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CYNTHIA GREGG, MD
FACE & BODY SPECIALISTS

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CYNTHIA GREGG, MD,
FACE & BODY SPECIALISTS
Cynthia Gregg, MD, FACS
Cindy Wu, MD


3550 NW Cary Parkway, #100
Cary, NC 27513
Telephone: (919) 297-0097
www.cynthiagreggmd.com

Delivering a Feeling of Normalcy
During Challenging Times

Like Dr. Cynthia Gregg, Dr. Cindy Wu, a specialist in breast and body surgery, sees first-hand her patients’ desire to restore normalcy in these difficult times by investing in their health and self-image. “And, of course,” says Dr. Wu, “they want to do so safely—which means that we are taking many extra precautions for both patients and the practice.”.

All surgical patients, explains Dr. Wu, get COVID testing seven to ten days before their procedure and are then quarantined from that time until two weeks post-surgery. “Our staff wear at least N95 masks, upgrading to PAPR hoods—that filter the air they breathe in and out using special HEPA filters—while patients are being intubated. Pre-op patients use a disinfectant mouth rinse to minimize COVID contamination due to AGPs (aerosolized generating procedures), and new precautions reduce aerosolization while patients are asleep for procedures. And we use UV filters in our operating and exam rooms.”

Protecting patients during post-op is a special concern for plastic surgery, observes Dr. Wu. “Recently, there have been case reports of asymptomatic, healthy, young patients who come in for elective surgery, such as liposuction or a tummy tuck, who then develop COVID. Because they’re immune-compromised at post-op, they get strange complications. That is another reason we take extra care—both pre- and post-op—to minimize risks.

Before and after breast augmentation surgery

“Breast and body surgeries don’t pose the extra risks of aerosolization that some facial procedures do,” notes Dr. Wu. “So, with these precautions, we are able to perform nearly all the same procedures as before the pandemic—and are able to respond to a continued strong demand for breast augmentation and implants.”

Younger Patients, Evolving Needs

Like Dr, Gregg, Dr. Wu sees different needs and options for women depending on their ages and stages of life. Stress, aging, weight loss or weight gain can all bring patients into the practice, seeking refinements.
“I am also seeing more younger patients,” notes Dr. Wu. “This group—from age 18 up to age 40—typically is interested in breast augmentation. And, while implants are the most common procedure, increasingly I’m using a fat grafting approach for these women, who are younger, healthy, and athletic, and who want to have an augmentation with their own fat.”

Fat grafting, explains Dr. Wu, entails removing fat from other areas, purifying it, and re-injecting into the breast where it can establish a new blood supply. Since fat grafting can yield about a cup size increase in volume, Dr. Wu recommends it for those who want a little increase in volume.

“When you’re doing fat grafting, about 60 percent of the fat will survive,” explains Dr. Wu. “I do tell people that the fat cells that live will be with you for life. So, if you gain weight, those fat cells will get bigger. If you gain or lose weight, you don’t increase or decrease the number of fat cells. It’s just that the volume gets bigger or smaller.”

Achieving the initial one cup increase in volume likely takes multiple sessions, spaced out by two to three months. As Dr. Wu explains, “It’s like building a house. You have to lay the foundation and let that cure. Then you put the first floor and then the second floor down.”

For those seeking a two-cup or more size increase, Dr. Wu will use either silicone or saline implants, depending on patient preference. “There are a lot of different varieties of height, width, and softness that are available in the silicone implant versus saline,” she explains. “For all those reasons, the majority of my patients choose silicone. Plus, a saline implant is made up of a silicone shell, so the surface touching your tissue is still silicone.”
These patients usually go back to work in a week or less, and can resume normal physical activity after four weeks. For fat grafting, the recovery time is shorter, with many patients resuming work and activities even sooner.

Different Life Stages Bring Different Needs

“My patients in the 40-60 age range,” says Dr. Wu, “fall into different categories: the women who want to remove implants from when they were younger, and those without implants who simply want breast reductions.
“Whether they’ve had implants previously or not, these patients feel their breast size is too large,” says Dr. Wu. “Perhaps they have developed more breast tissue as they’ve gained weight over the years, or their breast size has always been a problem. And there are a number of reasons women have for wanting to remove their implants.”

For those having implants removed, Dr. Wu can perform other breast surgeries at the same time to lift and reshape the breast—a popular combination called “ex-plantation and lift.” A second option entails removing the implant and replacing it with fat. “The overarching benefit is that they don’t have foreign material in their body,” explains Dr. Wu. “They still retain some volume, but not due to a silicone or saline implant.

“And women generally tolerate this surgery very well,” she says. “Recovery is often simpler because it’s not a very painful procedure, and there’s less stress since the tissue has already been stretched from prior implants.”

Another group of patients Dr. Wu sees are women in their sixties and older who may have had implants performed a long time ago. “These are usually the women who have lived with implants over the decades, have gone through menopause, and now may be heavier,” she explains. “They may also be experiencing implant rupture or capsular contracture—which is hardening of the scar tissue around the implant. These patients want the implants out completely, and usually need an implant removal capsulectomy and other lift or reduction. I once had a 76-year old patient who needed that particularly surgery,” she recalls, “but she opted out of a lift, saying: ‘I’m 76. I don’t care!’

“Since every patient is different,” says Dr. Wu, “I tailor the approach to individual needs and wants. And, mostly I try to manage expectations. I make sure the patient has realistic expectations about the result than can be achieved and also the postoperative recovery time.