Episode 6: To Lift or Not To Lift

Special Guest: Megan Parken

Dr. Franco: Welcome to “Plastic Surgery Untold” episode 6, To Lift or Not to Lift. I’m Dr. Johnny Franco, board-certified plastic surgeon, also known @austinplasticsurgeon. And I have the great privilege of our incredibly talented co-hosts here. And so we got one Travis Osborne who killed it on episode 5 if you guys missed it.

Travis: Thank you. Thank you.

Dr. Franco: We got Megan Parken known worldwide just as Megan Parken every time we ask her. And is it ex or is it still current most eligible bachelor in Austin, Gilberto Saenz?

Gilberto: Ex.

Dr. Franco: You seem a little speechless. We’ll get to this.

Gilberto: Yes, that sounds good.

Dr. Franco: So today we’re gonna talk a little bit about something called mastopexy, aug, so basically breast lift and augmentation. And this is sometimes done as part of a mommy makeover or sometimes just done as a standalone procedure. But before we get into the nitty-gritty of today, maybe we catch up on what’s been going on in everybody’s life. I know that we left a little bit of a cliff hanger at episode 5. It rocked the internet much like the Kardashian naked picture that I’m sure you’ve seen in, “Keeping up with the Kardashians,” Megan, as you’ve let us know you’re a legit follower here. But Gilbert dropped a bomb on Austin saying that he has reconnected with an ex.

Travis: I don’t think Austin was ready, to say the truth.

Dr. Franco: It wasn’t, it wasn’t.

Travis: I know I wasn’t.

Dr. Franco: I’ll tell you my DM was blowing up and they’re just like, is there any way you can introduce us to Gilbert? There was thoughts of questions like, is it really that serious?

Travis: I’m sure Megan was just getting hit up left and right. Is he really taken?

Megan: It’s true.

Travis: Is there any chance that I could be the one?

Dr. Franco: So when we just left, it sounded like they had just rekindled unless he was slow playing us. But maybe we can get a little update. What is this still happening? Two is, is this evolving? Three, have you told the parents, because being Mexican like myself, that’s a big deal.

Gilberto: It is a big deal. Yeah. Absolutely.

Dr. Franco: Where are we? So Megan can judge you.

Gilberto: No, we’re still seeing each other. We’re taking it slow, just kind of reconnecting.

Dr. Franco: What does slow mean?

Gilberto: And just kind of getting to know each other again. Because it’s been a while since we broke up.

Dr. Franco: Are you guys living together?

Travis: Slow like a walk or like a bullet train?

Gilberto: I mean, it’s all relative I guess.

Megan: You should enjoy the idea of dating each other again. I mean that’d be fun and kind of, you know, exciting.

Gilberto: Yeah. No, I think it’s important, you know, because so much time went by, you know, three years since we were last together. So it’s kind of just new and fresh again.

Dr. Franco: So what was the last date you guys went on?

Gilberto: We actually recently saw the Conor McGregor fight.

Travis: Nice.

Dr. Franco: Oh wow.

Gilberto: Yeah. She’s a big UFC fan. So we saw the Conor McGregor and Cowboy Cerrone fight.

Dr. Franco: But did you see that at your place?

Gilberto: It was a tossup. We were gonna go out, but ultimately we ended up staying in.

Dr. Franco: So Megan, this seems a lot like a Netflix and chill night. And as a…

Travis: UFC and chill?

Megan: I would have preferred if you had gone out and then came back. But I mean, you know?

Gilberto: It was her choice. I gave her the option.

Dr. Franco: Is this equivalent to Netflix and chill, Hulu and hangout?

Megan: Probably.

Dr. Franco: Disney and dirty.

Travis: UFC and chill? Is that a new hashtag?

Gilberto: I heard one, it was Disney plus and thrust.

Megan: That’s X-rated.

Travis: Oh, my God. Leaving nothing to the imagination.

Dr. Franco: The show was rated for all ages. Okay, well, you’re being a little coy right now, but it sounds like there’s still a little bit in the works here.

Travis: Like I said, we’re taking it slow. We’re kind of just getting to know each other again.

Dr. Franco: Okay. Okay. Megan, what’s going on in your life? Last we last heard it was complicated. Has this gone less complicated, more complicated? What’s going on?

Megan: I’m just on the idea of like, until I find someone that makes my life easier and better, I’m not in any rush.

Dr. Franco: Are you saying that you’re not complicated and actually on the market?

Megan: Well, no, no, no. I think I’m always…

Dr. Franco: Are you on the market, yes or no?

Megan: Am I open to meeting someone new?

Dr. Franco: Are you available?

Megan: Probably not. Like, I don’t know.

Dr. Franco: You’re not?

Megan: I’ve made an entire video about this if you want to check it out.

Dr. Franco: If Mr. Prince Charming walked into your life right now, you’d say I’m off the market.

Megan: Well, the issue with me is it takes a long time to get to the point of realizing that. Like I don’t just like off the bat think someone’s right. Like I wanna really get to know them and dive in deep and like really…

Dr. Franco: Travis, is it just me or is Megan like scared in this question?

Travis: It’s starting to sound like it’s complicated again. It’s complicated 2.0.

Megan: I think I’m complicated, is just the answer, honestly.

Dr. Franco: The door is not closed here, so you don’t wanna say it’s closed, but it’s not wide open.

Megan: Right. Yeah.

Travis: No, I’d say cracked.

Megan: Yeah.

Dr. Franco: So somebody could slide in?

Travis: The door’s cracked. There you go.

Megan: Honestly though, like in the past, like when guys have done the DM slide, like it is hard. That’s a hard move. There’s not much you can do with that that works well, honestly.

Dr. Franco: Let’s see what happens, the next episode we’re doing, I got about 16 accounts. I’m gonna see if I can slide into Megan’s DM. I will let you guys know. I will screenshot. I will send it to Producer Donald. We will see what Megan says.

Megan: I will say responding to a story is like a more like authentic way to get in, in just like a random DM.

Dr. Franco: I appreciate the tip. Okay. I’ll respond to some stories. I got a lot of free time and few thumbs.

Travis: There you go man. You got many things Dr. Franco.

Dr. Franco: Travis, what about you? What’s going on? What’s to do in your life? I wanna ask you about your relationship. You’re married, nothing happens. Boom, boom, boom. Let’s move on to our show.

Travis: That’s it. There we go.

Dr. Franco: Let’s move on to our segment here. Let’s move on to our segment.

Megan: Wait, do you guys have any kids?

Travis: No kids, two dogs. We got a Goldendoodle. It’s like medium size and a Sheepadoodle that we thought was gonna be medium size that is now 90 pounds, he is massive. It’s like owning a small horse.

Megan: Oh wow, so that is a human, yeah.

Dr. Franco: Do you mind sharing the story about how you got this dog? Because this is absolutely hilarious and why I’m not married right now.

Travis: So Mary wanted another dog and I did not. And we got another dog.

Dr. Franco: Boom, boom, boom.

Travis: That is how sometimes marriage is about compromise and also just picking.

Megan: What was your reasoning on not wanting another one?

Travis: I just felt like, you know, we like travel a lot and we’re busy.

Megan: But I feel like then they can be together then they’re not…yeah. Okay, yeah.

Travis: That was her… Do you all like sync up around the world?

Gilberto: I’ve heard this before.

Megan: You like her company, imagine how the dog feels if it has someone to hang out with.

Dr. Franco: You guys have traveled three out of four weekends this month, so that’s three of the four weekends that you’ve had to take now, not one dog, but a small dog and an over this size rather large for a dog to find a home for the weekend.

Travis: You sound as pragmatic as me.

Megan: But if you’re going anyways, you might as well bring the other one, you know, like.

Dr. Franco: Thank you, Mary. And I thought you guys were nemesis. You guys have mended. Like that “Battle Royale,” like this is coming down.

Travis: Y’all haven’t still met and y’all are right on the same page, so hilarious.

Dr. Franco: I can’t wait ’til they meet, but enough for the fun stuff. Should we get down to the dirty? A little Disney and dirty?

Megan: No. We’re not going there today.

Dr. Franco: Okay. Okay. But so today we’re talking about a little bit about mastopexy, augmentation, and hopefully G-Berto will jump in and help me out a little bit as some of you may or may not know, we actually used to operate before he went to the dark side. And so we did a lot of these exact surgeries together, which was fun and made stuff great. And got a second set of eyes to make sure that there was no crooked nipple. So love that.

Travis: What am I, chopped liver over here?

Dr. Franco: But you’re just the man behind the curtain.

Travis: I knew that was coming.

Dr. Franco: The man behind the curtain. He got a taste to be in in the spotlight last episode and he wants back in.

Travis: Oh yeah, I liked it.

Dr. Franco: But so for people who don’t know, breast lift, augmentation is a combination of two things because the augmentation fills breasts, restores the volume that either they lost or never had. The lift reshapes and puts the breasts into a good position. I think, you know, sometimes people think, “Oh, why can’t I just do a bigger implant?” It doesn’t really work like that because then you just got large, saggy breasts. So you really wanna get people into a good spot and get them a shape that they’re gonna love and be able to do it. And a lot of times people just want to look good if they’re not wearing a bra or they’re not. And depending on what kind of clothes they’re wearing.
Most people who get a breast lift or not are one of two things. They’ve either lost a lot of weight, which tends to be some of my younger patients that are overall pretty happy with themselves. They’re also super proud of the progress they’ve made from either a physical weight loss, diet, lifestyle, health change and kind of the breasts fall and just tends to be the kind of a reminder of where they were that they didn’t wanna be anymore.
And that tends to be kind of the story for a lot of my younger patients. Most of my older patients tend to be post children, breastfeeding, those things. Something else that deflates that was in. And obviously there’s no exact timetable, but those are two large categories in that category. I mean, you see a lot of patients as well. I mean, does that feel about right from the patients you see?

Travis: I think so. Your younger ones typically tend to be massive weight loss patients, or not even massive weight loss, even a small change in weight can really affect the shape of a breast. I mean, you’d probably agree with me on that. Then also pregnancy, you know, postpartum patients, breasts change a lot during pregnancy. Maybe you can talk about that a little bit.

Dr. Franco: Oh, for sure. And just so you guys know, Travis is for those of you who haven’t seen all of our other episodes. Travis does anesthesia for probably eight or nine of the top plastic surgeons in Austin. So it’s kind of cool. And that he gets to see a wide variety of the same things in a few different perspectives, in probably a wide variety of patients.

Travis: Absolutely.

Dr. Franco: Megan, you talk to me a little bit because of people’s mindset. I mean, I know you’re engaging with women all the time on your YouTube and trying to build confidence is a big thing and are different parts. And I think plastic surgery is part of that whole mindset, especially for people either if it’s after pregnancy, it’s like, “Hey, I’ve done so much for so many people. Like, it’s time for mama to do something for herself.” I think the weight loss is a very common is…especially here in Austin where people are trying to be a little bit more fit, a little bit healthier. I think it’s super important.

Megan: Definitely. Yeah. And I think honestly also to what you said, and I mean speaking from experience for the younger patients too, I mean, going through adolescence, like you can have weight fluctuations very easily. I mean, people talk about the freshman 15 and then maybe you get out of college, get into a better routine, you end up losing that weight. And I think for even myself, you know, even like 15 pounds can drastically change the way that my breast looked. And so I feel like, you know, it doesn’t have to be a major life thing, but it can be enough to where it’s subtle that you notice it and it’s something that you feel like you can improve upon. And I think ultimately it comes down to your personal views on stuff.

Dr. Franco: And I feel like those tend to be the patients that are happiest after the surgery. People who are doing it for the right reasons. I think if you’re doing this to save a marriage, if you’re doing this to find a boyfriend, if you’re trying to slide into Gilberto’s DMs, I don’t think that this is the way to get there. So just keeping those things in mind and making sure you’re doing stuff.

Megan: And that being said, honestly, like not to be crude or anything, but I feel like a lot of guys, like I’ve never heard guys be like, “Oh, her boobs are too low. I don’t like her.” You know, like that’s never like a thing that people think. I mean, guys are like, “Oh my God, I see boobs. I’m excited,” whatever. I mean…

Dr. Franco: So you’re saying our threshold is very low?

Gilberto: That seems pretty accurate.

Megan: I would say most guys, if they’re interested in women and then seeing boobs, they’d be like, “Oh, awesome boobs.” But I think for you personally, if it has to do like aesthetically with something you wanna wear or, you know, a certain look that you wanna go for, like that can be more towards why it would be personal to you, not for anyone else.

Travis: For sure.

Dr. Franco: In my experience, somebody’s breast is never the deal breaker in a relationship. It may be the excuse that’s given. That ain’t the reason.

Megan: Yeah. But just as the same it’s also not gonna be the solution. I mean, you’re not gonna come in with a new pair of boobs and be like, “Now, everything’s fixed and we have a great relationship.”

Travis: Absolutely.

Dr. Franco: No, no. One of the questions, just so we don’t get completely off topic, but people who says, can we do a breast lift without implants? And yes, you 100% can do a breast lift without implants. That’s super common.

Megan: Would you say that’s like…is it kind of split 50, 50 on if people do that only or how common is which one? I’m curious like when people come in.

Dr. Franco: I would say it varies in people’s practice. I would say in my practice probably 80% of women get an implant with a lift.

Megan: And do you give them also kind of the reasoning on why an implant would enhance or maybe work better for their specific case or?

Dr. Franco: And most of the time I can stand people just in front of the mirror and be like, “Hey, this is the look you’re gonna get with an implant. This is the look you’re gonna get with a lift without an implant,” and people get a good idea.

Megan: That’s important, yeah.

Dr. Franco: I think the people that fall in a little bit of a hard spot is someone who is just really deflated. They’ve lost so much weight or they’ve gotten so deflated because then there’s just not a lot of tissue to work with. So kind of depends what people are going for. But also too, I tell people, just because you put an implant doesn’t mean you have to do something, you know, out of this world crazy. You can do a really small implant. Just add a little bit of volume.

Megan: I think what you touched on is important. I feel like a lot of people, even, I thought this too, oh, if you have, you know, a bit of like deflated in this, can you just add an implant and it lifts it up? That’s not really how that works, but like in your mind I see how people could think that.

Dr. Franco: I think if you have just a tiny, tiny little bit of trying to raise that nipple just the tiniest of bit. I think that it works pretty well, but it’s a very small, it’s very subtle. The problem that a lot of people get into is they’re like, “Oh, I wanna do a big implant so I don’t have to do a lift.” What they end up with is breasts that are way too big. They end up coming back later, getting a lift, switching out the implants and they’ve kind of just been in this phase where they got something they didn’t want or need, trying to avoid…

Megan: They keep, yeah.

Travis: As a placeholder.

Megan: Interesting.

Travis: I think maybe you and Gilberto can talk about this a little bit. What is a mastopexy? Like, what is it? What are we doing? Surgically, how are we actually shaping the breast to change that shape?

Dr. Franco: Yeah. There’s actually three types of lifts that are commonly done. The most common of all the lifts is what’s called a full mastopexy or anchor breast lift. And that goes around the areola down the front and in the crease.

Travis: In the shape of an anchor.

Dr. Franco: In the shape of an anchor. We’ll try and keep stuff simple there.

Travis: For people that can’t see us talking with our hands at home. We have a horrible time doing that.

Dr. Franco: Exactly. And that’s the most common because it gives us the most control over things. You know, we can really shape everything. We can get stuff into a good spot. And then there’s something that we call a vertical. It’s basically it skips the horizontal version underneath the breast. And then there’s a circumareolar, which just goes around the areola. And so that’s, if you think about it, the more incisions, the more control, the more powerful the lift, the lesson incisions, the less powerful, the less control we have. So, you know, they probably go in that order too.

Gilberto: Do you ever have any patients that you kind of have to talk them into a specific type of lift versus…or they come in with the mindset of, you know, I kind of want something that’s just really, really minimal, but you know, I still want the lift. What kind of conversation is that?

Dr. Franco: It’s a great question because we get a lot of people who wanna do just the lift that goes around the areola and try and get them into a good spot, and that’s really, really hard. And so a lot of times we have a talk whether it’s even worth it or not and make sure they know what they’re getting because you got to be careful what you ask for sometimes because sometimes you get it and then you’re gonna be disappointed.

Megan: And that comes down to just like minding people’s expectations. Like if you can say, you know, we can do that, but if you did the other one, it’s gonna be a more powerful if, so you’re gonna be getting maybe two different outcomes.

Dr. Franco: Right. No question. And definitely spending a lot of time of where they’re gonna be. And then there’s a lot of factors because depending on the implant size, may dictate a little bit of the lift and so forth like that. So I think it’s a little bit of complicated, and this is where getting to a plastic surgeon and someone that you really know is gonna help guide you into a good spot here.

Megan: And with the different types, obviously the scars are different because the incisions are different, right?

Dr. Franco: No question. And so, you know, definitely the different lifts. Some have a little bit more incisions than others. And I think the amount of incision leads to how much recovery, and how much time you have to take off because…

Travis: That was my next question. What is the recovery like? Or could you explain what the recovery is like for a mastopexy aug, or a mastopexy alone or an aug alone?

Dr. Franco: Yeah, let’s talk about, you know, full mastopexy versus breast aug because those are kind of the two extremes there. And so with a breast aug, if we think about it, most people have a three, three-and-a-half centimeter incision underneath their breast. With a full mastopexy, it goes all the way around. And so, we really try and have people as be careful about pushing, pulling, those type of things, because you got to give it a good chance to heal, gotta let this heal as good as possible. So, you know, I think that’s super important.
Most people are off work for about 10 days. Most people need…everybody needs somebody to drive them home the day of because they have general anesthesia. And if you don’t know much about general anesthesia, please refer to episode 5. But needs someone to drive them home, needs somebody to stay with them that night to help them through the process and then go from there. That’s pretty typical for a desk job. Obviously if you’re doing something a little bit more physical, probably need a little bit more time.

Travis: More time.

Dr. Franco: You know, other things that people tend to ask us is, you know, what type of anesthesia? General anesthesia is the most common for breast lifts, especially if we’re putting the implants, which we typically put under the muscle because that helps soften it, it helps us give people a really, really good look about this.

Megan: Would you also say, I feel like from looking on your social media, when you guys are doing the mastopexies, I feel like the comments are popping off on those videos. Like, people are just like really interested in the way that you’re reshaping the breast. And I take a look at those and see they’re always good, but they’re like, people are just kind of shocked at what you can really do and like how all that works.

Dr. Franco: It’s actually pretty amazing what the breast can tolerate. You know, when G-Berto and I used to do these surgeries together, it’s amazing how we could open up the whole breast, reshape things. Also put an implant under the nipple, and that everything just heals.

Gilberto: Everything just feels so nicely. It’s just amazing.

Dr. Franco: There’s also the fun kind of our artistic part because, you know, and any of us who follow our Instagram, and I appreciate you watching, having a celebrity like you follow our Instagram is a little kind of…I’m a little emotional right now. But, you know, because once we get everything set, we’ll actually set people up. We do something that’s called tailor tacking and make sure everybody is even. We play with the sizers, and there’s a lot of times where, you know, if we have a PA such as Gilbert, you know, a lot of times we’ll ask the anesthesia or the nurse in the room to take a look too just kind of the more input you can get, the better off it is.

Travis: Yeah, for sure. People don’t realize like how long we actually sit a patient up, put them down and make a small change, sit them back up, look again, make a small change. When you were talking about tailor tacking for those of us that don’t know exactly what that is, could you explain that or one of you guys explain that.

Gilberto: So from what I recall, it’s when you kind of get the breast ready for the sizer and you kind of…it’s a placeholder in a sense while you’re kind of visualizing and making sure that everything is perfect before you actually do the final suturing.

Dr. Franco: Exactly. Because we wanna be able to play it, so we haven’t committed to anything so we can tighten and we can loosen it, we can take some different stuff. So let’s just tack it right into position before we actually commit to the mastopexy because then you can make it too tight that you can have a problem, not make them tight enough. Sometimes they’re not quite even. And I think this goes to the art of surgery. And sometimes, and you guys know, G probably know better than I do because you’re there all the time. But it’s just sometimes patients’ families get worried when surgery goes a little longer, a little shorter. But they don’t realize, you know, there’s times we sit up the patient once everything’s perfect, it’s like, boom, this is perfect, let’s do it. But if it ain’t, we’ll sit them up as many times as we need to. And I don’t know what our all time record is, but there’s times we’ve sat people up three or four times.

Gilberto: At least, yeah.

Dr. Franco: There’s no reason not to. I mean, we’re there to help them reach their goals and so we’re gonna do whatever we need to to get you into a good spot.

Travis: Absolutely. I think a lot of times women probably are trepidatious about going down the mastopexy route because of scarring, because of what that breast is gonna look like or what they think it’s gonna look like. What do you actually find that your patients say post-op after these, about those scars? About the actual procedure, how do they feel about it? What’s the trade-off like?

Dr. Franco: I’ll tell you, this is probably my favorite procedure of all the things I do, even though we’re probably most well known for butts. I would say this is probably my favorite just because it’s such a big transformation in people’s lives. One, most people that get a breast lift and aug have thought about this for a long time. Most people that fall into this category, and there’s some people that just have had large breasts, have just fallen and that’s obviously a category, but the two most common by far is people who’ve either lost a lot of weight from a hard work of lifestyle changes or have had kids and deflated. So, both of those groups have paid their dues and at this point finally doing something for themselves. So they just, they’ve thought about it for so long, they finally get to it. They tend to be so happy. And so there is a little bit of TLC that takes and letting everything heal and they look a little weird at first because they’re overly high and tight and then slowly settle in into place.

Travis: That’s awesome. From like a skincare perspective, what can people do to minimize the appearance of scars, or is there anything that they can do to minimize that?

Dr. Franco: It’s funny, a lot of times I’ll actually send people who wanna do a little extra things to one of my derma colleagues or G-Berto himself because there’s a lot of scar treatment mentioned, some lasers, some other things people can do to make them as good as possible.

Gilberto: Absolutely. So from our perspective, from what I do in terms of, you know, helping a scar look better, there’s a lot of different products out there that are really great. One of the more commonly used products that we recommend for scar appearance is like a silicone-based gel, which basically just over time, you know, using it over and over again helps kind of minimize the appearance of that scar. But depending on the type of scar, you know, there’s other things that can be done. Just like Dr. Franco mentioned, there’s different lasers that can be used to kind of minimize some of the redness that comes from like just natural…the healing process, other lasers that can actually minimize the appearance of the scar itself. But I can’t say that I can ever make the scar go away 100% and make it look like it was never there, because I mean, it’s always gonna be there to some degree.

Travis: But a small price to pay to have your breast finally in the shape that you want.

Gilberto: Yeah. And the confidence that you gain from that, it’s gotta be just, you know, incredible.

Travis: I’m sure.

Dr. Franco: And I think being super upfront with people about that, because people say, “Oh, how long is it gonna take for my incision to completely go away?” It’s like, nope, will never completely go away. But a lot of people get to a really, really faint spot where they’re super happy about. And I always tell my patients, and this may not be true for everybody, but the most very few people are gonna see you completely naked. You know? And that’s gonna be a handful of people. But in looking good in clothes, feeling good in the clothes that you’re gonna wear, wearing a dress, you know, that maybe you don’t wear a bra. That’s something that you’re gonna do quite often.

Megan: Right. And I think for a lot of women also the trade-off of, you know, having a small scar, but having the shape that you want and the look that you want, it might be worth it in the end. So it’s a good thing to think about.

Travis: Absolutely, yeah. For sure.

Dr. Franco: I think some just important take home stuff from a breast lift and augmentation is, is one, don’t fall into the trap that just doing a huge implant is gonna be a supplement for a lift. I think also too, if you’re trying to, and I think G-Berto brought this up about the different types of lifts and what people come in looking for is really talk to your plastic surgeons, get more than one opinion. I think it’s super helpful, but you know, if everybody’s recommending something it’s probably for a reason. I’ve seen so many of my revisions where people went and they got recommended something and they kept going and going until they find somebody that did what they wanted. And at some point if everybody’s recommending the same thing, it’s probably, you know, worthwhile.
And so just think about that. You don’t wanna do something, not get the results you want. And then a year-and-a-half, two years later you’re coming back again and now you feel like you’ve wasted all that time, money, effort. Because think about it. It’s not just the money that you pay, but it’s everything else. It’s the time off work. It’s the loved ones who’s helping taking care of you. If you have kids, finding grandma or somebody to help take care of those. So I think it’s super important.

Megan: And when people are coming in for revisions, are they coming from a different doctor and then having you do something different or how does that…like, can you change the way someone’s scar looks or the way someone’s mastopexy worked out? Or how does that work?

Dr. Franco: I wish I could say that 100% of my breast revisions were somebody else’s. So two points to that, one, you know, do I revise some of my own breast lifts? A hundred percent. You know, unfortunately I think it’s far…

Travis: Not 100% of…

Dr. Franco: Not 100% of them.

Megan: And is that a matter of people wanting more of a lift, like what would be a reason for…?

Dr. Franco: All sorts of things. You know, some things that you just can’t control is how the body’s gonna heal, how things are gonna set, you know. But we wanna get people through that one way or another. I think, you know, in some revision stuff for things, there’s definitely people who got lifts, got augs, something, and then are back 10, 15 years later and they wanna go bigger, they wanna go tighter. We do a lot of internal bras for people whose implants fall off to the side. A lot of people that have saline implants wanna switch them to the new gels, gummy bear implants. And so we do a lot of different implants.
And that’s one of the kinds of cool things about the breast lift and aug, is we talked a little bit about in our breast implants section, but there’s so many different implants, and just because you’re doing a lift, you still get a good choice and we could still try on implants. We can still find a good fit. Definitely get reined in a little bit more in terms of the size of the implant to be able to use.

Travis: When you’re doing it with the mastopexy.

Dr. Franco: When you’re with the mastopexy.

Megan: And why is that?

Dr. Franco: You gotta protect the nipple.

Megan: Oh, okay.

Dr. Franco: If you think about…it’s interesting, this is…well, thanks. This is a good one, Megan, and that’s what we’re gonna say. You know, it’s all about the nipple. And so if people had a uniboob, surgery for breast would be so much easier because, one, you’re not trying to match them. Two, if you think about it, blood supply has got to come to that nipple from somewhere.

Travis: Right. It’s gotta come from somewhere.

Dr. Franco: And when you think about a breast lift, aug, you’re doing two competing things. You’re decreasing the skin envelope, but you’re increasing the volume.

Travis: So you’re making the package smaller, but you’re stuffing more in it.

Dr. Franco: There’s so many things I wanna say.

Travis: Oh man, walked into that one.

Dr. Franco: But again, this is a family show and Producer Donald already shaking his head in shame at us. But the other part about this is you’re cutting the skin around the nipple and then we put the implant, we’re putting it under the muscle. So you can’t cut, take too much around, and then put the pressure underneath. So you just really have to be safe. And I tell patients sometimes there’s patients who want really large implants and I think you’ve been a part of these. And I know you’ve done some of these with me where we’ll do an augmentation, get them to a size they wanna be, come back three months later and do the lift, and again, goes to just having a frank conversation with people like, what’s our end goal. What are we trying to get to?

Gilberto: Yeah, exactly. I’m sorry, I lost my train of thought there, but yeah, I couldn’t agree more. I think it’s just…

Dr. Franco: It’s just there are so many good thoughts going through that it’s just like, which great thought do I wanna drop right now? I see. I see where you’re going with that.

Gilberto: But no, I couldn’t agree more. I think it’s talking to the patient, it’s setting their expectations, making sure that, you know, both the surgeon and the patient are on the same page.

Travis: And I know we’ve talked about this, we’ve touched on this at least in maybe every episode that we’ve done. Everything that we do, any of us sitting up here, is about the safety of the patient. If we’re not doing the safest thing possible, we’re not doing the right thing. I think staging a procedure like that, another great example of how can I be as safe as possible? Let’s protect the nipple. Let’s protect the patient. Let’s make sure we have a good result at the end of this.

Dr. Franco: A hundred percent. That’s what I tell our patients. We gotta get you there in the long run. You know, taking shortcuts isn’t gonna help. Any last questions before we wrap up the breast lift, aug segment here.

Megan: I mean, just, I guess to kind of go into like what a lift can do versus people thinking they could just work out or take a pill or do something else to lift their breasts without maybe going under?

Dr. Franco: I actually get that question a lot. What pills can I take to lift my breasts?

Megan: Or, [inaudible 00:28:14].

Dr. Franco: If I could invent a pill that would get rid of the need for a breast lift…

Travis: We’d be on a yacht, dude.

Dr. Franco: …I promise I will invite you all on my yacht. And unfortunately, you know, it’s a great point because I don’t want people out there getting scammed with stuff that just doesn’t work. It just doesn’t make sense. You know, there’s no magic pill. There’s no magic something. I’m 100% for people working out, feeling strength. I push my patients. I think the better physical shape you’re in going into surgery, the better you’re gonna be. And I am sure you would agree with that.

Travis: Anesthesia-wise too, yeah. Healthier patients…

Megan: For the recovery and everything too, quick on your feet.

Travis: Absolutely.

Dr. Franco: I mean, I even think Gilbert would agree the better shape they’re in coming in for their Botox, the better they’re gonna do with their lines.

Travis: One hundred percent.

Megan: That’s interesting.

Gilberto: Could not agree more.

Dr. Franco: I mean, those of you listening can’t tell. He’s trying to nod, but his face is so frozen. We can’t tell if he agrees or disagrees.

Travis: Not a wrinkle on him.

Dr. Franco: You know, but those things don’t work in terms of this. But I do tell people on the flip side, once you’ve done a lift, once you’ve got your breasts into a good shape, maintaining a good healthy lifestyle is super important because if you yo-yo diet and you go up and down 20 pounds, you could be back for another lift. And so that stuff we can’t predict. Also can’t predict if you get a lift when you’re young because you’ve lost a ton of weight and you get into a good spot. If you end up being pregnant, having four kids, I tell people, I don’t know where your breasts are gonna end up. I’ve seen women who’ve had four kids and they still have phenomenal breasts. I’ve seen people who just looked at a baby and their poor nipples fell down, you know. And so, it just really varies from person to person, kind of your overall skin quality.
Well, Megan, I think that was pretty phenomenal. I think we’ll go to…what should we…Producer Donald, what have we got next, fact or fiction?

Megan: Behind the bobby?

Dr. Franco: Behind the bobby. Let’s do behind the bobby.

Megan: We didn’t do it last time.

Travis: I feel like we touched on a little bit of what I was gonna cover behind the bobby this time. Mastopexy, aug, lends itself to perfectly to us sitting patients up. People don’t know that we do that in the back. I mean, if they watch all your Instagram stuff, they do. But we sit patients up every aug, every mastopexy. Are they even? What can we do to change the shape, affect the shape? What can we do better?

Dr. Franco: And you tell me because you’re obviously in different rooms than I am. Most surgeons do, but not every surgeon.

Travis: Not everybody. I would say 75%, 80% of surgeons that I work with routinely sit up their patients. Just look what they look like. Some guys have them pick before they ever start the case. Hey, we’re gonna use 350CC saline implants for this. Okay, cool. And then we do the case.

Megan: I think that’s important because, obviously if you’re laying down flat it’s gonna look different than if you stand or you’re sitting up and like you can see it from that view.

Travis: It’s definitely nice to be able to sit the patient up and look and see, and, hey, on the fly. How many times have you made a change?

Dr. Franco: Especially when people have a significant asymmetry. And you know, I’m a little ashamed to say this, but sometimes my entire car is filled with implants because when people have a real significant, sometimes we have to play with a little bit. A lot of times we’ll lock down. Okay, in the larger breast we’re gonna do a 300. On the smaller breast, we don’t know what we’re gonna be to match it up. And we’ll do sizers, we’ll play with it. And actually had something like that today where we tried a bunch of different sizes until we were super happy.

Megan: And that’s like, you know, obviously TL’s credit, like that’s going to give them the best result possible that you’re taking the time to make sure it’s perfect.

Dr. Franco: But I don’t wanna cast stones on people that don’t, because kind of like anesthesia. There’s a lot of ways to skin a cat. There’s a lot of different ways to do it.

Travis: A thousand ways to do it, for sure.

Dr. Franco: And I think sometimes, because I’ve had some patients who wanted me to do something that I don’t do because they saw something either on Instagram or, you know, maybe heard it on a podcast which would be insane that they’re listening to a podcast that’s not this one, but it’s, you also can’t push people to do things they are not comfortable with. When you get people out of their routine, that’s when people don’t get the results that they do. So if you like the results, if you’re happy with them, then let them do what they wanna do. If you really just don’t feel comfortable with the way they do stuff, their methods, then they’re probably not the right physician for you.

Travis: Could not agree more with that.

Dr. Franco: Well, on that note, maybe we’ll move to a little fact or fiction.

Travis: I like it. Let’s do it. Unless you guys have questions, I’ll roll here. Can we start with one, Megan Parken, since I feel like she skirted the question earlier? This is a fact or fiction only. Fact or fiction, you’re single.

Megan: My definition of single…

Dr. Franco: Fact or fiction is…can we just, for one second. Can we go to Producer Donald just for a rule check? Can we real check this that fact or fiction is only responded with fact or fiction?
Donald: Only fact or fiction.

Dr. Franco: So we’ve gotten the official rules.

Travis: You heard it from the producer.

Megan: I will give fact or fiction, but it might not be accurate, because the question is fraudulent.

Dr. Franco: Fact or fiction, you’re single.

Megan: I’d say fact.

Dr. Franco: Okay. Okay. Just for all you single men out there, it’s been said on the podcast, fact, Megan is single. Fact or fiction to one celebrity, Travis Osborne, and I think we touched base about this a little last time. We’re doing the podcast on a Monday because you’re out of town every weekend in January and half the weekends of February.

Travis: That is fact.

Dr. Franco: Okay. Okay. Just checking in. Fact or fiction, you did or didn’t get surprised with a vacation for your Christmas present.

Travis: Birthday.

Dr. Franco: Birthday, birthday.

Travis: Yes I did.

Dr. Franco: I get all your celebrity trips.

Travis: We still need to make a little tiny Franco so we can take you on vacation with us.

Dr. Franco: We have talked about that. We have talked about that.

Travis: We need to do that. We need to do that.

Gilberto: That’s awesome.

Dr. Franco: Gilbert, fact or fiction, the surgery center doesn’t make gloves big enough for your hands.

Gilberto: That’s a fact.

Dr. Franco: Because you said that it’s just that you feel like, like they’re too tight.

Gilberto: Well, I feel like it was cutting off my circulation at times.

Dr. Franco: You have very delicate fingers.

Travis: It’s the gag.

Gilberto: I feel like we needed to get a special order of size 8 gloves.

Dr. Franco: Fact or fiction, you’ve already told mom about the reconnection.

Gilberto: That’s a fact.

Travis: You’re serious, serious, all right.

Dr. Franco: Megan, I know this isn’t a…we’ll let you off the hook on just a fact or fiction, but we don’t know, let’s do fact or fiction. Fact.

Megan: What? I was off the hook and then I was on the hook.

Travis: You’re back on.

Dr. Franco: Fact or fiction, it’s a big deal when you tell mom about your new love life.

Megan: Easily fact, obviously.

Travis: Obvious fact. There you go.

Dr. Franco: Boom, boom, boom. On that astonishing note, we’ll let the lovely ladies think about whether G-Berto is still Austin’s most eligible bachelor. Do we have a little quote of the day?

Travis: We got a little quote of the day. It is actually an old military saying, I have no idea where this actually came from. But when I was in a rotation at Camp Lejeune, Naval hospital Camp Lejeune, when I was in anesthesia school and they would say, “Slow is smooth, smooth is fast.”

Gilberto: I’ve heard that one before.

Travis: And it didn’t make sense to me until I started doing anesthesia and I was like, “Oh my gosh, the slower and more methodical I am with this, the smoother and faster I become at doing it.” And I thought it was so cool and I was like, that’s a great, great quote.

Dr. Franco: So what’s the last thing that that directly applied to?

Travis: I would say…I mean I always think about it when I’m doing anesthesia. I think like any chaotic situation, if I slow it down and I make it as slow and as smooth as possible, it’s gonna end up being taken care of in a more timely fashion.

Dr. Franco: That’s where the term anesthesia delay came from. Just slow and steady, slow and steady. Megan.

Megan: I don’t connect with that too much. I have to think about how…

Travis: Really?

Megan: Yeah.

Dr. Franco: I feel like the military stuff starts at like 6 a.m., you know…

Travis: Yeah, I know.

Megan: It might not be my…

Travis: She’s just going to sleep at that point.

Dr. Franco: G-Berto? I mean, this could apply to your daily life because…

Travis: There you go.

Dr. Franco: …you have said that you’re taking it slow and steady.

Gilberto: This is true.

Dr. Franco: But this has only been going on three weeks and it’s already on mom. Word on the street is that you guys are living together, you know, we’re gonna save that for next week’s fact or fiction. I don’t wanna leave some teasers.

Megan: I’m saying for the next episode, Johnny needs to be put on the spot.

Travis: I agree with that.

Megan: We’ve all been put on the spot, but I think we all need to flip the script a little bit.

Gilberto: No doubt.

Dr. Franco: And this has been an incredible episode number 6, “To Lift or not to Lift.” I wanna give a shout-out and a special thanks to one Producer Donald, who’s keeping us in track and making sure that Megan stays to the rules of fact or fiction. I wanna give you guys a little heads-up. Episode 7 is actually gonna be about social media and plastic surgery, which I think is an incredibly hot topic. I think the infamous Megan Parken is actually gonna lead us through that. And so stay tuned. Super excited.
Thank you, Donald. Thank you everyone. Appreciate you guys listening to the number one podcast in America, run by us in Austin. Thank you. Boom.

About The Author

Dr. Johnny Franco
Episode 5: The Truth About Going Under!Episode 7: Social Media – Has it Changed the Perception of Beauty


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