01:11:14 GRAPHICS ON SCREEN
Berman & Berman
For Women Only

01:11:18 Female Interviewer VO
How do you feel about women who have breast enhancement surgery?

01:11:18 GRAPHICS ON SCREEN
<obscured> women who have breast enhancement surgery?
Berman & Berman

01:11:23 Female with blue turtleneck OC
Like somebody to have plastic surgery to make them bigger, if that makes them happier, that's completely their choice, and you know, if that makes them much more comfortable with themselves, that's great.

01:11:32 Female with scarf OC
I wouldn't necessarily, wouldn't choose that type of surgery, but I can understand why other people would, and I think it's fine.

01:11:41 Female with black hair OC
I think women who do have implants, they do it for themselves.

01:11:45 Female Interviewer VO
Has a man ever asked you to get breast implants?

01:11:45 GRAPHICS ON SCREEN
<Inaudible> you to get breast implants?
Berman & Berman

01:11:47 Female with blue and white T-shirt OC
Yes. Not, and I think that they weren't really joking, but they were, but they weren't. And I did. I went through the whole phase of, "Oh, my God, should I have them done? Everybody else is." And you see the dangers and you want to do it, but you want to do it.

01:12:00 Female Interviewer VO
How did you feel when a guy asked you?

01:12:00 GRAPHICS ON SCREEN
<Obscured> guy asked you?

01:12:02 Female with blue and white T-shirt OC
Terrible. It's like what, I mean, not only do you feel bad about yourself to begin with, but then he has to ask you that. It's like, okay, you know what, you can just leave now. Don't even, don't even talk to me.

01:12:18 Dr. Laura Berman OC/VO
Our topic, breast and sexuality.

GRAPHICS ON SCREEN
Laura Berman, Ph.D.
Therapist

Now we'll focus on augmentation. It seems like we're bombarded with images of sexy women with large breasts, but what do you do if you don't fit that image, and what do you do if you want to avoid surgery? There are a lot of enhancement options out there, but do they really work? To explain them all to us, from the Encino Outpatient Surgery Center is plastic surgeon Dr. Malcolm Lesavoy. Welcome and thanks for being here. Jennifer…

01:12:42 Dr. Jennifer Berman VO/OC
Hi, and thank you for being here.

01:12:43 Dr. Malcolm Lesavoy VO/OC
Hi, Jennifer.

01:12:44 Dr. Jennifer Berman OC
We work together…

01:12:45 Dr. Malcolm Lesavoy OC
Thank you.

01:12:45 Dr. Jennifer Berman OC/VO
…at UCLA also, so we're really lucky to have him here. I'm just going to show our viewers in our audience some of the quick fixes, and then I want you to talk about, a little bit more, of the dramatic alternatives. So, here we have the curves, which I see infomercials for all about on TV. And these, you can just slide right in under your bra, and they'll give you a little extra boost. And I actually tried them on before the show and they gave, you know, you a have a little bit of a torpedo effect going, but they do feel true to life. There's also the, this is called the gel-bra. And they also have a water bra. I know Victoria Secret makes a water bra, but this is actually a gel bra. And it gives you, probably, what do you think, about a half size, if?

01:13:32 Dr. Malcolm Lesavoy VO/OC
Maybe not quite that.

01:13:33 Dr. Jennifer Berman VO/OC
Maybe not quite? But I think it does lift and push together a little bit more.

01:13:37 Dr. Malcolm Lesavoy VO
Yes.

01:13:38 Dr. Jennifer Berman VO/OC
And we even have for that special effect is the artificial nipples. Actually 29 percent of women have what's called inverted nipples. It can be fixed surgically…

01:13:50 Dr. Malcolm Lesavoy OC
Surgically.

01:13:51 Dr. Jennifer Berman VO/OC
…and non-surgically with these. And if you're just are out for a night on the town. You've brought something with you, this, this contraption. What is that?

01:14:00 Dr. Malcolm Lesavoy OC
Well, this is called the Brava system.

01:14:03 Dr. Jennifer Berman VO
Does it work?

01:14:05 Dr. Malcolm Lesavoy VO/OC
It does work. It really does seems to work…

01:14:07 Dr. Jennifer Berman VO
Can you show us…

GRAPHICS ON SCREEN
Dr. Malcolm Lesavoy
Plastic Surgeon

…how it works?

01:14:09 Dr. Malcolm Lesavoy OC/VO
Yes. Well, I can't show you. But, this is the, this is a dome. And it's made out of an acrylic type of material, and the back part is a silicone gel, so to speak that actually sticks right on to the chest wall. And the breast obviously is inside. These, this tubing fits in like so, and obviously there's two of them. Although this has been used very well for women that have asymmetric breast, where one side hasn't developed as much as the other. And this then is hooked up to a pump, and this pump, we call this the smart box, is hooked up just like so, and a suction is then obtained inside this dome. And it then stretches the breast or vacuums the breast inside this contraption. A specially made bra is, is fitted. And the patient then has to wear this for ten hours a day.

01:15:14 Dr. Jennifer Berman OC
Oh, my goodness.

01:15:15 Dr. Malcolm Lesavoy VO/OC
And it is a major commitment for a minimum of ten to 12 weeks.

01:15:21 Dr. Jennifer Berman OC
And does it, is it painful?

01:15:24 Dr. Malcolm Lesavoy OC/VO
I've never worn it, but the patients, the patients get used to it. Now, the point is, what will the patient expect to gain? And that is about 100 CC's. And I tell patients that they would gain about a half a cup size, maybe three-quarters of a cup size.

01:15:41 Dr. Jennifer Berman VO/OC
We actually have Lisa here. Lisa's…

01:15:43 Dr. Malcolm Lesavoy VO
Oh, Lisa's here, yes.

01:15:44 Dr. Jennifer Berman OC/VO
…one of you patients who's tried the Brava. Did it work for you?

01:15:48 Lisa VO
Yes.

01:15:49 Dr. Jennifer Berman VO
Let's have, you were an A before, and…

01:15:53 Lisa OC
No, I was less than that.

01:15:54 Dr. Jennifer Berman VO
…less than A, and now you're about an A.

01:15:56 Lisa OC
Just about an A, yeah.

01:15:57 Dr. Jennifer Berman VO/OC
And you tolerated this ten-hour a day sucking…

01:16:00 Lisa OC
Oh dear, God, yes.

01:16:01 Dr. Jennifer Berman OC
Yeah?

01:16:02 Lisa OC
No, if someone tells you that your boobs can get bigger, all you have to do is sacrifice ten hours a day for ten weeks…

01:16:08 Dr. Jennifer Berman VO
For ten weeks.

01:16:09 Lisa OC
What the heck, yeah.

01:16:10 Dr. Jennifer Berman VO/OC
What made you choose this versus, undergoing the implants, which we're going to talk about in just a minute?

01:16:16 Lisa OC
For two reasons. One, I didn't want to have major surgery just because I was unhappy with my boob size. And two, I didn't want have to go in and have the implants replaced every five to seven years which I was told would happen.

01:16:31 Dr. Jennifer Berman VO/OC
But you're happy with your results thus far? They look good to me.

01:16:34 Lisa OC
I have results. I wouldn't necessarily say that I'm very happy with the results, but you know, every little bit helps.

01:16:41 Dr. Jennifer Berman VO/OC
Sure. Well, let's move on now into the more invasive options for women that are not satisfied with their breasts. Obviously the breast implants, saline and silicone…

01:16:51 Dr. Malcolm Lesavoy VO/OC
The silicone implant has been shown by many, many studies and is now accepted by every single scientific journal, not to cause disease. It does not cause connective tissue problems, rheumatoid arthritis, lupus, any of those things. But there are mechanical problems with a silicone implant, just like there mechanical problems with the saline implant. One of them is the rippling. The saline implant and the silicone implant both have exactly the same envelope, the same shell, which is a silicone textured or smooth shell. The inside, the only difference is that the inside here is filled with saline, which is like water. The inside of the silicone gel filled implant is filled with a silicone gel.

01:17:42 Dr. Malcolm Lesavoy VO/OC
Absolutely. And in my opinion, and in most everyone's opinions, the silicone gel-filled implants are more natural. Essentially there are three different ways of putting these implants in, either from an incision underneath the crease of the breast, through an incision around the nipple and areola, or through the armpit.

01:18:02 Dr. Jennifer Berman VO/OC
And there is a difference if you put it directly under the skin or directly under the muscle. So, you're going to draw for us?

01:18:08 Dr. Malcolm Lesavoy VO/OC
Yes, and that is, that is…

GRAPHICS ON SCREEN
Berman & Berman
For Women Only

…one thing that is still a little controversial. The whole point is, is that, if here is the breast, and the breast gland, and here are the ribs, like so. And the muscle is like so. So, the muscle only comes down to about the level of the nipple and areola. I personally prefer to the implant in front of the muscle because it gives a much more naturalaugmentation and shape. Some surgeons put it behind the muscle, I'd say maybe 50-50, put it behind the muscle.

01:18:44 Dr. Jennifer Berman VO/OC
What is the advantage of one versus the other?

01:18:46 Dr. Malcolm Lesavoy VO/OC
Well, I personally feel that there's disadvantages to putting it behind the muscle because it gives too much stuff above and for that reason, it gives an artificial appearance. And you can tell who's had an implant and who has not. If you're walking down the beach and you're wearing a nice bikini and somebody says, "Oh, she's had her breasts done." That in my opinion defeats the purpose. There are advantages, however, to having it, one advantage to having it under the muscle and that it tends to decrease the rippling. Because there's more stuff between the implant and the actual breast. But if you have enough breast tissue to begin with, and you're looking for an augmentation, I personally feel that in front of the muscle is much more effective.

01:19:29 Dr. Jennifer Berman VO
Better.

01:19:30 Dr. Malcolm Lesavoy VO/OC
Unfortunately, under the muscle, every time you move your arms, the implants move and…

01:19:34 Dr. Jennifer Berman VO/OC
Or they can protrude out this way like mine do.

01:19:36 Dr. Malcolm Lesavoy VO
Not quite that much.

01:20:37 Dr. Jennifer Berman VO/OC
So, Dr. Lesavoy, we have some before and after shots. Let's take a look. Okay, there's…

01:19:41 Dr. Malcolm Lesavoy VO/OC
This is just a before, and then the next slide. This is just after. And this patient, I mean, in all of my patients, anyhow, I make the incision in the very top part of the armpit. So, it is imperceptible.

01:19:57 Dr. Jennifer Berman VO/OC
Let's take a look at another before. That's about an A.

01:20:01 Dr. Malcolm Lesavoy VO/OC
Yeah, that's an A.

01:20:02 Dr. Jennifer Berman VO
And then after?

01:20:06 Dr. Malcolm Lesavoy VO/OC
It is nice and natural, so there's a nice natural sweep to it. But, every patient is different. So, one can't really judge just from one photograph or picture.

01:20:17 Dr. Jennifer Berman OC/VO
Does anyone in the audience have implants? Okay, there's one. What's your name?

01:20:22 Sharon OC
I'm Sharon.

01:20:22 Dr. Jennifer Berman VO
And you had implants how long ago?

01:20:25 Sharon OC/VO
Actually I had two sets. And my first set I had received in '94, in around there. And they were saline the first time, and I had gone through the armpit, and just last year I had them redone. I had a capsule, like, on one of the bags. And but they were over the muscle and everything you were talking about, which is very similar to what Dr. Lesavoy…

01:20:47 Dr. Jennifer Berman VO
So, you had a capsule, meaning it was hard, one felt really hard…

01:20:50 Sharon VO/OC
There was just like a lump on…

01:20:51 Dr. Jennifer Berman OC
Okay.

01:20:51 Sharon OC
…top of the bag. So…

01:20:53 Dr. Jennifer Berman VO/OC
And do you have saline or silicone?

01:20:55 Sharon VO
The first set was saline, so when I had them redone, I wanted silicone.

01:20:58 Dr. Jennifer Berman VO
You got the silicone.

01:20:59 Sharon OC
Yeah. Because I do a lot of swimsuit modeling, so I stay very lean. And as you're saying, with the rippling, because my skin's so thin, it was just really noticeable, and especially being over the muscle, the whole bag was rippled.

01:21:11 Dr. Jennifer Berman VO/OC
Could you feel it or you could see it?

01:21:13 Sharon VO/OC
I could see it, I could feel it, I could feel like everything, you know. If I just stood still, it was fine, but if I leaned over, it was just all rippled through.

01:21:20 Dr. Jennifer Berman VO
And, but are you happy now? They look great.

01:21:22 Sharon OC
Well, you know what, I'm happier with the silicone. I definitely like it better. The armpit, I have to say, for me, it was so painful.

01:21:29 Dr. Jennifer Berman VO
Really?

01:21:30 Sharon OC/VO
I mean, it's painful anyway. I mean, you know that going in, but the second time I went through the nipple and I went under the muscle this time, which I'm not happy about.

01:21:39 Dr. Jennifer Berman OC
Because?

01:21:40 Sharon VO/OC
Because, as the doctor was saying earlier, they moved, they were more natural over, and most of my girlfriends that are fitness models because they stay so lean were under the muscle and they said, they felt better with it, and the bag didn't move around as much and so forth. But, I…

01:21:56 Dr. Jennifer Berman OC
But, you liked the moving, natural

01:21:58 Sharon VO/OC
Yeah, absolutely.

01:21:59 Dr. Jennifer Berman OC
How long do implants normally last?

01:22:02 Dr. Malcolm Lesavoy OC/VO
Well, they should last forever, and there shouldn't be any reason, necessarily to replace them, except if there are these mechanical problems like you had mentioned. And rippling is one problem, but the rippling can be avoided many times in a saline implant if it's filled properly. And if, if just like any balloon, if you under-fill a balloon, you'll have that rippling in the shell of the balloon. If you overfill it, it's round and hard and that's not what we want, obviously. So…

01:22:28 Dr. Jennifer Berman OC
So, there's a happy medium.

01:22:31 Dr. Malcolm Lesavoy VO
Exactly.

01:22:31 Dr. Jennifer Berman OC/VO
Well, I've got rippling over here, and I don't like it.

01:22:34 Dr. Malcolm Lesavoy OC/VO
Let me give you my…

01:22:35 Dr. Jennifer Berman VO/OC
I'll take it. So, our topic is breast and sexuality, and Dr. Lesavoy has given us the straight scoop on enhancement, but bigger isn't always better. For women who are more, well endowed, the consequences can be painful. So, when we come back, Dr. Lesavoy's going to discuss the latest techniques for reduction.

01:23:00 GRAPHICS ON SCREEN
Berman & Berman
Next Breast reduction
Later Losing a Breast to Cancer

01:23:09 FADE TO BLACK