Dr. Donn Hickman

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« on: November 14, 2008, 03:20:24 AM »
Dear Ms.:

     It was nice meeting you.   While I am most concerned
about your irregular heart beat problem, if you obtain a good clearance from your
Cardiologist ( note or letter) letting him know what procedure and services
you are planning, it would be possible to perform your requested procedure.
I have a few misgivings if the workup is not complete, but it seems you are
just fine and the condition does not limit your activities nor is medication
being recommendation. While not as common as the other arrhythmias and can
require intervention, the Cardiologist will know best.  Since you are
getting in the best possible shape and feel that can reduce your symptoms,
the Cardiologist may wish to follow you along, but if there is clearly no
problem and we have the okay, you may proceed.  This would be for any
surgeon and services you choose.

    You are a good physical candidate for the style 1600 Mentor
saline-filled smooth shelled breast implant augmentation in a range of 350
to 400 cc.  I would reserve the consideration to perhaps go with a slightly
higher profile (Style 2000 Mentor saline implant)  to optimize the larger C
size on your frame, although the template I placed on your chest would
accommodate a more moderate profile style 1600 implant.

   Discussion of Breast Augmentation from our BREAST WEBSITE:

   The Mentor Corporation web site has the implant types and size ranges

   We have covered the material and inherent benefits, precautions,
appropriate clearances, alternatives, options, and potential risks, and
complications of breast surgery with implants. The approach, pocket
placement behind the muscle, and issues surrounding sensation and breast
feeding were discussed as well.  Extended warranties are highly recommended
which is a fee of $125 you submit independently within 30 days after surgery
can help with potential expenses with deflation problems that can occur
under 10 years.

    Check on financing if that is a payment option for you.


Donn Hickman MD, FACS


>      Thank you for your inquiry on breast augmentation.  It is recommended
> that you discuss any plans of elective Cosmetic Surgery with a primary
> care physician or your Cardiologist so you may be cleared for anesthesia.
> If the condition mandates that you take anticoagulants principally
> Coumadin (Warfarin) I believe the risks of surgery are too high to stop
> such medication for the 5-7 days around the time of a Breast Augmentation
> since there can be bleeding around the implants at any time even months
> down the line.
>      It would be helpful to know if you have PAT (paroxysmal atria
> tachycardia), Idiopathic Ventricular Bigeminy,  Idiopathic PVCS,
> arrhythmias which have a drop in pressure where you may pass out (Syncopal
> episodes related to heart arrhythmia),  or conduction problems with Bundle
> of His, WPW Syndrome, etc.   The surgery itself is straightforward and
> standard in the majority of cases, but this history is kindly received as
> it appears you are a responsible person making this choice.
>     We have been performing Breast Augmentations since 1984 and currently
> prefer an approach through the lower edge of the areola, and fashion a
> pocket behind the chest muscles, where we insert moderate profile smooth
> shell saline implants that take on a slight round tear shape over time.
> The softness rate for this approach and with these implants in this
> Practice is over 99%.  While silicone implants are currently available
> since November of 2006, this may be another choice for you.  They cost
> about twice that for saline implants, and do have a higher proclivity for
> firmness and capsular scar formation (11-21% at 4 years).  The recovery is
> 4-5 days before driving, but you can return to work in 6-7 days as a rule.
> The breast will be firm and round at first, then settle in and achieve
> their near final shape and softness at about 6 weeks from surgery.  The
> patients with a tighter chest configuration may see the results at 3
> months or more.
>      The operation takes about an hour or so, and we do prefer a general
> anesthetic, which is provided at a local hospital in your particular
> situation. This will insure that you are properly monitored and watched as
> the operation is conducted and you recover from the anesthetic.
>       Our office will contact you at the number provided. Again  we
> appreciate your email of interest.
> Sincerely,
> Donn M. Hickman MD, FACS
> (videos of before and after and educational features
> as well).