried about sickness from old leaking implants, it takes out the doubt that something there may still be affecting you.

3. BIA-ALCL. This is a rare cancer, called Breast Implant Associated Anaplastic Large Cell Lymphoma. It presents with fluid (seroma) around the implant and is cured by capsulectomy. Older implants with texture place you at higher risk, and any patient with an unexplained seroma around the implant should be tested.

These three situations are fairly rare, and if your implants are “normal” you may not choose to remove the capsule. From a surgical point of view, once I see the capsule that gives me additional information. Sometimes the capsule is fine, see through, and would be difficult to remove as it so gossamer thin (link to normal capsule video). At other times I am shocked by how thickened and calcified it is. In these cases, when the patient is healthy and we don’t know ahead of time if there will be a problem, I remove the capsule based on the appearance. A complete capsulectomy, if the capsule is abnormal, is certainly worth the increased recovery time; this will involve a drain for a few times and will be slightly more sore.

The disadvantage of removing the capsule is that it does make the surgery more extensive, and if you are fat grafting to replace some of the lost volume, then it limits how much fat can be grafted. So, I do argue against the attitude of removing it no matter what; you should never electively do any surgery without a good reason. Finally, don’t forget to ask your surgeon to repair the pectoral muscle if your implants are sub-pectoral. Either way, go to a surgeon that doesn’t have a “never” or an “always” attitude; the right answer is in between.

Lisa Cassileth MD, FACS


Should I Replace My Breast Implants?

measuring-womans-bustWhen you first decided on getting a breast augmentation, it likely did not occur to you that you may want, or even need, to have your implants removed later on. However, every year there are thousands of women who undergo breast implant removal surgery for a wide variety of reasons. Some women have physical or medical complications, some have a change of heart or their idea of the “perfect figure” changed.

Our patient chose to have her breast implants removed on the 20th anniversary of her breast enhancement procedure. Here is her story and what she experienced leading up to her decision.

Our patient’s story

As a teenager, I looked forward to having full, big breasts like my older sister. Despite lots of hope and wishful thinking, my breasts were a small B. Years later, in my 20’s, I felt insecure with my small breasts. After much debate and careful thought, I decided to get breast implants when I turned 25. Having a breast augmentation made me more confident and outgoing. For the first time in my life, I found joy and empowerment in wearing bikinis, tank tops and tight dresses.

Over the past few years, I began thinking about having my breast implants removed. My breasts began to cause back pain, and they made it nearly impossible to exercise without discomfort. I also watched as the body confidence movement took off, celebrating women of all shapes and sizes. As I thought more about my breasts, I realized that my augmented look simply didn’t feel like me anymore.

So, on the 20th anniversary of my breast implant surgery, I got my implants removed – and I couldn’t be happier. While I don’t regret my decision to get implants, I happy and proud of my decision to remove them; I’m thrilled to have returned to my natural breast size and shape. In making my decision, I wanted to work with an excellent Beverly Hills plastic surgeon and am so happy I found Cassileth Plastic Surgery. They made my breast implant removal surgery an experience that restored my happiness in my physical appearance and my comfort.

Ideas of Beauty Can Change

Over time, through fashion or personal preference, a women’s ideals evolve and often change, including what is considered the perfect breast size. Many patients come to Cassileth Plastic Surgery to have their breast implant revision surgery to have their breasts replaced or removed after having had implants for years. This procedure can be combined several other procedures, including fat transfer to breast — where fat is liposuctioned from one part of the body (usually the tummy or “love handles”) and transferred to the breasts, to fill out the area, in a natural way.

We support each and every one of our patients and their view of beauty. There is no perfect breast, just the perfect breast for you. We want everyone that comes to our office to have the body and breasts they desire and will work with you to achieve the results you want.

Exercise or cosmetic surgery to get your flat belly back?

tummy tuck in beverly hillsMaybe you had kids. Maybe you got old. Either way, there is something you are really not happy about in your tummy zone. When we see patients for abdominal laxity, or fat, or skin, we have a huge arsenal of new (and old) techniques that can help. Each patient may benefit from a different combination of treatments, some don’t even require surgery!

Level 1: The muscle zone.
Pregnancy stretches your abdominal wall out, leaving may patients with a rectus diastasis. How can you tell if you have one? Lie on your back, and so a small sit up, coming up only inches off the floor. Now feel your muscles. Are they together in the midline, or is there a gap? Did the abdominal wall get flat when you do a sit up, which is good, or did it actually stick up and out more? Does your belly look flat in the morning, but you just can’t “suck it in” by the end of the day or after a big meal? If so, you have a rectus diastasis. With exercise that focus on external obliques and core strength, you can close that gap by 3 to 5cm. We offer a combined exercise and binder regimen,m called the Tuppler technique, with great results for the diastasis only patient. For patients with a greater gap, we offer a surgical rectus diastasis repair. This can be done through a C-section only type small incision, or can be combined with a tummy tuck if you have a lot of excess skin.

Level 2: The fat.
A little fat that you can’t lose on your own is perfect for Coolsculpting, a noninvasive technique that removes unwanted fat with no downtime. For patient with more than a handful of extra fat, we offer liposuction as well as laser-assisted liposuction, which can be done for up to 5 liters of fat removal. We have a lot of patient with excess fat and skin, which is perfect for a combination procedure of liposuction and skin removal. These results can be very dramatic, as they aim to completely transform your waistline and remove any and all overhanging skin.

Level3: The skin.
Skin can be mildly excessive after kids, and we recently purchased the Thermi Laser a radio frequency laser that tightens excess skin without invasive surgery. If you have an actual overhang, it may require a mini-abdominoplasty (just skin on the lower abdomen only) or a full abdominoplasty (excess skin is on the lower and the upper abdomen)

For more information about these procedures or other treatments available at Cassileth Plastic Surgery call 310.819.9340 and schedule an appointment today with the best plastic surgeon Beverly Hills has to offer!

New Mom’s: Is Exercising Not Working for You?

happy-mom-and-babyWhile there is nothing that changes your life in such a positive way as having a baby, for some new mothers, getting their body back to their pre-pregnancy look, or any desired look, can be a difficult hurdle to overcome.

Extreme dieting isn’t really a viable option for a new mom and having the time to spend hours at the gym is unlikely. Even if a new mom can find the time to do so, it’s no guarantee of results.

Pregnancy and childbirth often create tremendous stresses on a woman’s body that diet, exercise and time are not going to undo. But it is possible to get that body back with a Mommy Makeover.

“Your life really changes after you have kids. You devote your time and energy to taking care of your children, following up on their care and making sure they’re well-fed, clothed, and safe. We really let our physical appearance become something on the back burner. A mommy makeover is such a nice thing to give moms.” – Dr. Kelly Killeen

A Mommy Makeover is a combination of procedures that offer patients different choices and may include the following procedures:

Tummy Tuck (abdominoplasty)
Mastopexy (lift)
Facial Rejuvenation
Liposuction (fat removal)

Moms may choose between surgical and non-surgical options for their makeover experience. Hormonal changes, after a pregnancy, can affect the skin as well as the body.

Dr. Cassileth and Dr. Killeen recommend patients wait at least 6 months after pregnancy, as well as after the child is weened, before a mommy makeover procedure is considered. After 6 months, most women achieve a more stable body weight. (Post-pregnancy weight fluctuations may otherwise obscure the surgical experience).

“Thank you for giving back to me a very positive body image. People always told me it was an achievement to have lost over 110 lbs, but even after the weight loss, I could not stand to see my stomach… Today I have become a stomach exhibitionist, strutting my flat abdominals for all to see. There have been sightings of my bellybutton all over town. Imagine that!!”

To find out more about how a Mommy Makeover would work for you, come see us for a consultation by clicking here or by calling us at 310.819.9340.

Big Talk About Breast Reconstruction

Recently the Cosmetic Surgery Times wrote a wonderful and insightful article about the successful Reddit AUA (ask us anything) hosted by our own Lisa B. Cassileth, M.D., FACS, and Kelly Killeen, M.D.

In this interview following their lively and popular Reddit Q&A (over 2,100 comments), Dr. Cassileth and Dr. Killeen discuss why women should “expect more” with mastectomies and breast reconstruction, including sparing their nipples and avoiding devastating scarring.

Check out the entire article:
Cosmetic Surgery Times Logo

Big Talk About Breast Reconstruction

by Randy Dotinga, Cosmetic Surgery Times

A pair of Beverly Hills plastic surgeons has a simple message for women with breast cancer who seek mastectomies and reconstruction: Expect more.

Beverly Hills Plastic Surgeon Dr. Lisa CassilethLisa B. Cassileth, M.D., FACS, and her partner Kelly Killeen, M.D., tell their breast reconstruction patients that it’s often possible to spare their nipples and avoid devastating scarring. It’s all thanks, they say, to their partnerships with top breast surgeons and a strong focus on aesthetics.

“Women often feel they can’t be naked after a mastectomy, that they feel asexual: ‘I’ve had this happen to me and I’ll move on, but I’ll never be able to be naked again or have anyone see me naked again,’” says Dr. Cassileth, the clinical chief of the Division of Plastic Surgery at Cedars-Sinai Medical Center and an assistant clinical professor at UCLA.

The reality, she believes, is the exact opposite. In fact, women can often even get the breasts they always wanted.

Beverly Hills Plastic Surgeon Dr. Kelly KilleenDr. Cassileth puts it this way when she talks to breast cancer patients: “Sorry to be so superficial, but my job is to make you hot.”

In July, the two surgeons became a hit on the Internet bulletin board Reddit when they took part in an AUA — Ask Us Anything — titled “We are two female Beverly Hills plastic surgeons, sick of seeing crappy breast reconstruction — huge scars, no nipples, ugly results. There are better options!” Their discussion drew more than 2,100 comments.

Cosmetic Surgery Times reached out to the surgeons and asked them to describe their approach to mastectomy and breast reconstruction.

Q: What does the public misunderstand about breast reconstruction after breast cancer?

Dr. Cassileth: The reality is that women have no idea about it. Maybe their mothers or someone they know had a mastectomy, but it’s a taboo subject. You may never be told that you have this big cut across your chest. Then they look online, and the pictures can be really horrific. These women come into my office, and they’re shell-shocked. They just want to get this done.

Q: How have surgeons typically looked at the nipple in mastectomies and reconstructions?

Dr. Killeen: Traditionally, cancer surgeons considered the nipple to be part of the breast tissue, and it was removed. In fact, the nipple can be safely left behind in most patients. This leads to superior cosmetic outcomes, and women feel psychologically better keeping their nipple. Unfortunately, a lot of the country has been slow to adopt this as the standard of care.

Q: Why do you think nipple-sparing surgeries are so uncommon?

Dr. Cassileth: The majority of surgeons I’ve worked with don’t know how to do that. That’s why I’ve reversed the flow so we only work with breast surgeons who are fabulous.

Q: So you choose the breast surgeon instead of a breast surgeon choosing you?

Dr. Cassileth: I’m driving the consult back to the general surgeon, not the other way around. I’m first, and they’re second.

Q: What does your approach mean for the risk of mastectomy flap necrosis, a common complication of breast reconstruction?

Dr. Cassileth: The published complication rate is 15%. I’ve seen an average of 30% among surgeons, and one surgeon reached 55%. They want to do a good job, but they’re not fully aware, it doesn’t hit them like it hits us. All we care about is the aesthetic. When we choose the general surgeon, we keep statistics on every single one of our patients. We’re under 1%. I had one surgeon get up to 2%, and I said this will never happen again.

Q: You perform breast reconstruction at the same time as the mastectomy instead of separating the procedures. What does that accomplish?

Dr. Killeen: Traditionally, a lot of surgeons don’t pay as much attention to creating a perfect pocket. They don’t think they have to get it right the first time, since can be fixed when the patient comes back to get an implant later.

When you get the implant in on the first go, you have to treat that reconstruction with respect. You aren’t coming back another time.

Q: In the Reddit Q&A, you mention something surprising about how many men deal with the breast reconstruction of their loved ones. Can you tell that story?

Dr. Cassileth: When you give a man an implant to hold, they close their eyes and massage it: What does that feel like? I like it when they do that. They’re really committing. They’re fully committed that this will be their wife’s boob.

Q: How can men support the women in their lives when they undergo these procedures?

Dr. Cassileth: The woman’s facing this idea that they’ll somehow be maimed or damaged. They’re inhibited by the idea that their husbands are judging them. If the husband weighs in too heavily, even if he’s trying to be helpful, women will often take that as a criticism of themselves. They’ll feel more nervous and insecure about their reconstruction. Men who say “I love you, I don’t care about what you look like” — even if they’re lying — help women to feel unconditional love.

Skin Cancer Awareness Month: Ways to lower your risk of skin cancer

ways to lower risks of skin cancerSkin cancer is by far the most common cancer in the United States, and it can be deadly. Fortunately there are things you can do to reduce your risk of getting skin cancer. Limiting sun exposure is the best way to protect yourself, here are other top tips to help lower your risk.

Avoid Tanning Beds

If you are a tanning bed devotee, the best way to lower your skin cancer risk is to avoid them! Tanning beds direct UV light to the skin, which causes the skin to produce melanin (brown pigment) and causes damage that may lead to skin cancer. In fact, a law making its way through the Kansas legislature would ban minors from using tanning beds because of their harmful effects on skin. Dr. Kelly Killeen, a Beverly Hills plastic surgeon and an advocate for anti-skin cancer issues, spoke to the legislature on behalf of the bill. As a medical professional and a survivor of melanoma herself, Dr. Killeen has seen firsthand how tanning can harm skin health and elevate cancer risk.

Use Sunscreen

Apply sunscreen with an SPF of 30 or higher on your face and neck every day, even when it is cloudy. As an added bonus, you’ll keep your skin looking younger than those who do not use sunscreen. Over 90 percent of visible signs of skin aging is caused by the sun’s ultraviolet rays. If you anticipate being outside for more than 15 to 20 minutes, apply sunscreen to your whole body. A good rule of thumb is to use a shot glass-sized amount of sunscreen to cover your skin. Reapply every two hours, or after swimming or sweating.

Use Alternative Skin Tanning Products

If you crave that sun-kissed glow, consider using tanning lotion or a spray tan instead of heading out into the hot sun. Unlike the orange streaky looks of the past, today’s tanning alternatives look natural.

Wear a Hat

If you do venture out into the sun, always wear a hat (particularly if you are balding). A hat protects the crown of your head, which can receive considerable amounts of sun exposure.

Comfortable in One’s Skin

Comfortable in ones own skinDoes getting older mean the end of feeling beautiful, or is it just another chapter? When I meet with older patients, all too often they have a defeatist attitude when it comes to their perceived beauty. The truth is, our skin transforms as time makes its inevitable passage forward. But reaching the point of maturity doesn’t mean you have to accept skin that sags and wrinkles. There are so many methods to help correct years of skin damage and the natural effects of aging. I’ve even seen patients look as vibrant and youthful as someone half their age.

So, how can you achieve youthful, glowing skin after forty—or thirty, for that matter?

Getting older doesn’t mean you have to compromise your personal definition of beauty. For most, attractive skin means a smooth, taut, plump surface that is still flexible enough to not look overdone. When executed properly, men and women can enjoy amazing results from injectables like Botox and other fillers. But the thing is, that’s not your only option.

I really encourage my aging patients to reevaluate their lifestyles, as well as explore other corrective skin treatments that are just as effective. First, medical spas offer a number of laser, peel, microneedling, and other results-oriented regimens that yield incredible cosmetic results over just a few sessions. Whether you’re self-conscious about your fine lines, unevenness, general loss of volume, or hyperpigmentation, there are so many rejuvenating methods to complement your injectable routine.

But how can you gain youthful skin at home?

In between MedSpa treatments, I also educate my patients about healthy eating, exercise, and moisturizing habits. It’s important to maintain your skin in between sessions. Dermatologists have specially formulated creams and lotions designed to improve the appearance of damaged or aging skin. These options have given my patients stunning results in smoothing wrinkles and improving texture, tone, and suppleness.

Healthy habits mean healthy skin.

It may seem cliché, but get moving! Regular exercise is scientifically proven to reverse skin aging, especially in individuals who start working out later in life. Forget the aesthetic benefits. Exercising makes you feel healthy and happy, and in turn, you’ll feel beautiful. With all these regimens combined, your gorgeous, glowing appearance won’t be mere smoke and mirrors.

Just remember that getting older doesn’t eliminate beauty—it just means we have to work a little harder at it.

Your Eyes Are The Window To Your Soul

Cosmetic treatments for your eyesEyes convey emotion, sparkle with laughter, and facilitate communication. As we age, the delicate skin around the eyes can become dry, crepey and wrinkled, which detracts from the beauty of your eyes and makes you look older.

The good news is that the skin around the eyes can be improved, depending on the level and depth of the wrinkles or dryness, treatments range from topical products to IPL and laser treatments. The right treatment can transform your look.

Eye-Related Cosmetic Treatments That Take Years Off Your Life

The key to better eye appearance, is to restore moisture and help tighten the skin. Because the skin around the eyes is so delicate, the loss of elasticity and hyaluronic acid (the body’s natural hydrator) associated with getting older, is often first noticed this area. Wearing a daily moisturizer with at least 30 SPF for UV protection is a good way to prevent fine lines and wrinkles. Additionally, use of topical products can provide the intense moisturizing needed to make skin firmer. Choose an eye cream with retinol to decrease the appearance of wrinkles.

Cosmetic fillers are another beneficial, minimally invasive cosmetic procedure. Dermal fillers such as Restylane or Restylane Silk actually restore volume to the under eye area. These fillers improve sagging and create a smooth, youthful skin surface.

Eyelashes also thin as we age. The topical medication Latisse is a wonderful option to improve the length and thickness of eyelashes.

Some people initially worry about investing in cosmetic procedures to restore eye aesthetics. They express concern that this makes them vain or selfish. This couldn’t be farther from the truth. Given our eyes’ enormous role in communication and conveying emotion, they are among our most precious aesthetic assets. Investing in those assets will improve your confidence and restore your youthful appearance.

For more information about non-invasive cosmetic eye treatments including recommendations on home maintenance call 310.819.9340 and schedule an appointment today! Or visit us at Cassileth Cosmetic Medicine.


ariel winter breast reductionThere has been a lot of talk recently around Hollywood actress Ariel Winter (Modern Family) and why she chose to get a breast reduction procedure and I wanted to briefly chime in about it.

First, we should all applaud her on her decision. Making any modifications on your body takes courage, especially when you are a public figure. There is no doubt that she was aware of the potential repercussions of receiving a cosmetic procedure, and to come out as a delegate of breast reduction takes guts.

Like many women looking into a breast reduction, Ariel Winter decided to undergo the procedure after her back and neck pain became too much to bear. Large breasts can create a strain on the neck, back and spine, can make exercise difficult, and feeling good in clothes can be a challenge. Reducing one’s breast size can relieve a lot of this pain and match your proportions.

Having talked to many women considering breast reduction, I can tell you that it’s not uncommon for some women to have concerns about being judged by others for having this procedure. As a society we are trained to believe that larger breasts are better breasts (as reflected by the popularity of breast augmentation). For women with overly large breasts, they have the burden of carrying around all that “beauty” everyday. Beyond the discomfort and pain, breasts that are too large over time can lose their attractive natural shape and are more likely to droop. Bluntly: there is such a thing as too big.

If you are living with pain or discomfort from large breasts, you might want to consider a consultation with an expert. You don’t have to live your life with the discomfort and the burdensome weight. If done properly, a reduction will result in a breast size that compliments your figure and leaves you feeling better and more beautiful than before.

I applaud Ariel and her decision and I hope it inspires more women in her position to follow suite. It’s time for the well endowed woman of the world to stand up straight and be proud of who they are. After all true beauty is about feeling beautiful on your own terms, isn’t it?

Click the link for more information about the breast reduction procedure.