Waching daily May 31 2018

(Previously) Tell me, doctor, why do you want to do this?

(Previously) I think nobody has shown the reality

(Previously) behind this very serious operation.

(Previously) Why are you here today? What can I do for you?

(Previously) It's simple: I want breast enhancement.

(Previously) I'll ask for some information about your health, which is very important for this operation.

(Previously) Then we'll look at your breasts, do some measuring.

(Previously) Based on the measurements, I'll show you some volume options, let's call them.

(Previously) Afterwards, we'll discuss the rules, as well as the risks and complications, which, unfortunately, exist.

(Previously) And we'll talk about what needs to be done before and after the operation. Are you OK with this?

The Plastic Age - Documentary

DR. Radu Ionescu - Aesthetic Surgeon

Breast Augmentation - Each step documented

- The Plastic Age - "It's All or Nothing" Episode 2

What would you say is the public's opinion about breast enhancement?

Generally, I'd say the public has the wrong impression, based on articles, forums and personal opinions.

Nobody has taken the time to explain what this operation actually means.

So, we can educate the public a little.

People must understand that this operation, just like all other plastic surgery interventions, does not involve

major changes to the human body, but rather seeks to rebalance the body, to bring harmony.

I have always thought that communicating with the patient is extremely important.

To make your patient happy, you must communicate. And that requires what is known as "quality time".

Surgery is important, but not to the exclusion of everything else.

You need to understand what the patient standing before you wants, from the psychological point of view.

If you understand the patient's needs and aspirations, from the esthetic point of view, from the psychological

then you can decide if the patient should undergo that operation.

You can understand what the patient really wants, you can reduce the patient's expectations

and provide instead a more realistic view of the results.

This communication leads to a very high post-surgery satisfaction rate in patients,

because they feel in control of their demands and the results don't come as a surprise.

We live in an age when surgery is very predictable.

- OK, let's take a look at your breasts. - Just a moment.

- One second. I'll help you. Codin, please!

I want to ask you a very important question: if you had a magic wand, how would you change your breasts?

- I would lift them up a bit. - What does "a bit" mean?

From here. Like this.

Now, I'm going to ask another question. When I lift the breast like this, I have two options:

first one is this, and if you'll look here you'll see a natural slope.

Yes, natural!

There's no sudden change between the thorax and the breast. See?

The shape is perfect. The second solution is what a push-up bra would do.

The height is the same, but this area is bulging slightly, it's more rounded.

It doesn't go as high as the neck, but it looks like a small push-up bra.

- I don't like it. I've seen this often. - So, you like the natural shape.

- Yes. - OK. Now I want you to keep your hands at your sides.

I want to show you what I can do about your breasts. Good.

- One: I can push them this close together. Is that OK? - Yes.

Closer than this is not OK because they would be no space left between them.

But I can do something like this.

Two: I can fill the top side, while retaining the natural sloping.

This part is full, this part is empty, this part is full.

I would push the breast up to this position, but no higher, so the natural sloping is maintained.

- OK? - Yes.

Three: I would lift the breast's bottom. The bottom of the breast must be perfectly round.

- OK? This part. - Yes.

The breast is narrow in the central area and round

- here and here. - Yes.

(Warning! The breast's side line must not be exceeded) The breast cannot exceed this natural line.

(Warning! The breast's side line must not be exceeded) Otherwise your hand will hit your breast.

Moreover, if you look here, this is the breast, these are ribs.

If the implant is bigger than your breast and the side line is exceeded, you're going to feel it here

and the breast side will be visible, giving you an unnatural look.

The diameter is our limit. Another thing: this area, which is empty,

must be filled in order to maintain the breast's natural sloping.

Areola, meaning the darker area, cannot be on the underside.

You'll notice there's a difference between your breasts.

The areola must be in the breast's central area, it must point forward and slightly up, at a 15-degree angle.

- OK? - Yes.

Now, the scar will be located here, in the inframammary crease. See, a crease is forming when I push the skin.

- OK? - Yes.

There will be a 4.5-centimeter scar here. Since the scar will be located in the crease,

- you will not be able to see it. Is that OK? - Yes.

Now I want you to turn toward me. We need to measure your breasts.

- OK? - Yes.

This won't take long, but it's very important. I want you to keep your hands at your sides.

Codin, you want to learn about this operation. I'm afraid you're trying to steal my business.

-What I'm measuring here is the breast's diameter. OK? - OK.

Which is 13.81, OK? Let's say 13.8. Measuring the other breast, I can see it has exactly the same diameter. See?

Now, I'll measure the skin thickness. We'll measure two layers of skin at the same time.

- How much is it? 2.8. OK? - 2.8.

- But is that the skin? - It's the skin and the gland together.

So that was two layers of skin. Let's say the implant is here and there's skin on this side and skin on that side.

- Got it. - Now we must find the crease.

(Warning! The inframammary crease stabilizes the implant and prevents it from sliding downwards, under the skin) The crease is supposed to act as a barrier, right?

If the implant drops below the crease, then the bottom side of the implant will become visible

and the crease disappears. As a result, the implant can slide downwards.

Are there doctors who go below the crease?

- The problem is that doing it could lead to a complication called "double bubble".

The implant comes down to around here and the gland is here.

- OK? - OK.

It's very unsightly. There's another thing that can happen. The crease, which supports the breast, is gone.

The implant can slide under the skin, toward the stomach.

So there are doctors who ignore the limits and do implants that extend below the crease

or beyond the side line.

There are cases where, because of the patient's shape, who may lack that crease or have a very short one

I'm talking about malformed or tubular breasts – then the doctor must recreate the crease.

In her case, the crease is my limit and I need to measure the distance

between the crease and the nipple. The implant has a certain curve.

I must take into account, when choosing the implant, the width and the curve distance.

Since this is the maximum width,

I can extend the breast half a centimeter to the side without causing you any problem.

This half a centimeter is our margin. Your breast is approximately 2.8 centimeters thick.

If I measure this area – please, don't fall – that's 10 centimeters. OK? 10.09.

So, the width is 12-12.5 and this distance is 10. From this distance, I must subtract the thickness of your skin.

We'll measure the double layer again. It's 1.4 centimeters, which means 7 millimeters each layer.

The distance required by the implant, plus the skin cover, must be 10 minus 7 millimeters,

something like 9.3. That's the distance. Take a look at this table.

For 12 and 12.5, there are several options. OK? 9.2. And a maximum of 9.6.

As I said, there's a margin beyond 9.3. We're talking about soft tissues.

Therefore, the maximum implant diameter is 12.5, with a distance to the crease of 9.6 centimeters.

In order to see the difference, we'll decrease the figure by 10%, which is 12, our lower limit, by 9.2.

So, the biggest I can give you is 450 full projection,

the medium size is 400 and the smallest size is 380 full projection.

Now, this operation has five rules. Unfortunately for you, these are not negotiable.

(Warning! The post-surgery bra must be worn for 6 weeks after the operation) You must wear this wonderful post-surgery bra

(Warning! The post-surgery bra must be worn for 6 weeks after the operation) for a month and a half. OK?

- Beginning… - Beginning after the operation, obviously. Not before.

The bra must keep the breast in place, immobilize it, act as a wound dressing. OK?

(Warning! The elbow must not be raised above shoulder level for 6 weeks after the operation) The second rule is: for a month and a half,

(Warning! The elbow must not be raised above shoulder level for 6 weeks after the operation) you're not allowed to raise your elbow

(Warning! The elbow must not be raised above shoulder level for 6 weeks after the operation) above shoulder level.

You can do this. You can do this. You can't do this. This move would stretch the scar, which could open.

Or you could work the muscle too hard, which would push the implant out of position. OK?

- You can do this, arrange your hair, not like me. - 90 degrees?

Exactly. OK. Another rule: for a month and a half, your breasts must be protected from impact.

(Warning! All impact with the breasts must be avoided for 6 weeks after the operation) If your breast is hit, that could cause bleeding.

(Warning! All impact with the breasts must be avoided for 6 weeks after the operation) So, no fights for a month and a half. OK?

- That will be hard on her. - I don't know what you get up to.

- I can't even be touched? - Exactly. That's trauma, too.

Any impact could lead to bleeding.

(Warning! Avoid all physical effort for 6 weeks after the operation) For a month and a half, you are not allowed to lift

(Warning! Avoid all physical effort for 6 weeks after the operation) anything heavier than 3.5 kilograms.

The implant goes under the muscle. It needs between 4 and 6 weeks for the implant

to bind to the muscle and for the scar to form around it. If you lift heavy objects,

the muscle will contract, it will push down on the implant and that may lead to

the accumulation of serous fluid. That's called a seroma, forming around the implant.

The fluid must be drained, and the procedure is anything but pleasant.

After a month and a half, the implant's position is secure, and you can do things.

Basically, for a month and a half you are not allowed any physical effort, OK?

If it takes that long. After a month and a half, you can do some light running,

light physical exercise for your abdomen and legs, some bike riding.

- You mean targeted exercises? - Precisely. But only after 6 weeks.

For 6 weeks you do nothing. You'll be the laziest person.

- Can I walk? - Absolutely! As long as it doesn't take any effort.

(Warning! Sleep only on your back for 4 weeks after the operation) The last rule, which you must observe for only 30 days,

(Warning! Sleep only on your back for 4 weeks after the operation) is you can only sleep on your back.

Because the implant is not yet firmly in place, you roll on the side,

the bed pushes the implant, the implant starts wandering. OK?

This would lead to another operation, where I have to put the implant back in its place. You don't need that.

- We only want the first operation. - Good.

After a month and a half, you can also sleep on your side. Only after six months,

when the final result is in, can you sleep on your stomach. OK?

- Yes. - Good.

- Now, this is the first option. - You're taking account the fact that I exercise

- on a regular basis. - Of course.

- I need to exercise. - OK.

- We put this in. It's all right. - It's very beautiful. Seems pretty.

- You can't say it's a small breast. - No, it's not small.

It's a big breast. That's what you said: I want bigger breasts.

- Now, let's try the medium size. E7 + S1, OK? - Things are getting interesting!

I promised you right from the start it would be fun! That was our deal.

- This is a double D cup. OK? - Yes.

I made some calculations and I told you that 450 is the biggest size.

However, I think anything beyond double D could lead to spine problems, private life problems and others.

To put it differently: I said big, but what I'm showing me right now is the upper limit

and I don't want to go beyond it.

- How close is what you're showing us to the end result? - 100%.

- Really? - 100%.

- Both shape and size? What you see now is the end result, six months after the operation.

- What do you think of this? - I'm OK with it.

He's OK with everything. From that size down, he's OK with everything.

- Let Codin speak his mind. - Go on, Codin.

- I would go with the biggest one, no doubt about it. - 450! Congratulations!

Episode 2 Synthesis

- The breast's side line must not be exceeded;

- The inframammary crease stabilizes the implant and prevents it from sliding downwards, under the skin;

- Five rules for protecting the implant and the scar:

1) The post-surgery bra must be worn for 6 weeks after the operation

2) The elbow must not be raised above shoulder level for 6 weeks after the operation

3) All impact with the breasts must be avoided for 6 weeks after the operation

4) Avoid all physical effort for 6 weeks after the operation

5) Sleep only on your back for 4 weeks after the operation

(Next) There's another complication called "capsular contracture".

(Next) This means the body is rejecting the implants.

(Next) What you need to know is that 1 in 20 women develops capsular contracture.

(Next) Another problem, a relatively new one: it's a type of cancer caused by breast implants.

(Next) People think implants cannot cause breast cancer. That's true. But this is not breast cancer.

(Next) We're talking about a reaction of the scar surrounding the implant,

(Next) which is called Anaplastic Large Cell Lymphoma. It's a very rare condition.

(Next) There are only 359 known cases out of more than 15 million patients around the world.

(Next) But I must bring it up because it represents a severe risk.