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Rastogi vs M: my heart says one but my head says another. Help me choose!


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Hi girls,

I've had consults with Dr Rastogi and Dr M about a breast augmentation.

I want to reinflate my breasts after breastfeeding 2 children.  I am petite, with a conservative job.  I want my breasts to look small, natural, elegant, and beautiful.  I DON'T want them to be big and eyecatching.  It isn't me.

My heart says I should go for Rastogi.  I "clicked" with him.  He was lovely and I felt that he paid attention to what I was saying, and what my body looked like.  He spent a lot of time measuring me and determining which implant would suit best. And he does lots of small, elegant implants, which is the look I like. However, he is a cosmetic surgeon, not a plastic surgeon, and he uses polyurethane implants.  I've read that they can feel hard, stick to your chest and can ruin it when they explant later, and that the polyurethane coating can dissolve in your body.  I'm very health conscious and I don't like this idea at all.  I also saw some pics on his instagram of girls with quite obvious implants, like a very grapefruit-like cleavage. 

So my head says I should choose M.  I liked him too, just not quite as much.  I didn't get a bad gut feel about him, but I didn't get that gut feel about him that says "he is the right surgeon for you."  The reasons to choose him are: he's a plastic surgeon, he uses normal implants not polyurethane, he gets a lot of beautiful results, and if I ever did a tummy tuck, I could go back to him to do that too.  The reasons against him are: the consult was more rushed and he didn't measure me in order to choose an implant, I felt a bit more like a number, and he does a lot of big boob jobs, which I definitely don't want.  I'm scared he'll make me too big.

If Rastogi was a plastic surgeon and used normal implants, I would choose him.

What do you all think?  Any advice on either of these surgeons?  And should I follow my head or my heart with this decision? I've never had plastic surgery before so don't know how one makes this decision well.

 

 

 

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Hey hun.... If I were you I would consult with another surgeon. There are some very good plastic surgeons that you can consider who will take the time to talk with you and measure you properly and give you the understated result you are looking for. Please do not rush your decision. As for the cosmetic surgeon using polyurethane implants I would so no based on two reasons: 1) cosmetic surgeons are not as skilled or as qualified as plastic surgeons. in essence they are GPs with a scalpel. Polyurethane implants are never used by plastic surgeons for all the reasons you have outlined above, so you already know the answer to your own question. You may have "clicked" with the cosmetic surgeon, but that does not mean he or that type of implant is suitable for your body.

Seriously, there are many reputable plastic surgeons for you to choose from. Continue your research, have at least one or two more consultations. This is not a decision to rush into, this is your body and you want the best outcome for you.

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@MissS Please always go with a qualified plastic surgeon, they have trained for years and years for this type of surgery. I would say surgeons might not always have the greatest bedside manner, but what matters the most is that in the operating room they are the best and most skilled at what they do. You are paying them top dollar for their skill, training and experience in the surgery of choice, not their bedside manner. I wouldn't trust my breasts in the hands of a cosmetic surgeon, not for something so life changing and with such a high risk of disfigurement. There are many horror stories on this forum about cosmetic surgeons botching up BAs. I have nothing against cosmetic surgeons, I just do not think they should be performing such a highly delicate procedure without the proper training.

Dr Miroshnik has a great reputation both in this community and internationally and from his photos, he always seem to produce beautiful and natural looking breasts results with balanced clevage and side boob. He was one of the surgeons I was contemplating for my surgery, but because I wanted a more augmented/big look, I went with Dr Tavakoli.

I've just had surgery with Dr Tavakoli 4 days ago, so I'm going to shamelessly recommend him to you. He is very experienced in both natural and big breast augmentations, the results of which you will see on his instagram page, just look up his name. He does what he calls the 'mini boob job' which I think is what you are after. I am extremely happy with my results as he gave me exactly what I wanted. As an aside, my consult felt rushed as well, and I think the reason why was because as soon as I showed Dr T my wish photos, he knew exactly what to do, so he wasted no time in getting the prep done. As always, surgeons are happy to answer questions, just be prepared about them, write it down etc to ask during the consult, and should you forget and have any other questions their team are always happy to field them for you :) I'm sure Dr Miroshnik is the same. 

Reputable plastic surgeons have moved on from polyurethane implants, and from my asking around are using either mentor or the next generation motiva implants.

Like @sabP said, if you're not sure, consult with more doctors, as even though it might get expensive, getting a revision down the road from a botched job would be a way more expensive than getting your first surgery absolutely right and perfect, since fixing a bad first surgery is a complicated process and it might not be possible to get it completely right the 2nd time round. 

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Thanks girls.  I've actually consulted six surgeons (!) and these are the top two, so I'm deciding between them.  I don't want to consult any more surgeons because I do really like Miroshnik and Rastogi. 

I phoned Miroshnik's rooms with a couple more questions, because he didn't measure me for the implants the way Rastogi did, and I want to ask if/when he does that, and to check that he won't make me too big.  The staff are super unhelpful unfortunately.  They all seem to be young girls and they said if I have more questions I need to book another consult for $250.... I just paid $550 for the consultant and was really disappointed that they won't field a couple of questions for me.  It would only take 5 mins and I'm about to spend a lot of money on this. 

This is the kind of thing that makes me think Miroshnik is not right for me, like it's the universe telling me not to go with him... Rastogi's staff are so much nicer.  But yes, as you both say, you choose the surgeon for their results not how nice their staff are... I just feel very torn between my head and heart.  If I choose Miroshnik because he seems better on paper and get a poor result, I'd be kicking myself and thinking I should have followed my gut instinct.

Argh! What to do?  

Devibear I've seen Tavakoli's work and it looks beautiful, great that you're happy!  In the end I didn't consult with him because I'd seen so many surgeons all ready and also because I think he does the augmented look which isn't what I'm after, although I know he does do the mini boob job. 

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6 hours ago, MissS said:

Thanks girls.  I've actually consulted six surgeons (!) and these are the top two, so I'm deciding between them.  I don't want to consult any more surgeons because I do really like Miroshnik and Rastogi. 

I phoned Miroshnik's rooms with a couple more questions, because he didn't measure me for the implants the way Rastogi did, and I want to ask if/when he does that, and to check that he won't make me too big.  The staff are super unhelpful unfortunately.  They all seem to be young girls and they said if I have more questions I need to book another consult for $250.... I just paid $550 for the consultant and was really disappointed that they won't field a couple of questions for me.  It would only take 5 mins and I'm about to spend a lot of money on this. 

This is the kind of thing that makes me think Miroshnik is not right for me, like it's the universe telling me not to go with him... Rastogi's staff are so much nicer.  But yes, as you both say, you choose the surgeon for their results not how nice their staff are... I just feel very torn between my head and heart.  If I choose Miroshnik because he seems better on paper and get a poor result, I'd be kicking myself and thinking I should have followed my gut instinct.

Argh! What to do?  

Devibear I've seen Tavakoli's work and it looks beautiful, great that you're happy!  In the end I didn't consult with him because I'd seen so many surgeons all ready and also because I think he does the augmented look which isn't what I'm after, although I know he does do the mini boob job. 

Hey hun, it's good you've consulted widely and I'm sorry Miroshnik and his staff have been less than helpful and I can understand why you have been put off him. However, I would very strongly recommend you do not go with Rastogi, he is a cosmetic surgeon and they are not trained, qualified or as skilled as plastic surgeons - it simply is not worth the risk to your body, regardless of how "nice" he seems. Also the polyurethane implants have been linked very strongly with ALCL and no reputable plastic surgeon will use them and that should be warning enough for you. If you required revision surgery for any reason it is far more difficult to remove polyurethane implants and I've heard many stories on this forum whereby girls have had them removed and had to lose a fair bit of breast tissue as well. 

This is not a "heart" decision, this has to be a logical, clear-headed, rational decision for what is best for you and your body.

 

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Like the other girls i cannot tell you who to go with but personally if i were in  the same situation I would be putting my life and body in the hands of a qualified plastic/reconstructive surgeon  and there is no way i would consider having polyurethane implants, that being said there are a few girls in here who have these implants and have no issues and love their results but given the recent research and studdies with the increased link to ALCL its not an implant type id choose.  If you really like Dr Rastogi i would ask him if he would be open to using a different implant brand or does he offer a diffrent implant  brand. 

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I would be doing you research properly about both surgeons  - if your gut is telling you something then you really should listen to your intuition but at the same time - you really need to be 100% comfortable with your choice.
I have no doubt Dr Rastogi is a capable surgeon, he has been around for a long time, seems to operate with integrity however, I would definitely be arming yourself with the risks associated with ALCL and high textured implants - i recently (12 month ago) had my macro textured nagor implants removed after 5 years and I would not choose a high textured style in the future.

Most surgeons (Rastogi included) should be able to offer you a choice of implants, no one is bound to one brand only

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On 9/21/2018 at 10:01 PM, I HaveBoobs said:

Like the other girls i cannot tell you who to go with but personally if i were in  the same situation I would be putting my life and body in the hands of a qualified plastic/reconstructive surgeon  and there is no way i would consider having polyurethane implants, that being said there are a few girls in here who have these implants and have no issues and love their results but given the recent research and studdies with the increased link to ALCL its not an implant type id choose.  If you really like Dr Rastogi i would ask him if he would be open to using a different implant brand or does he offer a diffrent implant  brand. 

Thank you.  Can I ask you why you wouldn't choose the poly implants?  I asked Rastogi's staff and they told me that they have the lowest risk of ALCL compared to textured implants... is that incorrect?  I've googled but haven't been able to find anything showing what the risk is with different implants.  I was worried by reports of women on this forum sayihng that the coating breaks down in the body but I emailed the manufacturer Polytech and they told me that isn't true, that even after 9 years implantation 99% of the coating is intact.

I definitely want to choose the anatomical implants with the lowest risk.  My health is very important to me.

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Some of the ladies on here have had some bad experiences with removing poly coated implants. They have ripped out breast tissue along with the implants. The manufacturers also claim they lower chances of CC but there have also been ladies on here who have had CC with these implants. If they were really superior, every plastic surgeon would use them. 

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@MissS its like what LaurenT said , if they were that good then why don't all plastic surgeons use them and many of them dont for the above stated. While there are some positives with the Polyurethane implants (like them gripping to the surrounding tissue) therefore reducing the possibility of future sagging i wouldn't like to chance the risk of having the surgeon having to remove extra breast tissue to get them out if somthing were to go wrong. My surgeon uses Mentor implants and also uses the 14 point safty plan whics greatly reduces the risk of cc and any other infections .

This is just my opinion in the end the choice is ultimately yours so i would go with your surgeon's reccomendations.  ?

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21 hours ago, MissS said:

Thank you.  Can I ask you why you wouldn't choose the poly implants?  I asked Rastogi's staff and they told me that they have the lowest risk of ALCL compared to textured implants... is that incorrect?  I've googled but haven't been able to find anything showing what the risk is with different implants.  I was worried by reports of women on this forum sayihng that the coating breaks down in the body but I emailed the manufacturer Polytech and they told me that isn't true, that even after 9 years implantation 99% of the coating is intact.

I definitely want to choose the anatomical implants with the lowest risk.  My health is very important to me.

This is categorically incorrect

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@MissS I totally agree with @LaurenT and @I HaveBoobs and I have said so myself, reputable plastic surgeons do NOT use polyurethane implants. They have also been banned in the US. Research has shown that the coating does break down in the body. There is evidence on this forum from ladies having problems with these implants and they are incredibly difficult to remove if you need revision surgery.

You will, in the end, make your own decision re your choice of surgeon and your choice of implant. However, there are many excellent brands out there that are superior and used by plastic surgeons and again I agree with @I HaveBoobs that a good surgeon will follow a safety plan to minimise risks. 

You say your health is important to you, then perhaps you will take on board all that we have said and make an informed choice that is in your best interests.

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Thanks ladies.  I can't tell you how much I appreciate you taking the time to reply to me and share your experience, information and advice with me.  Even though I have done so much research, you have told me things I didn't know.

I've been researching my BA all year, and have consulted six surgeons, and they have been very superficial when it comes to details.  I would not have know that the PU implants can mean your natural breast tissue is removed when they remove the implant.  Sounds pretty awful.

Rastogi and his staff told me that the Polytech PU implants are the lowest risk for ALCL.  I was told the same thing by Dr Patrick Tansley in Melbourne.  Incidentally he is a plastic surgeon, so I had no alarm bells that only cosmetic surgeons use these implants.  Both surgeons told me they are the "safest" because of the lowest risk of ALCL and lowest risk of CC.  I told them both I was concerned about the PU coating breaking down in the body and they said it isn't toxic (but they didn't say that it didn't break down) hence why I emailed Polytech to ask if it breaks down, and they said it doesn't.  

Hmmm!!!

Miroshnik uses the Mentor implants and if those are safest I think I'll just go with him!  Plus of course he's a plastic surgeon, and seems extremely well-qualified.  

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16 minutes ago, MissS said:

Thanks ladies.  I can't tell you how much I appreciate you taking the time to reply to me and share your experience, information and advice with me.  Even though I have done so much research, you have told me things I didn't know.

I've been researching my BA all year, and have consulted six surgeons, and they have been very superficial when it comes to details.  I would not have know that the PU implants can mean your natural breast tissue is removed when they remove the implant.  Sounds pretty awful.

Rastogi and his staff told me that the Polytech PU implants are the lowest risk for ALCL.  I was told the same thing by Dr Patrick Tansley in Melbourne.  Incidentally he is a plastic surgeon, so I had no alarm bells that only cosmetic surgeons use these implants.  Both surgeons told me they are the "safest" because of the lowest risk of ALCL and lowest risk of CC.  I told them both I was concerned about the PU coating breaking down in the body and they said it isn't toxic (but they didn't say that it didn't break down) hence why I emailed Polytech to ask if it breaks down, and they said it doesn't.  

Hmmm!!!

Miroshnik uses the Mentor implants and if those are safest I think I'll just go with him!  Plus of course he's a plastic surgeon, and seems extremely well-qualified.  

Most surgeons will offer you another implant option, jsut because that is their preference -  they can easily call and order a different variety - why dont you call and ask

I think it is incredibly important to acknowledge your gut feelings about things. You want to feel comfortable enough with the surgeon you choose that they will be there for you if and when things go wrong and believe me they do, not just for cosmetic surgeons but also for plastic surgeons.

 

If ALCL is a concern, you might consider a smooth implant as there have been no incidences of ALCL with a smooth implant ever.
If anatomical shape is a high priority but ALCL is a concern, you might look at Motiva implants which are designed to take an anatomical shape with time and move more naturally with your body - they are silk surface texturing which means they act like a smooth implant.
Anatomical implants are very firm, by design - they need to hold their shape so in turn, they dont have the most natural feel.

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Thanks girls.  I phoned Miroshnik's rooms but it's impossible to get any help over the phone.  The girls have such attitude!! Very disappointing and surprising, I imagine he would lose a lot of prospective patients due to the unwelcoming and unhelpful receptionists.  I have tried explaining that I just have a few questions and is there anyone I can discuss them with before booking a date and paying a deposit and committing to surgery, but they are very "computer says no" and just say if you have more questions you'll need to discuss them with Dr M, and pay another $250, and he's not available until November.... by which time the December date I want will be gone.  

It makes me concerned that I am just a number there.  Rapport is important to me, particularly because I'd be flying up from Melbourne for the surgery. I want to feel taken care of and this experience now makes me suspect that after surgery, especially once I'm back in Melbourne, I'll be very much on my own and if I ring with questions, who will help me?  He doesn't seem to have a patient coordinator or anyone on staff who can assist patients.  So disappointing because I do think he gets beautiful results but I want a good experience and I want to feel like they will look after me - especially when you're willing to pay such a premium. 

I'm definitely leaning towards Rastogi now because when I call, you get to speak straight away with the patient coordinator, who remembers my name (the Miroshnik girls don't seem to remember who I am even though I flew all the way up for a consult just last week) and she put me through to speak to the nurse, who was lovely and spoke to me for ages about all my questions and concerns. Rastogi himself even called me quickly for a chat about some questions about ALCL.  It only took 10 mins of his time but made me feel so much more like he actually cares. 

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How disappointing that Miroshnik’s staff are so poor. Unfortunately I don’t think that would even affect his reputation or the amount of surgeries he performs.

But it sounds like you’ve found the surgeon for you ? which is good news. Your heart is so strongly towards him, it is evident from your first post. So it is good you’re sticking with your heart. 

 

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I met a lady today who had Brazilians for 6 years and developed ALCL. Healthy lady in her 40’s no other medical history. The Plastic Surgeon who revised believes these implants to be the cause. She has since had them removed along with some of her own breast tissue and is undergoing fat transfer to reconstruct. It’s the first person I’ve ever met who had ever had this!!  It’s so rare but definitely happens...

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1 hour ago, donatella said:

I met a lady today who had Brazilians for 6 years and developed ALCL. Healthy lady in her 40’s no other medical history. The Plastic Surgeon who revised believes these implants to be the cause. She has since had them removed along with some of her own breast tissue and is undergoing fat transfer to reconstruct. It’s the first person I’ve ever met who had ever had this!!  It’s so rare but definitely happens...

That's very scary, the poor lady! I'll keep doing research and I've contacted the Breast Registry because the TCA wouldn't help me, but Rastogi, Tansley, and Polytech all said there has only been one case of ALCL with the Polytech PU implants.  I wonder whether this lady's were the Silimed ones? Either way I want to choose low-risk implants, and it is surprisingly hard to get reliable info about the incidence of ALCL with different implant types

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This is a extract from the Plastic and reconstructive surgery journal

and i have attached for you the study on implant surface texturing and ALCL - i think it is misleading to suggest that because that particular brand has only had one incidence may not accurately reflect the true situation and that is that implants with a higher surface texturing will have a higher risk of ALCL 

Breast_Implant_Associated_Anaplastic_Large_Cell.1.pdfScreen Shot 2018-09-27 at 4.13.14 PM.png

honestly the information that Rastogi has given you is really a red flag for me 

Statistically, Poly coated implants only make up a very small percentage of implants inserted overall - so to say there has only been one ALCL case doesnt reflect the entire picture because that could be 1 patient with ALCL out of 1000 which then would be quite high.

 

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On 9/26/2018 at 9:17 PM, MissS said:

That's very scary, the poor lady! I'll keep doing research and I've contacted the Breast Registry because the TCA wouldn't help me, but Rastogi, Tansley, and Polytech all said there has only been one case of ALCL with the Polytech PU implants.  I wonder whether this lady's were the Silimed ones? Either way I want to choose low-risk implants, and it is surprisingly hard to get reliable info about the incidence of ALCL with different implant types

She went to a well known, now retired Brisbane Cosmetic Surgeon. He exclusively used the Brazilian only. I’m not sure of the exact brand sorry ? 

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It doesn't sound like Dr M is a good fit for you. 

Keep researching. I know you said you have had 6 consults, if need be have more. I know it gets expensive but this is your body. It's not like hair where if you get a bad cut it will grow back. I'm in your position where I don't know which surgeon to go with. I plan on consulting with one (I'm in Perth) based on his breast results and also the fact he does the 360 body lift which I need after a huge weight loss (still have 23.7kgs left to lose before surgery). It's a tough choice. I will say listen to your gut feeling. If you haven't consulted with him yet Dr T does a lot of mini boob jobs. Also Dr Dona is amazing. Yes he's known for going big but he does plenty of average sizes too. 

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  • 11 months later...

I’m interested who you went with. Dr Rastogi’s work is aesthetically natural and his reputation is well founded. I have a consult with him. Just a comment to consider on plastic v cosmetic surgeons. My first implants were by a top plastic surgeon. In fact he was the president of ACCS, member of FRAACS  and even after worldwide recall implanted PIP implants which both contracted and disintegrated. He was a lovely surgeon however just because someone has many years of surgical experience doesn’t mean they have a natural aesthetic eye nor focussed training in breast surgery. I cancelled a consult with another plastic surgeon, well trained after I saw his Instagram captioned “bolt ons” as natural. Past patient reviews, photos of their work, manner with listening to you  and sensitivity to your aesthetic, in my experience  are more important that cosmetic v plastic. As long as the surgeon is not simply a doctor and is well renowned in their speciality with relevant association credentials. Dr Scamp on the Gold Coast explanted my PIP implants (recalled worldwide and the subject of a class action). He is a plastic surgeon and was the rudest most patronising surgeon who told me to get a court order if I wanted anything in writing to explain that he removed my disintegrated implants and a comment on their condition. I needed reassurance of what action he took. 

It is so important to feel comfortable and reassured and the ease of having your questions answered by staff and the surgeon are as important in your decision as their qualification. 

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