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
Is Cosmetic Plastic Surgery Really Necessary? Almost Never. from Huffington Post
The bottom line is I could use some work, but I don’t like knives, I hate needles, and I don’t want someone to inject Jell-O into my lips. I’m not ugly, and I’m not a beauty. I don’t have Angelina Jolie’s face with those beautiful full lips or that fairly attractive skinny right leg; I don’t have Jennifer Aniston’s gorgeous legs and arms and flat stomach but I don’t want Brad Pitt so I’m good. If I got a face lift and had liposuction, I would look like someone who had a bad experience in the barn yard. It would go bad, I just know it. I’ve seen bad plastic surgery and the “after” is much worse than the “before.” If it could go wrong, it would go wrong on me. I just have that kind of luck.
I can’t even stand it that girls/women in their 20′s, 30′s and 40′s are getting cosmetic plastic surgery and Botox injections these days. There’s no reasonable explanation.
Actually there is a reasonable explanation: they want it and it is none of your business.
I read this Huffington Post article and could not resist the temptation to respond:
“While you have the right to your opinion much of it is based in ignorance. Cosmetic plastic surgery patients are not universally seeking perfection. Mine aren’t. They just want improvement. Not all women are in an “OC Housewives” competition for beauty either. Many patients seek reasonable improvements and get them not to become caricatures of television plastic surgery addicts. Most of my patients have one operation and do not become “frequent flyers.” Plastic surgery practices vary just as much as the patients.
I have been practicing plastic surgery for nearly 15 years and the patients you describe are not in mine. The only thing that you write that rings true to me is that you shouldn’t have plastic surgery. That’s because you don’t want it. And that is fine.
I do thank you for providing a topic for my blog post for tomorrow however and hold you no ill will. We just come from different perspectives.”
Cosmetic plastic surgery is not necessary by definition or else it would be reconstructive. But the opinions of those against it are no more or less significant than the opinions of those for it. The misconceptions upon which this article is based are multiple and remarkable.
John Di Saia MD
Originally posted 2012-03-01 07:30:29.
A woman stopped by my South Orange County office a few times over the last few days somewhat bewildered by the staff’s reluctance to give her an exact Botox price without an appointment. The ranges she was offered were not to her liking.
Botulinum toxin and filler services can get a bit complicated. It is true that the industry marketing for these products has been in a retail format. Clients are naturally under the impression that they can price them like this week’s market special. While it is good for sales to quote a price cheerfully when asked it frequently leads to misunderstandings.
Not every client coming for these items is actually treated as she might have foreseen. Buying Botulinum toxin injections is not like buying an eyeliner. Different people are served differently by different amounts of the treatment and the treatment’s effects do not mature for a few days afterward. This hints to the potential benefit of an evaluation by an experienced injector and in this case a board-certified plastic surgeon. If you price these clients without specifying their exact treatment first, you are guessing. The actual numbers end up different than initially quoted and people feel ripped off.
In addition, some clients are looking to get these services on the cheap and that is not my schtick anyway. I am not a nurse clinic in a strip mall. I am a plastic surgeon and while I am good I have overhead.
Suffice it to say I prefer to evaluate people before pricing them for anything. It is more accurate and leads to fewer misunderstandings.
John Di Saia MD
Originally posted 2012-08-09 07:30:53.
This frequent commenter got a phat discount off her redo breast implant surgery. She had had breast implant surgery with yours truly 13 years ago. Commenting here frequently got her a nice $1500 discount on her redo:
“At almost 13 years post-op I had a redo because I didn’t want to push my luck having them in too long past what I thought was safe.”
I believe she was worried about rupture although her original saline implants were still soft. She also wanted a little lifting.
John Di Saia MD
P.S. Keep an eye on the Giveaways Page to comment your way to some free goodies too.
Originally posted 2013-08-19 07:30:31.
I had breast implants and they have become hard over the last few years. Will capsulotomy surgery help?
Breast implants can harden (actually the tissue around the implants can harden) resulting in distortion of the breasts and at times pain. We have discussed the problem (Capsular Contracture) here before.
Significant breast implant hardening does not complicate all breast implant patients, but when it does additional surgery is the only good solution. The process involves the formation of a “capsule” of scar surrounding the breast implant. At times this capsule has an elastic consistency and at other times it can be “studded” by deposits of calcium that make it really rock hard.
Surgery to soften the hardened breast can involve scoring the scarred capsule to release the tension (Capsulotomy.) When the capsule is quite firm or studded with calcium, more involved surgery is in order. Capsulectomy involves the removal of all or parts of that scarred capsule.
Whether either of these treatments will work depends upon the cause of the contracture. Usually the implants can be replaced, but in really severe cases they need to be removed.
What you really need is a good evaluation by an experienced plastic surgeon to figure your best course of action.
John Di Saia MD
Originally posted 2011-07-06 07:30:03.
For years I have avoided Medicare breast reductions for a number of reasons:
(1) Poor pay for hours of work. An average breast reduction when done to a high standard usually takes 3-4 hours. I do not staple the closure.
(2) Medicare patients due to their age are at higher risk for wound healing problems.
(3) 90 day global fee period – These patients routinely need follow-up care and that care is not billable.
Recently I ignored my better judgment and performed the operation for a lady in whom back pain (ICD-9 724.5) and back surgery had been long term problems. She also had a pretty nasty rash (ICD-9 692.89 Dermatitis and eczema [in the infra-mammary fold]) under her right breast that just wouldn’t go away. These of course were all in addition to the usual diagnosis of large breasts (ICD-9 611.1 Hypertrophy of breast.)
Medicare showed me yet another reason for my hesitation to do these cases when they denied payment for the operation saying it was not medically indicated. They will probably pay on appeal, but the thought that I should have to appeal the case adds insult to injury.
John Di Saia MD
Originally posted 2010-06-01 07:30:04.
Non invasive technologies are all the rage. It is still amazing to me that companies can release a new product with no proof of efficacy, a slick name and a marketing line of copy and expect to make money. Still more amazing is the case in which they actually do.
From the looks of the web site the i-Lipo system looks like a laser shined on your skin claiming to encourage fatty tissues to shrink. The images on their web site show modest if any results that might be accomplished “when paired with a change in lifestyle to maintain your results, typically just simple diet and exercise.” I’d bet much of the change they show might be accomplished with exercise and diet modification alone.
And if that is not enough Bob look behind curtain #1 to find the new and improved i-Lipo Ultra Plus system. This incorporates vacuum massage ( a la endermologie) and infra red skin tightening (a la Thermage) to the system. This might be their “everything but the kitchen sink” product.
I would not be spending money you can’t afford to lose on these. I doubt they work very well at all. But who knows our immediate gratification hungry public might just make them some money. It has happened before.
Originally posted 2012-05-22 07:30:02.
Should your cold cancel surgery? Colds and other minor mild infectious ailments are a fact of life. They can intercede with plans for surgery however. This question pops up now and again in surgical patients affected by a common cold virus. As usual you will find the answer to this is a matter of opinion.
When people become afflicted with the common cold virus, they become variably ill. Some develop chills, a fever, muscle aches or even more serious complications from that cold. Others just get a bit of a stuffy nose or post nasal drip. A question to ask is whether or not the surgery might make the cold worse? Anesthesia can suppress the immune system a bit temporarily, so the answer is potentially “Yes.” Is the potential patient ill already and would this worsening of the cold make him or her dangerously ill?
The consideration of cancelling surgery is a matter of a risk versus benefit equation: Is the benefit of the surgery worth the risk of the surgery with the cold? Elective cosmetic surgery is discretionary by definition. Moving ahead with liposuction in an ill patient would be considered by many a poor choice.
For patients who are healthy, generally surgeons look at objective signs such as fever. If the patient has a temperature > 101 degrees or is more than just a bit affected by the cold, many surgeons consider postponing the surgery. If you are developing a cold as your surgery day approaches, you should be communicating with your surgeon’s office.
John Di Saia MD
Originally posted 2013-02-27 07:30:10.