This week on the Plastic Surgeon Podcast, Dr. Sajan and his patient, Chandra Maben discuss what motivated her to undergo breast augmentation surgery. She discusses choosing her breast implant size, deciding whether to tell her family or not, and why she picked Dr. Sajan for her breast augmentation.
Subscribe to the Plastic Surgeon Podcast for more plastic surgery stories from real patients and providers. Follow Dr. Sajan and the Plastic Surgeon Podcast on social media @realdrseattle.
To learn more about the Plastic Surgeon Podcast, visit https://www.plasticsurgeonpodcast.com
Learn more about Dr. Sajan’s plastic surgery at https://www.allureesthetic.com
Dr. Javad Sajan 00:01
Ever wonder what motivates people to get plastic surgery? Did they regret it? What can we learn from the stories of plastic surgery patients? We're here to explore the questions and get some answers today with my guest, Chandra Maben, on the plastic surgeon podcast.
Dr. Javad Sajan 00:33
Welcome back and thanks to our listeners for the amazing feedback and responses we've gotten. It's been amazing. We're going to listen to real plastic surgery stories of triumph and pain from real patients and providers to further understand the motivations of why they would risk their life under the knife? I'm Dr. Javad Sajan. Today I have an amazing patient for you. She's going to discuss her journey of breast augmentation. She did her surgery with us about two years ago, and I'm really excited to hear her journey. Chandra, how's it gone?
Chandra Maben 01:07
Dr. Javad Sajan 01:08
So we met about 2 years ago, right?
Chandra Maben 01:09
Dr. Javad Sajan 01:10
And you were thinking about getting a breast augmentation at that time?
Chandra Maben 01:13
Dr. Javad Sajan 01:14
So how do you decide to come to me for surgery?
Chandra Maben 01:17
I hadn't been to, I think, four other surgeons prior to coming to you. I just really wanted to do my due diligence and making sure it was comfortable.
Dr. Javad Sajan 01:27
And why were you thinking of getting breast augmentation?
Chandra Maben 01:30
I have wanted them done since I could look up surgeons in a phone book, so I've just always have wanted to have that. And then after having my son and then aging, it was time.
Dr. Javad Sajan 01:44
When you say you've always wanted them done. A lot of women will often say that sometimes that comes from a particular spot, someone pointed something out or they saw something. What gave you that urge?
Chandra Maben 01:56
I don't really think that there was ever a time where somebody pointed anything out. I came from a family that was all large busted and I was the one who wasn't. And I just, in my mind, that's what I was supposed to look like.
Dr. Javad Sajan 02:11
And you had a few consults when you were having these consults. What were you thinking about as far as what's important to you?
Chandra Maben 02:19
I wanted to be larger for one. I wanted, I guess I didn't want a lift with them. And a lot of those surgeons were saying I needed a lift. And so I was trying to navigate that, to see if there was any options for not having that done. And then I was getting ready. I had just moved out family's house and it was just time.
Dr. Javad Sajan 02:48
Some people, when they say they want to get larger, some women will say I'm doing this because I want to be more noticed. I want to feel more feminine. I want clothes to fit. I know you told me that you were wanting this because you saw this in your family. Tell me more was what is one of those reasons that I said, is that something that stood out to you?
Chandra Maben 03:09
I wanted to fit my body. I feel like I have bigger hips and a really small upper body. And so I wanted to balance that out. And then if I was going to do surgery, I didn’t want to do it twice. And I've read, I did extensive research and everyone had been saying like, they wished they'd gone bigger or they never regretted going bigger.
Dr. Javad Sajan 03:29
Make sense. The journey of getting consults. How did you decide which doctors to go see?
Chandra Maben 03:37
I was on a Facebook group called "Bust Mom". And so you could search your area. So I saw real people's results on there. And then I went on, there was another website.
Dr. Javad Sajan 03:55
Sure something with reviews.
Chandra Maben 03:55
Yeah. It was like real people posting about their experience. And they would post pictures of their before and after’s. And just talking to people who I knew personally. And I had gone, I had a friend who worked at Bellevue Surgeon who I did her hair. So I went to him. I had another person at another Bellevue one. So people I knew personally, and then the experience of searching their before and after pictures.
Dr. Javad Sajan 04:22
Got it. And when you came to me, we talked about gummy bear breast augmentation, and that's what we ended up doing. And we'll talk about that. But before we got there, you saw the other people before me. Right?
Chandra Maben 04:34
Dr. Javad Sajan 04:34
Tell me a little bit about what they were recommending?
Chandra Maben 04:37
Each one recommended something different, which was unsettling. The first person I met with, I realized he didn't have any hospital privileges or any I think he was just a, which I don't, I'm not sure which one's which, the cosmetic surgeon or plastic surgeon, whatever one was like the lower he was that, and that he just was like, "Oh, we'll just do this. And we'll put this in there". And just so nonchalant about everything. And he didn't really have a plan. So that kind of scared me a bit.
Dr. Javad Sajan 05:11
Did he do sizing with you and help you figure out what size?
Chandra Maben 05:14
Yeah. Kind of, he just, he did the over the, like the implants in the bra.
Dr. Javad Sajan 05:21
Chandra Maben 05:22
And didn't do any measuring, didn't do anything. It was just like, yeah, this will be fine. Then I went to another one and they were very adamant on staying really small and low profile. And I was like, I don't, well, that's definitely not what I want to do. And then the third person told me that I might potentially need a lift. The second one also said that that was a potential, but the third one was more on that page that I would need a lift, but he was so unsure that he told me he would size me and determine if I needed to lift while I was under anesthesia.
Dr. Javad Sajan 06:01
Really. So he was basically going to cut you up a new lift without you really knowing you were going to need that.
Chandra Maben 06:06
Yes, and picking the size also would have been under anesthesia. And that just made me really feel uncomfortable. That I, one didn't have a say in it. And then also the fear of like capsule contracture and introducing more bacteria that didn't need to be there.
Dr. Javad Sajan 06:24
I can't believe somebody contemporary, who does breast augmentation would ever say that.
Chandra Maben 06:28
I know it was kind of crazy. The person I know that referred me there, there's already looking to get them redone. So I'm really glad I didn't go there.
Dr. Javad Sajan 06:35
Did she have a complication with them?
Chandra Maben 06:37
They're just really far apart.
Dr. Javad Sajan 06:41
Chandra Maben 06:42
Yeah, no cleavage.
Dr. Javad Sajan 06:43
I've never met a patient who's told me don't give me cleavage.
Chandra Maben 06:45
Right? No, no. That's what you go for.
Dr. Javad Sajan 06:49
Exactly. And then you ended up coming to me and I think I was the only doctor you met, who does gummy bear implants, is that right? Or did the other guys.
Chandra Maben 06:57
I think the other ones did also, but none of them had suggested the anatomical and they were all suggesting different profiles and just, yeah, it was just all, all over the place.
Dr. Javad Sajan 07:10
Yeah. And when you came for the consult, we talked about doing those anatomical gummies and we talked about going under the muscle.
Chandra Maben 07:16
Dr. Javad Sajan 07:17
And there's different kinds of implants through saline, so regular silicone and gummy bear. There's different kinds of gummies, there's round, and then there's shaped. For you I recommended anatomical or teardrop shaped implants. And the reason I recommended those was because we wanted to create a lifted appearance without causing all the lifts and scarring...all the scarring from a lift and the lift scars around the nipple, down on the side, it's that anchor incision. Where as when I can just do an implant, I can make a small, approximately five centimeter incision along the breast fold. And that's what you wanted. You didn't want all of those lifts scars, right?
Chandra Maben 07:55
Yes. At least not right now, if it had down the road, it was necessity. That would be, we would reach it at that point but-
Dr. Javad Sajan 08:03
And then we looked at sizing. I remember you told me you wanted a full size. So we looked at different implants together and I measured you. We looked at sizing and we went with 620cc.
Chandra Maben 08:14
Dr. Javad Sajan 08:14
Why did you want to go that big?
Chandra Maben 08:17
I don't know, I just did. All of the pictures on Instagram. All the people that I was looking at, they were all larger busted and I felt like it fit my body, which I still do think it fits.
Dr. Javad Sajan 08:30
Yeah, absolutely. And when you pick implants, it's so hard because there's no right answer. There's no equation. And that's one of the reasons you got so many different answers from different doctors. I wouldn't sit here and tell you, any of those doctors are wrong. What I would say is everybody has their own way of doing it. And the best way that works for that doctor consistently is what they'll keep recommending. And the good thing about 2020 or 2019, 2018... is you as a patient now can do the research and you can meet different people, and figure out who's the best fit for you. Because back in the day in the phone book days you'd have about two or three options there. Now you've got about 60 in Seattle.
Chandra Maben 09:09
I just felt like I wanted to go with the person that seemed confident in their answer. Even if it was telling me no to something, nobody was telling me no, or yes, or this is what I could do, until, I met with you, you were like, this is what I can do. And I'm confident in that. And I was like, okay, I get that. Especially from a hairstylist standpoint, I tell people that all day long, this is what I can do.
Dr. Javad Sajan 09:32
So what about the console made you comfortable with me?
Chandra Maben 09:35
You were just very straight forward and honest I felt, and you didn't over promise or under promise. It was just, this is the facts and this is what I can do. And that is what I appreciated.
Dr. Javad Sajan 09:47
Thank you. And when I remember, when we saw your anatomy and I read your case, certainly before this, cause it was two years ago. One of the concerns I had was there was a little bit of ptosis or sagging, right? That normally happens with pregnancy. So I recommended the anatomical to give you that lifted look. The other reason I liked that implant for you was I could go big while also decreasing risks. Now, one of the reasons some doctors don't want to go big is because they're harder to do. When you go big. There's a higher risk of the implants falling too low, settling too high, getting an infection and losing an implant. The advantage with my technique and the gummies that I use is I can minimize those risks to very low. They're still there while giving you a shape that's perky and full. So then we went with the six twenties under the muscle and our implants can be placed two places, above and below. You did some research on that before, and we decided below. Now, the reason we decided below the muscle was because there's less risk of capsular contracture. They sag less. They, I feel they give a much more natural look and you've got that gentle slope that falls on the breast. Then you decided to have surgery based on our consult, and then surgery day came. How were you feeling?
Chandra Maben 11:02
I was always a little nervous about anesthesia. That was kind of the reason why I waited so long and just talking to people that are like, you can get in your car and you have more risk, like getting in a car crash. I was like, okay, I wanted this for at least 20 years. Like it's okay. Okay. It's fine. Like, that was the only thing that I was really fearful of.
Dr. Javad Sajan 11:24
Did you have a partner or someone in your life at this time.
Chandra Maben 11:27
I did, yeah.
Dr. Javad Sajan 11:28
Ok, and who was, what was the relation to that person?
Chandra Maben 11:30
He was my fiancé at the time.
Dr. Javad Sajan 11:32
And do you mind if I ask you a couple of questions about that?
Chandra Maben 11:35
Dr. Javad Sajan 11:36
How did he feel about you getting implants?
Chandra Maben 11:38
He was actually at the time, not in favor necessarily, like he wasn't opposed or in favor, he was just kind of like, it's up to you, but in his mind he didn't prefer implants.
Dr. Javad Sajan 11:52
Why do you say that?
Chandra Maben 11:53
He just didn't like the fake look. He likes natural feel and boobs.
Dr. Javad Sajan 12:00
Did he tell you any other reason why he wasn't supportive of it or as supportive or aesthetic about it or excited about it?
Chandra Maben 12:07
No, not really. He was kind of like, just, he's always been that person lives, like whatever you want to do, like, and I'm the type of person that nobody's going to tell me what to do. Yeah.
Dr. Javad Sajan 12:20
So, was he happy to take care of you after surgery and take you to surgery and all that kind of stuff?
Chandra Maben 12:25
Yeah, he did all that. And then he took care of my son too during that time.
Dr. Javad Sajan 12:28
Surgery day came, we did the surgery, took about an hour to do you had recovery went really well. After surgery, how was the pain?
Chandra Maben 12:37
Initially it was different than I thought it was going to be. I didn't realize how much my arms were going to be affected, but it wasn't too bad. And then the morning boob, I didn't really know about that.
Dr. Javad Sajan 12:56
Tell us what morning boob is?
Chandra Maben 12:56
It's like you wake up and they're so stringy in sleeping on my side. Cause I'm a side sleeper I think is what made it worse. So I ended up pillow in between and underneath, and that seemed to help some, but it was such a weird sensation.
Dr. Javad Sajan 13:13
When you came to your first post-up we looked at them in the mirror. What did you think? Did you regret it or were you like, Oh, it's okay.
Chandra Maben 13:20
No, initially I thought they were too small.
Dr. Javad Sajan 13:22
Chandra Maben 13:23
Yeah. But then everything settled and, they're definitely not too small, but at the time I was like, I’d like to be bigger.
Dr. Javad Sajan 13:33
Why did you feel they were too small? What about it? Do you think it fit? Or was there something specific?
Chandra Maben 13:40
I think just because everything was so tight at the time. And there was like, no, like they weren't, I don't know how to explain it. There was no crease or anything. It was just sitting on top. They just didn't see big enough.
Dr. Javad Sajan 13:54
When we, you know, when I size people for breast augmentation, there's multiple formulas. Some people believe you just measure the patient and go by what the book says, and if I would have done that, I wouldn't have done more than 400cc in you. And I would have got you through the operation, but I guarantee you would have been miserable. And you would have been back for a revision. I found the best way for me to gauge happiness or satisfaction after a surgery is to measure the chest and then measure the implants on the chest with you, with a bra and determine what look you like? In what you liked the most with the bra, I found statistically is the highest predictor of your happiness. So then over the few, next few months, the implants settled and you got a more natural look as they dropped. Is that right?
Chandra Maben 14:39
Dr. Javad Sajan 14:40
And how do you think, what do you think about the size now?
Chandra Maben 14:42
Now I think they're good. I think any bigger, I would really struggle finding like, bras that fit, that's already a struggle, but yeah-
Dr. Javad Sajan 14:51
And your fiancé at the time, is he still involved?
Chandra Maben 14:56
Dr. Javad Sajan 14:57
Okay. Got it. How did he respond to your recovery and you having a larger chest?
Chandra Maben 15:04
And he loved them. He thought that they were like the best he's ever seen. So-
Dr. Javad Sajan 15:08
Chandra Maben 15:09
Yeah, he was like, okay, these are better implants.
Dr. Javad Sajan 15:12
And then what happened?
Chandra Maben 15:14
What do you mean?
Dr. Javad Sajan 15:15
Oh, do you mind sharing with us, why you guys are friends now or?
Chandra Maben 15:18
Well, that was just, we were supposed to get married and then we didn't. And so now we're friendly. I don't really know the whole answers to that.
Dr. Javad Sajan 15:32
Okay. Okay. What was it, one of your decisions, are you guys both sort of reached to that conclusion?
Chandra Maben 15:37
It was his decision. Yeah. And then I did not want that. So he has to go, he's doing his own thing.
Dr. Javad Sajan 15:47
After surgery, do you notice that you were getting more attention by men or women?
Chandra Maben 15:53
Not really. I feel like when I'm out, like at work and stuff, I'm pretty modest in what I wear, because I don't want attention from people, especially working so closely to people's faces and stuff. I didn't want that to be especially managing, I didn't want to draw attention in that way. And I honestly didn't tell my family for a few months after, and nobody noticed.
Dr. Javad Sajan 16:19
No one noticed?
Chandra Maben 16:20
No, because I think just cause I kept them hidden. Now they notice because I wear v-necks and things, but it took awhile for me to get comfortable being open with it.
Dr. Javad Sajan 16:33
Do you remember who was the first person that noticed?
Chandra Maben 16:36
I think, I don't remember if anybody noticed or I eventually just told them. I know on Christmas, I think it was Christmas when everyone found out. Cause I was, I think showing my cousin and then she was drinking wine on Christmas and told the entire family. So then they took turns looking.
Dr. Javad Sajan 17:00
Did people make any comments? That weren't nice about it?
Chandra Maben 17:04
No, not really. I think everyone was like way more positive than I expected them to be.
Dr. Javad Sajan 17:08
Were you the first person in your family to have implants placed?
Chandra Maben 17:11
Yeah, because they are all big. If anything, they're going to go backwards and I still never told my dad.
Dr. Javad Sajan 17:18
He doesn't know yet?
Chandra Maben 17:19
I mean, he might but he's never going to ask me. I'm like, that's not a conversation we need to have.
Dr. Javad Sajan 17:26
And, so our listeners know you work as a hairstylist, right?
Chandra Maben 17:30
Dr. Javad Sajan 17:30
And you got six twenties, which are, you know, larger implants that, you know, the average person with me gets around 400ish. Did you feel that your neck and back hurt at all from that as working?
Chandra Maben 17:40
I mean, my neck and back already hurt from working. So I really don't feel like it's increased at all since having them.
Dr. Javad Sajan 17:49
Do they get in the way when you're cutting closely or by someone's face or not too much?
Chandra Maben 17:53
No, not too much.
Dr. Javad Sajan 17:56
Since then you said now you're wearing a little bit more fitted clothes. Do you think people notice more now?
Chandra Maben 18:03
I mean, they might, they just don't say, do you think, I know I've had comments on pictures on Instagram. Cause I'm more, Instagram is like my more like open social media and I've had people private message me asking me if I've had them done, but usually girls yeah, woman. And they have had them done. Typically they have had them done also, if they're asking.
Dr. Javad Sajan 18:30
Why do they ask you that?
Chandra Maben 18:32
I don't know.
Dr. Javad Sajan 18:33
Do you tell them the truth?
Chandra Maben 18:34
Yeah. I'm like such an open book with things like that. It doesn't really bother me to keep other than my dad.
Dr. Javad Sajan 18:44
A lot of patients will often ask me, how am I going to feel after surgery months out or years out? Now you're almost two years out. How do you feel now? Do you feel more confident?
Chandra Maben 18:54
Dr. Javad Sajan 18:56
In what way?
Chandra Maben 18:57
I just feel like, it makes my body make sense now. Like all fits together better. Instead of being like a pair, it's an hourglass, which is what every woman wants to look like.
Dr. Javad Sajan 19:09
When you think back about having the experience or having the surgery done, is there something you think you would do differently?
Chandra Maben 19:17
I don't think so. Maybe sooner, but otherwise, no.
Dr. Javad Sajan 19:22
Have you had to change the kinds of clothes you buy?
Chandra Maben 19:25
A little bit like, I mean, cause I was a lot smaller before. So like fitted tops or peplum tops, things that really like flare out under looks crazy. Cause it's just like big and then big. So like skirted shirts are not as cute, but actually wear more fitted things than I did before. Cause I feel thinner, which is cool.
Dr. Javad Sajan 19:56
Yeah. Did anyone in your life respond? Not positively about this?
Chandra Maben 20:03
I don't think so. Like even my grandma was like good for you. They're all so supportive.
Dr. Javad Sajan 20:09
That's awesome. That makes it a lot easier. Especially with the recovery. A lot of studies have been done looking at how people heal? In people that have positivity in their life, what their, whatever procedure they get to heal much better. And you healed with no complications went very, very smooth. Aside from having standard pain and discomfort that many women have, I mean your life since then since you know, your fiancé is your friend now, have you had other relationships with people?
Chandra Maben 20:35
Dr. Javad Sajan 20:36
Still seeing what's out there?
Chandra Maben 20:38
Yeah. Just hanging out.
Dr. Javad Sajan 20:41
Yeah, Of course. Why not? What would you, if someone was thinking about getting an augmentation done, what would you tell them now in hindsight looking at this experience you've had
Chandra Maben 20:53
I still, I have this conversation a lot with people and I've actually had a friend say that I am her plastic surgery concierge because obviously I always refer them to you, but I still suggest them go meet with other people because I feel like that made it so me so much more sure. And my decision to go with you. Like my friend that it's getting them done next week, she only met with one and that kind of freaks me out a bit because she's just so impulsive, but everybody's different and that's her. And so I definitely would say meet with people and be sure in your decision. And I think that everything I did, I would still do now.
Dr. Javad Sajan 21:35
With the recovery, anything you wish you would have had or done differently with that part of it?
Chandra Maben 21:42
I maybe would have bought a pillow that like chair pillow for my bed instead of just having a bunch of little pillows, I was like, really the only thing I went on vacation two weeks after to Vegas and it was all fine. Like it was good.
Dr. Javad Sajan 21:58
Do you think having had one procedure done makes you likely to have more done now?
Chandra Maben 22:05
I don't know if it makes me more likely if there was something that I wanted that I could afford, I might, but at this particular moment, as far as like surgical procedures, there's nothing that I really feel that I need.
Dr. Javad Sajan 22:20
And one thing you talked to me about was being worried about the anesthesia. And when I do these surgeries, you can do them really three different ways. What I do is general anesthesia, which I feel is the safest. So we have you totally asleep with the breathing tube in your mouth. And that way, you know, we can do the surgery safely without you moving or interacting. The other way of doing it is pure local. Some doctors do that. There's one doctor in this area does that.
Chandra Maben 22:48
Yes, I looked into him.
Dr. Javad Sajan 22:50
Yes. And the middle way is doing something called Twilight where they have an I.V.,- no breathing tube and they're putting the implants in. I've seen it done all three ways. The reason I do it with general is because when you do it under local, it hurts. And the patients usually end up screaming. And it's very hard to go under the muscle. Have you ever heard stories about that?
Chandra Maben 23:12
Yeah, when I was, cause I initially didn't want to do anesthesia and I was like, “Oh, I have had a kid. I have a high pain tolerance. It's fine. I don't need that”. And then I researched more into why you need anesthesia. And I was like, “okay, fine”. And like, I've also heard that going under the muscle without the anesthesia can it won't relax totally.
Dr. Javad Sajan 23:35
Exactly. It becomes very hard to create the pocket or the space where the implant sits. And so that's local for me was like a no-go. Twilight is another way, while Twilight is sort of like wisdom teeth anesthesia, where they give you an I.V. and they give you usually propofol or that white stuff, Michael Jackson died of. But the problem with that is even though somebody that’s like half asleep when you're trying, I've seen someone do this. So someone in town does that way too. What happens is the patient is moving a lot. And so you're trying to put an implant in a very risky space, which is right above the lungs, below the pack muscle. And if that patient's moving in, you're cauterizing, there's a risk, you can get into the lung cavity. So that's why I don't do it. So I did it with general. And that's what, you know, you were scared about that. What were you worried about the general anesthesia?
Chandra Maben 24:23
I don't know, just not waking up, being a mom, having a son take care of like, just a little bit of me was had a little, you know, mom, guilt of, I am risking this for vanity, which I was like, is it worth it or not? But then obviously I chose it was worth it because of the chances being so like the risk being so small.
Dr. Javad Sajan 24:47
And a lot of people tell me that, "Oh, I think I'm a vain by doing this". Do you think I'm being vain? What would you tell women who are thinking that?
Chandra Maben 24:55
I think that your happiness makes you a better mom and a friend and family member. And so if it makes you happy, then do it because I definitely feel like more myself and then me, my son can be closer that way, even though like, obviously he doesn't care if I have boobs or not. He's 11. Like if he finds out I have him, he's probably going to be mortified, but I don't think it makes you a bad mom or a person for doing it now.
Dr. Javad Sajan 25:24
I think, for example, if someone's getting, going to get a filling done or they lost the tooth and they're getting an implant in that is a procedure now that's safe that people do all the time. And I think with breast augmentation and I know some people aren't going to like me saying this, but with breast augmentation, for a woman, who's had some deflation after pregnancy or doesn't feel that she has a proportionate shape. I don't think it's that different from getting an implant versus maybe getting some like implant dental implant in, or a small procedure because we have it so safe now.
Chandra Maben 25:52
Yeah. And it's your confidence that you're walking around with. So you're not going to walk around without a tooth.
Dr. Javad Sajan 25:59
Exactly. You can live without a tooth, but it's not going to be, life isn't going to be as good, right?
Chandra Maben 26:03
Dr. Javad Sajan 26:04
Yeah, exactly. I think the same thing. And I think many people don't realize this, that when we're doing these surgeries, people sometimes classify them and categorize them as vain, as unnecessary as borderline medicine. But they don't know how transformative it is for somebody, you know, it's a one hour surgery, relatively safe, relatively low risk, but it totally changes someone's life, aside from feeling more confidence. Is there anything else that you feel differently about now?
Chandra Maben 26:36
I mean, my outlook on the whole surgery is different. And so when I'm talking to other people and when they're going into it, it's different, like my friend who's doing it next week. She was so scared of what people would think and didn't want her family to know. And I didn't tell my family either, but then I being able to share my experience and outlook on things, she did, end up telling her and everything, but he's positive. So just having like a more positive outlook on just people like trusting the people in your life more is different. And my confidence is different.
Dr. Javad Sajan 27:12
Why didn't you tell your family initially? Are they more conservative?
Chandra Maben 27:15
No, they're not conservative. I was more concerned about them knowing about the money because you know, I'm still a kid, even though I'm 33 years old. In their mind, it's like, “Oh you are the child. You shouldn't be spending money on this X, Y, and Z”, whatever. There are nosy kind of.
Dr. Javad Sajan 27:34
They might've been a little bit judge.
Chandra Maben 27:36
Yeah. Not in the actual surgery, just more choosing to spend money that way.
Dr. Javad Sajan 27:43
So when you came to me and talking about the costs and I never asked you this. Was my cost more, less, or same as other people?
Chandra Maben 27:51
I think they were all relatively the same. Other than when the one who said, I might need the lift and that price varied. And I wouldn't know how much I was spending.
Dr. Javad Sajan 28:02
Yeah. I don't know how you can sign up for something like that?
Chandra Maben 28:04
I don't know either. Yeah, no.
Dr. Javad Sajan 28:08
Yeah. And that's a really good point. I want to talk about just for a moment. The question becomes, when do you decide if someone needs a lift? So a lift is needed. If the gland and nipple is very low on the chest. And for me, it's a very black and white answer. Almost always there are some exceptions to every rule you get in trouble in life where you try to live black and white. But usually it's very easy to know. And the way you know is if the gland and nipple are typically below the breast fold, then not doing a lift is going to give you a deformity. But if they're above the fold or at the fold, then you have a way of doing it, usually not always without a lift. People sometimes are really unsure or unconfident, I find not always, they don't have enough experience and they haven't seen and done enough where they can make that call. When you've seen and done hundreds or thousands or tens of thousands. Like, I need, you know, I care, you know what color you can do, give someone, you know, what style you can usually cut for someone if you've done enough of it, wouldn’t you say?
Chandra Maben 29:17
Dr. Javad Sajan 29:19
Now if you're a newb, you've done 5 or 10, then of course, you're going to teeter totter and you're going to build in every single exception you can to protect yourself so you can work around whatever's needed. And I think that's something patients really have to be cognizant enough. How do you decide if someone has experienced or knows what they're talking about, and the consult is what tells you that. In sometimes you don't know what's unless you've experienced if you, and when I have patients, I'll often tell them, get three consults and then figure out what's the best fit for you. And when I say that, almost always ended up coming to me for various reasons. But having that experience helps you understand what you have or don't have, because sometimes you don't know if that experience is good or bad on this. You know what else is out there?
Chandra Maben 30:02
Yeah. There was no way other than just this like inner feeling of going, and it's not quite right. There was nothing. It wasn't like, I don't know what I'm doing. I'm not a surgeon, but it just, until the comparison, I was honestly waiting for somebody to agree with each other. So to choose because I was like, okay, well, if I get two people who agree on what to do, then that's the right thing to do. But not one said the same thing. It was just then meeting with the competence. And it was definitely more black and white, like this is, and that's what I needed.
Dr. Javad Sajan 30:38
And the reason I felt that way is because I had done many cases similar to yours. So I knew, okay, now every person is different, everybody's unique, or having treated a similar body type and physique. I knew the most likely path that we were going to go in. And that's what gave me the confidence to tell you, Chandra, I feel I can do this. This is what we're going to get. There's some risk of this. If this happens, we'll do this. If this doesn't happen and we're great, and that's what it's going to be. And we either, we can do it or we can not. And that's sort of my philosophy, right? Give you all the information and we figure out what's the right path to go down.
Chandra Maben 31:12
Yeah. And I looking back, if I were to have gone to somebody else with round implants, without a lift, I would have ended up with like a Snoopy nose. And now would have been awful.
Dr. Javad Sajan 31:23
Exactly. And one of the ways I prevented that snoopy-ness and for a lot of women in this will, I think help them is if you're borderline, like you, if the nippling land is after fall, then you have borderline ptosis or sagging. Sometimes in that case, if you use a specific type of implant that can project or push that nipple out and you can put it a little bit lower to push it up, you can give somebody a lift appearance by avoiding that. Now, if you've never done that before, and you go to a doc who all they know did is put an implant in or do a lift. They're not going to be able to give you that nuanced operation. The operation, someone who doesn't know that, what they're going to do is put an implant in lift the nipple. Or put an implant in if it's not sagging. But the borderline patient is the one that's hardest to manage. And a lot of women are in that position.
Chandra Maben 32:10
Dr. Javad Sajan 32:12
Your friend is having surgery as hers is an implant with the lift or just an implant?
Chandra Maben 32:15
So hers, she might need a lift on one side, but he doesn't do them at the same time.
Dr. Javad Sajan 32:21
Chandra Maben 32:22
So she's doing over the muscle, which I haven't met any of them are friends that have done that. But he's hoping with doing different implant sizes that it will correct the difference. And then if not, then she'll go back.
Dr. Javad Sajan 32:39
So above versus below the muscle. So we talked about some of the advantages of going below. Now, a lot of doctors, some of them do believe above the muscles, the technique that it's not my favorite technique for these reasons. Number one, when you go above the muscle, depending on who you ask, there's up to a greater than 20% chance of getting a capsular contraction, a capsular contracture is when you get hardening over the implant. If you remember, we talked about that, that we really don't know exactly why that hardening happens. Whenever you put an implant in the body, you get a capsular shell that grows around the implant. So that shell needs to be nice and soft for some reason. And I'll tell you the prominent theories, in some women that shell becomes really hard and really firm. And when you go above the muscle, it's much more likely than when you go below the muscle usually.
Dr. Javad Sajan 33:33
We think there's usually two reasons that can happen. One reason is bacteria can get on the implant and he causes an inflammatory response. And you've got that hard capsule. The reason we think that is in women, who've had contractures, they've cultured the capsule in the lab and they've growing bacteria. So going above the muscle, exposes the implant oftentimes to the main or your breast tissue and this ducts and all that in there. And we think there's bacteria that can see the implant. Does that make sense?
Chandra Maben 34:04
Dr. Javad Sajan 34:04
So that's why the other reason is for some reason, you know, some women just reject the implants. So in that case, that's what it is. The other reason, it's not my preferred option is I think what I've seen, I think many people will agree is when you go above the muscle, the sagging is much more faster, and much more aggressive because there's no support. What does skin do? All skin in life sags. So going below the muscle gives you that internal bra, if you will, that holds it up. The other reason it's not my favorite technique is above the muscle. You'll see a rippling almost always, because there's not much covering, I don't know if your friend has a lot of breast tissue or not, but--
Chandra Maben 34:41
No, she's super thin.
Dr. Javad Sajan 34:43
Yeah. So in my experience, I've seen that I'm uncomfortable rippling that can happen, especially when someone bends forward, you'll see the lines right over here, around the side of the breast. Good any other insight you want to share with anyone Chandra about who's thinking about having surgery or their experience that you would tell them, the one most important thing you think?
Chandra Maben 35:05
I feel like probably the consults is the most important and research and knowing being open-minded, but also knowing what you want.
Dr. Javad Sajan 35:17
Exactly. And I think sometimes you do have to take no for an answer, but don't take no without doing some research and having some consults. And that really, really helps a lot of people. So Chandra, thank you so much for being our guest today. I've learned a lot from you and your experience, and I hope your ordeal teaches our listeners how and what to expect when they are on their own cosmetic surgery journey? I appreciate you, your story and having you as a patient that we've had the privilege of getting to know over the years. Thanks for listening to the plastic surgeon podcast and tune in next week for my guest, who has an amazing story. We look forward to hearing from you in next week and catch us on all social media @realdoctorseattle.