"The biggest myth is that breasts can be enlarged with your own fat," says plastic surgeon Ivan Justan

Let's begin by outlining the philosophy and approach of your clinic to patients.

Clinic Mediestetik approaches patients in a way that, in the first place, does not harm them. In the second place, it provides them with maximum comfort and maximum care. Thus, a patient who comes to us should fall into experienced hands, which are capable of offering him the best that the field has to offer and which are also capable of assisting him and guiding him through the whole treatment, the entire process for which he came.

You offer an innovative method of breast augmentation. What is the main difference compared to traditional techniques?

I would rather say that the approach to the augmentation itself has changed and the approach to the entire plastic surgery is changing. In my younger years, surgery was always performed under general anesthesia, and gradually procedures are being sought that can only be carried out under local anesthesia. This means that a procedure that used to be necessary under general anesthesia,

Today we are capable of doing it under local anesthesia, and that goes for augmentation and even breast enlargement. Currently, we are able to perform these procedures under local anesthesia. It is important to inform that this is not suitable for everyone.

Not everyone can undergo such a procedure, but most clients can go for augmentation with local anesthesia.

So who is not suitable for?

It is not suitable for patients who come repeatedly.

For patients who would want a large implant, for patients who need not only augmentation but also modelling at the same time.

The indication criterion is relatively narrow and precise there, which the clients always find out at the consultation and we jointly find the way.

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What are the benefits of this method for patients in terms of convalescence and result?

The advantage is that the whole thing takes place under local anesthesia, so the patient, respectively the client, comes in, the day we perform the surgery, goes home two hours after the surgery, already has her breasts enlarged, could come in for a check-up the next day, if everything is fine, she could come for a check-up even a week later, depending on the clinic and how it will be arranged.

Basically, the main advantage is that she does not have to stay overnight at the clinic, she can go home two hours after the surgery and everyone feels best in their home environment.

How does the procedure itself take place and what can the patient expect during the operation?

The procedure does not differ from the standard procedure, which we perform in classic augmentation under anesthesia, so the operation is very similar, only the whole takes place in local anesthesia. After going home, it does not really differ from classic augmentation, and postoperative care, attention is the same. I have been offering all my clients since 2015 that we can discharge them even after anesthesia, but after anesthesia it is possible only six hours after the procedure, unlike local anesthesia, which can be done two hours after. And indeed, several clients took advantage of that. So we did the procedure at eight in the morning and they were going home in the afternoon, it works that way.

But now we have the possibility that even an afternoon client, who comes and goes for surgery at four or five o'clock, can leave that evening.

Otherwise, the process is very, very similar to a classic augmentation under general anesthesia.

What materials, implants are you using with this method. Are they special in any way?

The implants are standard, as used in classic augmentation, just

In case an implant is inserted in a cut under the armpit, a special implant called the "diamond implant" is used there, because it is shaped like a diamond.

How does this method reduce the risk of complications after surgery?

In my experience and opinion, the method reduces the risk of complications as it is only used for smaller breast enlargements,

When a client comes and wants a four hundred, five hundred implant, this method is not suitable for her, but for sizes two hundred, three hundred, at that moment the method when we use smaller implants

is actually less complicated and we can achieve long-lasting results, because during surgery we do not disrupt as much tissue as with a classic procedure with a larger implant.

What do you think is the biggest myth about breast augmentation that you would like to debunk?

There are more of these myths, probably the biggest one is that breasts can be enlarged with fat. Yes, they can, but for A I have to have that fat and for B, even if I have it, that fat will enlarge the breast by half a size in one session. If I want to enlarge my breasts by two sizes with fat, more sessions will have to occur. Another myth is that an anatomical implant hangs.

An anatomical implant will never hang in the body by itself and will not look like a hanging breast.

Another myth is that we are able to change the shape of your breasts however you ask. Like if my breasts are too far apart, please bring them closer and up. For me, that is not the right solution, if anyone even tries to do that.

We plastic surgeons, and this is my philosophy, should only underline your beauty, not take the breast and violate it in its entirety. We should only nudge it gently towards that beauty and not make it a violated form.

How do you think the field of breast enlargement will develop in the coming years?

I think that as we have moved into the area of local anesthesia, meaning a procedure that allows you to go home right after the surgery, surely a part of the patients will shift to this procedure, let's say 10%, 20%, 30% will be operated on under local anesthesia. And other trends that are related to this, are related to the implant itself, because implants are going through their own development and have various surfaces and various contents, they have their own properties and this is a deeper philosophical debate for experts, where science will allow us, because if science proves that the surface is not entirely suitable for someone, then in these indications we will not be able to use the implant, which already happened a few years ago, when it was said that a certain type of implant is not entirely suitable for someone and since then it simply is not produced.

Now in Europe, we use a certain type of implants, America uses another type of implant, each of us has it a bit different and that's the trend I see developing.

What would you recommend to women who are considering breast enlargement, but are not yet completely decided?

I would advise not to think at all. I think the worst phase in a woman's decision whether to undergo it or not is to think about it and search for information on the internet, which are not completely based on facts. These are rumors, rumors and discussion forum information, where she sees herself, she thinks she sees herself in some picture before, after and she immediately writes: "how big implants do you have?" But she herself could be one hundred and fifty centimeters and in the picture she sees a one hundred and ninety basketball player and the basketball player writes: "I have five hundred". And the one hundred and fifty centimeter woman comes to me and says: "I want five hundred, I like it."

Therefore, I believe that if a woman wants to sort it out right from the start, she should visit two or three plastic surgeons, each of whom might give her a different opinion, and then do research from that and only then start thinking about it,

because I believe that for us plastic surgeons, this is our craft, we can give you an educated opinion, and if we give you one, you should work with it. Whereas when I read it on the internet, it could all just be rumors, clouding your judgement.

I know about you that you are an authority in the field, because among other things you are also dealing with breast modeling in case of gender change, most often probably from male to female. It's a complicated procedure. So what is the most difficult part of it? How did you get into it and what is the interest in this surgery?

I got into it completely by accident about fifteen years ago, because I went to the so-called transsexual commission and at that commission they decide if the client is already mature enough to undergo gender reassignment surgery and regardless whether it's from male to female or from female to male. Since then, I have been devoted to this field and the number of clients we operated on gradually increased, we perform surgery on about thirty to fifty transsexual patients a year and I must say, that it is a very interesting and very trendy topic lately. Fifteen years ago, it wasn't that trendy, but in the last five to ten years in terms of transsexuality, non-binary, the trend emerged. And I think that at present we are past the peak and that the problem is now truly focused on people who are transgender, who feel trapped in the wrong body and our sexologists can now diagnose quite accurately, which is why there are these commissions. The commission decides and then the operation takes place.

The operation from woman to man, meaning the removal of breasts, is relatively easy, but it requires routine and perfectionism and conversely, from man to woman, it might seem like an easy operation, because it's the insertion of implants, but it's important to realize that the male chest has differently positioned nipples, different anatomy in general, so the final result might not be as apparent.

In several cases, we performed operations of extreme breast enlargement, so I have clients who came basically wanting really large breasts and we ended up with huge numbers. This area is very interesting and I've been dealing with it for the past fifteen years.

Does the regular course of the procedure differ from the procedure for changing sex?

It differs because we are talking about completely different types of surgery.

So the convalescence is different and the number of procedures is higher?

Yes, it's different.

Have you ever encountered cases of someone regretting the transformation?

From our base of over three hundred clients, I know of two cases where they regretted it, or where they considered switching back to the other gender. I would rather emphasize that this is a question of diagnosis and whether there really was a correct diagnosis at the beginning, that it is a transgender person, this is very difficult.

Because at the time of a big wave and a great boom, it is an interesting topic, so essentially at that moment a lot of, in quotes, confused teenagers thought they were transgender and I think that needs to be filtered out and I think that has been successful recently.

Do you perform these procedures here in the clinic as well?

Some of them, yes.

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How many such people do you perform surgery on here?

In the ambulance plus or minus thirty.

You are such a capacity in this field, there probably aren't that many doctors who would perform these procedures?

I don't think there are so many of us. There are relatively few of us plastic surgeons and within our community, I think that a few more doctors are also dealing with this.

Thank you very much for the interview.

Source: author's article, own querying