A thought leader and visionary in the future of plastic surgery, Dr. Kamakshi Zeidler is a founder of Aesthetx and practices in Silicon Valley, Northern California specializing in all types of breast surgery. Dr. Zeidler discusses the various treatment options available for breast augmentation, why women select this procedure in the first place, and the empowering value of the work she does.
Tell us about your background; what brought you to this type of work? I have always been enamoured with art in the form of painting and sculpture, and also drawn to taking care of people in a deeply personal way. These two interests formed the foundation of becoming a plastic surgeon – one who has an eye for beauty, a passion for understanding each patient’s ideal aesthetic, and the technical skills to achieve those desired results in a personalized, caring and supportive manner.
Give us more insight into your philosophy of plastic surgery; namely, when a mentor compared learning to be a plastic surgeon with the art of learning how to become a chef. How do you marry the idea of set principles and fundamentals with an exercise in creativity? Plastic surgery is much more than art, in fact my business partner, Dr. R. Laurence Berkowitz equated it to architecture which is an analogy that really makes sense. In plastic surgery, there are principles that must be adhered to including functionality and creating an enduring structure that is fundamental to having long lasting results. Patients do not want to wake up resembling a Picasso painting. They want to see recognizable improvements in themselves – ones that were created in a safe surgical and healing environment by a surgeon who has a knowledge of how the body changes over time. That being said, there is always room for creativity and the reliance upon a set of principles to examine each individual with their unique anatomy and develop a customized set of procedures that will fit each patients’ unique goals and lifestyle. The course of surgical action has to take into account how much the individual is willing to endure to get the results they would like to achieve. Sometimes something less invasive with an understated result will make the patient the happiest. In the end, I want my patients to feel confident, beautiful, strong, sexy, youthful and vibrant in their own skin. The results of surgery are dynamic and not simply limited to what someone looks like in an after photo. It is also important for them to feel good while trying on clothes, wearing a bathing suit or simply when they see their reflection in a mirror. The appreciation for the artistic and creative nature of both architecture and cooking like a chef honors these principles, but allows for creativity in the way operations and treatments are individualized based on each patient’s unique style.
How has your personal experience with breast cancer shaped your ideals and given you a unique perspective in understanding aesthetic and reconstructive plastic surgery? I have a special affinity for performing breast surgery. Some of this stems from my family having the breast cancer gene which makes this very close to home for me. I understand the burden of knowing this information – what to do about it, the impact on relationships, marriage, having children, the constant monitoring, the worry about finding an abnormality and the upheaval of finding information so life altering that it can be a lot to handle. I understand the difficulties of making a decision to proactively take charge and the guilt of not knowing whether it was a decision made in vain. I also understand how deeply personal these decisions are and the effects they have on every nuance of life. In addition to my personal connection with breast cancer, I have gone through extensive training to learn advanced techniques for creating natural looking breasts after patients have gone through a mastectomy. The breast is a part of the body that is very tied to femininity and personal self-expression, both with personal style and intimacy. There is such a unique perspective from each patient on what the ideal shape and size is which makes planning surgery very unique. We do lifts, reductions, augmentations, and sometimes we combine the techniques. Both breasts need to look the same – which always brings a challenge of creatively determining what method and technique is going to achieve the perfect and symmetric result.
“The breast is a part of the body that is very tied to femininity and personal self-expression, both with personal style and intimacy.”
What is your highest goal when it comes to both patient care and satisfaction? Ultimately, my goal is to make all of my patients happy. My favorite days at work (other than actually doing surgery) are days when a patient comes in thrilled with their result and we both look back on the journey together. Nothing is better then being able to look in the mirror with my patients after surgery and see the smile on their face once they see the results. I measure myself not by the cup size they ultimately achieve, but rather by the patient’s willingness to take selfies in a bikini and their renewed confidence. My patients choose to have surgery truly because they want to feel a certain way – to feel comfort, confidence – whatever form that takes. My goal is to understand exactly what my patients want, and to then help them achieve that feeling with specific changes – ones that are done done safely in a very personalized way.
What are the various treatment options available in terms of surgical and non-surgical breast augmentation? How do they differ from one another? This question warrants a very long answer but if I could summarize, I would have to say that breast augmentation is the most popular procedure I do. There is something about having full breasts, regardless of the specific aesthetic that makes women feel feminine, sexy and confident. Although women are not defined by their breasts, it is a part of the body that fits in clothing a certain way, that speaks to fashion and personal style, and is a critical body part that plays a role in body confidence for most women. That being said, the only really good way to achieve long lasting augmentation is with a surgical procedure. Breast implants are the mainstay because they have a defined shape and volume and are powerful at maintaining predictable results and shaping the breast. It is truly an exciting time in this industry because there are so many options for augmentation and new ones on the horizon. Breast implants are also safer than they have ever been so patients should have a lot of confidence choosing them. Silicone is the mainstay as they feel more natural. There are teardrop shaped implants and all sorts of different options in terms of specific shape and firmness to be able to deliver a highly customized result.
The other option for permanent augmentation is fat transfer which is less powerful at reshaping a breast, but does have the benefit of using natural tissue with a very low risk of complications. The wonderful thing about fat transfer is that it “kills two birds with one stone” allowing liposuction of other parts of the body and then reusing this fat to make the breasts look beautiful.
To summarize, breast augmentation and fat transfer are the two most common surgical treatments available. Additionally, many times a breast lift is needed or a small reduction in specific areas is needed to create the best possible shape.
Non-surgical breast augmentations do not get the results women are asking for. Theoretically, fillers can be used but they are very expensive and not permanent, so I do not encourage my patients to choose this option. Instead, I would suggest a really good padded bra like Victoria’s Secret bombshell bra which is engineered to create some dramatic fullness.
What are the pros and cons to each? How do you work with a patient to determine which is the best option for them? Breast implants offer many benefits. First, you get what you put in and there is very little change over time in terms of volume and shape. The other plus is that if you want to change the shape of your breast, an implant will do that and there are so many implant options with a perfect shape for everyone.
Fat transfer is ideal for patients who only want a cup size at most increase and who are happy overall with the shape of their breasts. It is also great for patients who are not keen on having a foreign device in their body.
The downside of implants is that they are not meant to last forever and as such, they do require maintenance. I spend a lot of time taking out old silicone implants from 20 and 30 years ago and the scar tissue can be significant. Women need to know that implants require maintenance and likely will need replacement. This doesn’t mean that a 10 year-old implant is a ticking time bomb, but MRIs are required for silicone implants to monitor any leaks because if detected early they can be replaced before they become a real problem. The downside of fat transfer is that the final volume can be slightly unpredictable and disappointing once all the swelling subsides. It is important to go to someone with extensive experience with fat transfer to set the right expectations.
Is non-surgical breast augmentation as effective as surgical? Is it as long-lasting? I do not recommend non-surgical breast augmentation because there is not anything, in my opinion, that really works. I am interested in delivering real and long-lasting results, and this can only be achieved with surgical procedures.
We often place assumptions on why a woman would seek breast augmentation, but there can be many different reasons why a woman would electively choose this procedure that go far beyond aesthetic preferences. Who is the woman seeking breast augmentation, and how is she different from what we might assume? The big mistake is thinking that there is the pre-defined “woman” seeking breast augmentation. Women who come to me want all sorts of things and their reasons for doing it vary as much as people’s tastes in fashion and food. There are patients born with significant asymmetry – D cup on one side and A cup on another side. There are women with such little breast tissue that their chest looks like a 14 year-old boy’s chest with no defined fold under the breast. There are women born with tuberous breasts which means they have a malformation with a missile-like shape. There are women who have really sagging breast tissue despite not having gone through breast feeding or massive weight loss. There are women who have had massive weight loss and have deflated breasts. There are moms who lost all of their fullness after breastfeeding their children. There are some women looking for just a little bit of shape and finally, there are women looking for dramatic curves with big voluptuous breasts.
“The one thing that these ‘women’ all do have in common is that they do this procedure for themselves.”
Some women are looking to achieve a sense of normalcy, symmetry and normal shape. Some women are looking to regain what they had before other things, such as having children, changed their bodies. Some women want to feel really sexy with full breasts. The universal, unifying theme is that women do this to feel a certain way in their own skin, to feel confident in their naked bodies, to fill out clothes and bathing suits in a certain way, and to feel a certain way when it comes to intimacy. Women do not undergo this procedure to fit a certain mold or to impress a significant other. The one thing that these “women” all do have in common is that they do this procedure for themselves.
Dr. Kamakshi Zeidler, founder of Aesthetx
A thought leader and visionary in the future of plastic surgery, Dr. Kamakshi Zeidler is a founder of Aesthetx and practices in Silicon Valley, Northern California specializing in all types of breast surgery. She is known for blending traditional cosmetic and reconstructive techniques together to achieve beautiful natural results. Dr. Zeidler has authored numerous medical journal articles and has lectured nationwide and internationally. As a physician whose family is affected by the breast cancer gene, Dr. Zeidler is dedicated to offering her breast cancer patients with the same results she expects in cosmetic surgery. She continues to partner with companies that bring advances to the field and is pursuing her academic research with new technologies that will improve the process and results of both reconstructive and aesthetic breast surgery. Dr. Zeidler is a member of multiple renowned professional societies, like the American Society of Plastic Surgeons, the American Society for Reconstructive Microsurgery, the California Society of Plastic Surgeons, the California Medical Society, the American College of Surgeons, the Santa Clara County Medical Association and the South Bay Chapter of the American Medical Women’s Association. She is also very active when it comes to charitable work and serves on the board of directors the Cancer CAREpoint. To learn more, visit Aesthetx.