Question 1

What happens to breast implant visibility after significant weight loss?

Accepted Answer

Losing a lot of weight can make breast implants more visible, which is more common than many realize. This occurs because the breast is composed of fatty and breast tissue; when fatty tissue shrinks with weight loss, there's less coverage over the implant. This can be particularly noticeable in very thin women or those with little natural breast tissue. It's a normal body change, and there are options to discuss if this occurs.

Question 2

What is Dr. Killeen's approach to breast cancer risk and prevention?

Accepted Answer

Dr. Killeen emphasizes that knowing your family history and understanding genetic risk is crucial for breast cancer prevention. She notes that BRCA1 and BRCA2 are not the only genes associated with increased risk, and genetic testing can help identify inherited risk. This allows for a more personalized screening and prevention plan. For women with significantly elevated risk, risk-reducing surgery like a prophylactic mastectomy may be an option to discuss, as more knowledge about risk leads to more protective options for the patient's future.

Question 3

What is symmastia, and how does Dr. Killeen approach its correction?

Accepted Answer

Symmastia is a condition where the breasts connect in the middle, eliminating the distinct cleavage valley. There are two main types: surgically created (a complication of surgery) and naturally occurring. The sternal area is a 'zone of adherence' where skin is aggressively stuck to underlying tissue; if this is disrupted, it's very difficult to restore. Surgically created symmastia typically results from implants being placed too close together and is much easier to fix. However, natural symmastia, often seen in women with large breasts where skin floats over the sternum, is considered by Dr. Killeen to be 'not a fixable problem,' with many attempts failing and reverting within six months. She emphasizes that surgeons must respect natural breast anatomy to avoid causing this difficult-to-correct complication.

Question 4

What is tuberous breast deformity, and what is Dr. Killeen's approach to insurance coverage for its correction?

Accepted Answer

Tuberous breast is a congenital deformity where a tight ring of tissue causes the breast to grow in a tubular shape, resulting in a narrow, long breast and a wide areola. While there's nothing functionally wrong, Dr. Killeen strongly believes surgery for tuberous breasts should always be covered by insurance. However, insurance coverage is highly inconsistent; some insurers don't cover it at all, while others have specific age qualifications (e.g., 26 or younger). Her practice always attempts to secure insurance coverage, with approximately a 30% success rate. She notes that even if covered initially, insurers often refuse to cover ongoing maintenance or care for implants in these patients, which she considers 'really wrong.' She advises patients with tuberous breasts that it's always worth trying to get insurance coverage, especially if they are young.

Question 5

Which cosmetic procedures does Dr. Killeen advise against or personally avoid, and why?

Accepted Answer

Dr. Killeen strongly advises against several procedures due to high risks, unpredictable outcomes, or aesthetic concerns. She highlights the Brazilian butt lift (BBL) as having the highest death and complication rate, and dislikes the associated 'hero worship culture.' She would never undergo an upper lip lift, citing the visible scar that she believes is not worth the benefit, and the potential for permanent 'weird texture' of the lip. The 'fox brow/fox eye lift' is also on her list, as she finds it looks 'weird' and advises against permanent facial surgery for temporary trends, recommending non-surgical alternatives like makeup. She would also never undergo massive fat grafting to the breast due to higher risks of complications like cysts, fat necrosis, and the potential for a 'dumpier looking breast' lacking structural support. Lastly, she considers thread lifts an 'awful procedure' due to visible thread pull during motion and complications like infections and extrusions. While acknowledging rhinoplasty can be amazing for the right person, she personally would not undergo it due to the year-long swelling and unpredictable scarring.

Question 6

What are typical post-operative care expectations after cosmetic surgery with Dr. Killeen?

Accepted Answer

After cosmetic surgery, it is standard to return to see your plastic surgeon the day following the procedure. Common medications prescribed include a trio like Cipro (though Dr. Killeen usually uses a different antibiotic, Cipro is commonly used), Oxycodone for pain, and Zofran for nausea.

Question 7

What factors does Dr. Killeen consider for teenage breast reduction surgery?

Accepted Answer

When discussing breast reduction with families and teenagers, Dr. Killeen considers several key factors. Primarily, she assesses how long it has been since the teenager's first period and if their breasts are still growing. Studies suggest that two to three years post-menarche, breast size should be relatively stable, making it a suitable time for surgery. However, if breasts are still actively growing, it's generally not the best time. Breast size is also crucial; while an F-cup is different from an M-cup, early intervention may be considered for 'juvenile gigantomastia' where enormous breast size significantly impedes function and clothing. During consultations, she ensures the young woman fully understands the procedure, its risks, and long-term implications, such as the potential inability to breastfeed. It's vital that the patient is fully on board, understands the risks, and is ready to proceed, as this is a complicated and highly individualized decision, acknowledging the significant psychological and physical torment large breasts can cause young people.

Question 8

What specific safety measures does Dr. Killeen employ during liposuction to prevent complications?

Accepted Answer

Dr. Killeen treats liposuction with the same respect as any major plastic surgery, focusing intensely on patient safety. She always places her hand on the patient's stomach to continuously monitor the cannula's position and angle, ensuring it remains superficial and does not enter the abdomen, which could cause intestinal injuries (aneurotomies). She is also vigilant about patient positioning, avoiding angles created by pillows or patient tilt that could lead to dangerous cannula placement. To manage bleeding, she uses tumescent solution containing epinephrine to constrict blood vessels and frequently administers TXA (tranexamic acid) to help with bleeding and bruising. Crucially, ethical surgeons like Dr. Killeen limit the total amount of tissue and fluid removed to 5 liters or less to prevent severe complications such as fatal lidocaine toxicity, dangerous drops in blood count, and fluid shifts that can lead to cardiac arrhythmias or cerebral/pulmonary edema.

Question 9

What are the primary causes of symmastia, beyond just implant placement?

Accepted Answer

Symmastia is a condition where the breasts connect in the middle, eliminating the distinct cleavage valley. There are two main types: surgically created (a complication of surgery) and naturally occurring. The sternal area is a 'zone of adherence' where skin is aggressively stuck to underlying tissue; if this is disrupted, it's very difficult to restore. Surgically created symmastia typically results from implants being placed too close together and is much easier to fix. However, natural symmastia, often seen in women with large breasts where skin floats over the sternum, is considered by Dr. Killeen to be 'not a fixable problem,' with many attempts failing and reverting within six months. She emphasizes that surgeons must respect natural breast anatomy to avoid causing this difficult-to-correct complication.

Question 10

What specific procedures are on your 'would not do' list and why?

Accepted Answer

Dr. Killeen strongly advises against several procedures due to high risks, unpredictable outcomes, or aesthetic concerns. She highlights the Brazilian butt lift (BBL) as having the highest death and complication rate, and dislikes the associated 'hero worship culture.' She would never undergo an upper lip lift, citing the visible scar that she believes is not worth the benefit, and the potential for permanent 'weird texture' of the lip. The 'fox brow/fox eye lift' is also on her list, as she finds it looks 'weird' and advises against permanent facial surgery for temporary trends, recommending non-surgical alternatives like makeup. She would also never undergo massive fat grafting to the breast due to higher risks of complications like cysts, fat necrosis, and the potential for a 'dumpier looking breast' lacking structural support. Lastly, she considers thread lifts an 'awful procedure' due to visible thread pull during motion and complications like infections and extrusions. While acknowledging rhinoplasty can be amazing for the right person, she personally would not undergo it due to the year-long swelling and unpredictable scarring.

Question 11

Can symmastia be fully corrected, and what does the revision process typically involve?

Accepted Answer

Symmastia is a condition where the breasts connect in the middle, eliminating the distinct cleavage valley. There are two main types: surgically created (a complication of surgery) and naturally occurring. The sternal area is a 'zone of adherence' where skin is aggressively stuck to underlying tissue; if this is disrupted, it's very difficult to restore. Surgically created symmastia typically results from implants being placed too close together and is much easier to fix. However, natural symmastia, often seen in women with large breasts where skin floats over the sternum, is considered by Dr. Killeen to be 'not a fixable problem,' with many attempts failing and reverting within six months. She emphasizes that surgeons must respect natural breast anatomy to avoid causing this difficult-to-correct complication.

Question 12

Is tuberous breast deformity always congenital, or can it develop later?

Accepted Answer

Tuberous breast is a congenital deformity where a tight ring of tissue causes the breast to grow in a tubular shape, resulting in a narrow, long breast and a wide areola. While there's nothing functionally wrong, Dr. Killeen strongly believes surgery for tuberous breasts should always be covered by insurance. However, insurance coverage is highly inconsistent; some insurers don't cover it at all, while others have specific age qualifications (e.g., 26 or younger). Her practice always attempts to secure insurance coverage, with approximately a 30% success rate. She notes that even if covered initially, insurers often refuse to cover ongoing maintenance or care for implants in these patients, which she considers 'really wrong.' She advises patients with tuberous breasts that it's always worth trying to get insurance coverage, especially if they are young.

Question 13

What does Dr. Killeen say about their approach?

Accepted Answer

Dr. Kelly Killeen's practice aims to prevent patients from undergoing multiple breast surgeries in a short period after their initial procedure. Dr. Kelly Killeen's practice follows patients closely to prevent finding advanced cancer or prevent cancer development altogether.

Question 14

What does Dr. Killeen say about their techniques?

Accepted Answer

Dr. Kelly Killeen finds that Motiva implants are slightly softer and can lead to less rippling compared to very firm implants like Allergan SCs. During abdominal liposuction, it is important to maintain a specific cannula angle and avoid angles that would place the cannula in the abdomen. Dr. Kelly Killeen's practice considers fat grafting an excellent option for patients with rippling after reconstruction, especially when they already have the most cohesive implant on the market.

Question 15

What does Dr. Killeen say about what they specialize in?

Accepted Answer

Dr. Kelly Killeen, due to her specialization, is trained to identify subtle breast asymmetries.

Question 16

What does Dr. Killeen say about consultations?

Accepted Answer

During consultations for teenage breast reduction, the doctor ensures the young woman fully understands the procedure and its long-term implications, such as the potential inability to breastfeed.

Question 17

What does Dr. Killeen say about safety?

Accepted Answer

The general preference for tissue and fluid removal in liposuction is to keep it to 5 liters or less. So even though it's liposuction and we all know it's a small procedure, to be safe and prevent these complications, it's really important that we take all of these steps and we treat this procedure with as much respect as we treat anything else we do in plastic surgery.

Question 18

What does Dr. Killeen say about recovery?

Accepted Answer

In Dr. Kelly Killeen's experience, most patients do well with one round of fat grafting to cover the implant, but those with a very thin mastectomy flap might require more than one round.

Question 19

What does Dr. Killeen say about cost and consultation fees?

Accepted Answer

I maybe have about a 30% success rate with getting insurance to kick in at all for my tuberous patients.

Question 20

What does Dr. Killeen say about results?

Accepted Answer

Dr. Kelly Killeen informs patients with very high aesthetic standards that they will likely still perceive asymmetries after surgery, though they will be different.

Dr. Kelly Killeen, MD, FACS

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