Sultan of Skin

Flesh insight from an esteemed St. Louis plastic surgeon

"Silicone is extremely inert," says Centeno. "It's so safe they use it in Pam cooking spray."

"FDA-approved for baby formula, too," Young adds. "What's dangerous is what happened to a patient who came in about a month ago."

The St. Louis woman, says Young, went to a local hotel room, where she plumped up her breasts with injections of industrial-grade liquid silicone. "Supposedly there's a woman who comes down from Chicago and does it," Young says. "The patient got worried because she had a mammogram, and it looked like a bag of grapes in there."

Liposuction is  the most popular cosmetic surgery nationwide.
Jennifer Silverberg
Liposuction is the most popular cosmetic surgery nationwide.
Master skin sculptors: C.B. Boswell, Leroy Young, Rob Centeno.
Jennifer Silverberg
Master skin sculptors: C.B. Boswell, Leroy Young, Rob Centeno.

Young and the staff agree that they'd approve of breast augmentations for their own daughters as long as they knew the risks: hardening, deflation and altered sensation.

"And there's always the risk men won't look you in the eye," adds Young. "One time we were operating — it was a breast reduction — and we had this new anesthetist. The conversation got onto how socially awkward it is to have big breasts. Well, I looked at the new nurse, and I said, 'You know, I can understand — it's the same thing for guys with big dicks!'"

With his Kentucky twang and folksy manner, Young manages to get away with some risqué remarks other surgeons wouldn't dare utter. "Is she recently single?" he asks one day, noticing the shaved pubic area of a young patient asleep on the OR table. On another occasion, he enters a post-op exam and says to a breast-augmentation patient, "You're going to do some damage at the pool this summer, aren't you?"

Meanwhile, the 63-year-old implant patient's chest is totally deflated — practically concave. "Titopenia!" Young announces. "Micromastia," says Centeno, correcting the doctor and shaking his head.

"It's better than that little gal we put implants into last week," says a nurse.

"Oh yeah, she had nothing," says Young. "When I interviewed her, I said, 'Now what is your goal?' She looked at me like I had three heads. She said, 'Doctor, I want big breasts!'"

Young, Centeno and Boswell are known as "Da Boys" to the OR staff at Barnes-Jewish West County Hospital. Each has a specialty: Young, the breasts and genitalia; Centeno, the nose and body contouring; Boswell, the face. They operate as a team — unusual in the field — often with the Bavarian State Orchestra or Guns N' Roses streaming from their iPods.

The doctor's next patient this March morning is a fortysomething blond with skin the color of caramel and size-D implants. "Those are some biiiiiiig breasts," he says, donning latex gloves. "We're going to put some smaller implants in. Sometimes life involves a trade."

The nurses haven't yet arranged all the tools Young needs, so he surveys the room, gloved hands resting on his belly. The doctor rarely chides anyone, but it's easy to spot annoyance in his silence. He hates wasting time, especially with "OAFAT": Obligatory Anesthesia Fuck-Around Time, as one OR nurse calls it.

A minute after making the first incision, Young removes an implant and hands it to a nurse. Another assistant drops the capsule into a white plastic container for him to cart home.

"We've got two or three thousand implants in [an assistant's] basement, in case we want to study them," he says. "I used to save gallstones, too, but that was a long time ago. You could make necklaces out of them — kind of a Native American look."

Young positions his scissors at the bottom of the right breast and begins stitching a suture: a small pedestal for the implant to rest on and prevent the nipple from turning upward.

A few minutes later his face reddens as he uses his whole body to press the woman's new implant through the small incision above her nipple.

"Like trying to put a cantaloupe through a straw," he mutters. "There we go, that's a nice little titty."

After a brief lunch — sauerkraut and wieners — it's on to liposuction for two women, both pale and rotund. Young pokes a cannula through a small incision and probes over a five- or six-inch area — a violent motion that resembles sawing. Chunks of yellow fat come slogging through a clear tube attached to a gray apparatus that looks like a vacuum. The fat then collects in clear, 1,000-gram canisters. Blood settles at the bottom.

Sometimes Young or one of his partners will spin the fat in a centrifuge and inject it into the patient's lips — about a three-minute procedure. "It only lasts six or eight months, because think about how much your lips move all the time," says C.B. Boswell. "But we can do it in the office — just suck a little a fat off a person's knee near their thigh and inject that. It's normally $1,500 to $2,000."

Liposuction appears fairly cut-and-dried, but, Boswell cautions, "You can leave a big divot if you're not paying attention.

Adds Young: "You want to leave a little padding — about one centimeter — between the skin and the muscle. Remember 'The Princess and the Pea'?"

The only decoration adorning Rob Centeno's office is a girly calendar opened to a blond bombshell with a honey-colored derriere. "Leroy gave that to me as inspiration for my research," he explains. "The Greeks would call her kallipygos. We'd say callipygian, or bootylicious. Did you know 'bootylicious' is even in the dictionary?"

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