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Breast Surgery


Dr. James McMahan provides insight on the different types of breast implants used in breast augmentation. Dr. McMahan is a skilled surgeon who works with each individual patient to understand her unique needs and help her determine what type of implants are best for her. Dr. McMahan offers silicone, saline, and “gummy bear” style implants.

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Announcer: Whether you can plan your life around, NBC4, here, for you.

Interviewer: One of the most popular forms of plastic surgery is breast augmentation, and there are many factors to consider when deciding whether or not to have that procedure. Here to help answer some of these questions is Dr. James McMahan, a plastic surgeon with advanced aesthetic and laser surgery. Welcome, Dr. McMahan, nice to have you here.

Dr. McMahan:: Thank you.

Interviewer: And we are going to do something we’ve never really done on this show before and I appreciate. We are actually going to show the different types of breast implants that there are and how they are different and how we’ve come through the last few decades in changes. But before we get to the examples, why would a woman come to you for a breast implant, for an augmentation?

Dr. McMahan:: Basically, there is pretty much two sets of women. The younger ones, coming in their early 20s they realize they’re never going to get to what they wanted to be and a lot of times just for a little more self-confidence, and then you get the group of women, usually in their early 30s or maybe 40s that have had a couple of kids, and with breast feeding they kind of lost what they used to have. So they’d like to kind of get their figure back.

Interviewer: So you give advice to these folks to about everything from the psychological part of this to the physical part of this?

Dr. McMahan:: Absolutely.

Interviewer: And one of the physiological parts is the changes in the breast implants. This is amazing what you brought today. So let’s start with, this is what?

Dr. McMahan:: That’s a saline implant.

Interviewer: And this is what you call one of your older styles?

Dr. McMahan:: Well, they became popular when silicone became controversial in about 1991. So we were pretty much only using saline implants, except for research, from ’91 until about 2007.

Interviewer: And the controversy?

Dr. McMahan:: With the silicone was, can silicone cause immune diseases like rheumatoid arthritis, scleroderma, lupus, fibromyalgia and the studies that have been done looking at the incidents of those diseases with implants and women without implants show they’re exactly the same and that’s why the FDA re-approved silicone. That’s the old one. That’s the pre-1990 implant.

Interviewer: It’s not very firm.

Dr. McMahan:: No, it’s very thin. The shell is very thin, the gel is very thin. So it’s very liquidy.

Interviewer: Yeah, okay.

Dr. McMahan:: Right.

Interviewer: And this is the new, the latest?

Dr. McMahan:: Well, this is the one that was approved in November, 2006. So the shell is thicker, the gel is thicker. So it’s more cohesive, they say.

Interviewer: So you are really going to let us see what’s inside these?

Dr. McMahan:: Absolutely.

Interviewer: Okay. Which one do you want to start with?

Dr. McMahan:: We’ll start with the saline. Now, there is a touch of air in there, and that doesn’t happen when it’s inside of you. So you don’t sound like that, okay?

Interviewer: Like you’ve been in a pool all day long.

Dr. McMahan:: Right, exactly. So what we are going to do is I’m going to hold this up, and you are just going to cut a little slit in the bottom.

Interviewer: Alrighty.

Dr. McMahan:: And I’ll hold it down there, and that is going to all leak out.

Interviewer: Oh boy!

Dr. McMahan:: Uh-huh, I didn’t get you.

Interviewer: But this was what could happen in some women?

Dr. McMahan:: When a saline implant ruptures, this is what happens. So flat tire. Okay, so it’s not …

Interviewer: You certainly know how to use your words. But is it harmful?

Dr. McMahan:: No, not at all. It’s sterile salt solution that we put in there. So you absorb it, it goes away. So it’s not there. You don’t need to do any special test, you pretty much know your saline implant has ruptured, right?

Interviewer: Something’s happened. All right.

Dr. McMahan:: Next we are going to do, I was going to show one more thing.

Interviewer: Okay.

Dr. McMahan:: If you’ll put these two in your hand, and I hold my hands like this, you can see how that one flows out or that one kind of stays. So now what we are going to do is we are going to rupture.

Interviewer: I get to cut this one too?

Dr. McMahan:: Yep, you need to cut that one.

Interviewer: This is going to be some gooey stuff.

Dr. McMahan:: This is going to be, yes. And what happens is …

Interviewer: Oh my!

Dr. McMahan:: It pretty much falls apart.

Interviewer: It’s gelatinous.

Dr. McMahan:: It’s gooey, sticky but it stays pretty much within the scar tissue in the breast. It’s not like it leaks all over the body that people are worried about.

Interviewer: Okay. So that’s good news.

Dr. McMahan:: Yes. So I’m going to take this away.

Interviewer: Alrighty. And as we’re talking about these and showing them, which one do you recommend or does it depend on the woman?

Dr. McMahan:: It really depends. Each one has its advantages, each one has its disadvantages. And you have to look at all of them to decide and that’s actually on my website, saline versus silicone, which is better. And you look at the advantages and disadvantages and decide which one is most important for you.

Interviewer: Okay.

Dr. McMahan:: Now here is the one we’ve been using for last several years, okay, and it’s little thicker, okay.

Interviewer: Nothing is coming out of it, really.

Dr. McMahan:: It’s not pouring. It eventually will but it’s more what we say, cohesive, but it’s still tacky.

Interviewer: And you think that gives the most natural look?

Dr. McMahan:: I think it gives the most natural feel and reduces the risk of rippling, yes. The look for saline and silicone usually is pretty much the same. It’s not a real big difference, okay?

Interviewer: Okay, we have one more example. We have a video tape to show this. So let me take a look at this one too. What’s this?

Dr. McMahan:: This is the new implant by Sientra, which is a brand new implant company and it’s so new I couldn’t even get a sample. But as you see, as you squeeze that, the gel just stays in place.

Interviewer: Nothing comes out, yeah.

Dr. McMahan:: Right and it’s completely cut in half.

Interviewer: Well, we have had your information in your website and phone because this is obviously, as you said, not just a woman’s choice but they need to be advised on what to do and you’re the person to help them out?

Dr. McMahan:: Absolutely, right.

Interviewer: This is fairly interesting. Thank you very much, Dr. McMahan.

Dr. McMahan:: Good. Hope you had fun.

Interviewer: I did.

Dr. McMahan:: Good.


Skin and Laser Treatments


Dr. James McMahan discusses a wide range of anti-aging skin treatments. From the Obagi® skin care products to dermal fillers to laser treatments and microdermabrasion and surgical solutions, patients can select the best treatments for them. Dr. McMahan encourages his patients to choose conservative treatments when possible.

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Interviewer: Most of us want to look as young as we feel. Usually, though, the aging process is working against us. Yet, there are many new techniques to rejuvenate our look and joining me today with a range of options is Dr. James McMahan, a plastic surgeon with advanced with advanced aesthetic and laser surgery. Welcome Dr. McMahan, nice to have you here.

Dr. McMahan: Thank you. Thanks for having me.

Interviewer: There are so many more options today, as they say, less invasive, more invasive. What are some of the best options that you see your patients getting results?

Dr. McMahan: I like patients to start conservative and gradually move up and obviously, number one, avoid the sun, avoid the sun. Learn to love the shade. Then, I think an aggressive skin care program is beneficial. A lot of woman have the over the counter products, their cupboards are full of them, they just haven’t worked. So I like patients to get on an aggressive program that you can get in a physician’s office. We like the Obagi System because the more aggressive you are at home, the less you are coming to me and getting peels and facials and injections and things like that.

Interviewer: So you do all those and that would be the next step after the over the counter products are inaudible, actually not over the counter, they’d come to you for those products.

Dr. McMahan: But after those products, then what would be some options?

Dr. McMahan: Next, I like the HydraFacial. It’s kind of combined microdermabrasion with the facial. It cleanses the skin, cleans the pores, hydrates the skin and you can infuse antioxidants into the skin to really protect the skin. So that’s the next phase before you get into the Botox fillers. I like Juvederm as a filler. Botox is more of an upper facial thing, the filler is typically more of a lower facial thing.

Interviewer: So when a patient comes to see you, Doctor, do you look at their lifestyle and everything and what they need done and help them decide the best route to take?

Dr. McMahan: Absolutely. If I think they’re spending too much time in the sun, I am going to hound them, get out of the sun. If they’re smoking, please, you got to stop smoking because that’s really detrimental. But rather than say this is what you need, I am more of tell me what bothers you. Tell me what you don’t like.

Interviewer: And what are you looking at here and don’t like, right?

Dr. McMahan: Exactly. Then I can tell you what your options are, what the advantages and disadvantage of each product, whether it’s a laser, a filler, something like that, are.

Interviewer: The more aggressive you talk about using some of those lasers, and what do you mean when you say aggressive?

Dr. McMahan: Most people have gotten away from the old CO2 laser, which I still have and it’s a great coat rack, but most people don’t want to go through the three to four weeks of redness and peeling and scabbing and things like that.

Interviewer: So there is downtime with that?

Dr. McMahan: There absolutely is. So that’s why a lot of the lasers have gone to the fractional treatments and most of the new lasers coming out are comparing themselves to the Fractal Laser, which is a wonderful laser that you can have it done and you can get nice results but look good in just a few days. You do typically get more than one treatment, but it’s no bleeding, scabbing, crusting, oozing. You are just pink and swollen for a few days.

Interviewer: Boy, you really made that first stuff sound … The Fractal sounds good after that, and then we have some wonderful before and after pictures of surgical options which some women want, some men want. And the before and after pictures are amazing to me, doctor. When we are looking at these, what have some of these patients had done surgically?

Dr. McMahan: This patient had pretty much of a standard facelift. I think she has had her upper eyelids done as well, and I think you can see she looks like the same person but younger and refreshed. And probably the biggest changes you see in her are the jowls and I think her upper eyelids. I think those have made a dramatic difference.

Interviewer: You made a point of thing that, that is your goal, is to keep your patients looking like themselves when you are done.

Dr. McMahan: Right. You don’t want them to look like they’ve had an operation. You just want them to look better. So hiding the scars, which I think is important which you typically don’t get with the quick recovery weekend fix, fast facelift type procedures. Where the scar, you don’t have the time to hide the scars and be meticulous and really gear the surgery towards what that particular patient needs. It’s not just a one procedure fits everybody.

Interviewer: That was my next question. Are you really honest with people if they come to you and they want so many things. Are they really what they want, you can look at them and go, “You really won’t like the result?”

Dr. McMahan: Oh, absolutely. Patients, sometimes, come in and they want a big procedure but they already look pretty good and their benefit is going to be this, and you don’t want to go through this and get that. You rather go through this, of course, and get that but absolutely, I try to get patients away from overdoing the procedures and really focus on the things that they need the most.

Interviewer: Interesting stuff. Doctor, your phone number has been up there if some of our viewers want to get in contact with you and learn something today. Thank you very much.

Dr. McMahan: Right, thank you.

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