Chandra Maben
Episode 6

Breast Augmentation Journey

Chandra Maben

This episode includes topics about

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

Learn more about Dr. Sajan’s plastic surgery at

Transcription pending. Check back soon!


Dr. Javad Sajan  00:01

Ever wondered 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 Maybin other plastic surgeon podcast. 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 motivation so 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 going? It's good. So we met about two years ago, right? Yeah. 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 for 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 wanted them done since I could look up surgeons in a phone book. So I've just always have one to have that and then after having my son and then aging, it was time.

Dr. Javad Sajan  01:44

When you see what was one of 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 concepts. 

Chandra Maben  02:13


Dr. Javad Sajan  02:13

When you were having this console, what were you thinking about as far as what's important to you?

Chandra Maben  02:19

I wanted it 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 when they say they want to get larger, someone, some woman will say I'm doing this because I want to be more noticed. I want to feel more feminine among clothes to fit. I know you told me You are 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 read I did a extensive research and everyone had been saying like, they wish they 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 Best mom. And so you could search your areas. So I saw real people's results on there. And then I went on. There was another website. Sure something with reviews. Yeah, it was like real people posting about their experience. They would post pictures of their before and afters and just talking to people who I knew personally. And I had gone. I had a friend who worked at a 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 there 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? Yes. Tell me a little bit about what they were recommending.

Chandra Maben  04:36

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 cop, which I don't I'm not sure which ones which the cosmetic surgeon or plastic surgeon. Sure. 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.

Dr. Javad Sajan  05:10

Um, it did you do sizing with you and help you figure out what sorry, yeah,

Chandra Maben  05:14

kind of he just needed the over like the, like the implants in the bra. Got it 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 saying really small and low profile, okay. 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. And the second one also said that that was a potential but the third one was more on that page that I would need to lift but he was so unsure that he told me he would size me and determine if I needed a lift while I was under So he anesthesia

Dr. Javad Sajan  06:01

really so he was basically gonna cut you up a new lift it without you really knowing you were Yes.

Chandra Maben  06:07

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. We can't believe somebody contemporary who does

Dr. Javad Sajan  06:25

breast augmentation would ever say that.

Chandra Maben  06:27

I know it was kind of crazy the person I know that referred me there's already looking to get them redone. So I'm really glad I didn't have a complication

Dr. Javad Sajan  06:35

with them.


They're just really far, far, far apart. Yeah.

Dr. Javad Sajan  06:40



No cleavage. Yeah. 

Dr. Javad Sajan  06:42

I've never met a patient who's told me don't get me cleavage,

Chandra Maben  06:45

Right. No. That's what you go for.

Dr. Javad Sajan  06:49

Exactly. And then you ended up coming to me? Yeah. And I think I was the only doctor you met who does gummy bear implants. Is that right or did the other guy.

Chandra Maben  06:56

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 from the console, we talked about doing those anatomical gummies. Yes. We talked about growing under the muscle. Yes. And there's different kinds of implants. They're saline, so regular silicone and gummy bear. There's different kinds of gummies there's round and then they're 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. Whereas when I can just do an implant, I can make a small approximately five centimeter incision along the breast fold. Yes, and that's what you wanna you do want all those left scars, right?

Chandra Maben  07:55

Yes, at least not right now. If I had down the road, it was necessity. That was be, we would reach it at that point but

Dr. Javad Sajan  08:03

and then we look at sizing. I remember you told me you wanted a full size. Yes. So we we looked at different implants together. I mean, I measured you looked at sizing and we want with 620 cc's. Yes. 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 begin plans, I, 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 I can do research and you can meet different people and figure out who's the best fit for you. Because back in the day in the phonebook days, you'd have two or three options. Yeah. Now you got about 60 in Seattle,

Chandra Maben  09:09

Well and I just felt like I wanted to go with a 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're 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 all day long, this is what I can do. So

Dr. Javad Sajan  09:32

So what about the console made you comfortable with me?

Chandra Maben  09:35

You are just very straightforward 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 when we saw you're an admin, I reviewed your case certainly before this because it was two years ago. One of the concerns I had was you there was a little bit of Towcester sagging right. I know normally happens with pregnancy. So So I recommended the anatomical to give you the lifted look. The other reason I like 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 620s under the muscle and our implants can be placed to places above and below you did some research on that before, and we decided below. And the reason we decided below the muscle was because there's rest less risk of capsular contracture. They sag less, they I feel they give a much more natural look and you get a gentle slope that falls on the breast. Then you decided to have surgery based on our console. And what and then surgery Came How are you feeling?

Chandra Maben  11:02

I was I was always a little nervous about anesthesia. That was kind of the reason why I waited so long. And just talking to people are like you can get in your car and you have more risk, like getting in a car crash. I was like, okay, I've 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

Do you have a partner or someone in your life at this time? 

Chandra Maben  11:27

I did. Yeah. 

Dr. Javad Sajan  11:27

Okay. And what was what was the relation to that person?

Chandra Maben  11:30

Um, he was my fiance at the time.

Dr. Javad Sajan  11:32

Yeah. And you, you might have asked her a couple questions about that. Sure. How did he feel about you getting implants?

Chandra Maben  11:38

Um, 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  11:51

Why do you say that?


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, ecstatic 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. Yeah.

Dr. Javad Sajan  12:20

So he was he happy to take care of you after surgery and take you to surgery and all that kind of thing.

Chandra Maben  12:25

Yeah, he did all that. And then he took care of my son too, during that time.

Dr. Javad Sajan  12:29

So Judy came, we did the surgery took about an hour ish to do. You had recovery went really well. After surgery. How was the pain?

Chandra Maben  12:37

Um, initially, it was, it was different than I thought it was gonna be. I didn't realize how much my arms were gonna be affected, but it wasn't too bad. And then the morning boob. I didn't really know about

Dr. Javad Sajan  12:53

that. Tell us tell us what morning brew beds.

Chandra Maben  12:56

It's like you wake up and they're so steamy and Sleeping on my side because I'm a side sleeper i think is what made it worse. So I ended up pillowing 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 op and 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. Really? Yeah. But then everything settled in it's they're definitely not too small but at the time I was like

Dr. Javad Sajan  13:33

wow, why did you feel there? were too small What about it and you feel it in the fit or what what what was there something specific

Chandra Maben  13:40

I think it just because everything was so tight at the time and there was like No, like, 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 because

Dr. Javad Sajan  13:53

and when we 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 400 cc's 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 surgery is to measure the chest and then measure the implants on the chest with you with a bra in determine what look you like. And what you like the most with the bra. I found statistically, is the highest predictor of your happiness. So then over the next few months, the implant settled and you got a more natural look as I dropped Is that right? Yeah. 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 brows that fix that's already a struggle, but

Dr. Javad Sajan  14:50

yeah, and your fiance at the time? Yes, he's still involved.

Chandra Maben  14:55

Um, we're friends. 

Dr. Javad Sajan  14:57

Okay. Got it. How did you respond to your recovery and you having a larger chance.

Chandra Maben  15:03

Then he loved um, he thought that they were like the best he's ever seen. So after surgery, yeah. Yeah, he was like, Okay, these aren't bad implants. And then what happened?

Dr. Javad Sajan  15:14

What do you mean? Oh, do you mind sharing with us? Why you guys are friends now?

Chandra Maben  15:19

Um, well, that was just we were supposed to get married and then and then we didn't. And so now we're friendly.

Dr. Javad Sajan  15:28

You know, I don't

Chandra Maben  15:29

really know the whole answers to that.

Dr. Javad Sajan  15:33

Okay. What was it one of your decisions? Are you guys both sort of reach 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? Or woman? Not

Chandra Maben  15:54

really. I feel like when I'm out like at work and stuff, I'm pretty modest in what I wear. 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 I nobody noticed

Dr. Javad Sajan  16:19

no one noticed.

Chandra Maben  16:20

No because I think just because I kept them head in. Now they notice cuz I wear v necks and things but it took it took a while 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

Oh, I think, I don't remember if anybody noticed or eventually just told them I know on Christmas we I think it was Christmas when everyone found out because I wish 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, this is our whole big. If anything, they're gonna go backwards. I still never told my dad. He doesn't know. Yeah, I mean, he might, but he's never good as asked me. Yeah. Yeah. Like, that's not a conversation we need to have.

Dr. Javad Sajan  17:25

And so our listeners know. Yeah, you work as a hairstylist, right? Yes. And you got 620s which are, you know, larger implants that you know, the average person with me gets around 400 ish. You feel that your neck and back hurt at all from that is 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. Yeah. Do you think people notice more now?

Chandra Maben  18:03

I mean, they might they just don't say everything. I know I've had comments on pictures on Instagram because I'm more Instagrams, like my more like, open social media. And I've had people private message me asking me if I've had them done. But this is like us men or women are usually girls. Yeah, women. And they have had them done. Typically they have had them done. Also, if they're asking

Dr. Javad Sajan  18:30

why did they ask you that? I don't know. Did 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, years out? No, you're almost two years out. How do you feel not? Do you feel more confident?

Chandra Maben  18:54

Yes, definitely. In what way? I just feel like if like it makes my body makes 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 by 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

Do you have you had to change the kinds of clothes you buy?

Chandra Maben  19:25

Um, a little bit like, I mean, because I was a lot smaller before. So like, fitted tops, or peplum tops, things that in retail really, like flare out under looks crazy. Such as just like big and then big. So, like, skirted shirts are not as cute, but actually were more fitted things than I did before because I feel thinner. Mm hmm. Which is cool. Yeah.

Dr. Javad Sajan  19:58

The anyone in your life respond. No positively about this.

Chandra Maben  20:03

I don't think so. Like even my grandma was like, good for you like,

Dr. Javad Sajan  20:08

they're also supportive. That's awesome. That makes it a lot easier. Yeah. Especially with the recovery. A lot of studies have been done looking at how people heal, and people that have positivity in their life with their whatever procedure they get to heal much better and you healed with no complications went very, very smoothly. Aside from having standard pain and discomfort. Yeah, many women have have in your life since then. Since you know your fiancee is your friend now. Have you had other relationships with people?

Chandra Maben  20:35

Um, no.

Dr. Javad Sajan  20:37

still seeing what's out there? Yeah.

Chandra Maben  20:40

Just hanging out.

Dr. Javad Sajan  20:41

Yeah, of course. Why not? What would you if someone was thinking about getting augmentation done? What would you tell them now that 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'm her plastics. Do a concierge, because I will and obviously I always refer him 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 in 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 of it 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  21:36

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 there like chair pillow for my bed. Um, instead of just having a bunch of little pillows I like really the only thing I went on vacation two weeks after to Vegas and it was all fine. Like

Dr. Javad Sajan  21:56

do you think? Yeah, yeah. Do you think having had one procedure done makes you likely to have more done now.


Um, I don't know

Chandra Maben  22:07

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, like surgical procedures, there's nothing that I really feel that I need.

Dr. Javad Sajan  22:20

And I one thing you talked to me about was being worried about the anesthesia. Mm hmm. 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  22:47

And yes, I looked into him. Yes.

Dr. Javad Sajan  22:50

And the middle way is doing something called Twilight where they have an IV 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. It is very hard to go under the muscle. Have you have you ever heard stories about that?

Chandra Maben  23:12

Yeah, when I was because I initially didn't want to do anesthesia and I was like, Oh, I had a kid. I have a high pain tolerance. It's fine. I don't need that. And then I researched more into why Nina anaesthesia and I was like, Okay, fine. Yeah. And like I've also heard that going under the muscle without the anesthesia can it won't relax totally exactly because

Dr. Javad Sajan  23:35

very hard to create the pocket or the space where the implant sits. And so and so that's local for me was like a no go, Twilight is another way. We're Twilight is sort of like wisdom teeth anesthesia, where they give you an IV and they give you usually pro before that white stuff. Michael Jackson died. But so the problem with that is you will know somebody that's like half asleep. When you try I've seen someone do this. So someone in town does that does that way too. What happens is the patient is moving a lot. And so you're trying to put an implant in in a very risky space, which is right above the lungs below the PEC muscle. And if that patient's moving in your 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 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  24:46

and a lot of people telling me that I think I mean vain by doing that 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 boobs or not. He's 11. Like, if you find out I have him, he's probably going to be mortified by 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 your filling done, or they lost a 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 gonna like me saying this, but with breast augmentation in for a woman who's got some deflation after pregnancy or doesn't feel she has a proportionate, proportionate shape. I don't think it's that different from getting an implant versus maybe getting some implant dental implant in or a small procedure because we have it's so safe now.

Chandra Maben  25:52

Yeah. And it's, 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 gonna be life isn't gonna be as good, right? Yeah, yeah, exactly. I think the same thing I think many people don't realize this, that when we're doing these surgeries of people sometimes classify them and categorize them as vain as unnecessary as you know, 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?

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, and I didn't tell my family either, but then I been able to share my experience and outlook on things she did end up telling her and everybody's positive. So just having like a Put more positive outlook on just people like trusting the people in your life more is different. And my confidence is different.

Dr. Javad Sajan  27:10

Mm hmm. Why don't you tell your family initially? Are they more conservative?

Chandra Maben  27:14

No, they're not conservative. I they, I was more concerned about them knowing about the money. Because, you know, I'm still the kid, even though I'm 33 years old, in their mind. It's like, oh, you're the child. You shouldn't be spending money on this. XYZ, whatever. There's no leak. I know,

Dr. Javad Sajan  27:33

the way they might have been a little bit judgey.

Chandra Maben  27:36

Yeah. And you're not an actual surgery just more choosing to spend money that way.

Dr. Javad Sajan  27:43

So when you came to me, talking about the costs, in any raster This was my cost more or less the same as other people. I

Chandra Maben  27:50

think they were all relatively the same. Other than when the one who said I might need the lift and that price varies. And I wouldn't know how much I was spending.

Dr. Javad Sajan  28:02

Yeah, that I don't know how you can sign up for something? I

Chandra Maben  28:04

don't know.

Dr. Javad Sajan  28:06

Yeah, no. And that's a really good, good point I want to talk about just for a moment. The question becomes when do you decide if someone needs to left? So a lift is needed if the gland in nipple is very low on the chest? And for me, it's a very black and white answer. Almost always, there are some exceptions or 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 glandon 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 left. People sometimes are really unsure unconfident, I find not always they don't have enough experience and they haven't seen it. done enough, where they can make that call. When you've seen and done hundreds or thousands or 10s of thousands like, like, I need to, 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, why don't you say yes, if you're a noob, you've done five 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 is needed. And I think that that's something patients really have to be cognizant enough. How do you decide if someone has experienced or knows knows what the talking about in the context of hotels you that in sometimes you don't know what's there unless you've experienced a few. And when I have patients often tell them, get three consoles, and then figure out what's the best fit for you. And when I say that almost always end 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. Add on this you know what else is out there?

Chandra Maben  30:02

Yeah, there's there was no way other than just this like, inner feeling of going 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 they just Intel the comparison I was honestly waiting for somebody to agree with each other 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 you that with the competence and it was it was definitely more black and white like this is

Dr. Javad Sajan  30:36

and that's what I needed. Yeah, 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 it doesn't happen, we're great. And that's where it's going to be. And whether we can do it or we cannot. 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  31:11

Yeah. Now, 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 that would have been awful.

Dr. Javad Sajan  31:23

Exactly. And one of the ways that prevented that skin pass, and for a lot of women in this world, I think helped them is, if you if you're borderline like you, if the nipple and gland is after fold and you have borderline toeses 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 Lord 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 normally do 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 gonna do is put an implant in lift the nipple, or put an implant in if it's not saggy, but they're borderline patient is the one that's hardest to manage. And a lot of women are in that position. Yeah. Your Your friend is having surgery is hers is an implant with the lift or just an implant.

Chandra Maben  32:15

So hers, she might need to lift on one side, but he doesn't do them at the same time.

Dr. Javad Sajan  32:21

Oh, really.

Chandra Maben  32:22

So he's doing she's doing over the muscle. Which I, I haven't met any of my 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 there's a lot of doctors some of them do believe above the muscles a technique. That is not my favorite technique for these reason. 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, or 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 goes 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, there 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 get that hard capsule. Now the reason we think that is and women who've had contractures they've cultured DHA capsule in the lab and they've gone bacteria. So going above the muscle exposes the implant oftentimes to the mammary or breast tissue and is ducks and all that in And we think there's bacteria that can see the implant. Okay. Does that make sense? Yeah. So that's why the other reason is for some reason, you know, women, some women just reject the implants. So that 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 is skin do all skin in life sex. So going below the muscle gives you that internal brow, if you will, that holds it up. The other reason it's not my favorite technique is above the muscle, you will see rippling almost always, because there's not much covered. 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 lines right over here, around the side of the breast. Good. Any other insight you want to share with anyone chandrababu who's thinking about having surgery or their experience? I would tell them the one most important thing you think,

Chandra Maben  35:03

Said. Hmm, I feel like probably the console's 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 have to take no for an answer, but don't take no without doing some research and having some consults. And that that really, really helps a lot of people. So, Shonda, thank you so much for being our guest today. I've learned a lot from you and your experience, and I hope your deal 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 and next week, and catch us on all social media at real doctor Seattle. Sam

Episode 5

Episode 7