On one of the forums at which I occasionally contribute the question came up of breast implant massage for textured implants as a preventative measure to avoid hardening (Capsular Contracture.) The question was under what circumstances does it make sense to massage textured implants within breasts to prevent hardening. As is frequently the case, the answer relates to the history of breast implants and hardening:
To make a long story short, one of the most frustrating issues when working with breast implants is the tendency over time for them to harden within the breast. To be more correct, the breast tends to harden around the implant. This is more often the case with silicone gel breast implants, implants with relatively little soft tissue coverage, in smokers, and in cases in which infection, radiation treatment or bleeding have been involved. Back in the seventies and eighties, there were studies with differing methods of decreasing these tendencies. The studies had varying results (unfortunately) showing loose associations with implants with textured surfaces and patients in whom breast massage was used showing inconsistently favorable results.
Surgeons do not all do things exactly the same and frequently a surgeon’s experience affects his or her practice. Breast implant surgery is no exception to the case. Some surgeons will tell you that there is no need to massage textured implants. Others will tell you the opposite. There is no consensus here.
Many surgeons will look at issues with a particular patient to determine what to advise. If patients have had more issues with capsular contracture, then massage and/or textured implants might be advised. Many of us rarely if ever use textured implants for other reasons (for example they are more often associated with rippling.) Suffice it to say following your surgeon’s advice and having follow-up visits with that surgeon is probably the best strategy to try to avoid capsular contracture. I tend to use more saline filled implants and moderate sizes and have had very low contracture rates over the years in my practice. If you are going to massage your implanted breasts, have your surgeon show you how he or she would like you to do it. The method is debatable as well.
John Di Saia MD
Initial Post 11/3/11 7:30 AM -
I am thinking of changing my ride. The idea of driving a Prius appeals to me. I get to use less gas which makes me feel a bit better about not contributing so much to our pollution and gas industry problems. There are a few environmentalist quirks I picked up as a Berkeley undergrad. The nerd in me likes efficiency and with the miles I drive I might need to stop less frequently. Some of the docs around me have commented that they are not so sure my clients will take well to their plastic surgeon driving a more green machine however.
So you can vote on it:
Update 9/26/12 – I have had my Prius for nearly a year and really love it. It is not a really sexy ride but I have been over that for years. It has been reliable and not stopping for gasoline so much has been pretty cool. The AC could be a bit stronger, but otherwise I am happy.
John Di Saia MD
Originally posted 2011-11-03 07:30:41.
Once in a while I hear a patient complaining about her inability to communicate with her plastic surgeon. Not everyone can be a Dr D patient you know. The truth be told, I do not always have all the time in the World to talk either.
There are some facts that contribute to the tendency for surgeons not to always be so free with their “talking time:”
(1) We get paid to operate. Examining a patient is important, but talking over and above a certain amount is actually counter productive. I break this rule frequently which might explain why I am in solo practice.
(2) When we need to talk, the topics are not always so wonderful. I have had long conversations about how what a patient says she wants is actually risky and likely to fail. This is the ultimate in revenue negative when we talk about why you shouldn’t have surgery. Remember rule #1?
Life isn’t always dollars and cents, but remember I do cosmetic and reconstructive plastic surgery. In my latter capacity, I need to move around quite a bit to make it work.
It as absolutely true in modern medicine that the things that patients want pay much better than the things they need. And surgeons have more overhead to pay.
John Di Saia MD
Originally posted 2012-09-12 07:30:15.
Low Maintenance Breast Implant
Surgery – Is this achievable?
I am looking into getting breast implants but want to keep redo surgeries to a minimum. Some of my friends have had 2-3 boob jobs in ten years, so I am not going to their doctor. I saw a few of your patients online saying that the implants you put in they kept for ten years. I want to get a worry-free boob job?
Thanks for the compliment.
There are several things you can do to reduce your risk for the need/desire for re-operation after breast implant surgery:
(1) Have surgery by a good qualified surgeon. In my book, that means a good ABPS board-certified plastic surgeon.
(2) Request guidance from your surgeon regarding the volume to which you can go safely. The leading cause of poor outcomes with implants that I see is the placement of implants too large for a woman’s available soft tissue coverage. Good surgeons know this although many fear “losing the case” if they share their concerns.
(3) Choose saline-filled implants and have them placed beneath your pectoral muscles. Silicone gel is another option but I feel the breast hardening rate (capsular contracture} is higher with them. Capsular contracture is also higher in some other cases that you may want to review before surgery.
(4) If you have any degree of breast sag, talk about breast lift surgery as an option before you have your operation.
John Di Saia MD
Originally posted 2011-04-22 07:30:34.
Statins are so positively heralded in the medical literature and had kept my LDL cholesterol low for eight years, it seemed that it made sense to try to stay on them. So one of my first manipulations to get rid of the muscle pain was to try to alternate a every other day Statin with an alternative drug:
So 20 mg of Atrovastatin every other day with alternative days on fenofibrate at 145 mg:
Total Cholesterol: 155
LDL Cholesterol: 86
HDL Cholesterol: 41
My Creatinine Kinase bumped to 222 (44-196) on this regimen though and my muscle pain was intermittent, but still present so the equation was not quite right yet.
John Di Saia MD
I had a tummy tuck two months ago. Now I have a little water-filled “pouchie” above my couchie where the water waves move when I poke it. My surgeon says it is not a problem and will go away. Should I be worried?
A seroma is a lymph filled pocket in your soft tissues. We are most aware of them when they are just under the skin as they can demonstrate a “fluid wave” phenomenon when they are tapped. Larger scale surgery is more of a risk toward the formation of a seroma and tummy tuck surgery is included.
On the positive side, these things tend to resolve when small and wounds are newer. The longer they manage to persist, the greater the chance that they will not go away, but rather form a scarred in cavity that will tend to stay. In a worst case scenario they can require surgery to fix. Alternate treatments include draining them intermittently with a needle or with a drainage tube or injecting them with a chemical to encourage them to shrink or go away. Opinions as to how often or urgent treatment of a seroma is vary substantially. Left alone they can mar good tummy tuck results, so I like to deal with them quickly. My tummy tuck results have benefited by this policy by my way of thinking. I haven’t needed to re-operate to repair one in over ten years.
Seromas are best avoided. The best ways to do this involve the proper use of drains and compression garments after a large scale operation as well as tailoring that operation to be less risky.
John Di Saia MD
Originally posted 2011-06-09 07:30:09.
Most patients are comfortably oblivious to the wide open nature of cosmetic surgery and the doctors who perform it. There are no laws against doctors of any level or type of training in cosmetic surgery opening their private clinics to the masses and performing surgery. The question of what training is really needed to entitle a doctor to perform this kind of surgery is hotly argued in many cases by the same doctors who wish to garner your business.
Board certification often comes into play. The problem is that there are many boards and relatively little oversight. I have been criticized by those representing cosmetic doctors for my lack of respect for their prowess. It is often hard to respect a doctor with little if any verifiable training who purports to be my equal. Unfortunately for consumers their experiences often can be subject to trial and error as they wade through the marketplace.
My point of contention is and has been that doctors who have not completed residency training and have not been certified by verified ABMS (American Board of Medical Specialists) boards that include cosmetic work in their residencies are not good bets for their patients. Inspection of your prospective surgeon regarding qualifications before surgery is an absolute must if you want to maximize your potential for a good outcome. News stories that have run recently have reinforced this point a great deal.
John Di Saia MD
Originally posted 2011-01-07 07:30:03.
The American Society of Aesthetic Plastic Surgery publishes statistics every year indicating which cosmetic operations are on the rise. A journalist at the OC Register asked a group of plastic surgeons why this might be. Being that I am opinionated (why do you think I blog here,) I figured I’d take a shot at some of these:
I. Statistic: TEENS – Nosejobs and Otoplasty (commonly referred to as “ear pinning”) on the rise
Dr D: Part of the development of the teen psyche involves becoming aware of social norms. As they do this, they also become aware of differences and develop standards of beauty. Many of these teen nose jobs are justified as medically-needed, but appearance usually factors in. Otoplasty is a similarly social operation.
II. Statistic: YOUNG ADULTS – Breast implants. Ages 19-34. 166,000 a year. (ASAPS)
Dr D: “Beauty standards” are important motivators here as well. Young adults in the workplace (and social groups) see those around them doing these things and often being complimented. Some of these patients may also be seeking after childbirth “body repair.”
III. Statistic: EARLY MIDDLE AGE – Liposuction. Ages 35-50. 143,000 a year. (ASAPS)
Dr D: A slowing metabolism in this age group combined with more involved work schedules (with increased sedentary time) equals increased trouble “holding back the fat.” Liposuction is easy and can help with that. Add some post-pregnancy issues here as well.
IV. Statistic: YOUNG ADULTS – Botox. Ages 19-34. 371,000 a year. (ASAPS)
Dr D: The fad of Botox use in the really young is an advertising phenomenon as there is no good reason for young people to do this other than to “feel” hip.
My opinions of course.
John Di Saia MD
Originally posted 2011-07-04 07:30:33.
A surgeon I’m thinking about seeing said on his site that breast implants were able to be done under local + intravenous anesthetic (like twilight). Can this really be done? I always thought it was too invasive for just twilight, especially if it is under the muscle. Is there an advantage to using twilight? After looking it up there are lots of differing opinions out there but I think that this may just be a way for the surgeon to cut costs. What is the cosmetic surgery truth here, Dr. D?
I am not a fan of local or twilight sleep for breast implant surgery except in rare cases (simple redos and such.) The reasons are patient comfort and practicality. I place most of my breast implants under the pectoral muscles and these muscles need to be relaxed for this to work out. That relaxation is suboptimal under less than a general anesthetic.
An interesting aside to the argument of sedation versus general anesthesia is the fact that under less than a general patients often need more medication to maintain them in a narrow range of alertness. This translates to more drugs for twilight sleep which is contrary to the reason many of these patients wanted less than a general anesthetic in the first place.
John Di Saia MD
Originally posted 2010-12-09 07:30:25.
I’m just wondering what your thoughts are on this. I am 5 months po from a FTT, MR (full tummy tuck with muscle repair). I have been working out and still eating healthy as I did b4 surgery, BUT my hips and butt seem to expanding. I’ve been going for lymph drain massages for my tummy and while it is helping that, I can’t help but wonder if it’s pushing fluid to other places. Not only can I not get back into my preop size 8 jeans, but I couldn’t even squeeze into a 12! I’m frustrated because I keep hearing different theories on this.
Prior to surgery did your weight fluctuate much? Patients like this following abdominoplasty can gain this weight in new places. This can become a problem.
At this point swelling is usually coming down, although in large cases it may not be completely gone for 6-8 months. Did you have much liposuction with your tuck? Liposuction frequently makes swelling more pronounced for a longer period of time. Also if you smoke, try to stop it or limit it as it interferes with wound healing. Assuming you went to a good surgeon, give it time. It gets better.
John Di Saia MD
Originally posted 2005-09-18 17:44:00.