Frequently Asked Questions
General Questions
Breast Augmentation Questions
Breast Reconstruction Questions
Breast Reduction Questions
Blepharoplasty (Eyelid) Questions
BIA-ALCL Question
General Questions
Q: What will my recovery be like after a surgery?
A: Recovery is different for everyone and varies by procedure. Most surgical procedures will need a 1-2 week recovery process and many will require activity restrictions beyond this. You might be out of work for one to two weeks. There will be some discomfort initially, but most patients return to light activities within a few days. The recovery for your specific procedure will be discussed in detail at your consultation.
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Q: Am I a good candidate for surgery?
A: If you are healthy non-smoker, have no underlying illness, and are honest about your expectations, you may be a good candidate for plastic surgery. A consultation with the surgeon is the best way to determine if you are a good candidate.
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Q: How do I start the process?
A: Call us to schedule a consultation. Dr. Bateman will spend time with you to answer your specific questions and determine if your desired procedure is a fit for you. We can be reached at 303-388-1945. Our goal is to make the process as smooth and comfortable as possible.
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Q: Is there financing available?
A: We accept VISA, Mastercard and Discover, but do not offer any financing. In general, Dr. Bateman’s view is that plastic surgery should be done with disposable income, not a second mortgage.
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Q: How long until I can schedule surgery?
A: Once Dr. Bateman has completed your consultation, you can meet with his surgery scheduler to determine your surgery date. Date selection is based upon the amount of time needed for your procedure, operating room availability and your schedule.
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Q: Where does Dr. Bateman perform surgery?
A: Dr. Bateman has privileges at Rose Medical Center, Littleton Adventist, UCHealth Highlands Ranch, and Sky Ridge hospital.
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Q: Does Dr. Bateman accept my insurance?
A: Cosmetic procedures are not covered by insurance, but Dr. Bateman accepts most types of insurance for reconstructive surgery. Please contact our office to inquire about specific carriers.
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Q: Where are you located?
A: The office is located on the Rose Medical Center Campus at: 4700 Hale Parkway, Suite 520 Denver, CO 80220. We are located in the Founder’s Building. View Michael Bateman, MD Office Location Map.
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Q: How much will my procedure cost?
A: Each patient is unique and will require varied surgery times. Once you have met with Dr. Bateman during the consultation, you will receive an individualized surgery quote. All doctor’s fees, anesthesia fees, hospital fees and follow-up care will be included with the cosmetic estimate. For insurance coverage limitations, refer to your individual policy.
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Breast Augmentation Questions
Q: How do I know if I am a candidate?
A: Breast augmentation is primarily an operation to increase volume of the breast, though we do have some ability to change the shape of the breast as well. An ideal candidate has enough breast tissue to cover the implant without risking the implant being palpable or demonstrating any type of wrinkling. In addition, good skin quality and minimal aging or post pregnancy changes associated will typically lend the best results. If changes are present, the addition of a mastopexy (breast lift) may help considerably with final shaping of the breast. We will spend considerable time in the office evaluating your particular breast and chest wall characteristics to help guide you through this process.
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Q: What incision is used?
A: Currently, the most common incision utilized is at the fold of the breast. We will do our best to ensure that this incision stays in the fold once the implant has been placed to minimize its cosmetic effect. An incision around the lower aspect of the areola is also possible in certain circumstances.
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Q: With the sensation of my nipple be affected?
A: Most commonly, a patient will maintain sensitivity of their nipple postoperatively. However, there are patients that will develop heightened or diminished sensitivity with her nipple areolar complex. These changes can be permanent though much more commonly will involve some temporary shooting or burning pains to the nipple as the nerve regenerates.
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Q: What is the difference between a saline and silicone implant?
A: There are 3 main types of implants currently used in a breast augmentation. These include a round saline implant, a round silicone implant, and a shaped silicone implant. A saline implant has a silicone shell and is filled with IV saline. Its main advantage is that a rupture is typically quite obvious with some or even all the saline being resorbed by your body within a couple of days after the rupture. Many patients describe this as developing a “flat tire.” The shell remains in place and eventually will need to be removed surgically. A silicone implant has a very different feel to it than the saline implant which many patients prefer. Its main drawback is that a rupture is often less obvious because silicone is not resorbed by your body. In order to screen for silicone implant ruptures, she will likely need to have periodic MRIs to evaluate the integrity of the implant.
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Q: Will my implants need to be replaced?
A: The short answer is yes. Much harder to answer, however, is over what time course. The old adage of replacing them every 10 years has been replaced by ongoing evaluation both clinically as well as radiologically in the case of silicone implants. Like nearly all other mechanical devices placed within the body, a breast implant will eventually fail requiring removal and replacement as it does not continually repair itself like the rest of the body. We will advise you on the latest data of the best (and easiest) imaging techniques and timing to evaluate the integrity of the implant over time.
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Q: What is capsular contracture?
A: Your body will typically form scar tissue around nearly any foreign device and a breast implant is no different. The lining that your body creates around the implant is called a capsule and is quite normal. A capsular contracture is an abnormal process when the scar tissue can become thicker and create a tighter pocket around the implant. This may even distort or create discomfort associated with the implant. We perform a number of intraoperative maneuvers in order to try to minimize this. Overall, the likelihood of a capsular contracture is quite low and we will discuss it further as we talk about implant choices.
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Q: What is the recovery like?
A: We would typically use a long-acting anesthetic in the operating room to help with pain control for the first few days. With this, most patients require only a few narcotic pills, if any, to adequately control the pain postoperatively. Depending on your job, most patients are able to return to work within just a couple of days. We recommend restricting your lifting and activities considerably for the first 3-4 weeks. If you have a strenuous or physical job, you may need a bit longer to return to work.
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Q: What is a mastopexy?
A: A mastopexy, or breast lift, can help address some of the excess skin or lower breast tissue typically associated with aging or post-pregnancy changes. Often, we might utilize a lift in conjunction with an implant to help control the size AND also the shape of the breast. The implant helps address the volume loss in the upper aspect of the breast, and the lift allows us to address both the nipple height as well as the shape of the lower aspect of the breast. This can result in some additional scarring on the breast, most commonly, the scar pattern includes an incision around the nipple areolar complex as well as a vertical incision down the lower aspect of the breast.
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Breast Reconstruction Questions
Q: What type of reconstruction am I a candidate for?
A: At your initial consultation, we will spend a great deal of time discussing all of your reconstructive options ranging from using tissue expanders and implants, going directly to implant reconstruction, as well as utilizing your own tissue with or without an implant. Ultimately, this will be dependent on both your body type as well as personal preferences. Nearly all of these options involve a series of procedures with very few patients getting away with a “one and done” result.
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Q: Can I save my nipples?
A: This question is answered on an individual basis and the team of your general surgeon, plastic surgeon, and oncologist, will help you determine the best path. Our hope is to preserve the nipple at the time of mastectomy, but the advice of your team, and the blood supply to the nipple during the mastectomy all play a role in ‘sparing’ (keeping) the nipples. In addition, an ideal candidate has good nipple symmetry and manageable aging changes prior to surgery (don’t worry, we’ll assess this at your consult).
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Q: What if I have had or will need radiation?
A: Some of our patients will require radiation as part of their breast cancer treatment, and it can unfortunately have some effects on our reconstructive process. If you have previously undergone a lumpectomy with radiation therapy and now need to proceed with a mastectomy, we may need to consider utilizing your own tissue to help reconstruct the radiated side. Alternatively, if you are proceeding with a mastectomy and reconstruction, but will then require radiation therapy as part of your initial treatment, we will typically recommend proceeding with either a tissue expander or implant initially, but perhaps delaying the next step of your reconstruction until 6 months following completion of your radiation therapy. Unfortunately, radiation does increase both the infection rate and capsular contracture rate associated with implant reconstruction.
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Q: What is the difference between a saline and silicone implant?
A: There are 3 main types of implants currently used for breast reconstruction. These include a round silicone implant, a round saline implant, and a shaped silicone implant. A saline implant has a silicone shell and is filled with IV saline. Its main advantage is that a rupture is typically quite obvious with most or all of the saline being resorbed by your body within a couple of days after the rupture. Many patients describe this is developing a “flat tire.” The shell remains in place and eventually will need to be removed surgically. A silicone implant has a very different and more natural look and feel to it than the saline implant, and most of our patients prefer this option. Its main drawback is that a rupture is often less obvious because silicone is not resorbed by your body. In order to screen for silicone implant ruptures, she will likely need to have a periodic imaging to evaluate the integrity of the implant.
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Q: What is capsular contracture?
A: Your body will form scar tissue around nearly any foreign device and a breast implant is no different. That lining that your body creates around the implant is called a capsule and is quite normal. A capsular contracture is an abnormal process that the scar tissue can become thicker and create a tighter pocket around the implant or even distorting or creating discomfort associated with the implant. Overall, the likelihood of a capsular contracture is really quite low and we will discuss it further as we talk about implant choices. In addition, we perform a number of intraoperative maneuvers in order to try to minimize this.
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Q: What is the recovery like?
A: Following a mastectomy and initial reconstruction, anticipate needing approximately 2-3 weeks off from work, depending on your job. We will also recommend significantly restricting your lifting as well as overall activities during this period. So, if you have a strenuous, physical job, you may need a bit longer to return to work. Typically, the later surgeries in the reconstructive process will have considerably less discomfort and a much faster recovery time.
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Breast Reduction Questions
Q: Am I a candidate for breast reduction?
A: Good candidates for breast reduction include patients with a history of chronic neck, back, or shoulder discomfort despite attempts to relieve the symptoms with exercise, physical therapy, massage, anti-inflammatories, and specialty bras. Many patients will also demonstrate grooving with shoulder straps bra and difficulty with physical activities. Many of these symptoms can be significantly reduced or relieved almost entirely with breast reduction surgery.
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Q: Will my insurance pay for this?
A: During your consultation with us, we’ll formulate a letter to your insurance company describing your current symptoms with attempts to relieve the symptoms. Ultimately, most insurance companies will evaluate these symptoms in the context of both your height and weight as well as our assessment of your anticipated weight removal from each of the breasts. Insurance coverage varies widely by carrier and your specific plan.
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Q: Will my nipples be removed?
A: No. The nipple and areolar complex is repositioned into a more appropriate position based on the new size and shape of the breast. We do maintain the nipple areolar complex on the native breast tissue in order to preserve both the blood supply and nerve supply to the nipple. Although the blood supply to the nipple areolar complex can be affected by the surgery, this happens very rarely. Only in exceedingly rare circumstances is the nipple ever removed and placed back as a nipple graft.
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Q: What will the scars look like?
A: In order to address this skin excess associated with a large breast, we did place additional incisions of the breast itself. Most commonly, the scar pattern includes an incision around the nipple areolar complex as well as a vertical incision down the lower aspect of the breast. Patients with larger breasts or more skin excess will require an additional incision on the lower fold of the breast.
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Q: Will the sensation of my nipple be affected?
A: Most commonly, patient will maintain sensitivity of their nipple postoperatively. Unfortunately, there are patient that will develop heightened or diminished sensitivity with her nipple areolar complex. These changes can be permanent though much more commonly will involve some temporary shooting or burning pains to the nipple as the nerve regenerates.
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Q: Will this affect future mammograms?
A: There is some evidence that the scarring following a breast reduction can lead to some additional calcifications which can be found on mammograms. This can result in additional biopsies. For many patients, we will recommend a preoperative baseline mammogram followed by one approximately 1 year later as a new baseline and then to maintain ongoing screening mammograms based on your physician’s recommendations.
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Q: Will this affect my ability to breast feed?
A: The data varies rather widely in terms of the percentage of patients that are able to breast feed postoperatively. Most studies and our experience suggest that there is some diminished ability to breast feed after a breast reduction surgery.
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Q: What is the recovery like?
A: We generally use a long-acting anesthetic in the operating room to help with pain control for the first few days. With this, most patients require a handful of narcotics to adequately control the pain postoperatively. Depending on what you do for work, most patients are able to return to work within just a week or two. We will restrict your lifting and activities considerably for the first 3-4 weeks. If you have a strenuous or physical job, you may need a bit longer to return to work.
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Blepharoplasty (Eyelid) Questions
Q: How do I know if I am a candidate for an upper lid lift?
A: Upper blepharoplasties (lid lift) will address the excess skin and fat, from the upper eyelids. During your consultation, we will assess the degree of excess skin as well as ptosis (eyelid droop) and overall eye health. This might be surprising to you, but upper blepharoplasties can usually be done in the office with local numbing to the skin, and most patients state the procedure is easier than going to the dentist! The recovery is usually quite quick with minimal pain medications, though there will be some activity restrictions for the first week. Bruising is quite common following this procedure often from the injection of the local anesthetic. If we feel you have significant drooping of the eyelid due to the underlying eyelid muscle, we will typically refer you to an oculoplastic surgeon for ptosis repair which can be performed concurrently.
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Q: How do I know if I am a candidate for lower lid lift?
A: Lower blepharoplasties (lid lift) will address the excess skin and fat as it contours to the upper cheek. This is most frequently performed in the operating room utilizing an incision on the inside of the eyelid to remove the excess fat or reposition the fat which is currently present. If there is significant skin redundancy, this needs to be corrected with an external incision just beneath the lash line or utilizing a laser. We will also assess the laxity of the lower lid, which in some cases will also require tightening in order to adequately support the lid postoperatively. This will most often create some additional swelling as well as likely adding time to the initial recovery and a temporary change to the shape of the eye as it heals. Strict adherence to your postoperative activity restrictions is required for this surgery to minimize the risk of complications.
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BIA-ALCL Question
You may have seen news stories about a rare cancer associated with breast implants. Currently, there are 320 cases of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) worldwide, with 9 deaths attributed to it. For perspective, greater than 800,000 implants are used each year in the U.S. alone, so BIA-ALCL remains an exceedingly rare association. Current estimates approximate a 1 in 300,000 chance of developing BIA-ALCL, although these odds may increase over time as we become more aware of the presentation and more aggressive in our surveillance. For comparison, the risk of developing breast cancer as an American woman is 1 in 8 women, and the likelihood of being struck by lightening over your lifetime is 1 in 13,000.
Since BIA-ALCL is a rather rare disease, information is somewhat slow to develop and we are very much in the early stages of learning about both the disease and its contributing factors. Here is what we have learned from both the published literature and presented material from plastic surgery conferences over the past year (this information is quite fluid so we will attempt to update it periodically as more information becomes available):
- Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) appears to be a variation of a rare T cell lymphoma. At this point, this diagnosis appears to be primarily associated with textured implants, regardless of silicone or saline fill. Alternatively, to date, I am only aware of BIA-ALCL diagnosed cases where a few women have smooth implants at the time of diagnosis, but they previously had a textured tissue expander or implant. Though we certainly do not know why texturing is tied to these cases, there may be some association with the Ralstonia bacteria. Much more needs to be studied before a true cause can be determined, but speculation has been that Ralstonia may create a chronic inflammatory process leaving a local condition vulnerable to developing BIA-ALCL.
- The average time of onset from placement of the implant to presentation of BIA-ALCL is 8 years. Most women have presented with swelling on one side and fluid collecting around the implant (seroma). It is important to note that late-stage seromas are very different from seromas that happen soon after surgery – these post-surgical seromas can be common and are not at all associated with BIA-ALCL. A simple ultrasound can diagnose the late-stage seroma and the fluid can (and should) be tapped with a needle and sent to pathology for further evaluation for a cell membrane protein, CD30. This can confirm the diagnosis of BIA-ALCL. For most patients, the treatment for BIA-ALCL includes removal of the implant, the capsule, and the fluid around the implant. Fortunately, it appears most patients will just require this surgical treatment. But, there is a small number of women who have presented with a rare solid BIA-ALCL mass that may carry a less favorable prognosis.
- You might ask the question, why do we use textured implants anyway? The texturing on the implant can be quite helpful to maintain proper positioning of the implant over time. This can be helpful in cases of thin tissue left behind after a mastectomy, or for patients with very little breast tissue for support during breast augmentation, or for someone with a challenging chest wall shape. Tissue expanders used in the initial stages of breast reconstruction are almost exclusively textured. Also, it is necessary on all tear-drop shaped (“gummy bear”) implants to maintain the proper orientation to prevent them from rotating into an improper position. Texturing is also found on some round implants, used for breast reconstruction or cosmetic augmentation. In certain circumstances, the texturing appears to decrease the risk of capsular contracture.
Q: What do I do from here?
A: What we do know is that BIA-ALCL is very rare, and the prognosis is excellent when the disease is limited to fluid and the surrounding capsule, which is the majority of cases.
Fortunately based on the current data and the rarity of BIA-ALCL, 99.9997% of women with implants will never be affected with this disease. And unless you have unexplained swelling of your breast, fluid around your implant years after your surgery, or a breast mass, the only thing you need to do is follow your normal routines with medical care and follow-up, and stay well-informed from your plastic surgeon, the American Society for Plastic Surgeons, and the FDA. We will include several educational links about this topic.
