To our valued Patients,
My name is Vanessa Bogaert, and I am the co-owner of Gorin Plastic Surgery & Medspa. The tragic murder of George Floyd has prompted conversations with my husband, Dr. Aaron Gorin (Medical Director) and members of our team, about how our company should respond.
We do not want to simply make statements to check the box and consider our work done. The issue of racism and its pervasive presence in our society has always affected me deeply as it has been a personal experience of mine. Growing up one of the few Latina children in my school, I received countless slurs and attacks from racist classmates and even sometimes their parents. My parents often had to fight to make sure my siblings and I received the same educational resources as white students did. I grew up very aware that being different came with the struggle for acceptance and fair treatment. As I began attending bigger, more diverse schools, I made many friends from a myriad of different backgrounds, and began to see as the world became larger, in some ways it became safer and more accepting. But I also understood that the struggle for equity in our system would take ongoing work. In my personal life, I have committed to fighting systemic racism by donating regularly to the ACLU and the SPLC. I have used my personal social media accounts to speak out about injustices, and yes, have even lost patients and friends who do not agree with my positions. But as I witnessed the violent death of not only George Floyd, but Ahmaud Arbery and Breonna Taylor, it has become apparent to me that I must utilize our company to push this work further along to our collective goal of a more just and equal society.
The last few days we have seen great tragedy, sorrow and anger. We have had friends of ours have their businesses attacked in the looting incidents that have hit the city. We have seen our friends and family members in the police force express frustration of their profession yet again being undermined by corrupt agencies and bad actors that act with impunity. But most importantly we have seen the anguish of black mothers, daughters, fathers and sons who have lost their loved ones to violence, and that effect on the broader black community. While the structures of our community can be rebuilt, the lives of these loved ones lost can never be replaced.
So knowing this, where do we go as a member of our community? It is not enough to make simple statements expressing our recommitment to conducting our business without preference or discrimination to any race, gender, sexual orientation, or religion. We must do what we can to push the conversation forward on challenging systemic racism and prejudices in our community. With that in mind, I wish to express our first thoughts on the actions we as a company can take to help our community move closer to the above goals. This is by no means a definitive list, and as we learn and grow more, we hope to expand our goals and targets:
1. We will work towards further diversifying our marketing campaigns and expanding our reach to communities of color.
2. For new hire positions, we will work to ensure we actively recruit with diversity as a goal.
3. We are making an initial donation of $5000 to the Urban League of Portland which has worked since 1945 to safeguard the civil rights and empower the black community to achieve equality in education, employment, health and economic security.
4. Require and provide our staff with continuing education opportunities on how to best serve our patients of color, especially in regard to medical treatments and services.
5. Empower our staff to speak out if they witness racial mistreatment of any kind in our office, either from staff or patients.
We encourage you, our valued patients, to reach out with any questions, concerns, or suggestions on how we can do better to reach our commitment to fighting racism. We are not by any means experts in this fight, and we will continue to learn, listen and follow those who have studied and researched solutions to the issue of racism. Lastly, if you feel moved to act, to speak out, to donate, we hope that you take those first steps towards getting involved. We are including at the bottom of our statement some resources you may find helpful. I truly believe as Dr. Martin Luther King said “that the arc of the moral universe is long, but it bends towards justice.” but it cannot move that way without our collective efforts.
With great sadness, hope and love,
~ Vanessa Bogaert, Dr. Aaron Gorin and the team at Gorin Plastic Surgery & MedSpa
1. Donate to one or more of these:
Black Lives Matter: https://secure.actblue.com/donate/ms_blm_homepage_2019
Urban League of Portland: https://ulpdx.org/
2. Read these:
The Case for Reparations by Ta-Nehisi Coates: https://www.theatlantic.com/magazine/archive/2014/06/the-case-for-reparations/361631/
The 1619 project (also an amazing podcast series): https://www.nytimes.com/interactive/2019/08/14/magazine/1619-america-slavery.html
the New Jim Crow (Book) by Michelle Alexander: https://www.amazon.com/New-Jim-Crow-Incarceration-Colorblindness/dp/1595586431
3. Pick a few of these to commit to doing together or alone, acting locally is a really good way to approach massive problems:
75 Things White People Can Do for Racial Justice: https://medium.com/equality-includes-you/what-white-people-can-do-for-racial-justice-f2d18b0e0234
4. If you use Instagram, follow some accounts that provide really good content about how to be more aware and take action on these issues. Just a few of my favorites are:
- @Laura.edmondson (has a story highlight with many more great accounts to follow!)
5. If you use twitter, here are some other accounts you can check out:
To our valued patients,
The last several days have presented all of us with unique challenges on how to plan our days. As always, the safety of our patients and employees is our number one priority. With that in mind and out of an abundance of caution, we have made the difficult decision to close the Medi-Spa side of our clinic until 4/6. We will have staff answering phones and checking messages if you have any questions or concerns, and we will be rebooking currently scheduled appointments, as well as continuing to book future appointments starting 4/7. Our surgical side will remain open, and we are continuing to see new surgical consults and are still booking surgery. However, available appointments times have been reduced in order to comply with the CDC directive of less than 10 people together at a time. Our surgical suite is Quad A certified and we adhere to the strictest policies and procedures related to infection control. This includes continuing education of staff on the most current procedures for hand-washing and sterile processing of all instrumentation, a strict no-work rule for any employees who are ill with any symptom, requiring staff to wear gloves and masks when interacting with patients, and having patients wait in their car to facilitate social distancing guidelines. We have also instituted additional disinfectant rules for our office, which include regular and frequent wiping down of surfaces.
We will continue to monitor the health of all our staff, and should any of us come into contact with another person suspected or confirmed to have contracted Covid-19 OR have any symptoms of fever, cough, shortness of breath, malaise, etc… they will be asked to remain home and to contact their health care professional for guidance. They will not be allowed to return to work until they have a passed a two week period AND are symptom free. We ask all patients to do the same and notify us if you need to reschedule your appointment. During this period, we are suspending any late cancellation or no-show fees, though we ask that you give us the courtesy of notifying us as soon as you determine you cannot make your appointment. It is important to note that the vast majority of patients infected with this virus have very mild symptoms or a mild flu leading to complete recovery. We are also constantly monitoring the news as well as following the Oregon Medical Board news board, other hospital notifications and the CDC to make sure we have the most current information in order to better serve you.
As always, we are incredibly grateful for all our wonderful patients and the support you have shown us. We encourage you to follow the CDC guidelines of frequent hand-washing, social distancing, and disinfecting your work and living spaces on a regular basis. But most importantly, we encourage you to use this time to practice self-care activities. Reading, spending time in nature, music and other such activities will help to ease the mental stress and burdens we are all feeling at this time. We are working behind the scenes with other businesses to see how we can best support our community through all this as well.
Stay positive and stay healthy!
-The Gorin Plastic Surgery & MedSpa Team
Question: Is a revision of silicone breast implant surgery advisable?
In 2006 I got silicone breast implants and a breast lift. In 2009 I had a mammogram and was told the implants were not positioned correctly. They are not in a “pocket”, instead, they are positioned sideways of the breast not in the front. I want to have a tummy tuck in the near future and wonder if it would be advisable to have a revision of the implants at the same time. Will the original implants be reused or should I get new ones?
Answer: Combining the procedures is do-able
Assuming there is no health issue that would preclude you from having a surgery that would last 4-5 hours, it would be a good time to perform the breast revision at the same time as the tummy tuck.
However, the first thing to do is get examined by a plastic surgeon board certified by the American Board of Plastic Surgery to figure out what type of revision is necessary. It is difficult to figure that out based on a mammogram.
Question: Can Under the Muscle Implants Be Moved to Over?
I am 5’8″ in height and weighing 138 lbs. I’m in good shape–I jog, do push ups, and light weights. I’ve nursed 3 children for the last 5 years. I have 425 cc implants placed partially submuscular a year ago. The slightest flex of chest muscle makes my breasts appear unnatural. It makes the implants move upward while the bottom part ripples out. It’s becoming more obvious over time. Overall, my breasts look natural and pleasant when the muscle is relaxed. But to keep this from worsening, can one go from under the muscle implants to over?
Answer: Definitely possible, but, is it the best idea?
A ‘plane switch’ from behind to in front of muscle is do-able. However, the long term result could be compromised with excessive stretching, etc. There is a technique called ‘subfascial placement’ which is ‘sort of’ above muscle, but, might help prevent the above muscle downsides. The place I would suggest looking into would be Dr. Richard Baxter in Seattle. Whenever I come across a consult that I feel could be better served by one of my colleagues I am happy refer there.
Question: Uneven Nipples After Breast Augmentation and Lift
I had breast lift and implants (200 cc, 1 cup size bigger, age 26, no kids) 2 weeks ago, and my nipples look like something out of a child’s coloring book. They’re completely uneven, choppy, and not at all near perfectly circular. Will these eventually fix themselves? I also thought the breasts would be higher. Does this look like a well executed lift?
A: Too early to tell
This is actually a very good result. You will be amazed at how much things soften and smooth out/even out over the first 3-6 months. Things can be quite easily revised later on if necessary, but, based on the photos, you are right on track :)
Question: I had Breast implants done 1 year ago and I think one has bottomed out. What’s an average price? I had 430cc’s under the muscle.
Answer: revisions are unfortunate, but, are a part of all of our practices
This is definitely something that I see and tell all of my pre-op patients that this is one of the risks of this surgery. I actually do not charge anything in the first year post-op for any revision. However, this is a bit unusual. Most docs here will waive the surgeon’s fee and still charge for the facility fee, anesthesia, etc. Your best bet is to return to the original surgeon to discuss the options.
Question: There’s a “hole” around my areolar incision after Breast Lift, Is this normal? (photo)
Keep in mind that I am quite pale and even the smallest scrapes look red and terrible when I get hurt! That being said, I had a breast lift done exactly 3 weeks ago and now notice this spot around my areolar incision. I had something similar underneath my breast last week which has since cleared up. Does this look alarming or should it heal on its own as the other “hole” did?
Answer: Not uncommon
I generally tell all patients to expect some minor wound healing issues at the top and bottom of the vertical incision after a breast with with implants. They generally are extremely small in nature but sometimes can get quite large especially in smokers At this point, I assume your plastic surgeon is actively involved. However, this is likely a situation that would only require a topical antibiotic cream and extra healing time. In the end, it should look very good.
Question: 425 cc High profile silicone implants with lift, too big? Measurements and pics attached.
I was very persistent on getting the mod plus 371 but my surgeon said that I would benefit from the 425 Hp due to my loss of volume. (With circumareolar lift) 36 years old, 5’8″ tall, 125lbs. Breast fed for over a year. Currently deflated A-B cup. I am active, gym, weights, yoga, surfing. Measurements/ pics attached. Every body is different, we have different starting points, my starting point is with very deflated breasts. He said that the 425 hp won’t look too big because of my volume loss.
Answer: Needs more than a Benelli
I personally feel that, in order to get the best result, you would need more than just the circumareolar lift.
In my opinion, you need at least the lollipop scars if not more. I would highly recommend asking your surgeon to review with you photos of women with similar anatomy. This is very much surgeon dependent. In my experience, the circumareolar lift does very little actual ‘lifting’.
Question: Follow up to my previous question: How can my asymmetry be fixed and do I need a lift?
I asked if I need a lift previously and posted a side view to hide my tattoos. Most Doc comments requested front view. Sorry for the scarf! Might as well ask how to address my asymmetry as well. What procedures do you recommend? I will be scheduling my breast aug for next summer when I find the right doctor.
A: Breast Asymmetry
Thanks for the question. A few things to consider. Based on the photo, it does not look like the left side needs a lift. The right side very well may need it. I always tell my patients, with pre-op asymmetry, to really expect asymmetry post-op despite all of our efforts. However, you still should like the final results.
Another thing to consider is checking out an office that uses the 3D imaging (like ‘Vetra’) which can give you an idea of what to expect with just implants. Best thing to do is ask the surgeon to show specific examples of before and afters of patients with similar asymmetries.
Question: I scheduled for a Benelli Lift and 600cc Implants…..good idea?
I’ve always had some droop to my breasts….now after 3 kids I want to have a pair to be proud of! One dr said a vertical scar lift with 500cc gummy bear implants and the other 2 I went said a benelli lift with 600cc implants…I wear a D cup bra already…
The Benelli lift is a procedure that is loved by some surgeons, disliked by most (in my area, at least). The problem is that the (IMO) the benelli doesn’t really ‘lift’ anything. I feel it’s best for circumferential skin removal without really moving the nipple that much.
In your case, my guess is that you want the breasts as high and full as possible. In my hands, this would definitely require a vertical scar. Additionally, whenever I contemplate a breast lift with implants that big I always have the discussion with the patient as to the increased risk of complications. Many surgeons would suggest doing the lift or implant first f/b a 2nd stage.
One thing to consider is to ask for specific before and afters with each of those surgeons on cases with a similar anatomy.
Question: I have lost all volume. Am I a candidate for breast augmentation, lift, and areola reduction?
I’m 5’6. A cup. 110 lbs. I would like to know what my options are and if I could have a nice result before I waste money and time going to see doctors. I would like to have full round (flattish) closer together breast. I’ve had kids and they’ve just got worse over the years. Thank you.
Answer: Breast augmentation will probably work out great here
With those photos it doesn’t appear that a lift would be necessary. Rather a breast augmentation without the lift would likely be the best option.
As far as the areolar reduction, that is a possibility, but, with the implant in there you may not need it. Plus, that is an extra scar that might not turn out great.
Best thing is to look at multiple before and after photos of the surgeons you are researching. Also, check out 3D imaging with the Vectra (only available at select offices).
Question: What are some “MAJOR” complications that can/may “OCCUR” after having an Extended Tummy Tuck and Breast Lift with Implants?
I am going to have an Extended Tummy Tuck and Breast Lift with Implants in September. I need to know what are the most common and major complications that can occur after surgery (during the healing process)? Can/Should the Emergency Room assist if I have medical insurance? Is there a legal document that can be signed by my Plastic Surgeon (haven’t chosen one yet) if I did not RECEIVE what we discussed in the consultation? Is there additional insurance offered for post op issues?
Answer: Major complications are rare, but, can happen.
The main ‘major’ complication I discuss with my patient is a ‘pulmonary embolism.’ This is where a blood clot can form in the legs and travel to the lungs which can be life threatening. Surgeons generally take special precautions to prevent this. These methods include avoiding the breathing tube for anesthesia, using a special medication to lower the risk, getting the patient up and moving asap (even the first night), etc.
Other major complications include things like a hematoma, bad infection, anesthetic complications, etc. However, your surgeon should review all of these in detail at the ‘preop appointment’.
Question: I Am Allergic to Codeine. Any Suggestions for Pain Control After Mommy Makeover?
Answer: Many options
Pain control post-op is of great importance. The less pain, the more you are walking around which equates to less complications and a better overall sense of your recovery. Narcotics, like codeine, have issues. Still, most patients need something post-op.
In addition to narcotics, other meds can be used like muscle relaxers, gabapentin/Neurontin, Celebrex (if not sulfa allergic), etc. All are non-narcotic in nature. Another option which I have used for the past year is Exparel which is an injectable, long lasting (3-4 days), delayed release pain medicine (Marcaine) which is injected into the muscle layer. I found this works amazingly well for most patients.
Question: What is the most effective oral pain medication after Tummy Tuck/Mommy Makeover with Breast Augmentation? I’m about a month pre op and researching pain management. My surgeon does not offer a pain pump. What is the most effective oral pain medication after tummy tuck/mommy makeover with breast at?? Thank you, Timberel
Answer: Pain control after mommy makeover varies
Thanks for the question. Each surgeon will have their own specific protocol for postop pain management. Narcotics, like percoset, are common place. I Rx these for my patients. However, I also like to use a muscle relaxant (like soma or flexeril), Neurontin (gabapentin), and Celebrex. All are non narcotic and can go a long way to reducing the # of narcotics that you would need. Additionally, you should also research Exparel which is a long lasting type of pain medicine that I have found extremely helpful, especially after tummy tucks. This is injected into the muscle layer before completion of the tummy tuck and can last 3-4 days.
Question: My Husband and I enjoy fishing a lot. How soon after surgery can I resume boating/fishing. Also, since I would be exposed to the sun, I will be taking extreme measures to prevent any direct sun exposures to my incisions. Thankfully its Fall/Winter so swimming and tanning is out of the picture for me!. What would be a good/safe wait time to resume boating/fishing? Even if its just boat cruising around the bay?
Answer: 6-10 weeks
For my mommy makeover patients I like to suggest zero exercise, or anything that is going to stress the tummy muscles, for 1 month. Between 5-10 weeks I have the patients slowly increase their activity so that at 10 weeks they are unrestricted. Boating and fishing would be okay at about 6 weeks, but, no water skiing, etc, for 10 weeks. Again, this will vary widely between surgeons.
Question: I had a tummy tuck and umbilical hernia repair 16 days ago. Can I sleep on my stomach yet? My drains are out, but I’ll have stitches for another week.
Answer: Best to wait
I personally feel that waiting at least two or three months before lying perfectly flat on your tummy is the best idea. However, I generally allow my patients to sleep on their side after the drains are out.
Question: My pubic area is higher and bigger since my Tummy Tuck. Can this be fixed?
My tummy tuck was 1 1/2 year ago, is it possible to change the look of my belly button and my Pubic area? My pubic area sticks out and seems as if fat stores there. Also the area around my belly button is still tight. Is this Normal?
A: Possibly, But…
It all depends on the anatomy that you currently have, in particular how lax the tissues are. If the tissues are already quite tight without much give then there is a good chance that it may not be worth this kind of revision.
Question: Is it unwise to decide to do TT with 1st Dr. I consulted with? The other two Drs I’m interested in can’t see me for another week or later. I’m stressed for time. I have to get my surgery done by the 2nd week of May. The Dr. I saw is far from where I live (about an hour), the other two are like 10 min from me. I liked him and the staff, he does the surgery at a hospital. He is double board certified, I looked at pic etc. So is it unadvisable to go with the only Dr. I interviewed?
Answer: Due diligence
I suggest to all consults I see that they visit with at least one more surgeon. I understand there’s a time crunch. However, it’s important that you do your due diligence before making a decision. An exception to this could be if you have multiple friends that have gone to that first surgeon and are happy with their experience there.
Question: I had a tummy tuck and lipo on April 4 and the drainage came out on April 13. I did my surgery in the Dominican Republic. I have to get it drained because my stomach is growing due to liquid in my stomach. Where can I go in New Jersey to get the drain out? Please advise. Thanks, I am really scared.
Answer: Little options
I generally advise not to fly anywhere for any cosmetic procedure unless you’re convinced there is no one in your area that is qualified to do it. At this point, I believe your only option is to head into the emergency room. The only other thing to consider is to get on the phone and call around to local plastic surgeons to see what their thoughts are. Finally, what you can do is contact your original surgeon and see if they have made arrangements for these types if situations.
Question: I was 40 on BMI and high risk. I am five weeks post-op for a full Tummy Tuck w/ Liposuction on flanks and back, my Plastic Surgeon only had me come in for the day after surgery check up and to have my drains removed. I was told I do not have to come back again for five months when I have a my after pictures taken. I also had a post-op infection, foul odor from drain tubes and yellow brown drainage. How concerned should I be that there are no follow-up appointments?
Also is it normal that when I suck my tummy in it is uneven; 2″ higher on one side than the other?
Answer: This Varies
The frequency of follow-ups varies widely between offices. However, yours is exceptionally low. I think it is important in my practice to see patients at day one, day four, day 12, one month, two months, three months, six months, etc. The best thing to do is to contact your surgeon to see about getting in for a recheck.
Question: If I get the Smart Lipo on my stomach will it help get rid of some of my stretch marks?
Answer: Unfortunately, stretch marks are not treated by liposuction, smart or otherwise
Question: I’m trying to determine if I am a candidate for Smart Lipo? Or do I need a full Tummy Tuck after 2 C sections? (Photo)
I am very interested and ready to get PS. I am researching my options. I want work done on my stomach, inner thighs and flanks. I’d prefer to have smart lipo as opposed to a full Tummy Tuck but I am not sure whether my body type makes a candidate? From the pics can any doctors give me their feedback? I’d greatly appreciate it.
I’ve had 2 C sections and my stomach is stretched, loose and hangs.
Answer: Possibly a combination of lipo and tummy tuck.
With your anatomy, you may benefit from a tummy tuck and liposuction. However, many surgeons do not feel comfortable with combining the two as it can increase the risks. One thing to keep in mind is that there appears to be a certain amount of fat that is behind the muscle and around all of the organs. This cannot be addressed with surgery, but, can be helped with weight loss. Unfortunately, this fat can detract from the overall result. However, I feel that you will love the result.
Question: Hi, I’ve been struggling with weight loss for a while now, and seeing as a combination of exercise and abstinence isn’t working out too well for me, recently I’ve been looking into surgical solutions. A friend of mine did get a cryopolysis surgery done, and it has proved very efficient. As it happens, however, most sites discourage using cp. against overweight rather than targeting specific areas. I weigh roughly 115kg and am about 190cm. Most of the fat is on my hips and stomach.
Answer: Liposuction Combined with CoolSculpting
I would not suggest this combo procedure. I understand the thought process (hitting the areas with the maximum power available). However, I just do not see how this would work well. In the future, studies may be performed showing a benefit here. For now, I would suggest one then the other.
In my practice, I would be liposuction (laser assisted, ultrasound assisted, power assisted, etc) first. After 6 months, I would consider CoolSculpting as a secondary treatment as needed (I actually had this sequence myself a few yrs ago).
Answer: Sientra implants are already available.
Their teadrop or gummy bear implant were the first to obtain FDA approval. However, the other two companies now also have similar implants.
Question: I have seen two different MD’s regarding breast augmentation with a possible lift. One MD told me I needed a lift (anchor) and the other told me implants should give me enough lift and I wont need an actual lift, however if I wanted higher nipple placement he would do a lollipop lift with the implants. Scarring really concerns me, and if I can get away without any lift that is the route I prefer. However, I do not want huge droopy boobs. He measured me at 25 and 25.5. What do you suggest?
Answer: Lift? Absolutely
With your anatomy, a formal breast lift 100% will be necessary to avoid a weird shape. I would ask the other surgeon to show photos of prior patients who he/she felt looked like you and only had implants. I have patients ask me this. I would never just do implants here.
Question: I would like to get breast implants but before i do i would like to know about breast augmentation prices. How much do breast implants cost?
Answer: It varies by a wide variety
Cost for cosmetic procedures, not just breast augmentation, vary widely not only between cities, but, within cities. It’s best to call around to see what the average is. However, I would caution going to the absolute cheapest. Better to rely on word of mouth, before and afters, online reviews, etc.
Question: How Long Do Breast Implants Last? I have had breast implants for 14 years and I am now developing a large rash under my left breast, and it hurts and I feel alot of air pockets. One doctor told me to replace them every ten years and another told me you never have to replace them.
Answer: It depends
Saline implants have the advantage of ‘telling’ you when they need to be replaced (ie: deflation). Silicones do not do this. Some surgeons suggest replacing every ten years. Some do not. IMO, replacing silicones at ten years if they look and feel good is probably not necessary. However, an MRI test could be considered to help rule out a leak.
In your situation, with the rash, etc, it’s best to return to the original surgeon (if available), or another board certified plastic surgeon.
Question: Hi! I’m a 19 year old girl who is petite build, short about 150cm (4’9″), breast size about an A cup and is going to get Breast implants but I’m not sure which style to go for. I was told the tear drop as it is more natural and due to my petite built. I just wanted to know if I were to get round implants would it look that bad?
Answer: Depends on the particular anatomy
Shaped implants can certainly be a good option for many women depending on the anatomy we are starting with. If the goal is to minimize the upper pole fullness and maintain the most natural appearance a shaped device is certainly something to consider.
My friend went under the breast muscle w/ her implants…but now it looks rippling on the bottom. During consultation with a respected plastic surgeon in LA he told me under the pectoral muscle is much better… less risk from capsular contracture, safer for breast cancer screening, more natural (less stripper looking…his words, not mine!). Thoughts?
Answer: Rippling is still possible going under the muscle
‘Under the muscle’ placement of implants generally is not very accurate. The lower 1/4 to 1/3 of the implant, when going ‘under the muscle’, is, in fact, usually not ‘under the muscle’. It is covered by skin and breast tissue. The upper 2/3rd’s is usually covered by skin, breast tissue and muscle. I personally place all implants under the muscle except for a very specific situation called ‘tubular breasts’. The advantages that the LA surgeon laid out are exactly what I tell my patients.
Q: How Long is Breast Implants Recovery Time?
I am a phys ed teacher and would like to get breast implants. I want a very natural look and do not want anyone to know. I am afraid that if I take additional vacation time either before or after winter or spring break, everyone will notice. Is it possible to be back to work after only a week of recovery?
A: It is possible
I would say that returning to work at 1 week is definitely possible as long as you are not using your upper body at work. As for keeping it a secret, that is definitely possible depending on the implant size as well as the clothes you wear.