Filed under: breast augmentation
by Terrye Tebbetts
I must be missing something! First we don’t know if we are going to be going to be big enough, then we don’t know how to tell people we have breast implants and are afraid of people – friends and relatives – being RUDE to us. I copied a couple of real questions from a forum below – I am constantly amazed that in none of the talks, questions or discussions do potential patients ask or wonder, “what will my body allow safely?” “what will look really good on me?”
There is a difference between breast enhancement and Boob Job and let’s be really clear here – there is NO in between!
First question….
I posted earlier about picking my size with my PS yesterday….Is 492cc too big??? I tryed on the 450’s and just did not see the look that I wanted plus I am taking into account that everyone says that they look smaller once placed under the muscle. Now I am wondering if I am going to be way too big…I mean I do like the big look and I have hips and a big butt with a small waist so I think that I can balance it out but im so scared. Am I goin to be able to fit into a bathing suit top???? Please help me with your stats and your decisions so I can compare…Im 140 lbs 5′3″ and i think about a 34 B. I want to be a full D to DD. All responses will be so much appreciated!
Second post… Ok so my BA is in 13days!!!!So excited and thanks to you ladies I am feeling more and more confident in my decision with 492cc’s. At first Iwas very worried that they may be too big, but I am feeling better now. But my next fear is my boyfriends parents and family…My mom is fine with it and my grandmother is too( I dont have much more close family). But my boyfriends dad can be very honest and rude at times. Im so nervous that his family might say bad things about my decision or think that I am superficial. He coems from a family of all boys so I dont think that anyone would understand. I dont want to tell them but my boyfriend will be staying at my house for a few days to help me and I dont know what we are going to tell his parents. I just want to have them and have everything go okay and stop having boobs constantly on my brain!!!! lol
Has anyone had issues with telling people or anyone ever saying anything rude…how have you guys dealt with this???thanks so much!
My response….
How did you and your ps arrive at your size? Have you had children – what was the change in your cup size with babies?
If you do not ASK your TISSUE to go where is has not been before, then after surgey you just look AMAZING but if you force your tissue to a great big 492 cc implant and you are a tiny little A cup with no babies and stretch – - EVERYONE is going to know and you will have a ton of complications in the future.
That is why I ask, did your PS use High Five – measure you and help you choose a size based on your breast and your breast tissue and your breast stretch – or did you tell him a cup size, look at a photo of another woman or stick a sizer in your bra????
The ps has to work with what you bring to the OR – whether people will know and how you end up explaining it will all depend on the decisions YOU made PRE- OP.
Chosing to have breast implants can change your body in a wonderful, amazing way that you can never do on your own through diet and exercise. They should enhance what you have, fill the empty space that babies took away – - not try to turn your body into something it has never been. To go into surgery, plan a breast aug without employing High Five is, in my opinion, asking for trouble, miscommunication and complications long term. Preop planning should be based on your BREAST and your Measurements for optimal results!
Filed under: breast augmentation
by Terrye Tebbetts
I am constantly amazed by how ladies who decide to have a breast augmentation will research endlessly how they can help themselves recover and have a better experience – yet they inevitablly miss the importance of researching and understanding one of the most important aspects of the entire operation – the surgeon and the surgical procedures/techniques that will be used during the operation. I guess some of it goes back to that inherent “trust” we have of our doctors? I don’t know. But I hate to see women try to FIX it all on the back end – after the surgery – thinking that if they take a certain vitamin or supplement that it can fix what could have been done better in the OR. Here is a conversation between two women that is very common about the use of vitamins pre and post op to help in their BA process….
Hi Ladies! I will be getting my BA in about 4 weeks and wanted to see if anyone has recommendations of what vitamins I should start taking to prepare for my surgery.. Thanks!
Hello, my BA is in 2 days - From what i’ve read, as well as what my PS told me, to STOP taking all vitamins and minerals, herbs, etc… the only one that I was recommended to try is Arnica Montana (ask your PS about it) It’s supposed to help with brusing and swelling after the surgery…. i’ll let you know if it does work! 
I haven’t found out any more info on vitamins, but i’m just following what my PS says. Oh and they also told me not to start taking any vitamins etc until 4-5 days after the surgery. Hope that helps?!
Here is my response to both ladies…….
What you experience post op and how you heal over time is effected by a combination of things – but the two primary factors are how you heal as an individual and how the surgery was done to begin with.
Vitamins can help how you heal as an individual a little – but honestly, your genetics are going to rule over what you take by mouth pre and post op. And what you take by mouth pre and post op could possible impact your recovery negatively (which is why they ask you to stop a lot of things pre and post op) – vitamins and supplements are not regulated as closely as medications and although most see them as natural and good for you – they can really be problematic in and around surgery.
How the surgery is done is really the most important factor here – you, as the patient, should not have to take a bunch of vitamins and supplements to compensate for what happens in an operating room. Breast augmentation is an elective procedure that you do when there is NOTHING else going on in your system. So the ps gets the best of circumstances in the OR. There are surgical techniques that the surgeon can use to prevent, limit, eliminate bleeding during the proceedure. See, the more you bleed, the more inflamation, trauma to tissue and increased need for bras, bandages, straps, drains and pain meds or pain pumps. If there is blood, then there is bruising. If you can dissect the pocket with no blood – guess what? No bruising. So why should you have to take Arnika and whatever else to help reduce something that could have been prevented during surgery?
We know in our 24 Hour Recovery papers and studies that when we eliminate blood, recovery and healing improve, and the incidence of capsular contracture is reduced dramatically.
Having a BA is a team effort between you and your ps – but how you heal is only part of the equation. Newer, better surgical processes exist to help both members of this team achieve better short term experiences and long term results!
Filed under: breast augmentation
By Terrye Tebbetts
I popped onto an implant forum this morning and saw another post about all the pain and restrictions after breast augmentation surgery. The post was titled 7 Hours Post op… “Hi Everybody. Well, I made it through and it hasn’t been too bad!! I’m a little loopy on the Percocet but not much pain. The hard thing is to remember not to reach up, around, etc right now – don’t want to do anything to undo all of this!”
This just floors me! At 7 hours post op a 24 Hour Recovery patient has already eaten, showered, done her hair and makeup and is out and shopping and going to dinner taking nothing but Motrin!! Better, more precise surgical procedures eliminate the need for pain killers and restricted movement. Dr. Tebbetts developed these methods and published and scientifically proved them so other surgeons could offer this better experience to their patients too.
24 Hour Recovery is a reality and not only does it limit pain and down time, but in the end, patients who resume normal activity and movement immediately also see lower risk of capsular contracture!
Ladies, there is no need to endure pain and drains and straps and ace wraps and pain pills and pain pumps and weeks of down time and higher reoperation risks!! But you have to search out the new ways – you have to ask for 24 Hour Recovery – if you ask for it, then more ps’s will be motivated to change their ways. Right now as it stands, going through a standard breast augmentation is like going through natural childbirth! It hurts like hell but you still love your kids in the end. BA hurts like hell but you still love your implants in the end (but with a higher risk of revision and reop)!
It doesn’t have to be that way but you – patients – have to demand the better, surgical procedure or it will never change. As long as yall are willing to put up with the pain and the Percocet, plastic surgeons are not going to change – they have no reason to because yall will keep going and keep paying them to do it just as it was done and has always been done for 30 years!
Choosing to have a breast implant is something we want to do for ourselves – it is a luxury. If you are going to choose to indulge in a luxury, don’t you want the absolute best you can for yourself? Demand state of the art from your surgeons – if they hear it enough, you guys can change the way BA is done for the better. As Jerry McGuire said in the move, “Help me..Help you!” You are the patient, the one changing your body for life – you deserve the BEST!
Filed under: breast augmentation
By Terrye Tebbetts
I recently learned that an acquaintance of mine, along with her new plastic surgeon , made a very poor decision to try to revise and fix something that probably never needed to be “fixed” in the first place. She ended up with a really bad staph infection and had to remove one implant, 2 operations, a trip to the ER and months of agony. I read stories about it on the forums all the time ~ “I think I will have my ps just tilt this nipple up a little more” or “My right implant is a little lower than the left one, so he is going to fix them” or “I see rippling when I so this at the gym, so I am going to have them fix it” or “I think I’ll change from unders to overs and go up 100 cc’s”. Ladies, we need to come to an understanding. There are no two breasts alike on this planet before surgery and there will be no two alike after surgery!
Patients
Breast implants are not magic. They cannot fix differences in your breasts, make you into a supermodel or fix your troubled marriage. Breast implants simply make you a bigger version of what you already are. You are responsible for what you bring the surgeon to work with – he or she cannot change the number of pregnancies you have had, or the weight you have gained and lost, or certainly your genetic qualities that determine tissue elasticity and the shape and position of the breasts you were born with. As a patient, the sooner you recognize the reality of what you are augmenting to begin with, then the happier you will be with your result. This is why OBJECTIVE measurements – the High Five System of operative planning – are so important. When you and your plastic surgeon measure the 5 critical measurements and review them with your photos, you will be able to see what the surgeon sees and you can gather your expectations and make them realistic. Breast augmentation is an amazing operation, provided that you are not expecting an implant to do something it was never meant to do. You know how you are always surprised when you hear your voice on your voicemail message? Guess what, what you see in the mirror is not what you will see when you can look at your photos objectively with a surgeon and correlate what you see with your measurements.
Surgeons
I know I am taking a troubled road here – but so be it. Plastic surgeons have a responsibility in this whole perfection, revision for” ify” reasons too! If surgeons used measurements and were honest with patients PREOPERATIVELY about what can and cannot be successfully, clinically done, then I don’t think we would see as many revisions and problems post op. If surgeons are not upfront and honest with patients and discuss all the hard issues before surgery, then when the patient comes back and wonders why her left breast is different than her right, he or she is more likely to try to go back in and operate again to “fix” it. When the reality is – it was different from the beginning and no surgical procedure can make them identical! This is reality – think about it – even if a surgeon lifts one nipple to try to match the level of the other nipple – one nipple has a SCAR on it and the other doesn’t – - so they are never the same – - – it all comes back to a different set of differences! And as surgeons, they are supposed to be responsible for patients and provide the best care possible – sometimes that means saying NO. Patients can be just like children and ask you for things that you know will may not be in their best interest. As a parent, if my daughter asks me for something that I know may cause harm to her, I have the responsibility as her Mother to say NO. I think surgeons have that responsibility to patients too. Sometimes the best care your surgeon can take of you will be to just simply tell you NO.
It all comes back to communication and honesty BEFORE surgery – patients and surgeons must take a new look at the responsibility that each have in this procedure. Breast implants have taken the rap for what patients and surgeons do far too long. Remember, implants sit in a box until patients and surgeons put them into action.
Breast augmentation is an amazing operation that can change a woman’s body in a way that she can never change it on her own. The surgical techniques and devices are improving. Now if we could just get the two players – patients and surgeons – in the game to improve their research, education and communication preoperatively, I think we would see a lot more happy patients and fewer revisions and reoperations. Remember, the very first operation is the best chance to get a good, long term result that you will enjoy.
Filed under: breast augmentation
by Terrye Tebbetts
The following is a transcription of Terrye Tebbetts live question and answer session on ImplantInfo.com on September 30th, 2009. Many women from around the country joined the session to ask her questions about breast augmentation and breast implants. Ms. Tebbetts is co-author of the books The Best Breast and The Best Breast 2. She has managed one of the world’s largest and most sophisticated breast augmentation practices for twenty years, making her one of the most knowledgeable women in the United States about breast augmentation from both the patient’s and surgeon’s perspectives. Read on and enjoy the discussion.
Terrye Tebbetts:
Hello Ladies – thanks for the opportunity to hang out with you all for a little while tonight – I love the live sessions because we can actually communicate and work through the issue instead of having to come back and see if someone responded – so fire away…..I am here to help. Terrye
Q: Correcting and Preventing Bottoming Out
Hello and thanks in advance…
I am 5 yrs post-op and have bottomed out. I have saline under the muscle implants with 410 cc’s, which fits my frame well. I was wondering what your opinion is on the best way to correct it and prevent it in the future. I am planning on having a redo to switch to silicone and to have this corrected. I work in law enforcement and have to wear a vest, which puts weight on my chest. What’s the best procedure for me to have this fixed? I also will wait 6 weeks after surgery to wear the vest. Thank you.
Terrye Tebbetts:
Whenever stretch occurs in the tissue, it is always difficult to predictably fix. There are a few surgical techniques that can be use to reinforce the inframammary fold area and switching to a silicone implant, I believe, is the right move as they tend to put less weight on the tissue long term. But the best thing that can help prevent this from happening again, and you won’t want to hear this, is to go down in size. If your tissue did not hold the 410cc well the first time, it is unlikely it will cooperate this time. I trust you ps suggested you go down in size???
Follow-up Comment: Glad I Asked!
Thank you very much for your response. My PS did not mention going down a size. But if that is what is needed to prevent it, I can definitely live with a smaller size. I also developed some rippling on one side, which hopefully silicone will help that too.
When I first starting researching BAs, “The Best Breast” was the first thing I wanted to get my hands on and was very informative. I trust your advice and thank you for responding!
Terrye Tebbetts:
I am so glad you are open to a slight downsizing – that will help not only with the bottoming out but with the rippling too – there are 2 kinds of rippling – one from under filled implants and one from any implant that is too big for you – so if your implant was heavy enough to cause the bottoming out – it may have contributed to the rippling too – hopefully you can kill two birds with one stone here!
And thanks for your comment on the book – glad it was helpful!
Follow-up Comment: I knew I should post here tonight!
Your advice makes a lot of sense to me. The PS I went to for a consultation on a redo (not the original PS) confused me. He suggested the possibility of going even bigger- which I don’t want. I thought smaller would help- at least with rippling. It didn’t occur to me the weight of the implant itself would be a factor for me because I always thought it was the vest I wear at work that caused the bottoming out.
I am glad you are here tonight. You really made my day! I couldn’t wait to post!
Terrye Tebbetts:
I really don’t think there is a better group of women out there to help you through these issues and questions – although we may have differing opionions and experiences, the community here is here to help and see that everyone is welcome and benefits from there time here – so we are glad you were here tonight too.
Now all you have to do is keep us posted on your progress as you head into your re-do!
Q: Rice Test – How is this done ?
I’d like to determine what would be the difference in CC’s. Could someone let me know how to do the rice test?
Terrye Tebbetts:
Red’s post to point you to the FAQ should give you a good idea of the rice test, but I would encourage you to also think about measurements as you try to determine size with your ps – I can email you a measurement how to sheet if you’d like to try it – just email me at TTebbetts@plastic-surgery.com Terrye
Q: How Long Does Dropping and Fluffing Take?
Hi Terrye!
I just had my BA last week, so I know it’s still kinda early but I’m wondering, how long will it be before I really know what size I am? How long is the “dropping and fluffing” process? When should I expect it to happen?
Terrye Tebbetts:
Have you heard the old expression a “watched pot never boils?” Right after surgery I think it is so hard for women to wait and see the dropping and fluffing process because we have waited so long to get them – we want them to hurry and do it! But in reality, it takes on average about 4-6 weeks for them to not feel and look engorged (or like they are in a push up bra all the time) and really a good three months before they feel like they are part of you and you can truly go try to figure out what cup size you will be.
If your ps put you in a special bra or strap, please disregard this suggestion but if he/she did not – then right now is the perfect time to play with the new look in things like camis with shelf bras – they are colorful and can be worn to be seen or not, they fit you right after surgery and three months from now.
Don’t worry it will happen – just takes a little time!
Follow-up Comment:
LOL @ “the watched pot never boils.” I totally know what you mean. I guess I’d better find something to get my mind off of them for a few weeks!
Thanks a bunch!
Terrye Tebbetts:
You are welcome – and it will happen, but there are so many things to enjoy now too! I got your email and will send you a book out tomorrow – it will help too as you go through some of the other adjustments as they settle during the next few months. I often have patients tell me they refer back to the book even more post op than they did pre op – just to be sure all is going well. I would love to know what you think about it after you have a chance to read it.
Q: More on Dropping and Fluffing
I’m only 5 days post op-I know it’s very early but I can’t help wondering when they will drop and fluff and all that good stuff. Also, I have a really full/tight feeling and I wonder when it goes away. And how long do I have to where this damn strap?!
Terrye Tebbetts:
I am with Red on the strap – your ps has to make that call. But most patients tend to see the “dropping and fluffing” deal happen within the first 4 – 6 weeks after surgery. It requires a little patience but you will get there – just enjoy the different stages as they do drop – and see how different clothes fit – have fun with it and wait to buy real bras (figure out what cup size you are) until you are about 3 months post op. Terrye
Q: what size?
I’m 5′4 150 but muscular…teach aerobics. Went for pre-op today for lift and implants. I want to be a full C I believe. I want to go as big as I can without it making me looking heaving. I’m probably a mid B right now. I wear a 36 C in the VS Very Sexy Pushup bra but don’t quite fill it out. My PS suggests I do 425 cc. Is that a lot? Some friends told me that would make me a big D. Any comments would be appreciated!!!
Terrye Tebbetts:
CC – How do you know you need a lift? Do you know what the nipple to inframammary fold distance is? You must have had some stretch along the way????
Follow-up Comment
Yes def need a lift…he did the measurements but don’t know what they are now. I’ve had one child and honestly have never had “perky” breasts. They are almost tuberous breasts. The implant I’m getting is a mod profile so we can create more of a base as well. Also this is something that I have thought about for a long time. Over the past three years I have gotten a consult from the same Dr and others. Three years ago I didn’t need a lift..in the past year I have. I’ve also lost and gained weight a few times.
Terrye Tebbetts:
Ok – with a tubular breast and stretching issues, then it sounds like you are on the right track – the width of that implant may very well be what is needed to help round out the bottom part of your breast. If your ps measured – then I am sure the recommended amount will be in the ball park for you – because you guys used your tissue to plan the operation – good work!
Terrye Tebbetts:
Down below there is a post – like many others I have seen here – asking for help in determining size ~ those of you who have read my posts before know how much we rely on our patient’s tissue to help determine the implant size – we chose to implement a measurement system called High Five to help take some of the confusion and guess work out of picking the implant size. When you rely on subjective things like sizers, cup size, rice tests and photos of others – the problem is – none of those methods take into account the breast envelope and tissue you will be operating on. So to plan your operation, if you and your ps apply a measurement system to the process – you are more likely to achieve a result that looks like it belongs on you and will age gracefully with you and be the least likely to cause you more risk of reoperation.
Now it is true – you can put ANY implant in any breast – but if you ask the tissue to go where it hasn’t been – you are opening yourself up to all the risks and revision reasons we see on here every day – traction rippling, bottoming out, edge visibility etc – - so you have to be very aware – if you want to push your tissue now, what does that mean to you in the future and is it worth the temporary gain to you?
All of these issues you should go over with your ps – they want you to have the best long term result as much as you do – everyone just has to reconcile what you want with what your tissue will realistically allow you to have.
Just food for thought……
Q: Question About Fat Transfer to Cleavage Area
Hi Terrye, thank you for being with us tonight. I live in Canada and had my BA in March 2006, unders, tear drop 410MX 290gr. I’m petite, about 5′ 1”, 110 lbs so the PS advised for under placement. I didn’t want to be too big but PS said that this was the smallest volume he could put in for them to look nice. I didn’t know back then about sizes, etc. So I didn’t know what he meant. The problem I have now is that, the base of the implants do not match my breast base. They are actually smaller by about 0.5 inches. So one can actually see an arch that cuts/goes into my breasts whenever I flex. I feel very uncomfortable with that as I find it makes obvious that I have implants. So I can’t wear any tops that come a bit low because I see that arch. I have read that fat can be transferred to the breasts to either augment or to cover implant edges. Do you think I should try that option or just change implants to match my breast size? I really don’t know what the best option is since with both options there could be complications and I don’t know which one is riskier. I also don’t feel so comfortable with the projection but I don’t know if less projection would make them look droopy. Any advice? Are you or your husband familiar with fat transfer procedures to the breast? Thanks for your opinion.
Terrye Tebbetts:
Yes, the fat transfer question keeps coming up – it is not a widely used procedure here in the US…yet, I think in part due to the trouble US ps experienced with fat transfer to the lips back in the day. Fat is very sensitive and needs its blood supply – I know there is talk, but I am not sure the science supports the talk yet. The folks over in the UK are pushing it too – but I just have yet to see the published reports that it really works well long term.
As for your implant dilemma, I am not sure that I completely understand what you are seeing – are you talking about seeing the implant edge in the medial area (over/near the sternum)? I would love more details if you can. I do have very nice experience with a ps in Canada that I can share with you and who has a TON of experience with the form stable implants.
The distortion you are seeing may very well be a muscle issue – not an implant size issue……
Follow-up Comment:
Terrye, Yes. I see something which is actually the edge of the implant in the medial area close to the sternum. One can see it even when I’m not flexing and it’s right where the implants end, which is not where my breasts end a little bit closer to the sternum. Could you please tell me who is the PS here in Canada and what other details I could give you for making the problem clearer?
Terrye Tebbetts:
Sure – just email me at TTebbetts@plastic-surgery.com and I will get the ps information for you – I am doing this from home and don’t have all my contact information with me.
Also, if you want to send photos to me of what you see, perhaps I can be of better assistance. The best way to take them without distorting your chest is to stand with your hands on your hips and take them from neck to waist – a front view and a lateral or profile of each breast. I will pass them along to Dr. Tebbetts too so he can help us out!
Follow-up Comment:
Thanks so much for all your help. I’ll take the pictures and email them to you.
Terrye Tebbetts:
Perfect – I look forward to seeing them and trying to get you to the right place for another opinion.
Your situation once again proves, there is no substitute for good soft tissue coverage!
Q: Yoga/implant displacement
Terrye: Can you tell me if practicing yoga twice a week can cause the implant to move? I am reading conflicting info on exercising the chest muscle and distortion. Yoga is not really “building” the chest though – your thoughts would be appreciated! Thanks!
Terrye Tebbetts:
There are three basic placements of the implant (and yes, I am skipping subfacial for the moment) 1. Sub mammary, 2. PRP – basic subpectoral placement (partially under) and 3. dual plane placement
The first order of business in pocket location is Soft Tissue coverage – if you have less than 2 cm in the upper portion of the breast, then more soft tissue coverage is generally recommended. Most women who want an implant don’t have much up top so they tend to need more coverage but would often choose “overs” to avoid more pain and the possibility of distortion. In the past, with traditional PRP placement – those were the trade offs – more pain and lateral displacment or window shading over the implant. The advent of the Dual Plane placement and technique has basically eliminated those two negatives – so if there is no real negative to more coverage over the implant, your tissue is only going to get thinner as you get older and radiologist prefer more coverage for better imaging, why not?
In my 20 some odd years in this specialty, we just don’t see displacement or distortion – especially with the newer techniques.
I have seen Dr. Tebbetts turn away patients who had too much pec – had built up too much muscle and there would be no way to blend it with the implant – but just the average person, staying in shape and being fit – yoga, boot camps, Pilates – I don’t have any experience with these normal fitness activities moving an implant.
I think you are safe – if you are just staying in shape and fit. And usually more soft tissue coverage over an implant is a better choice long term.
Follow-up Comment:
Thanks Terrye! You and I have had our phone “conference” and you have all my pictures. I know that we will be going dual plane/ silicone/. Just wanted to put my mind at ease! Thanks for being here tonight!
Terrye Tebbetts:
No problem! Glad I could clear up that issue!!
Q: BA With Current Autoimmune Disease
I am curious because I have a present auto immune disease (chronic auto immune thyroiditis) and was just wondering if breast implants of any type caused any problems. I just don’t want to do anything that may cause me to get any other auto immune diseases or complications with my BA. I am going to ask my endo about this Friday but I wanted to ask you if you had patients that had present autoimmune disease and has done well with implants. Thank you so very much.
Terrye Tebbetts:
This is a tough one – I just had a visit with a patient who was an awesome candidate for implants and really got all the information and, quite honestly, really needed the implants, poor thing! But in the end when we discussed some of the medical issues, she revealed to me that she has Fibromyalgia. It is under control now, but she asked me the same thing you did above.
Breast implants do not cause auto immune diseases, but (and you knew this was coming, right), but – if you change anything in your routine and your chronic auto immune thyroiditis status changes in ANY way – most likely the edno will have to blame the most recent change – the implants. No one knows exactly what causes auto immune conditions to flare up or not – endos are the best detectives on the planet – constantly searching for reasons why your condition might have changed.
In the book, we caution very seriously about adding an implant to a body that has an auto immune issue – I just don’t think it is worth it.
Sorry I can’t be a better cheerleader on this one….
Follow-up Comment:
Thank you SO SO much for your honest answer I agree. It isn’t worth it and I REALLY need boobs..LOL..I am flat as they come. I can’t even fill up an A cup! Thanks for your time. I do appreciate it so much.
Terrye Tebbetts:
You are so welcome – I respect the fact that you are feeling all of this out and doing your research – still run it by your endo – but have a feeling they will say the same thing.
You know, BA is a reasonable thing to do for yourself if all the stars align – because you can’t change your breast in any other way – so to contemplate surgery – it’s reasonable. But implants are ALWAYS – no matter the situation – something we WANT – not need and if there is even a hint that it or they might compromise your health – then the decision becomes really easy!
Q: Risk of Infection in Revision Surgery
Just to have another opinion besides my ps…What are the risks of me getting another infection in the same breast when I go back for my revision/replacement? I am starting 3 types of anti. 3 days before the surgery. Is there anything that I can do to prevent this from occurring again?
Terrye Tebbetts:
Breast implant infections are BAD deals as you well know now. It is never easy to go through one and it is even harder to hear what I am about to say – but you asked….
In our practice, we educate our patients ahead of time about the risks of infection and how we handle them if they happen – Dr. T is very adamant about this in the book – it is the only post op risk that can actually make you really sick really fast – the only thing that can really hurt you in BA. So our policy is – at the first sign of an infection – both implants come out and they stay out. Once the intracapsular space is infected, it is almost impossible to cure it with surgery/drains/betadine flushes and high powered antibiotics – as long as it stays there it acts like a splinter and just creates more problems and puts you at risk for more tissue damage. To replace the implant – you have to go back to basically the same pocket location – having been through the infection – that pocket is more likely to be at risk for a secondary infection and capsular contracture when reimplanted. That is why he will not put them back in – he doesn’t want to put patients at high risk again.
With your history of MRSA – I am not saying it can’t be done – sounds like they have you on all the powerful meds – but there is no way around it – a secondary infection is a huge risk for you. I would develop a what if plan with your ps – so that if, if, it happens again you are both clear on the best possible treatment plan to keep you safe and healthy.
I will think REALLY good thoughts for you and your ps on this one – I am sure all the other ladies will too! Please keep us posted – God Speed!
Follow-up Comment:
Thanks so much….. I am happy to hear the truth even though it hurts. I need a backup plan because I can’t get in that shape again. So it may come down to removing both. Thanks for filling me in.
Terrye Tebbetts:
No problem – I do so hate being the bad guy!
Are they starting you on Vanco? Is it oral or a pic line?
Follow-up Comment:
no um a nasal anti,bactrim, and cephalexin all 3 anti. [Terrye—need your help deciphering this one!!]
Terrye Tebbetts:
I have heard great things about the nasal treatment – that is really good!
Q: Terrye’s Book
I recently had a BA six weeks PO and I would love to get a copy of your book for myself and to share with my girlfriend who is considering the gummy implants…could you tell me how to go about getting this book…I am so excited to read it….
Thanks…
Terrye Tebbetts:
Lisa – just send me an email – Nicole put a link up at the top of the page – and I will be happy to send you one – the more we all know about this -the better the choices, decisions and outcomes will be – I am so glad you will share it with your friend!
Q: Lifting Heavy Weights Post-op
I am 6 weeks PO and I have been considering being a caregiver for a short time while I finish up my degree in school for a 20 year old disabled woman…she is approximately 100 pounds so some lifting in and out of her car, etc., will be needed…..do I need to worry about my unders placement at all…I know that in these cases our legs and arms can help balance out using your chest muscles…could I damage the work I have had done in some way or do you think I should be clear to go…this is probably a silly question, but I am still a bit tender in my breast area and have been babying them now since the surgery..
Terrye Tebbetts:
Not a silly question at all and one I would certainly run by your ps first.
Our general post op rule is that after 3 weeks you are ok to lift more than 35 pounds. But you have to remember, we employ all of the tenants of 24 Hour Recovery – these surgical techniques allow us to have patients have their arms above their heads the day of surgery, showering, washing and drying their hair, closing car doors etc – they can lift up to 35 lbs immediately and after 3 weeks resume heavier lifting. I do ask that really aggressive boot camps and horseback riding (barrel racing and rodeo stuff – we are in Texas you know so rodeo is a real deal here) and completive tennis players give it more like 6 weeks before they really go after it. If you were our patient and our surgical techniques had been used – I would tell you to go for it and take the job.
But since we did not do your surgery – please please clear it with your ps before you do anything – hopefully they will say ok!
Q: Working Out and Implant Placement
Many women have posted recently with concerns about unders placement and working out their upper body. Also their PS’s advising against doing upper pectoral type workouts after unders are placed, as they feel they can/would displace their implants.
What have you found in your practice with this occurring for women? One lady was wanting to re enlist in the military but was afraid to do so , because of the strenuous upper body workouts she would have to be doing, like pushups,etc… (As her PS advised “not” to do them)
I understand the Dual plane or the Subfascial placement may work better for some women…if they live a life style of Body Building or Personal Trainers.
Terrye Tebbetts:
I just posted on this a little above – sometimes it is hard to reconcile a life style with the limits of breast implants – I can’t tell you how many times a patient will say, “I want them as big as they can be, but I run 10 miles every day and I don’t want them to interfere with my running” – well, now, that presents a problem – yes you can augment any breast, but if that breast belongs to a lifelong marathoner – then she may have to make a few changes. Now if it is just about staying healthy and fit – then no, I just don’t see distortion or lateral shifting or window shading – - especially with the advent of Dual Plane.
When it comes down to it – once again, it is about working with what each patient brings to the OR table – putting implants under extremely thin coverage (“overs”) just doesn’t make sense to me.
There is a place for “overs” – no question – but in the very slim, slight, really athletic patient, more coverage is generally needed and the patient has to really reconcile the life style choices – whether it’s professional (i.e. the military career) or just for fun and fitness.
Q: Recovery Bra
Terrye – what kind of bra is the best to wear during recovery? I have heard several different opinions on this – wire, no wire, sports bra, no sports bra, etc. Thanks.
Terrye Tebbetts:
You first and foremost must follow your ps rules on this one – but if they don’t direct you to a certain type then here’s what I tell my patients:
Because of the precise dissection techniques that Tebbetts uses, there is no need for a bra, strap or bandage – so we encourage you to wear whatever makes you feel comfortable – for some that is nothing at all – others need to feel held together and like sports bras. I think patients misunderstand the “No Underwire” warning – to me – its anything – any elastic band or wire – that rubs your incision. If it is rubbing and irritating – don’t wear it!
I like the camis with shelf bras for the first 4 – 6 weeks post op and I love the Best Form bra I found a WalMart – I posted below on it – I ride horses, and am a novice, so I bounce around too much and those Best Form bras at least keep my Implants from bouncing too much too – now if I could figure out something to cushion my butt – I’d be good to go!
I hope this helps. T
Q: Gummies approved yet?
Terrye – is there any word on when the 410 gummies will be approved for everyone (not just the study)?
Terrye Tebbetts:
AHHHH – alas – no. We were hopeful that the FDA would release them at the end of the last 6 month stretch (which ended in August) but they extended the study for 6 more months – September to March is the current study time period.
Q: Sleeping on Implants
Hi Terrye, I know the last doctor on here mentioned that we should never sleep on our implants and worried some of us a bit. I am a slide sleeper but in the middle of the night I roll onto my right breast and put a lot of pressure on the breast.
What are your thoughts about implants and sleep positions. Thanks!
Terrye Tebbetts:
I knew this would come up! Ahh, you guys love putting me on the hot seat huh?
Far be it from me to disagree with a surgeon – as I am not one, only married to one! But in our practice and experience, we do not discourage patients from lying on their breasts or sleeping on them.
For those of us who don’t really care for that position, once you have implants, I think it is really uncomfortable for most of us. But some stomach sleepers – women who cannot sleep unless their bellies are on the matress – they can fall asleep that way from the get go!
Perhaps the ps was concerned about pressure on the incision in the very beginning – especially in very thin patients – and just wasn’t clear about the time frame. I don’t know.
But I do know that we do 6-8 BA’s a week, have for 27 years and do not limit our patients’ sleeping position.
Whew – I hope that helps…..
Q: More About Sleeping on Implants
Terrye- I have the same question. The last dr worried me a bit too. I really think the fact that you participate so much on the board, it has earned our trust a bit more…. How do you feel about sleeping on implants??? I know Patty says she sleeps however and has never had a problem. Thanks alot!!! Lissa
Terrye Tebbetts:
I answered a similar question above – and no, I don’t think there is harm in sleeping on your breasts long term – but please read that entire post so you get the entire content of my position. It is always hard for me to disagree with a ps.
And thank you for your comment! I am so happy to be part of the community you guys have here-its the best one going! And this is what I do day in and day out – so if you have a question – please don’t hesitate – just email me at TTebbetts@plastic-surgery.com – post it here – but if I don’t see it – jog my memory so I can hop back on!
Follow-up Comment:
Thanks Terrye….I giggled a few times reading your post!! Glad you’re off the hot seat now!
Q: Sensitive Areola Area???
I will be a week PO tomorrow and I have noticed my areolas are very sensitive. Is that normal?
Terrye Tebbetts:
Yes – Emily – it’s normal and will be there for a while – nerve regeneration takes up to 6-9 months to even begin to normalize. But don’t worry – it will vary in intensity – so if it’s really bad today – it might be just fine tomorrow. Tingly nipples are usually a good thing as Martha Stewart would say!
Q: Lifestyle and Capsular Contracture
I was just curious if you know of any research that has been done on how an individual’s lifestyle such as diet, alcohol intake, exercise, smoking, stress etc. can affect a person’s chances of developing CC? I have heard some women say they are told to take vitamin E as well as some other supplements….but I wondered if it was thought to be likely for any other lifestyle elements to play a role…It seems like these factors would have a huge impact on our body’s ability to heal itself properly…What are your thoughts?
Terrye Tebbetts:
Beth – the disappearance of silicone implants from the scene during the 1990-2006 and the advent of better, more precise surgical techniques have given us some VERY valuable tools for dealing with the issue of CC -
There are three basic factors that affect CC risk – 1. How does each patient heal? 2. Which implant device are you using and 3. How is the surgery done?
I wrote a LONG piece on the Mystery and Misery of CC – it is posted to my blog – just go to www.thebestbreast.com and click on the blog button on the home page – then jsut scroll down to get to the CC piece.
But in a nut shell – here is the REAL advance and scoop on CC – How the surgery is done – how much trauma and blood that is created in the initial dissection of the pocket is critical to reducing your risk of CC long term! I know some of the folks here think I am a nut for talking about 24 Hour Recovery so much – but we now know that there is a clinical significance to 24 Hour Recovery – when patients can return to normal activity the day of surgery, we have published data that shows it can reduce the CC risk to 1.5% – that is a huge benefit to you guys!
So the lesson here is, CC is still the biggest wild card in BA, you can’t control how you heal, the implant data for CC varies just slightly from device to device, so the only thing the patient and the surgeon can control is how the surgery is done – that is why there are 2 Recovery chapters in the book – the more you know about what it will be like post op – the more it will tell you about what is happening in the OR and that is important – crutial to your long term results!
So individual healing does impact CC – but that is a genetic quality that you can’t control -I am not aware of any scientific data that equates lifestyle directly with CC risk.
Q: Nipple Reduction
Terrye – you responded to my post a few days ago and I didn’t see it until tonight. You asked whether I was speaking of a nipple or aerola reduction. I am speaking of a nipple reduction. I breast fed two boys for about 3 months each. I have 500cc HP silicone implants. I have that headlights look in almost everything I wear. The strange thing is that in the morning my aerolas and nipples are soft and my nipples are not enlongated/hard. That only lasts for about 5 minutes and then they stick straight out the rest of the day. I have tried all of the petals, etc. My breasts are a bit bigger than I wanted, so I don’t want to go with a heavily padded bra to avoid the show through. Not to mention that finding bras in my size (32DD) that I like and that are not too uncomfortable is hard enough. I checked out a few photos of a nipple reduction. If I could get the result shown in those photos I would be very happy. The patient in the photos looks to have my build but with smaller implants and the photos of her nipples “before” look sooo much like mine. I am not concerned with losing sensation, as that has never been one of my “things”. I do not plan on having more children, so the possible inability to breastfeed is also not an issue.
Sorry for the long post. Any advice, comments, personal experiences would be greatly appreciated. I promise to check this post sooner than I did the last one.
Terrye Tebbetts:
D–We just don’t see many cases like yours so I am at a bit of a loss. However, if sensation is not an issue and the ps can tell you what the risk of infection (to the implant) would be doing a nipple reduction post op and its a low, acceptable number – then I would go for it.
Another alternative, or at least a stop gap while you are thinking, have you ever tried the Gap Body T-shirt bra? I love them because they are not thick and padded but whatever they are made out of allows me to wear any t-shirt without having any headlight issues. Just a thought. T
Terrye Tebbetts:
Ladies -
Thanks for all the questions – this was a great session! Remember if you asked a question and you would like a copy of the book – just follow the link at the top of this page and we will ship it out tomorrow.
Again, thanks for the opportunity to be here! Terrye
Visitor Feedback for Terrye
Terrye,
I just wanted to thank you in this forum for being so caring and going the extra mile. Not only did you take the time to see my pictures, but also called me to clear my new doubts. I now have a better understanding of what I would need to consider for solving my BA problem. I cannot thank you enough for sharing all your knowledge and being so generous with your time. Thanks a bunch!!
Visitor Feedback for Terrye
Ditto. She is wonderful!
Visitor Feedback for Terrye
Thank you for taking your time to drop in from time to time to help us out here and for being here this evening. A wonderful session it was. I, as well as all the ladies, appreciate you, your time and your very informative answers to our questions.
Visitor Feedback for Terrye
Terrye, your input was very much needed and appreciated!
Thanks a bunch!
Visitor Feedback for Terrye
Thank YOU for your valuable advice Terrye
Terrye Tebbetts: You are very welcome!
Thank you all – I hope a little insider insight will help you as you continue your research! Let me know if anything else comes up! T
Filed under: breast augmentation
John Tebbetts, M.D.
First, our most sincere thanks to all who have been so incredibly supportive and caring. Your thoughts and prayers have helped immensely.
Terrye is progressing slowly, but steadily. On Saturday, October 3, the day after the injury, surgeons performed a partial vitrectomy (removed some of the gelatinous material from the rear chamber of the eye) and repaired the puncture in the front portion of the eye. Blood in both the front and rear chambers of the eye persists, but is slowly clearing—enough that her surgeons were able to identify a puncture and tear of the retina at the rear of the eye, indicating that the dart penetrated completely through the front and back of the eye. On Tuesday, October 6 and again on Friday, October 9, T’s surgeons performed a series of laser procedures to the retina to try to limit further bleeding and retinal detachment.
Going forward, Terrye’s surgeons advise us that recovery will be prolonged over several months, and that other challenges can arise, including retinal detachment, increased pressure in the eye due to scarring of the filtration mechanism injured by the puncture, and scarring and clouding of the lens (traumatic cataract) that would require lens replacement. Further clearing of the blood in the eye that is continuing to affect Terrye’s vision will be a slow process over many weeks.
Throughout, Terrye, Kas and I have tried to focus on the positives. This injury could have happened to Kas or another of the many children standing near Terrye; the puncture on the rear of the eyeball missed the optic disc and nerve by only a few millimeters that almost certainly would have resulted in loss of vision; so far with big time antibiotics on board, T has not developed infection in the eye; and though her vision remains impaired, she is able to see light, motion, and discern some objects.
Last bit of good news is that Saturday, a week and and a day after the injury, we were able to take Terrye to our place in East Texas to see her horses and her favorite mule, Pepe. Hugging a horse is one of T’s great pleasures. With special girls like Terrye and Kas, life moves on, despite the challenges.
Filed under: breast augmentation
By John B. Tebbetts, M.D.
On September 15, 2009, an article in the British tabloid The Sun advised the public that “breast enlargement using natural fat from other parts of their bodies are to be offered to women” by the Harley Medical Group of London “early next year.” The article contains several statements that may be misleading for patient and patients should carefully consider more information before signing up for the procedure.
What a concept (especially for revenue seeking surgeons)– remove unwanted fat from areas like the buttocks, thighs, abdomen, and arms, and transfer it to the breast to enlarge and improve breast shape. Imagine the market for such a procedure. How many women would instantly sign up to relocate unwanted fat to their breasts?
Sound too good to be true? It’s true that the procedure being done, but it’s also true that the entire concept may turn out to be a major disaster with uncorrectable and even potentially deadly consequences for patients. The observations that follow are directed specifically at fat that is harvested from one are of a woman’s body and then transferred to her breasts.
What are the most critical questions that must be answered by independently monitored scientific studies before fat should be injected into women’s breasts? Here is a short list of the critical questions and the status of the answers:
1) How much fat survives? Surgoens who promote the procedure claim high survival rates of the fat, but this is not proved by independently monitored studies.
2) How much inflammation does fat injection create? No definitive studies answer the question
3) What is released from injected fat and subsequent inflammation? No definitive studies answer the question.
4) Could any substances released from injected or dead fat possibly be carcinogenic (cause cancer) or potentially increase risks of breast cancer? This is a critically important question for patients, and it remains unanswered in independently monitored, long-term studies.
5) Could any chemical released from injected fat stimulate or promote tumor growth? This question remains unanswered
6) We know that fat injected into the breast causes calcifications (calcium deposits) that are visible on mammograms and MRI imaging of the breast. To what extent might the calcifications caused by injected fat interfere with the detection of smaller calcifications that enable early diagnosis and treatment of breast cancer? This critical question has not been answered in long-term, independently monitored studies.
7) How many procedures, how much time, and how much money are required to inject enough fat to provide an average volume breast augmentation? We know that most women who have breast augmentation have at least a 250cc volume augmentation. Based on presentations by surgeons who advocate fat injection for breast augmentation, we know that multiple procedures, much longer anesthetic times, and much greater costs are common compared to conventional breast augmentation.
8) What does the FDA or any other regulatory agency think about fat injection to the breast for breast augmentation? No regulatory agency currently has any jurisdiction over fat injection into the breast in the United States. Surgeons can inject fat into the breast in any quantity or in any manner they choose, with no independent monitoring or oversight. The two largest and most respected professional organizations for board certified plastic surgeons have both expressed substantial negative concerns and lack of science based evidence of safety of fat injection into the breast.
I have personally taken a very strong position against fat injection into the breast for breast augmentation in plastic surgeon professional education forums and other communications to colleagues for the following reasons:
1) Currently, there is insufficient scientific evidence from independently monitored studies, for anyone to claim that fat injection into the female breast for breast augmentation is safe for patients.
2) Fat injection into the breast should be at least as thoroughly studied as breast implants—possibly even more. While breast implants have their own set of risks and tradeoffs, they have been more thoroughly studied than any other aesthetic device or procedure. As a result, patients considering breast augmentation have solid, independently monitored scientific data on which to base their decisions. Equally valid scientific evidence does not currently exist for fat injection into the breast.
3) The best current scientific studies indicate that breast implants neither cause cancer nor promote tumor growth if it occurs. No studies prove that injected fat poses no increased risks of breast cancer.
4) Until surgeons can provide patients with conclusive, valid, long-term scientific evidence that fat injection is safe and poses no increased risks compared to other alternatives, surgeons are not providing patients the best information to enable patients to make the best decisions.
5) Transferring fat from unwanted areas to the breast for augmentation is a pie in the sky marketing package that may potentially deceive and harm patients. The concept sounds so good that unless patients receive optimal education about potential risks, costs, and tradeoffs, many patients may elect to have the procedure based on emotion and marketing appeal instead of optimal scientific facts and information. The potential for misinformation or lack of information for patients, combined with the potential revenue generation for surgeons is a dangerous combination for optimal patient safety.
6) Until equivalent, independently monitored scientific studies with criteria and follow up equal to FDA PMA studies for breast implants are available for fat injection for augmentation, fat injection should not be performed except in carefully controlled and monitored studies.
Injection of small amounts of fat as a supplement to post mastectomy breast reconstruction is very different compared to injections of large amounts of fat for first time breast augmentation. Surgeons should not be trying to sell patients on the safety of fat injection for breast augmentation based on a very limited experience with injecting small amounts of fat in breast reconstruction procedures. Advising patients that small volume fat injection verifies the safety of larger volume fat injection is scientifically and ethically questionable, and not in the best interests of patients. Injecting large volumes of fat for breast augmentation exposes potentially large numbers of women with normal breasts to risks they would otherwise not incur. Mastectomy patients have already lost their breast, and risks of small amounts of fat injection in those patients as a supplement to major breast reconstructive procedure is potentially much safer compared to large volume fat injections for breast augmentation.
I have challenged some of the most prominent advocates of fat injection for breast augmentation in national and international surgeon education venues, specifically asking if they would commit to performing independently monitored studies to confirm the long-term safety of fat injection. On public record in these forums, prominent advocates of fat injection have made the verbal commitment to perform independently monitored studies. To date, not a single surgeon advocate of the procedure has performed an independently monitored study. If surgeons who purport to be world experts on fat injection fail to assure patient safety by performing independently monitored studies, patients should be very wary of the procedure and question the veracity and priorities of surgeons who try to sell fat injection for breast augmentation.
If surgeons who stand to profit most from a procedure are not willing to fund and carry out independently monitored research to assure patient safety of the procedure before subjecting patients to a potentially unsafe course of treatment, I openly question the priorities of those surgeons, especially when they have made public verbal commitments to perform independently monitored studies. There is simply no excuse for not assuring patient safety for any procedure, much less a medically unnecessary, totally elective procedure that is unmonitored and uncontrolled.
Until we can provide patients the best quality, long-term, independently monitored studies, I strongly advise patients to prioritize their safety above their emotions to move fat from an unwanted area to the breasts. Patients should insist on information from independently monitored studies, and not be duped by marketing for fat injection for breast augmentation. I further suggest that surgeons who perform the procedure be very careful to assure that patients receive only the best, honest, valid scientific information on which to base their decisions.
Surgeons who market fat injection to the breast for augmentation or perform the procedure on patients are responsible for untoward or dangerous consequences that happen to patients because the surgeons did not assure adequate scientific study to assure optimal patient safety and optimal patient outcomes.
Filed under: breast augmentation
By Terrye Tebbetts
I get questions like this one from Julie all the time and I want to share this with you – these are very important issues. When planning your breast augmentation for the first time, if you know, if you are educated, then you can make good decisions with your ps that will limit the risk of revisions and reops but you have to have knowledge and you have to be reasonable in your expectations.
Now, if you have already had BA and you are in a situation like Julie’s, then you have to stop, think and evaluate - how did I get to this point and what can clinically be done to get me out of this vicious revision cycle? Again, you have to understand the how you got to where you are, before you can finally see the light at the end of the tunnel.
Dear Terrye,
I need a 4th breast revision. After my original BA, I had another surgery to repair both breasts that bottomed out, and one that also had a double bubble. 2 weeks after that surgery I developed Hematomy/Seroma, and had another surgery to clean out the capsule and insert a drainage tube. This operation was 5 months ago. I developed CC which is going into the 4th stage where it’s starting to hurt, the pocket also closed on top, and the other breast bottomed out and I have the double bubble back.
My original doctor will do another surgery on me, but doesn’t sound thrilled about it. He makes me feel like I should really be satisfied , and basically told me “after this time, it will be the last time.” He also said to me ” we’ll if you think you don’t like your breasts, you should see one of my other patients” Because of those things he said and also that he always sounded so sure and convincing in the past, and many things did not happen the way he said they would, I am just hesitant to use him again.I don’t know if he has the expertise to fix these kind of problems. But I will have to pay for a whole other BA in almost less than a year. Should I just let him do it for a small fee, or borrow the money and HOPE that the doctor I find is good!!!
I live in Georgia , and have been searching all over my area, and so far I have not found anyone who is excellent in revision breast surgery. I have been on the Internet every single night for hours and hours! I have found a few Dr.s across country who sound like they may have experience in revisions. Would it be advisable to travel across country on an airplane for such a surgery, since there may be complication involved afterwards?
If you know of someone in my area, please let me know. It really would ease my mind to know I could drive or get on a train, instead of having having to fly and stay in motels !!! I know how many times a Dr. has to been seen if complications do arise. I just don’t know what to do!
Thank-you,
Julie
Julie –
I am so sorry that you have had to go through all of this! But before you get in a rush to have another surgery, you need to understand the reasons why things happen so if you have another surgery, you can try to make it the best it can be.
Bottoming out generally occurs when TOO much implant is put in the pocket and the breast envelope cannot handle the weight – that is why we harp on using measurements (the High Five system) to plan the operation and not asking your ps to take your breast size to a place it has never been! While it is true you can put any implant in any breast - you cannot do this without significant tradeoffs and risks – which you are experiencing now.
Blunt/blind dissection, multiple times in a pocket, will always lead you to more risk of post operative complications – like hematoma/seroma and once there is blood in the pocket – then there is more risk of Capsular contracture – once you form CC – you are 50% more likely to form another Capsular contracture. Most ps will want a capsule to “mature” before they reoperate to reduce the risk of recurrence – usually 6 months.
This is another reason we always stress the importance of 24 Hour Recovery – because to have it, you must have a dry, precise dissection which in turn reduces your risk of CC and you can be up and moving the same day too – what a country!
So you are in the middle of a vicious cycle right now – and the best thing maybe to just slow down and not try to reoperate immediately. I would strongly recommend you get our book and read it through VERY carefully before you interview any more surgeons or entertain the idea of another operation. You can order it off Amazon.com and I promise it will be worth every penny you spend on it – if you think you have done research so far….wait until you get this book!
I hope you will really think about the “state” you are in right now and understand the mistakes of how and why you got to this point before you move on. Please let me know if you have any other questions and I do have a ps in mind for you in your area – so that when you are ready we can get you into good hands.
Best of luck to you!
Terrye
Filed under: breast augmentation
John B. Tebbetts, M.D.
|
24 Hr. Recovery Is Likely Predictable |
“Rapid Recovery” Is More Likely Buzzword than Real and Optimal |
| Surgeon can provide you copies of scientific studies that support the relationship between 24 Hour recovery and the lowest reoperation rates in the future. | Surgeon does not even mention, much less provide you scientific evidence, of the relationship of rapid recovery to lower reoperation rates in the future. |
| Surgeon and personnel emphasize the importance of 24 hour recovery to your long term outcome and risks of reoperations. | Surgeon or personnel try to minimize or reduce the importance of rapid recovery, or advise you there’s no difference in a day or a few days recovery to your long-term outcome and risk of reoperations. |
| Surgeon and personnel emphasize that they fully expect that you WILL be out to dinner or shopping the evening of surgery with a 95% predictability. | Surgeon and personel hedge discussions of out to dinner or recovery with “we’ll provide you an opportunity” or other hedging statements about being out to dinner or 24 hour recovery. |
| At least an hour of guided patient education
before you see the surgeon (not random Internet information) |
Less than comprehensive, guided patient education
before seeing the surgeon.
|
| Surgeon and personnel use the term “24 hour recovery”, not “rapid recovery.” | Surgeon and personnel use the term “rapid recovery” and avoid directly answering questions about how long your recovery will be. |
| Surgeon and personnel give you actual
percentages of patients that achieve 24 hour recovery and independent confirmation. |
Surgeon and personnel waffle or avoid directly answering questions about percentages of patients that achieve 24 hour recovery; provide little or no independent verification of recovery |
| Surgeon provides independent verification (published scientific studies or confirmation of recovery by an independent body such as a Clinical Review Organization or CRO) | Surgeon provides patient testimonials (written or video), but does not provide any independent verification that the surgeon really produces 24 hour or how predictably. |
| You know before surgery that you will not need and will not receive narcotic medications | Surgeon or personnel offer narcotic medication, advise you that you will need narcotic medications, or provide prescriptions for narcotic medications if you request, often making excuses that they are to “make you more comfortable” without emphasizing the downsides to your recovery and reoperation risks. |
| Surgeon or personnel provide information and postoperative recovery instructions before surgery that specifically tell you all the things you won’t have during recovery, including narcotics. | Surgeon rarely provides detailed information about recovery, and often mentions many other items you’ll experience during recovery with excuses or reasons for each (see below). |
| Surgeon never uses drains for first time augmentations | Surgeon either uses drains or makes arguments for the possible necessity of drains in a first time augmentation. Drains are necessary only if more bleeding or tissue trauma than optimal occurred during surgery. |
Surgeon specifically and clearly (no waffling or excuses) advises you prior to surgery that you WILL NOT HAVE ANY OF THE FOLLOWING
|
If surgeon or personnel advise that you will have ANY of the items listed at left, you are not likely to experience optimal out to dinner and 24 hour recovery. |
Filed under: breast augmentation
by John B. Tebbetts, M.D.
In the world of breast augmentation, “rapid recovery” has become a marketing buzzword on surgeons’ websites and in surgeons’ marketing materials. Large numbers of plastic surgeons worldwide advertise and promote “rapid recovery” to patients and the media. But what exactly is “rapid recovery”; how many surgeons really deliver it, and where is the proof that they deliver it?
I’ve heard many surgeons comment that it doesn’t matter if a patient recovers in one day or three weeks. I strongly disagree. While patients may tolerate unnecessarily long recoveries, it’s only because most of them don’t know they could be out to dinner the same evening and back to full, normal activities the next day. Most importantly, most patients don’t know that the length of time required to recover relates directly to how the surgery was performed, and to their risks of developing capsular contracture or having multiple reoperations in the future. Currently published scientific studies directly relate a 24 hour recovery to the lowest published rates of capsular contracture and the lowest reoperation rates in the history of breast augmentation.
The key message for patients: If you can be out to dinner the evening of augmentation and return to normal activities within 24 hours, you and your surgeon have significantly reduced your risks of having reoperations in the future!
What really determines how fast you recover? In order of importance:
1) Your level of patient education
2) How your surgeon performed your surgery, specifically a) how much bleeding occurred, and b) how much trauma occurred to your tissues during surgery
3) The drugs, drains, bandages, and other ancillary measures you received during and after surgery (the fewer the better for the fastest recovery)
4) Your ability and commitment to follow your surgeon’s instructions immediately following surgery.
Since our scientific studies detailing the processes required to deliver out to dinner and 24 hour recovery were published, surgeons worldwide are aware that rapid recovery is achievable for patients, and that patients are now looking at recovery as they choose a surgeon. As a result, “rapid recovery” has become a common marketing buzzword for surgeons. Regrettably for patients, surgeons can use any buzzword they like with very little accountability, unless patients are informed enough to ask the right questions that separate buzzwords and hype from a surgeon’s ability to really deliver 24 hour recovery. The reality is that far more surgeons use the buzzword “rapid recovery” compared to surgeons who can really deliver it. As a patient, what do you need to know to determine whether a surgeon really delivers an optimal, fast recovery?
The key issue for patients is determining prior to surgery whether the surgeon really delivers “rapid recovery”, just how rapid is it, and is there any independent confirmation (not isolated patient testimonials, but confirmation by an independent body of examiners) of the surgeon delivering predictable 24 hour recovery. Here’s information that should help.
Early in your interaction with a surgeon’s office, ask the following questions:
- “What will my recovery be like, and when can I return to normal activities.” If you can’t return to full, normal activities within 72 hours, for any reason, you won’t be experiencing optimal recovery. Prolonged recovery means that your tissues have experience more trauma, and/or that more bleeding has occurred…than is optimal for the most rapid recovery.
- “What drugs will I receive following surgery?” If the drug list includes ANY narcotic strength pain medication such as Vicodin, Darvocet, Percocet, any codeine containing medication, Demerol, or any other similar medication, you will not experience optimal recovery. If you require that level of medication, your tissues have experienced more trauma and bleeding than is optimal. The medications will make you drowsier, you won’t be able to mobilize as quickly, and if you don’t mobilize optimally in the first 8 hours, you will not experience optimal recovery. In addition, most of these medications increase your risks of nausea, constipation, and other side effects that slow recovery every time.
- “What will my bandages or special bras be like after surgery?” If the answer is, “You’ll have none of those”, great. But if you are going to require any of those, they will be restrictive, cumbersome, and restrict your ability to feel comfortable doing the type of mobilization that is essential for 24 hour recovery.
- “Will I have drains after surgery?” Again, if the answer is “Drains are unnecessary following a first time augmentation, great.” If you’re going to have drains, or even if the surgeon or personnel hedge the answer about drains, they know that you’re likely to have enough tissue trauma and bleeding that they feel drains may be necessary. No way are you going to experience 24 hour recovery with drains in place. Ever.
- “Can I get a pain pump or strong pain medication and muscle relaxants after surgery? I have a low pain threshold, and will need those.” If a surgeon suggests or provides either a pain or narcotic pain medications, the surgeon knows better than anyone else how much trauma and bleeding he or she is going to cause during the surgery—and if those are necessary, there’s way more trauma and bleeding than is optimal. If the surgeon is providing them just to satisfy you when they are unnecessary, it’s my opinion that you may not be getting anywhere close to the most optimal care that is available. Rather than educating you and helping you get the most rapid recovery with the least risks of drug side effects and retarding your recovery, surgeons who provide you with these drugs are not doing all they can do to assure you the most rapid recovery. As a colleague who really delivers 24 hour recovery told me, “It’s easier to give patients drugs after surgery than to educate them before surgery and learn to deliver 24 hour techniques. I’m glad I don’t have to do that anymore.”
- And finally, when a surgeon claims to deliver 24 hour recovery or especially “rapid recovery” in advertising materials or discussions, ask the question: “Aside from patient testimonials, can you give me any scientific data that you have published or any confirmation by an independent body that you predictably deliver 24 hour recovery?” It’s highly unlikely that many patients would ever ask a surgeon this question directly, but you can certainly ask the surgeon’s office personnel on the phone. Wait until they play the “rapid recovery” card in discussions with you (you won’t hear “24 Hour, but you will likely hear “rapid recovery”)…and then ask the question. You’ll likely get your answer from the expression on their face.
The best surgeon, if the surgeon performs a significant number of breast augmentations, cannot guarantee that you won’t experience a surgical complication. But the best surgeons’ complication rates are a matter of record in the medical scientific literature or the surgeon can share the rate of occurrence with you and provide verification of the facts.
Recovery is unquestionably the best measure of what a surgeon does that tells you how much trauma and bleeding occurred during your augmentation. More importantly, trauma and bleeding increase risks of capsular contracture, and that relates to your risks of reoperations in the future. No matter how you look at it, if you’re educated, recovery is your best measure of surgical performance in breast augmentation.
No surgeon’s photographic results in before or after books or on the Web come anywhere close to telling you as much about the surgeon compared to the surgeon’s record with respect to patient recovery and outcomes .
Surgeons can buy anything you see in a before and after book or on their websites. Any photograph of a before and after result that you see on the Web is a selected result…and trust me, what you see is the best the surgeon has ever done in 99% of instances. Any surgeon can assemble testimonials. Forget pictures when it comes to making decisions or selecting a surgeon. They are useless if you are educated. Fun to look at…maybe…but not any true measure of a surgeon’s skills and certainly not any predictor of how you’ll recover and your likelihood of reoperations in the future.
Remember—in supervised FDA studies that surgeons can’t manipulate, between 15% and 25% of first time augmentation patients had a reoperation within just 3 years. The only study ever published of patients within an FDA PMA study where all 24 hour recovery processes were applied had a zero percent reoperation rate at 3 years.
Recovery is one of the few things no surgeon can hedge on, claim to produce without producing, or manipulate to the benefit of the surgeon. It either happens optimally (24 Hour) or it doesn’t. When it doesn’t, there is always a reason, and the reason is always the same. The surgeon is not following the best scientific information and confirmed best processes and techniques to the letter. If he were, optimal recovery just happens and you’re out to dinner the evening of surgery.
The buzzwords “rapid recovery” mean virtually nothing. “24 hour recovery” means exactly what it says. It’s real, it’s verifiable, and it’s not a buzzword.
