Dr. Zegzula (00:00):
Dan Zegzula. I'm a plastic surgeon, Portland, Oregon at the Portland Plastic Surgery Group.

Eva Sheie (00:06):
Is there a way that you know about what size of implant that someone might need and how do you go about determining what the right size is?

Dr. Zegzula (00:16):
So the patient's anatomy plays a role, as I mentioned before, and we do measurements. And I think the most important measurement when you're examining a patient is the width of their breast or what I like to call the footprint. So how naturally wide the breast is. So that sets the tone for a range of implants that will look good in that patient as long as it's close to that width. Now, within that width, the implant manufacturers make a variety of different volumes. So say the width that you're looking for is 12 centimeters, you can probably find five different implant volumes that fit that 12 centimeters from a lower profile implant, that might be 225 ccs up to a very high profile implant that might be close to 400 ccs. And in that range, you can almost always find the right implant for patients. And the way I help get the patient's input is that we'll use a sizer, patients will put a bra, we use them in the office, they're not really sports bras, but they're like sports bras. Patients put that on and then they'll slide these sizing implants into the bra to see what that, two things, they see what the weight of those implants are because there is a weight to those things, and then how it looks on their frame. And especially if they put some clothes on top of it, like a T-shirt or a blouse, and they can see how they're going to wear their clothes. And that really helps narrow down the range of sizes that we're going to use for that patient. And I almost always get it right. I don't have to change sizes very often. Maybe once every couple of years will I have a patient come back and want to go up. But frequently in those situations, it's because the patients wanted a pretty big implant. And I said, I'll put the biggest one in you than I think I can that's safe. And I put that in, and then they're a year later, they're like, oh, can I go bigger? But what's happened is you've stretched the tissues with the first implant, so it's a little easier to get a bigger implant in the second time, but that's a pretty rare situation in my practice to have to upsize somebody.

Eva Sheie (02:23):
Do you have a preference for the brand of implant that you use? And does that even matter really at the end of the day?

Dr. Zegzula (02:29):
I use all the implant manufacturers that are available to us. That's Mentor, Allergan and Sientra. Of the three I tend to use Sientra more. I like the technology in the Sientra implants. They're the most recent ones to the market. They have a really good gel inside the implant. And importantly, I think Sientra also has the best warranty in the field. They have a 20 year warranty for rupture, and they also have a capsular contracture warranty for the first two years. So that protects your patients in case there's a problem. So Sientra is a great product and I use more Sientra than anything else, but sometimes, depending on the patient's size or their desires for size, I'll go to another manufacturer to get the right implant.

Eva Sheie (03:14):
On this podcast, we bring you directly to the doctors who are where before meets after Links to our guest's website and contact info are in your show notes. Follow us on Instagram @wherebeforemeetsafter. Where Before Meets After is a production of The Axis, the podcast agency for Aesthetics, theaxis.io.